bluuebunny/crossref_metadata_2025 huggingface dataset:
Project RARE (Recall and Relearn) It’s Effect on the Mathematics Performance of Selected Grade11 HUMSS Students
Authors: Lucero Arianne
Published: February 2025

This study focused on the effect of Project RARE (Recall and Relearn in improving the performance in General Mathematics of selected Grade11 HUMSS students of Tanza National Comprehensive High School during First Quarter period of the school year 2022-2023. This study is a one-group pre-test and post-test design. Mean, mean percentage score, standard deviation and paired sample t-test were used to determine the effectiveness of Project RARE (Recall and Relearn) in improving the performance in General Mathematics of the students. The study revealed the mean score of pre-test is 13.78 while post-test is 20.63 which increased by 6.5 and can be concluded that Project RARE improved the mathematics performance of the students in the first quarter. The computed t-value of -8.59 is at left of the critical t-value of ±2.01 at 5 percent level of significance with 45 degrees of freedom, indicates that there is a significant difference between the pre-test and the post-test results of the subjects of the study. This study was limited to the effects of the Project RARE (Recall And Relearn) in improving the performance of selected Grade11 HUMSS students of Tanza National Comprehensive High School in General Mathematics focusing on the prerequisite skills specifically, Operations on Integers and Operations on Polynomials needed for the First Quarter period of SY 2022-2023. This study reveals that Project RARE (Recall and Relearn) is a new and successful intervention program in recalling and relearning prerequisite skills needed particularly in General Mathematics.
Characterising Radiation Risks: Developing Scientifically-Based Protection Standards Through Radiation Health Physics Research
Authors: John Makoye , Mina Rose
Published: February 2025

Radiation protection standards aim to balance public health with enabling beneficial uses of radiation technologies. However, characterizing risks from ionizing radiation exposure presents ongoing scientific challenges, particularly at low doses where epidemiological data is limited. Continued research supporting robust risk quantification remains essential for establishing evidence-based protection policies as technologies and understanding progress. Numerous epidemiological cohorts have provided vital long-term follow-up data on cancer risks from high-dose exposures such as from atomic bombs in Japan. Analysing this dataset remains important for disentangling effects of dose and dose-rate. More recent international collaborative efforts are focusing on populations with lower-dose occupational or medical exposures through pooled analyses merging country-specific databases. Key research priorities include further exploring transmission of risks across generations as well as variations in individual susceptibility that could impact risk prediction. Cornerstone of optimization and providing the safest working conditions for those working in the nuclear industry. Large collaborative databases present opportunities to address limitations through standardized characterization of endpoints and robust dosimetry across settings like occupation and medical radiation exposure history. This paper argues sustained global commitment across disciplinary research remains essential for most accurately characterizing radiation dangers to better guide radiation protection policies worldwide. This paper reviews advances and limitations in current understanding through multidisciplinary research efforts.
A Multi-Center Randomized Study Assessing If Validated Short Videos Improve Sinus Education
Authors: Bailey Christopher Eric , Cabrera-Muffly Cristina , Chen Philip G. , Farrell Nyssa , Rangarajan Sanjeet V. , Yim Michael , Irish Joseph , Le Christopher H. , Chang Eugene H.
Published: February 2025

Objective:

To determine if a short 10-minute video of either CT images (Video1: V1) or CT and endoscopic surgical videos (Video 2: V2) could be used to improve sinonasal anatomy knowledge in medical students (Med) and otolaryngology residents (OtoR).

Background:

YouTube is a widely used platform for surgical training, yet many educational videos are of poor quality. We developed and validated two 10-minute narrated videos of sinus anatomy, the first (V1) incorporated CT images of critical structures while the second (V2) combined CT images and surgical endoscopic video. In tandem, we developed a sinonasal assessment used to test sinonasal anatomy, surgical landmarks, and situational awareness.

Methods:

We performed a multicenter, randomized IRB-approved educational study evaluating the efficacy of the V1 and V2 videos by comparing pre-test (PrT) and post-test (PoT) scores in Med and OtoR subject groups. Subjects then watched the alternate video and preferences were assessed.

Results:

A total of 30 Med and 37 OtoR successfully completed the study at 6 different institutions. There were significant differences in pre-test knowledge with OtoR scoring higher than Med in all 3 pre-test subdomains [(S1: 4.3 v s2.9, P < .0001, S2: 4.4 vs 3.1, P < .0001, and S3: 4.6 vs 3.2, P < .0001)]. In the Med group, both V1 and V2 educational videos significantly improved post-test scores compared to pre-test scores (V1: 10.06 vs 12.59, P = .0005; V2: 8.23 vs 11.08, P = .0008). In the OtoR group, only the V2 educational video showed significant improvement (13.24 vs 14.76, P < .0001). Both groups thought the videos were helpful and improved their spatial awareness of sinus anatomy.

Conclusions:

Short, validated videos significantly improve sinonasal education and should be incorporated in modern training programs.
Black Identity in Action: Examining Ethnic and Racial Identity, Racial Discrimination, and Collective Action Among Black Individuals
Authors: Ross Brianna Z. , Lee Fiona , Cokley Kevin
Published: February 2025

This paper examines the factors that contribute to Black participants’ use of collective action strategies (i.e., activism and active coping) to combat experiences of racial discrimination. Previously, researchers have examined racial discrimination, ethnic identity, and racial identity in separate models from one another. We propose that ethnic and racial identity both mediate the relationship between racial discrimination and collective action, such that both ethnic and racial identity explain Black individuals’ engagement in activism and active coping after discriminatory experiences. We surveyed 313 Black individuals about their experiences and conducted a parallel mediation analysis to test our hypotheses. The results indicate that, as predicted, ethnic and racial identity mediated the relationship between racial discrimination, activism, and active coping. Overall, the findings from this study have theoretical and practical implications for how ethnic and racial identity can be used to improve the well-being of individuals in the African diaspora.
In vivo two-photon microscopy imaging of focused ultrasound-mediated glymphatic transport in the mouse brain
Authors: Gong Yan , Xu Kevin , Ye Dezhuang , Yang Yaoheng , Miller Mark J , Feng Ziang , Hu Song , Chen Hong
Published: February 2025

The glymphatic system regulates cerebrospinal fluid (CSF) transport and brain waste clearance. Focused ultrasound combined with microbubbles (FUSMB) has shown feasibility for manipulating glymphatic transport, yet its mechanisms remain poorly understood. In this work, we used in vivo two-photon microscopy to reveal how FUSMB manipulates the CSF tracer transport in the mouse brain. A FUS transducer was confocally aligned with the objective of a two-photon microscope. Fluorescently labeled albumin was infused into the CSF via cisterna magna. FUS sonication was applied following an intravenous injection of microbubbles. Dynamic imaging was performed through a cranial window to record local changes in vessel and tracer dynamics. The fluorescence intensity of the CSF tracer within the treated region decreased rapidly upon FUSMB treatment. Concurrently, vessel deformation was observed, and the fastest diameter changes were observed during FUSMB treatment. A linear correlation was identified between the rate of vessel diameter change and the rate of tracer intensity change. Moreover, given the same rate of vessel diameter change, the tracer intensity changed faster around larger vessels than smaller vessels. These findings offer insight into the potential biophysical mechanism of FUSMB-mediated glymphatic transport.
CT Imaging of the Pancreas: A Review of Current Developments and Applications
Authors: Barat Maxime , Greffier Joël , Si-Mohamed Salim , Dohan Anthony , Pellat Anna , Frandon Julien , Calame Paul , Soyer Philippe
Published: February 2025

Pancreatic cancer continues to pose daily challenges to clinicians, radiologists, and researchers. These challenges are encountered at each stage of pancreatic cancer management, including early detection, definite characterization, accurate assessment of tumour burden, preoperative planning when surgical resection is possible, prediction of tumour aggressiveness, response to treatment, and detection of recurrence. CT imaging of the pancreas has made major advances in recent years through innovations in research and clinical practice. Technical advances in CT imaging, often in combination with imaging biomarkers, hold considerable promise in addressing such challenges. Ongoing research in dual-energy and spectral photon-counting computed tomography, new applications of artificial intelligence and image rendering have led to innovative implementations that allow now a more precise diagnosis of pancreatic cancer and other diseases affecting this organ. This article aims to explore the major research initiatives and technological advances that are shaping the landscape of CT imaging of the pancreas. By highlighting key contributions in diagnostic imaging, artificial intelligence, and image rendering, this article provides a comprehensive overview of how these innovations are enhancing diagnostic precision and improving outcome in patients with pancreatic diseases.
Nonprofit Revenue Portfolios and Exposure to Business Cycle Risk
Authors: Searing Elizabeth A. M. , St. Clair Travis
Published: February 2025

Public sector organizations frequently face increased demand for their services during economic downturns at the same time that their revenues decline. This problem is particularly acute for nonprofit organizations, who cannot rely on involuntary taxation in the same manner that governments can. In this paper, we document the business cycle risk that nonprofit organizations are exposed to, paying particular attention to the extent that various types of nonprofit revenue covary with economic conditions. We find that aggregate donation revenue is procyclical while program revenue is counter-cyclical. Furthermore, nonprofits that expand their share of revenues from donations will cause their revenue portfolio to become more procyclical, while those that expand their share of revenues from program revenue will experience the opposite. The results highlight a previously unexamined source of risk for nonprofits and emphasize the need for reserve policies that are attentive to organizations’ exposure to economic conditions.
Endothelin-1 as a Candidate Biomarker of Systemic Sclerosis: A GRADE-Assessed Systematic Review and Meta-Analysis With Meta-Regression
Authors: Mangoni Arduino A , Zinellu Angelo
Published: February 2025

Background:

There is an ongoing search for novel biomarkers of vascular dysfunction, extent of fibrosis and organ involvement in systemic sclerosis (SSc).

Objectives:

We critically appraised the studies investigating the circulating concentrations of endothelin-1 in SSc patients and healthy controls.

Design:

This was a systematic review with meta-analysis.

Data sources and methods:

We searched electronic databases (PubMed, Scopus, and Web of Science) from inception to 15 June 2024. We assessed the risk of bias and the certainty of evidence using the JBI Critical Appraisal Checklist and GRADE, respectively.

Results:

Endothelin-1 concentrations were significantly higher in SSc patients than in controls (26 studies; standardised mean difference, SMD = 0.98, 95% CI 0.73-1.23, P < .001; moderate certainty of evidence). In SSc patients, there were no significant differences in endothelin-1 concentrations between those with limited and diffuse cutaneous SSc (10 studies; SMD = 0.32, 95% CI −0.07 to 0.71 P = .11; very low certainty), and with and without digital ulcers (5 studies; SMD = 0.82, 95% CI −0.06 to 1.69, P = .066; very low certainty), pulmonary arterial hypertension (7 studies; SMD = 0.22, 95% CI −0.01 to 0.45, P = .066; very low certainty) or interstitial lung disease (3 studies; SMD = 0.09, 95% CI −0.18 to 0.35, P = .51; very low certainty). There was limited evidence in SSc patients with different video capillaroscopy pattern and telangiectasias. Subgroup and meta-regression analyses showed significant associations between the effect size and geographical location (studies investigating SSc patients and controls), year of publication (studies investigating SSc patients with limited and diffuse cutaneous SSc), and biological matrix assessed (studies investigating SSc patients with and without digital ulcers).

Conclusion:

The results of this systematic review and meta-analysis highlight the potential role of endothelin-1 as a candidate biomarker of SSc. Further research is warranted to determine the utility of measuring endothelin-1 in SSc subgroups with different extent of fibrosis and organ involvement.

Registration:

PROSPERO registration number - CRD42024566461.
‘I’m no diversity slut’’: Diasporic cinema and public film funding through a critical media industry studies lens
Authors: De Man Alexander
Published: February 2025

This article uses the case of Kadir Ferati Balci, a Flemish filmmaker of Turkish and Albanian descent, to offer a detailed, empirical account of the potential tactics, maneuvers and discursive frameworks employed by migrant and diasporic filmmakers as they navigate public film funds and negotiate their minoritized industry position. Drawing on a critical discourse analysis of policy and production documents (i.e. public funding applications) and two in-depth expert interviews with the filmmaker, it illustrates how funding agencies’ political discourses play a determinative role in shaping diasporic, minoritized workers’ quotidian practices. Nevertheless, it also reveals that they can draw upon a heightened sense of self-awareness to tactically navigate this context in a way that allows them to secure state support and public funding while deconstructing and rethinking notions of diasporic cinema, difference and recognition.
Plate Fixation and Hallux Valgus Deformity Impact on Nonunion Rates in First Metatarsophalangeal Arthrodesis A Retrospective Cohort Study
Authors: Kachooei Amir R. , Moncman Tara , Ghayyad Kassem , Raikin Steven , Daniel Joseph
Published: February 2025

Background

The combined effect of fixation type and preoperative deformity together might influence the union rate after the first metatarsophalangeal (MTP) arthrodesis. This study aimed to compare the nonunion and failure rate of dorsal locking plate versus cross-screws for the first MTP arthrodesis considering the preoperative deformity, including hallux valgus versus rigidus. We secondarily aimed to compare the observed nonunion rate with the rate in the systematic reviews.

Methods

This was a retrospective cohort study including 372 patients and 378 feet. The surgical technique was identical except for the use of a dorsal locking plate in 181 (49%) and cross-screws in 191 (51%) MTP joints. The radiographic union was assessed at 3 months postoperative. Those who did not heal by the 3-month follow-up were categorized as a “symptomatic” versus “asymptomatic” nonunion. Those categorized as nonunion after 3 months were followed until union occurred.

Results

The results demonstrated that dorsal locking plate fixation (OR = 10.1, 95% CI: 1.3-80) and hallux valgus deformity (OR = 4.7, 95% CI: 1.2-18) were significantly associated with a higher nonunion rate. At 3-month follow-up, a total of 19 (5%) patients showed nonunion. Of the total nonunions, 15 (79%) were fixed by the locking plate, and 4 (21%) were fixed by cross-screws. Of the 15 nonunions with plate fixation, 6 (40%) underwent a second surgery due to device failure, while none of the cross-screws required a second surgery. Out of the 6 secondary surgeries, 5 (83%) demonstrated a nonunion with valgus deformity and 1 required removal of hardware due to prominent hardware.

Conclusion

Our results support that a dorsal locking plate for the fusion of a hallux valgus deformity is associated with a significantly higher risk of symptomatic nonunion and a secondary surgery compared to cross-screws, possibly due to the failure of the plate in neutralizing the medio-lateral deforming forces.

Levels of Evidence:

Level IV, Retrospective Cohort
Custom 3-Dimensional-Printed Oncologic Endoprosthesis for Reconstruction of the Calcaneus A Case Report
Authors: Lesensky Jan , Blecha Ondrej , Belzarena Ana C. , Benes Michal
Published: February 2025

Primary tumors of the calcaneus present a reconstructive challenge. Their relatively low incidence leads to limited evidence, clinical experience, and ongoing discussion regarding the optimal surgical strategy. In this report, we present a case of a 19-year-old male diagnosed with an aggressive osteoblastoma who underwent subtotal calcanectomy. A custom 3D-printed titanium endoprosthesis was designed for limb-salvage reconstruction. Trabecular porous structure and screws were used to achieve subtalar and calcaneo-cuboid fusion and to compensate for the deficient ligamentous apparatus following resection. An innovative system for reattachment of the calcaneal tuberosity with spared of the Achilles tendon was also utilized. At 3 months, the implant was completely incorporated, allowing full weight bearing. At the 18-month follow-up, the implant showed no signs of loosening, the patient had no signs of recurrence, had excellent function, and successfully returned to all his pretreatment activities, underscoring the effectiveness of this reconstructive approach in the management of calcaneal tumors.

Level of Evidence: IV, Case report
Management of urethral diverticular stone with stricture: a case report
Authors: Boddepalli Yogesh , Patnana Bhanumurthy
Published: February 2025

Background

Acquired male urethral diverticula are seen in patients with traumatic urethral stricture, urethral surgery, or rarely following prolonged urethral catheterization. Inadequate drainage of the urethral diverticulum leads to urinary stasis and stone formation. Excision of the urethral diverticulum with reconstruction of the urethral defect is the definitive procedure. A limited number of cases were reported in the literature.

Case presentation

Excision of the urethral diverticulum with reconstruction of the urethral defect is the definitive procedure. Large urethral diverticulum with stone following urethral surgery with adjacent stricture is challenging to manage. We report a case of a urethral diverticular stone with stricture in a 58-year-old male treated successfully using an excessive diverticular wall as a flap to reconstruct the adjacent stricture after removing the stone. We performed a retrograde urethrogram (RGU) and obtained information about the caliber of the urethra and the location of the diverticulum. The objectives in the treatment of symptomatic urethral diverticula are relief of distal obstruction, removal of all calculi, excision of the diverticulum, and closure of the urethral defect. Management options for this case are excision of the diverticulum with urethral reconstruction, optical urethrotomy and lithotripsy, perineal urethrostomy with stone extraction, and two-stage operations to remove the stone followed by urethral reconstruction.

Conclusions

Even though the recommended management for acquired male UD is diverticulectomy with the reconstruction of the urethra, in selected cases, less morbid procedures like urethral reconstruction with excess diverticular wall without diverticulectomy can be done to maintain urethral patency.
Integrating QTL mapping with transcriptome analysis mined candidate genes of growth stages in castor (Ricinus communis L.)
Authors: Huang Guanrong , Lu Jiannong , Yin Xuegui , Zhang Liuqin , Lin Haihong , Zhang Xiaoxiao , Liu Chaoyu , Zuo Jinying
Published: February 2025

Background

The growth stages largely determine the crop yield, while little is known about their genetic mechanisms in castor. In this study, the QTL mapping and candidate gene mining of growth stages were conducted using populations F2 and BC1, combining with differential expression analysis and weighted gene co-expression network analysis (WGCNA). The traits studied included the emergence date (ED), the budding date of primary spike (PSBD), the flowering date of primary spike (PSFD), the maturation date of primary spike (PSMD), and the maturation date of primary branch spike (PBSMD).

Results

A total of 20 QTLs conferring four traits (ED, PSBD, PSFD and PBSMD) were identified in the F2 population, with a phenotypic variation explained (PVE) of single QTL ranged from 0.24 to 25.46%. Five QTLs underlying PSMD and PBSMD were identified in the BC1 population, with a PVE of single QTL ranged from 4.74 to 10.82%. To our surprise, almost all the identified QTLs were clustered within two marker intervals, the RCM1769-RCM1838 on linkage group 6 and RCM950-RCM917 on linkage group 3. Subsequently, 473 open reading frames (ORFs) were searched out within these two clusters and 110 differentially expressed genes (DEGs) were screened out from these ORFs by the comparative transcriptome clean data (a total of 140.86 G) at the budding date, the initial flowering date and the full flowering date between parental racemes. With these DEGs, five distinct gene co-expression modules were generated using WGCNA. Showing significant differential expression between parents, four candidate genes (LOC8261128, LOC8278994, LOC8281165 and LOC8259049) in module MEturquoise, were recognized and were annotated as RcSYN3, RcNTT, RcGG3 and RcSAUR76 respectively. This finding implies their potential role in regulating the growth stages of castor.

Conclusion

In this study, numerous QTLs conferring growth stages were detected and four candidate genes were mined, which need to be functionally validated. The results provided a new insight into the genetic structure of ED, PSBD, PSFD, PSMD and PBSMD, offered the candidate genes and molecular markers for their improvement as well in castor.
Excess mortality in COVID-19-negative people with non-communicable disorders during the first pandemic wave
Authors: Vigo Daniel V. , Hudec Kristen L. , Ferdous Saimoom , Munthali Richard J. , Pei Julia , Munro Lonna , Pendakur Krishna , Yatham Lakshmi N. , Kessler Ronald C. , Ng Raymond T. , Puyat Joseph H.
Published: February 2025

Background

Estimating the indirect mortality due to COVID-19 is of the utmost importance to develop adequate public health policy during future outbreaks.

Methods

From province-wide administrative datasets, we identified British Columbians who tested negative for COVID-19 during the first wave and never tested positive throughout 2020. We obtained a pre-pandemic (2018) cohort matched on age, sex, history of non-communicable disorders (NCDs), multimorbidity, and severity/acuity, and implemented a doubly robust estimation of the effect of the first pandemic wave on mortality.

Results

The adjusted odds ratio (AOR) of death was 3.2 times higher for a 2020 cohort who tested negative for COVID-19 (n = 123,133), compared to matched pre-pandemic controls. In both cohorts, a majority (72.5%) experienced at least one pre-existing NCD. Stratification by NCD shows an AOR of death ranges between 2–for people with substance use disorders– and 7–for people previously undiagnosed with NCDs (e.g., incident cases that went untreated). The largest subgroup was composed of people with mental disorders (47,413 people), with an AOR of death of 2.5. Though the COVID-19 direct mortality in the general population remained low (1.9 per 10,000), the excess mortality in this COVID-negative cohort was extremely high − 4,085 of the 123,133– which entails a minimum indirect excess mortality death rate of 6.5 per 10,000 in the general population.

Conclusions

During the first pandemic year, mortality in COVID-negative adults was several times greater than before COVID-19, in people with matched NCD distribution and severity. Our findings suggest that low direct COVID-19 mortality was accompanied by less visible–but much higher– indirect mortality due to undiagnosed and/or untreated NCDs, highlighting the need to focus not only on mitigating the harms of new agents, but also of continuing service delivery for treatable conditions.
Acculturation is associated with 12-month adherence to combined MVPA and sedentary behavior guidelines in a sample of midlife and older Latino/a adults: findings from the COMPASS physical activity trial
Authors: Zamora Astrid N. , Campero Maria I. , Garcia Dulce M. , Chavez Diana M. , King Abby C.
Published: February 2025

Background

Although some studies have shown that greater acculturation is associated with an increased risk of cardiovascular disease (CVD) among Latino/a adults, the relationship between acculturation and modifiable health behaviors in older Latino/a adults living in the United States (US) remains underexplored. This secondary analysis of the COMPASS physical activity trial explored the relationship between acculturation and adherence to combined movement behavior guidelines for moderate to vigorous physical activity (MVPA) and sedentary behavior guidelines at 12 months among 245 midlife and older Latino/a adults from the San Francisco Bay Area.

Methods

Baseline acculturation was measured using the Short Acculturation Scale for Hispanics, yielding a total score and three subscales on a 5-point Likert scale, higher scores represented higher acculturation. MVPA was evaluated via the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire, while sedentary behavior was measured using a validated 1-week recall survey. We employed logistic regression to analyze linear and non-linear associations between acculturation and adherence to the combined MVPA (≥ 150 min/wk) and sedentary behavior (< 8 h/day) movement behavior guidelines, adjusting for baseline MVPA and sedentary behavior, intervention arm, gender, income, body mass index, education, and years in the US.

Results

At baseline, 6.4% adhered to combined MVPA and sedentary behavior guidelines, with the prevalence of adherence rising to 30.2% at 12 months. Each one-point increase in language use acculturation subscale score was linked to 1.7 times greater adherence (p = 0.01) at 12 months. A similar pattern was observed when acculturation was operationalized as a binary variable (p = 0.03). For the summary acculturation score, participants with higher acculturation had 2.6 times higher odds of adhering to guidelines at 12 months compared to those with lower acculturation (p = 0.04).

Conclusions

Higher acculturation was associated with a higher odds of 12 month adherence to MVPA and sedentary behavior guidelines among a sample of older Latino/a adults. Results underscore the importance of incorporating acculturation into behavioral trialsand the need to tailor physical activity interventions for Latino/a older adults with lower acculturation.

Trial registration

Clinicaltrials.gov NCT02111213 Registered April 2, 2014 https//clinicaltrials.gov/study/NCT02111213.
Reducing anxiety and enhancing innovation in nurses: a psychological capital intervention study in China
Authors: Yan Dexiu , Chen Lan , Li Mengyao , Zhang Yuanyuan , Zhang Yaqing
Published: February 2025

Aim

This study aimed to test whether increasing psychological capital through psychological capital interventions affects anxiety and innovation among nursing staff through an experimental study.

Method

This study utilized a two-group (experimental and wait-list control) pre-test and post-test design. In August 2022, eighty clinical nurses from the same hospital were randomly assigned to either the experimental group (40) or the wait-list control group (40) to complete self-report questionnaires at pre-intervention (T1), post-intervention (T2), and one month post-intervention (T3). The experimental group received a 6-week training on the psychological capital intervention.

Result

The scores of anxiety, psychological capital, and innovative behaviour of experimental subjects in the two groups before and after the intervention showed no significant difference in between-group effects (P > 0.05). In contrast, the time effect and between-group × time effect were significant (P < 0.05), and the trends of anxiety, psychological capital and innovative behaviour over time differed between the two groups of nurses.

Conclusion

Online psychological capital interventions can weaken the constraints of time and space to maximize the effective development of nursing staff's psychological capital, reduce anxiety, and improve nurses' innovative behaviors.
Healthcare facility readiness and availability for hypertension and type 2 diabetes care in Puno, Peru: a cross-sectional survey of healthcare facilities
Authors: Lord Katherine E. , Acevedo Parker K. , Underhill Lindsay J. , Cuentas Gonzalo , Paredes Sonia , Mendoza Juan C. , Herrera Percy , Chou Victoria B. , Dávila-Román Victor G. , Hartinger Stella M. , Checkley William
Published: February 2025

Background

Non-communicable diseases are a rapidly growing cause of mortality and morbidity in Peru, accounting for 73% of total deaths. There is limited research on health system readiness to manage this rising burden. Our study characterized the readiness of healthcare facilities to manage patients with hypertension and/or type 2 diabetes (T2D) across two public healthcare systems in Puno, a largely rural and low-income department in Peru.

Methods

We adapted the World Health Organization Service Availability and Readiness Assessment to characterize resources and services for hypertension and T2D care. We administered the survey to personnel at healthcare facilities in Puno. Service readiness scores were calculated based on tracer items necessary for hypertension or T2D care. Facilities with ≥ 70% of tracer items were considered ready to manage each disease.

Results

Between June 2022 and June 2023, we surveyed 85% (414/488) of Puno’s government-run healthcare facilities. Overall, only 28% and 29% were considered ready to manage hypertension and T2D, respectively. Despite larger annual cumulative case volumes at health posts and low-level health centers, lower-level facilities were significantly less likely to be ready to manage hypertension (OR = 0.20, 95% CI 0.11–0.36) or T2D (OR = 0.03, 95% CI 0.01–0.06). Areas of concern included an overreliance on aneroid blood pressure monitors, their infrequent calibration, and limited hemoglobin A1c and urine testing. Additionally, only 66% and 48% of providers self-reported that they could diagnose hypertension and T2D, respectively. There was also low essential medication availability including insulin (7.2%) and fixed-dose combinations (0.5%) and a scarcity of trained healthcare professionals, particularly community health workers at health posts (49.8% had none).

Conclusions

Healthcare facilities were largely unprepared to manage hypertension and T2D, underscoring the critical need for health system strengthening to address disparities in non-communicable disease management across Puno.
Malaria in a metropolitan region of Southern Germany: past, present and future perspectives on a protozoan infection with the potential of re-appearance in Central Europe
Authors: Esse Jan , Leven Karl-Heinz , Kampen Helge , Werner Doreen , Göttler Silke , Bogdan Christian
Published: February 2025

Background

Malaria occurred endemically in Germany until the twentieth century. Climate change and globalization are known to promote the spreading of malaria. Erlangen is a city with just under 120,000 inhabitants located in the Nürnberg metropolitan region, Federal State of Bavaria, Southern Germany. Historical findings, current climate data, microbiological data (local and state level) and vector surveillance data are used to estimate the risk of re-emergence and autochthonous transmission of malaria in the area of Erlangen.

Methods

Historical data was obtained by searching literature. Climatic data were retrieved from the German Climate Data Centre. Data on reported (supra-)regional infections were obtained from the Robert-Koch Institute. Cases of malaria diagnosed at the Institute of Clinical Microbiology, Immunology and Hygiene (University Hospital Erlangen) complement this data. The citizen science project “Mückenatlas” (Mosquito Atlas), the German mosquito database (CULBASE) and the company Biogents AG provided mosquito surveillance data.

Results

Malaria was highly endemic in Erlangen in the nineteenth century, with 18% of hospitalized patients suffering from this disease in 1860, but disappeared during the first half of the twentieth century. After the end of World War II, autochthonous ‘malaria tertiana’ (tertian malaria) occurred in neighbouring Nürnberg, demonstrating the regional malaria potential. In recent decades, the average monthly temperature increased by 1.6 °C. In Erlangen and the surrounding area, three potential vectors of tertian malaria parasites are prevalent (Anopheles messeae, Anopheles maculipennis sensu stricto, and Anopheles plumbeus). In addition, Anopheles daciae, which has unknown potential of Plasmodium transmission, and Anopheles claviger sensu lato have been detected. In recent years, malaria diagnosed in Erlangen mainly resulted from travelling to Africa. Plasmodium vivax accounted for only a small proportion of these cases (2010–2023: n = 5, 17%).

Conclusion

Future autochthonous transmission of malaria parasites in Erlangen is possible, although re-establishment of a natural transmission cycle is currently unlikely. In order to avoid unexpected autochthonous malaria, surveillance and prevention measures should be considered. Patients with fever after visiting endemic areas need to be analysed for Plasmodium infection.
The costs of suboptimal breastfeeding in Ontario, Canada, and potential healthcare resource impacts from improving rates: a pediatric health system costing analysis
Authors: Onah Nnachebe Michael , Hoy Sandra , Slofstra Kathleen
Published: February 2025

Background

Human milk from the breast is the healthiest option for infants. Other sources of nutrition pose some risk to child, maternal, and environmental health. There are significant costs to suboptimal rates of breastfeeding for children, families and society. Over 92% of mothers in Ontario, Canada initiate breastfeeding, yet exclusivity and duration rates decline over time. This study estimates potential pediatric healthcare cost savings from increased exclusive breastfeeding.

Methods

We conducted a cost-effectiveness analysis to compare healthcare savings from enhanced breastfeeding rates against current practices by estimating pediatric healthcare costs associated with suboptimal breastfeeding and potential savings from improved rates. Savings are calculated from reduced incidence of childhood illnesses associated with breastfeeding, including lower respiratory tract infections (LRTI), gastrointestinal infections (GII), acute otitis media (AOM), acute lymphoblastic leukemia (ALL), necrotizing enterocolitis (NEC), childhood obesity, and asthma. Cost data were drawn from Canadian healthcare sources, supplemented with data from the UK and other international studies. We used initiation and exclusive breastfeeding rates at hospital discharge and six months postpartum.

The study assumes that the incidence of preventable conditions like LRTI, GII, and AOM is directly related to breastfeeding rates at these time points. A six-month threshold for exclusive breastfeeding, recommended by the World Health Organization, was selected for analysis. Partial breastfeeding rates were not separately modeled due to data limitations.

Results

Improving exclusive breastfeeding (EBF) rates at six months to match rates at hospital discharged and initiation rates could result in 47,114–91,457 fewer cases of LRTI, GII, and AOM, prevent 3,685–7,096 hospitalizations, and reduce 22,043–47,621 outpatient visits. Increased EBF rates could prevent cases of NEC (37–67), ALL (3–6), childhood obesity (1,199–2,661), and asthma (970–2,111). Suboptimal breastfeeding at 6 months for infants born in Ontario in 2019 cost the healthcare system US $72.2 million annually for treating four childhood illnesses and US $61.0 million for long-term conditions (ALL, obesity, and asthma). Increasing breastfeeding rates could save US $32–63 million in annual treatment costs and US $23.6–51.6 million in long-term healthcare costs.

Conclusions

Suboptimal breastfeeding rates impose a burden on the health of families and Ontario’s healthcare system. Supporting breastfeeding through evidence-based interventions could reduce this burden through lowering pediatric healthcare demands.
Using illicit drugs alone in Vancouver, Canada: a gender-based analysis
Authors: Gallant Kat , Hayashi Kanna , Sayre Eric C. , Choi JinCheol , Mansoor Manal , Kerr Thomas
Published: February 2025

Objectives

Canada continues to experience an epidemic of toxic drug-related overdose deaths. Public health messaging emphasizes the dangers of using drugs alone as it restricts timely overdose response or renders it impossible, yet this practice remains prevalent among people who use drugs. While drug use practices and associated harms are known to be highly gendered, little is known about how factors shaping solitary drug use may differ across genders (including cisgender men, cisgender women, transgender women, Two-Spirit people and gender diverse people). Thus, we sought to explore solitary drug use practices according to gender in Vancouver, Canada.

Methods

Data were collected through Vancouver Injection Drug Users Study, a prospective cohort study between June 2019 and May 2023. We used gender-stratified multivariable generalized estimating equation models to identify factors associated with using drugs alone.

Results

Among the 697 participants, 297 (42.6%) reported using drugs alone in the previous 6 months at baseline. In multivariable analyses, we found that being in a relationship was negatively associated with using alone for both cisgender men and cisgender women (adjusted odds ratio [AOR] = 0.25 and 0.34, respectively), while homelessness was negatively associated for cisgender men only (AOR = 0.45). Factors positively associated for cisgender men included daily illicit stimulant use (AOR = 1.90), and binge drug use (AOR = 2.18). For cisgender women, only depression was positively associated with using drugs alone (AOR = 2.16). All p-values < 0.05. While unable to conduct a multivariable analysis on transgender, Two-Spirit and gender diverse people due to small sample sizes, bivariate analyses showed larger impact of depression on using alone for Two-Spirit (OR = 8.00) and gender diverse people (OR = 5.05) compared to others, and only gender diverse people’s risk was impacted by experiences of violence (OR = 9.63). All p-values < 0.05.

Conclusion

The findings of this study suggest significant heterogeneity in gender-specific factors associated with using drugs alone. Factors exclusively impacting cisgender men’s risk included homelessness and daily stimulant use, and depression having a significant impact on cisgender women’s, but not cisgender men’s, risk. Ultimately, gender-specific factors must be recognized in public health messaging, and in developing policies and harm reduction measures to address the risks associated with using alone.
Bone turnover markers are risk factors for endplate injuries during lumbar interbody fusion: a retrospective case-control study
Authors: Kang Tae Hoon , Chung Sung Taek , Seo In-Wook , Cho Minjoon , Lee Jae Hyup
Published: February 2025

Background

Intraoperative endplate injury (IEI) is a type of fracture and a potential complication during lumbar interbody fusion (LIF). Osteoporosis diagnosed by bone mineral density (BMD) is a well-known risk factor for fracture itself and IEI also. The bone turnover markers (BTMs) are parameters of bone qualities and have some correlations with fractures, but there is no study about the BTMs and intraoperative fractures especially IEI. This study aims to identify the correlation between IEI and BTMs, especially in misTLIF.

Methods

We retrospectively reviewed 184 patients (230 spine levels). The IEI was diagnosed as the breakage of the endplate observed on postoperative 1 mm thin-cut CT scans. All surgical and endogenous risk factors of IEI were also checked including the bone resorption marker (serum CTX) and bone formation marker (serum P1NP) of BTMs. Additionally, the ratio (P1NP/CTX) and the subtype groups of BTMs were analyzed.

Results

The rate of total IEI was 38%. The sex, osteoporosis, spine BMD, femur BMD, CTX, P1NP/CTX, preoperative disc height, and the discrepancy between preoperative disc height and cage size were risk factors in multivariate logistic regression analyses. The subtypes according to BTMs showed a different rate of IEI, resulting in subtype 2 A (low CTX and P1NP and high P1NP/CTX ratio) having the lowest incidence and statistically significant odds ratios compared to other subtype groups.

Conclusion

This study demonstrated that the IEI is related to BTMs regardless of BMD in misTLIF. In addition, the P1NP/CTX ratio or subtypes could be helpful in predicting the risk of IEI due to the parallel dynamics of BTMs.
Unraveling the effect of choline-based choline based ionic liquids on the physicochemical properties and taste behavior of D( +)-glucose in aqueous solutions
Authors: Dorosti Sara , Shekaari Hemayat , Bagheri Mohammad , Ghaffari Fariba , Mokhtarpour Masumeh
Published: February 2025

To elucidate the mechanism by which choline-based ionic liquids potentially can enhance the sugar conversion to bioethanol, this work was conducted to study the thermodynamic behavior of D( +)-glucose in aqueous solutions of choline-based ionic liquids, choline salicylate [Ch][Sal], choline formate [Ch][For], and choline acetate [Ch][Ace]. This study involved measuring density, speed of sound, viscosity, and electrical conductivity at various concentrations and temperatures. Analysis of the calculated parameters, including apparent molar volume, V
φ, apparent molar isentropic compressibility (κ
φ), viscosity B-coefficient, and molar conductivity (Λ) values provide deep insights into intermolecular interactions between the components of the solutions studied. The standard partial molar volume values (

$$V_{\varphi }^{0}$$

V

φ

0

) of D( +)-glucose, show stronger interactions between D( +)-glucose and the [Ch][Sal]. The computed transfer volume values (

$$\Delta_{tr} V_{\varphi }^{0}$$

Δ

tr

V

φ

0

), with the help of co-sphere overlap model confirm intensified hydrophilic-hydrophilic interactions in [Ch][Sal] [(1.99 to 2.08) cm3·mol−1] solutions. Hepler's constants suggest that D( +)-glucose acts as a structure-maker in the presence of choline-based ILs, especially in [Ch][Sal] solutions. Also, the DFT-COSMO calculations result in [Ch][Sal] the most favorable interactions among the other choline based ILs. Apparent specific volume (ASV), and apparent specific isentropic compressibility, (ASIC), values revealed that D( +)-glucose exhibits the taste behavior with [Ch][Sal]. The hydration number of D( +)-glucose diminishes as the temperature rises due to weakened hydrogen bonds between D( +)-glucose and water molecules. These findings suggest that [Ch][Sal] could be a promising candidate for accelerating sugar conversion to bioethanol.

Graphical Abstract
Thrombocytopenia in the intensive care unit: diagnosis and management
Authors: Pène Frédéric , Russell Lene , Aubron Cécile
Published: February 2025

Background

This narrative review aims to describe the epidemiology and aetiologies of thrombocytopenia in critically ill patients, the bleeding risk assessment in thrombocytopenic patients, and provide an update on platelet transfusion indications.

Results

Thrombocytopenia is a common disorder in critically ill patients. The classic definition relies on an absolute platelet count below 150 × 109/L. Alternatively, the definition has extended to a relative decrease in platelet count (typically within a range of >30–>50% decrease) from baseline, yet remaining above 150 × 109/L. Thrombocytopenia may result from multiple mechanisms depending upon the underlying conditions and the current clinical setting. Regardless of the causes, thrombocytopenia accounts as an independent determinant of poor outcomes in critically ill patients, albeit often of unclear interpretation. Nevertheless, it is well established that thrombocytopenia is associated with an increased incidence of bleeding complications. However, alternative factors also contribute to the risk of bleeding, making it difficult to establish definite links between nadir platelet counts at the expense of potential adverse events. Platelet transfusion represents the primary supportive treatment of thrombocytopenia to prevent or treat bleeding. As randomised controlled trials comparing different platelet count thresholds for prophylactic platelet transfusion in the ICU are lacking, the prophylactic transfusion strategy is largely derived from studies performed in stable haematology patients. Similarly, the platelet count transfusion threshold to secure invasive procedures remains based on a low level of evidence. Indications of platelet transfusions for the treatment of severe bleeding in thrombocytopenic patients remain largely empirical, with platelet count thresholds ranging from 50 to 100 × 109/L. In addition, early and aggressive platelet transfusion is part of massive transfusion protocols in the setting of severe trauma-related haemorrhage.

Conclusion

Thrombocytopenia in critically ill patients is very frequent with various etiologies, and is associated with worsened prognosis, with or without bleeding complications. Interventional trials focused on critically ill patients are eagerly needed to better delineate the benefits and harms of platelet transfusions.