bluuebunny/crossref_metadata_2025 huggingface dataset:
Persistence of the developmental language disorder diagnosis, neurodevelopmental trajectories and attendance at offered interventions
Authors: Schachinger Lorentzon Ulrika , Billstedt Eva , Gillberg Christopher , Miniscalco Carmela
Published: November 2024

Aim

To study the diagnostic stability of developmental language disorders, other neurodevelopmental disorders and interventions received until age 6 years in children who screened positive for language delay, but not for autism, at age 2.5 years.

Methods

In 2016, in Gothenburg, Sweden, 100 monolingual or multilingual children underwent language assessment at a mean age of 2.9 years. At age 6 years, 85 of these children underwent language assessment. A review of paediatric records was performed after the clinical assessment to obtain information about other neurodevelopmental disorders and interventions received.

Results

At age 6 years, 74/85 (87%) of the children had persistent language disorders, and 20/85 (24%) had been diagnosed with at least one additional neurodevelopmental disorder. Five of them had autism. In general, families only attended half of the offered intervention sessions irrespective of intervention type and no difference between monolingual and multilingual families was found.

Conclusions

The persistence of language disorder and the presence of later additional neurodevelopmental disorders highlight the importance of longitudinal and multidisciplinary monitoring of children with delayed language development. Further studies and analyses are warranted to investigate the reasons behind the poor attendance rate for interventions offered.
Shedding light on biodiversity: reviewing existing knowledge and exploring hypothesised impacts of agrophotovoltaics
Authors: Schwarz Rachel , Ziv Yaron
Published: November 2024

The growing demand for energy and the shift towards green energy solutions have led to the conversion of open spaces and agricultural fields into photovoltaic (PV) power plants, exacerbating the “food–energy–environment” trilemma. Agrophotovoltaics (APVs), a dual‐use system combining agriculture and energy production on the same land, presents a potential solution to this challenge. While the environmental impacts of ground‐mounted utility‐scale PV (USPV) power plants and the effects of APV systems on agricultural yields have been extensively studied and reviewed, the implications for wildlife and biodiversity remain largely unexplored. This knowledge gap is pressing, given the accelerated global adoption of APV systems and the urgency of understanding their broader ecological consequences. In this concise review, we synthesise existing literature on the impacts of USPV installations on biodiversity and the effects of APV on crop production. Building on these foundations, we propose novel hypotheses concerning the potential pathways and mechanisms through which APV systems may influence biodiversity. We explore the complex interactions between agroecosystems and natural ecosystems, examining both direct and indirect effects. Our review culminates in a set of key research questions designed to guide future studies on the biodiversity outcomes of APV deployment. Future research should comprehensively address factors such as habitat type, climate, spatial scale, technology, and agricultural practices, as well as the overarching impacts of climate change. By highlighting the importance of these variables, we aim to facilitate a nuanced understanding of how APV systems can either support or undermine biodiversity. This work not only underscores the critical need for empirical studies in this emerging field but also sets the stage for more informed and sustainable implementation of APV technologies.
Exploration of the Active Components and Mechanism of Jiegeng (Platycodonis Radix) in the Treatment of Influenza Virus Pneumonia Through Network Pharmacology Analysis and Experimental Verification
Authors: Feng Zhiying , Wang Kangyu , Huang Jiawang , Liu Zhuolin , Fu Jingmin , Shi Jianing , Ma Xinyue , Li Ling , Wu Qiong
Published: November 2024

This study aimed to explore the pathogenesis of platycodin D and luteolin, which are both active components in Jiegeng (Platycodonis Radix), in the treatment of influenza virus pneumonia through network pharmacology analysis combined with experimental verification. The bioactive components of Jiegeng (Platycodonis Radix) were screened by TCMSP and literature mining, and the results were standardized via the UniProt database. The action targets for the disease were identified from databases including OMIM, GeneCards, TTD, DisGeNET, and PharmGKB. Then, the visualized key target regulatory network and protein–protein interaction (PPI) network for the active components were established using Cytoscape3.7.1 software. The findings were illustrated through Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. The intervention concentrations of platycodin D and luteolin were screened by the CCK8 method, and the important signaling pathways of platycodin D and luteolin for treating influenza virus pneumonia were verified by RT‐qPCR and Western blot tests. From data mining, 89 common drug‐disease targets were screened out, and five major active components of Jiegeng (Platycodonis Radix), including platycodin D and luteolin, were obtained. Besides, 11 therapeutic targets including IL‐17, IL‐6, TNF‐α, JUN, and MAKP1 were identified by PPI network analysis. GO and KEGG enrichment analyses showed that the pathways most related to the mechanisms of Jiegeng (Platycodonis Radix) against influenza virus pneumonia included the TNF and IL‐17 signaling pathways and apoptosis. In vitro experiments demonstrated that the model group exhibited a notable elevation in mRNA levels of IL‐6, IL‐17, TNF‐α, JUN, MAPK1, and the IL‐17/−acting protein ratio, as compared to the control group (p < 0.05). In contrast to the model group, the IL‐6, IL‐17, TNF‐α, JUN, MAPK1 mRNA expression levels, and the IL‐17 protein ratio in both the platycodin D group and luteolin group were considerably decreased (p < 0.05). Combined with network pharmacology and experimental verification, this study revealed that platycodin D and luteolin in Jiegeng (Platycodonis Radix) may treat influenza virus pneumonia by regulating inflammation through the IL‐17 signaling pathway.
Long Term Outcomes in Patients With Differences in Sex Development in Lucknow, India
Authors: Dominic Nibu , Bhatia Vijayalakshmi , Dabadghao Preeti , Ansari M. S.
Published: November 2024

Context

The long term outcomes for individuals with a difference in sex development (DSD) are influenced by ethnic, socio‐cultural and economic factors, besides the medical issues. Data from India on these aspects are sparse.

Design and Measurements

We report on gender identity, patients' opinion regarding timing of genitalia surgery, suicidal thoughts, romantic inclination, and quality of life (QOL, SF36 scale), in 31 young adults with a DSD.

Results

Median (IQR) age was 23 (19–27) years; 16 raised male, 15 female. Age at first surgery was 6.0 (2.0–16.25) years. Gender identity in 30 patients remained identical with sex of rearing. Majority (27) thought the timing of genital surgery should be in childhood. Six of 31 patients had attempted suicide at least once. Four patients reported sexual abuse in the past. Twelve patients reported romantic relationships, rates similar to reports from India, with seven reporting sexual intercourse. Eleven of 31 patients reported aversion to and fear of sexual activity, due to fear of rejection. Heterosexual orientation was reported by 25 of 29 patients. QOL scores were not different between patients and 46 healthy controls or 43 people with type 1 diabetes. Mental QOL scores were lower for those with history of teasing (37.10 ± 16.01 vs. 47.76 ± 9.4 in those without, p = 0.04) and with suicidal thoughts (33.9 ± 14.51 vs. 45.65 ± 13.2 for those without, p = 0.04).

Conclusions

The absence of prominent gender dysphoria in our young adults was noteworthy, as was their preference for early genital surgery. Lack of adequate mental health support is a high alert for our teams involved in the care of DSD and as well as for policy‐makers.
Women With Polycystic Ovary Syndrome and Excess Body Fat Exhibit Atypical Sympathetic Autonomic Modulation That is Partially Reversed by Aerobic Physical Training
Authors: Bernal João Vitor Martins , da Veiga Ana Catarine , Philbois Stella Vieira , Ribeiro Victor Barbosa , Aguilar Bruno Augusto , Paixão Tallys Eduardo Velasco , Chinellato Naiara , Sánchez‐Delgado Juan Carlos , Gastaldi Ada Clarice , de Souza Hugo Celso Dutra
Published: November 2024

Objective

The aetiology of impairments in autonomic modulation of heart rate variability (HRV) in polycystic ovary syndrome (PCOS) remains unclear, as does the impact of aerobic physical training (APT) on controlling endocrine‐metabolic disorders and HRV. This is because these women often present excess body fat. Therefore, we assessed whether the dysregulation in autonomic modulation of HRV in women with PCOS is due to endocrine‐metabolic disorders and whether the combination of excess body fat with endocrine‐metabolic disorders amplifies cardiovascular autonomic deficits. We also investigated whether APT positively influences autonomic modulation of HRV in PCOS.

Design

Non‐randomised clinical trial.

Participants

Women with and without PCOS with different percentages of body fat.

Measurements

Participants were divided into four groups: women without PCOS with a body fat percentage between 22% and 29% (CONTROL group; 22%–29%); CONTROL (30%–37%) group; PCOS (22%–29%) group; and PCOS (30%–37%) group. Hemodynamic, metabolic, and hormonal characteristics and HRV parameters were obtained before and after 16 weeks of APT.

Results

The PCOS (22%–29%) group exhibited lower vagal modulation than the CONTROL (22%–29%) group. In contrast, no significant differences were observed between the CONTROL (30%–37%) and PCOS (30%–37%) groups. Furthermore, the PCOS (30%–37%) group demonstrated lower sympathetic modulation than the PCOS (22%–29%) group. After APT, the PCOS (22%–29%) group increased in vagal modulation, while the PCOS (30%–37%) group increased in sympathetic modulation.

Conclusion

PCOS affects vagal modulation; however, this effect may be masked at elevated levels of body fat. Additionally, the combination of excess body fat with endocrine‐metabolic dysregulation appears to reduce sympathetic modulation, possibly due to sympathetic drive hyperactivity. APT positively affected HRV in both PCOS groups.
The needs and gaps in pharmacogenomics knowledge and education among healthcare professionals in Malaysia: A multisite Delphi study
Authors: Omran Safa , Leong Siew Lian , Blebil Ali , Mohan Devi , Ang Wei Chern , Teoh Siew Li
Published: November 2024

Lack of pharmacogenomics knowledge among healthcare professionals is the most significant cited barrier to implementing pharmacogenomics in clinical settings. Despite the growth in research initiatives and awareness of pharmacogenomics, healthcare professionals continue to report a lack of knowledge and confidence in practicing pharmacogenomics. This study aims to assess the current pharmacogenomics knowledge gaps and learning needs of healthcare professionals in Malaysia. A modified Delphi with a multidisciplinary expert panel was conducted, and a purposive sampling method was used with predefined selection criteria. Fourteen study sites in Malaysia were included. The cut‐off value to approach consensus was predefined as a threshold of 60% or higher, and a quantitative descriptive statistical analysis was performed. The study demonstrated that all experts rated the suggested educational content components as essential/important to be included in the educational intervention. Additionally, experts highlighted the significant barriers and gaps to adopting and practicing pharmacogenomics. To conclude, this multisite Delphi study enabled the development of a tailored, effective, evidence‐based, competency‐based educational intervention in pharmacogenomics for healthcare professionals in Malaysia. To keep up with the rapid evolution of the pharmacogenomics field, healthcare professionals should be equipped with the necessary competencies required to practice pharmacogenomics for better health outcomes. Future research is needed to determine the feasibility of the proposed educational intervention.
Measurement Invariance for Multilingual Learners Using Item Response and Response Time in PISA 2018
Authors: Park Jung Yeon , Joo Sean , Li Zikun , Yoon Hyejin
Published: November 2024

This study examines potential assessment bias based on students' primary language status in PISA 2018. Specifically, multilingual (MLs) and nonmultilingual (non‐MLs) students in the United States are compared with regard to their response time as well as scored responses across three cognitive domains (reading, mathematics, and science). Differential item functioning (DIF) analysis reveals that 7–14% of items exhibit DIF‐related problems in scored responses between the two groups, aligning with PISA technical report results. While MLs generally spend more time on the test than non‐MLs across cognitive levels, differential response time (DRT) functioning identifies significant time differences in 7–10% of items for students with similar cognitive levels. It was noticeable that items with DIF and DRT issues show limited overlap, suggesting diverse reasons for student struggles in the assessment. A deeper examination of item characteristics is recommended for test developers and teachers to gain a better understanding of these nuances.
Community‐Driven Health Promotion: Evaluation of a Rural Microgrant Program
Authors: Conlin Michele , McLaren Dorothy , Spelten Evelien , MacDermott Sean
Published: November 2024

Introduction

Microgrants for health promotion have the potential to engage communities in designing and implementing place‐based interventions to improve health and social outcomes. However, the evidence base around microgrants for health promotion is limited. This study presents the evaluation of a health service‐funded microgrant program for health promotion in rural Australia.

Methods

The evaluation framework was developed through a participatory approach and involved collaborative logic model building and co‐prioritized evaluation questions with health service staff and grant recipients. Evaluation questions focused on participation, short‐term outcomes, and the perceived value of program activities. Qualitative methods (reflexive thematic analysis) were used to answer the evaluation questions. Data sources included semi‐structured interviews with grantees (n = 11) and the health service's health promotion team (n = 4), electronic field notes kept by the health promotion team (n = 50 documents), electronic progress reports completed by grantees (n = 6) and information and feedback forums (n = 2).

Results

Since the program's inception in 2019, the health service has received 22 grant applications of which 15 were approved and 14 disbursed. Evaluation results show that grantees were community members with multiple roles, often with previous experience in applying for grants. Expected outcomes have been partially met, especially with regard to the program's aim of community empowerment. The most notable impact was the enhancement of participants' perception of and relationship with the health promotion team, as well as the creation of opportunities for community members such as exposure to art and bridging of social groups.

Conclusion

Microgrants represent a feasible way to increase health opportunities and foster community participation in the planning and delivery of health promotion programs. The key program activities identified and suggested improvements can help guide program replication and adaptation by other small organizations.

Public Contribution

Community members who had previously received a health service grant were invited to participate in collaborative workshops and follow‐up surveys to codesign the grant program evaluation framework, co‐prioritize evaluation questions and guide the results' dissemination plan.
A Qualitative Exploration of the Role of Culturally Relevant Social Prescribing in Supporting Pakistani Carers Living in the UK
Authors: McMullen Sarah , Poduval Shoba , Armstrong Megan , Davies Nathan , Dayson Chris , Kharicha Kalpa , Nair Pushpa , Mistry Manoj , Sajid Madiha , Walters Kate , Woodward Abi
Published: November 2024

Background

Approximately 5.7 million people in the UK are providing informal care. Carers across all ethnic groups can experience negative impacts on their physical and mental health but some minority ethnic groups face greater challenges. Higher levels of social isolation exist among Pakistani carers compared to White British carers, yet the needs of Pakistani carers and how well support services meet these needs is less well understood. Social prescribing can help people get more control over their health care in a nonmedical way. South Asian and other ethnically diverse populations are under‐served in social prescribing and there is little evidence available on why this is the case.

Aim

To explore the potential role of culturally relevant and adapted social prescribing in assisting Pakistani carers and identify the cultural and religious influences and barriers on carer health behaviours.

Methods

Semi‐structured one‐to‐one interviews with Pakistani family carers (n = 27) and social prescribing stakeholders (n = 10) living in London and Sheffield, UK. Participants were recruited through voluntary and community sector organisations (VCSOs), social media, religious organisations, and word of mouth. Interview data was analysed in NVivo using reflexive thematic analysis methods.

Findings

Two themes were developed; (1) Individual and community level influences: Navigating and accessing carer support within Pakistani communities, including carer identity and cultural barriers to accessing support provision, and cultural adaptation to facilitate support for Pakistani carer health and well‐being, (2) societal and structural level challenges: Accessing and providing social prescribing for Pakistani carers, including funding challenges for the provision of culturally relevant carer support, integration of primary care and social prescribing, and enhancing cultural awareness and competence in social prescribing for Pakistani carers.

Conclusions

There are complexities surrounding carer identity, family dynamics, stigma, and a lack of knowledge of social prescribing within Pakistani communities. There is a need for more culturally competent support, culturally relevant education, awareness‐raising, and collaboration among primary care and VCSO's to better support Pakistani carers through social prescribing, which acknowledges and addresses the complexities.

Patient and Public Contribution

The study included a patient advisory group comprised of two South Asian family carers who contributed towards all stages of the study. They provided feedback on study documents (topic guides and recruitment materials) and recruitment strategy, supported with translation of study documents and interpretation of the interview data, and helped with facilitation of our dissemination activities.
Clinical Significance of Complement and Coagulation Cascades Genes for Patients With Acute Lymphoblastic Leukemia
Authors: Tang Yuting , Chen Li , Xiao Yanni , Ran Qian , Li Zhongjun , Chen Maoshan
Published: November 2024

Introduction

Acute lymphoblastic leukemia (ALL) is the second most common acute leukemia in adults and the 5‐year survival remains low.

Methods

We analyzed the gene expression profiles of the complement and coagulation cascades pathway (CCCP) in 998 bone marrow (BM) and 122 peripheral blood (PB) samples of ALL patients and healthy individuals obtained from the TCGA database and evaluated their clinical significance in terms of being diagnostic and prognostic biomarkers.

Results

We identified 18 CCCP genes (SERPINA1, C5AR1, F5, CD55, PLAUR, C3AR1, THBD, CD59, PLAU, VWF, CFD, F13A1, C1QA, C1QB, C1QC, A2M, SERPINE1 and CR2) differentially expressed in the BM samples of ALL patients compared to healthy individuals. The expression levels of CD55, F13A1 and CR2 in BM were linked with the overall survival of ALL patients. While in PB only 11 CCCP genes (e.g., SERPINA1, C5AR1, F5, PLAUR, C3AR1, THBD, CFD, F13A1, C1QA, SERPINE1, and CR2) were differentially expressed and F13A1 was significantly associated with ALL patient survival. Machine learning enabled us to predict ALL using the CCCP genes and the accuracy can reach 0.9701 and 0.9167 using the BM and PB, respectively. Furthermore, using single‐cell RNA sequencing, we found that the differential expression of CCCP genes was found with diversity in the BM‐derived immune cells of ALL patients.

Conclusion

Our findings suggest that the CCCP genes may play a key role in the progression of ALL and can be used as potential therapeutic targets and diagnostic markers.
Future Nurses in a Changing Climate: Exploring the Relationship Between Environmental Literacy and Climate Anxiety
Authors: Amin Shaimaa Mohamed , El‐Monshed Ahmed Hashem , Khedr Mahmoud Abdelwahab , Morsy Omima Mohamed Ibrahim , El‐Ashry Ayman Mohamed
Published: November 2024

Background

Climate change significantly impacts public health, increasing the prevalence of respiratory, cardiovascular and mental health issues. Nurses, as frontline healthcare providers, need strong environmental literacy to manage these health challenges. This study explores how environmental literacy among nursing students relates to climate anxiety, aiming to improve educational strategies and mental health support for future nurses.

Aim of the Study

Is to investigate how environmental literacy among nursing students affects their levels of climate anxiety.

Methods

A cross‐sectional survey was utilised on a representative sample of 620 nursing students from each academic year.

Tools

Climate anxiety scale and the environmental literacy scale for adults were used to collect data.

Results

Environmental literacy and its components were positively linked to cognitive‐emotional and functional impairments and climate anxiety. Gender differences were observed, with females experiencing higher climate anxiety. Increased environmental literacy generally reduced climate anxiety, particularly in females, emphasising gender differences in environmental literacy's impact on climate anxiety. Despite the model's low explanatory power (R2 = 0.026), the findings highlight the importance of gender differences in the relationship between environmental literacy and climate anxiety.

Conclusion and Implications

Nursing students show promise in their environmental knowledge but face significant climate anxiety. Gender differences in anxiety levels warrant attention. Addressing these concerns is crucial for preparing nurses to effectively address climate change's health effects and ensuring a resilient healthcare system. The study underscores the importance of integrating environmental literacy into nursing education and promoting pro‐environmental behaviours among nursing students and professionals. It highlights the crucial role of mental health support services, policy advocacy and ongoing research in addressing climate anxiety and preparing nurses to tackle the health impacts of climate change.

Patient or Public Contribution

No patient or public involvement.
Quality of Life of Adolescents and Young Adult Survivors of Childhood Cancer: A Qualitative Study
Authors: Neris Rhyquelle Rhibna , Papathanassoglou Elizabeth , Leite Ana Carolina Andrade Biaggi , Garcia‐Vivar Cristina , Nascimento Lucila Castanheira
Published: November 2024

Aims

To analyse how adolescents and young adults who survived childhood cancer experience their quality of life and to explore their meanings and conceptualisations of quality of life.

Design

Narrative design following Squire's method.

Methods

In‐person and virtual recruitment, due to the global COVID‐19 pandemic, was carried out in Brazil between May and November 2021. Eighteen semi‐structured virtual interviews were conducted with childhood cancer survivors. These data were analysed using reflexive thematic analysis and employing a triangulation of investigators.

Results

Four subthemes were identified, encompassing participants' perceptions and meanings of quality of life. Through the reflection and synthesis of these subthemes, a central theme emerged entitled ‘New self’, capturing the profound impact of the cancer and survival experience on every aspect of the self, along with participants' sense of having gained ‘a new life’ and a ‘second chance’.

Conclusion

The study provides a rich and nuanced understanding of quality of life for childhood cancer survivors. The results highlight that after all the changes in life due to cancer, integrating the new self becomes a central aspect of quality of life for survivors.

Implications for the Profession and/or Patient Care

Recognising the profound shifts in self‐perception that survivors of childhood cancer undergo, nurses should engage early in empowering patients and families, offering education, space and support to help adolescents and young adults grow throughout their journey.

Impact

The richness and depth inherent in qualitative data on quality of life can inform the development of care standards and health policies for survivors, guide the allocation of strategic resources and shape the development of plans and interventions focusing on childhood cancer survivors.

Reporting Method

The COREQ checklist was used.

Patient or Public

No patient or public contribution.
Fibroblast‐derived miR‐425‐5p alleviates cardiac remodelling in heart failure via inhibiting the TGF‐β1/Smad signalling
Authors: Zhou Haijia , Liu Pengyun , Guo Xuelin , Fang Wei , Wu Chan , Zhang Mingming , Ji Zhaole
Published: November 2024

The pathological activation of cardiac fibroblasts (CFs) plays a crucial role in the development of pressure overload‐induced cardiac remodelling and subsequent heart failure (HF). Growing evidence demonstrates that multiple microRNAs (miRNAs) are abnormally expressed in the pathophysiologic process of cardiovascular diseases, with miR‐425 recently reported to be potentially involved in HF. In this study, we aimed to investigate the effects of fibroblast‐derived miR‐425‐5p in pressure overload‐induced HF and explore the underlying mechanisms. C57BL/6 mice were injected with a recombinant adeno‐associated virus specifically designed to overexpress miR‐425‐5p in CFs, followed by transverse aortic constriction (TAC) surgery. Neonatal mouse CFs (NMCFs) were transfected with miR‐425‐5p mimics and subsequently stimulated with angiotensin II (Ang II). We found that miR‐425‐5p levels were significantly downregulated in HF mice and Ang II‐treated NMCFs. Notably, fibroblast‐specific overexpression of miR‐425‐5p markedly inhibited the proliferation and differentiation of CFs, thereby alleviating myocardial fibrosis, cardiac hypertrophy and systolic dysfunction. Mechanistically, the cardioprotective actions of miR‐425‐5p may be achieved by targeting the TGF‐β1/Smad signalling. Interestingly, miR‐425‐5p mimics‐treated CFs could also indirectly affect cardiomyocyte hypertrophy in this course. Together, our findings suggest that fibroblast‐derived miR‐425‐5p mitigates TAC‐induced HF, highlighting miR‐425‐5p as a potential diagnostic and therapeutic target for treating HF patients.
A Narrative Review of Ethical Issues in the Use of Artificial Intelligence Enabled Diagnostics for Diabetic Retinopathy
Authors: Crew Alexandra , Reidy Claire , van der Westhuizen Helene‐Mari , Graham Mackenzie
Published: November 2024

Introduction

Diabetic retinopathy is one of the leading causes of avoidable blindness among adults globally, and screening programmes can enable early diagnosis and prevention of progression. Artificial intelligence (AI) diagnostic solutions have been developed to diagnose diabetic retinopathy. The aim of this review is to identify ethical concerns related to AI‐enabled diabetic retinopathy diagnostics and enable future research to explore these issues further.

Methods

This is a narrative review that uses thematic analysis methods to develop key findings. We searched two databases, PubMed and Scopus, for papers focused on the intersection of AI, diagnostics, ethics, and diabetic retinopathy and conducted a citation search. Primary research articles published in English between 1 January 2013 and 14 June 2024 were included. From the 1878 papers that were screened, nine papers met inclusion and exclusion criteria and were selected for analysis.

Results

We found that existing literature highlights ensuring patient data has appropriate protection and ownership, that bias in algorithm training data is minimised, informed patient decision‐making is encouraged, and negative consequences in the context of clinical practice are mitigated.

Conclusions

While the technical developments in AI‐enabled diabetic retinopathy diagnostics receive the bulk of the research focus, we found that insufficient attention is paid to how this technology is accessed equitably in different settings and which safeguards are needed against exploitative practices. Such ethical issues merit additional exploration and practical problem‐solving through primary research. AI‐enabled diabetic retinopathy screening has the potential to enable screening at a scale that was previously not possible and could contribute to reducing preventable blindness. It will only achieve this if ethical issues are emphasised, understood, and addressed throughout the translation of this technology to clinical practice.
Quality Management in Spanish Community Pharmacy: Implementation of ISO 9001
Authors: Barris Blundell Damià , García‐Agua Soler Nuria
Published: November 2024

Background

Spanish community pharmacy has been incorporating some methods and approaches in the evaluation and improvement of quality, with the ISO 9001 standard being the most used reference. The experience of a community pharmacy in Spain is presented. The pharmacy implemented a management system based on the ISO 9001 standard in 2020, using the Deming cycle with the aim of enhancing the quality of pharmaceutical care. The results obtained in the processes over the following 2 years are also presented.

Methods

The ISO 9001 standard was reviewed to ensure compliance. The Quality Management System control documentation was updated and included the following documents: quality manual, process map, operational processes and procedures, quality indicators and incident records. The pharmacy has planned and implemented a process of monitoring, measurement, analysis of results and continuous improvement for operational, strategic and support processes during the time period of the study. The main operational processes were associated with a set of indicators which permitted to know the results obtained, analyse deviations and implement improvements. The planning and development of the project encompassed approximately 1 year and involved several key stages: (1) diagnosis and assessment of quality situation, (2) analysis of processes, (3) preparation of documentation, (4) implementation of the Quality Management System, (5) internal audit, (6) monitoring of activities and continuous improvement, (7) follow‐up audit by the certifying body, (8) obtaining the ISO 9001:2015 quality certificate.

Results

The planned schedule was adhered and the documents were successfully drafted. In total, eight operational processes, nine support processes and six strategic processes were reviewed and included in the Quality Management System. Twenty indicators were established to monitor and analyse the performance of these processes. During audits, deviations in the system or nonconformances were identified and analysed. In the first year of system implementation, five nonconformances were identified, decreasing to two in the subsequent two periods. In 2020, three improvement actions were implemented with the objective of: (1) implementing a medication reconciliation service, (2) developing a medication dose adjustment service for polymedicated patients, and (3) implementing a service to measure and improve inhalation technique in patients using inhalers.

Conclusions

The implementation of a methodology based on the ISO 9001 standard has facilitated: (1) Integrating process management as a regular working methodology, (2) A focus on the continuous improvement of services, (3) Achieving recognition of the staff efforts and involvement.
Stroma‐and Tumor‐Associated Predictive Features in Salivary Gland Adenoid Cystic Carcinoma of the Head and Neck
Authors: Rytkönen Aleksi , Laine Hanna K. , Mäkitie Antti , Haglund Caj , Hagström Jaana , Almangush Alhadi , Leivo Ilmo
Published: November 2024

Background

There is lack of knowledge on the utility of prognostic histopathologic characteristics in adenoid cystic carcinoma (ACC) of the head and neck. We evaluated the prognostic value of tumor and stroma‐related histopathologic features in ACC.

Materials and Methods

A total of 65 cases of ACC from minor and major salivary glands were included in this study. We evaluated tumor budding, tumor‐infiltrating lymphocytes (TILs), and tumor‐stroma ratio (TSR) in hematoxylin and eosin (HE) stained sections.

Results

Stroma‐rich ACCs recurred more frequently (p = 0.029) during follow‐up and associated with distant metastasis (p = 0.038). In multivariable analysis, stroma‐rich tumors associated with poorer disease‐specific survival with a hazard ratio of 3.76 (95% CI 1.10–12.83, p = 0.034). ACCs commonly showed a low infiltration of TILs as 89% of the tumors was characterized by an immune desert pattern. Low infiltration of TILs associated significantly with increased tumor budding (p = 0.039).

Conclusion

Adverse features of TSR and tumor budding are widely expressed in ACC, and stroma‐rich tumors are associated with poor prognosis. Low number of TILs in ACC tissue indicates a weak immune response by the host and illustrates the nature of ACC as a relentless malignancy.
Innovation in the sharing economy: Examining Uber's transformation
Authors: Lee Erica Ji Hyun , Rindfleisch Aric , Kopalle Praveen K.
Published: November 2024

The sharing economy has altered transactions between providers and users in at least two pivotal ways. First, sharing economy offerings are often crowdsourced from a wide range of providers rather than a single firm. Second, these offerings are typically temporarily accessed rather than permanently owned. The effect of these two characteristics on how offerings are exchanged has generated considerable interest from scholars across a wide range of domains, including economics, management, and marketing. However, little is known about the impact of the sharing economy (and crowdsourced provision and temporary access), upon the way offerings are created. As a result, the degree to which innovation in the sharing economy differs from how it is typically conducted is largely unknown. Our research seeks to address this question. Specifically, we begin by reviewing the literature on innovation in the sharing economy and then offer a conceptual framework that focuses on the role of crowdsourced provision and temporary access within the innovation process. We then assess this framework by examining innovations introduced by Uber since its inception. In addition, we explore the degree to which sharing platforms differ from a typical profit maximizing firm by conducting an econometric analysis of the price differences between Uber and a traditional taxi service. We conclude by highlighting the implications of our research and suggesting avenues for future inquiry in this domain.
Supplier Carbon Management and Firm Idiosyncratic Risk: Empirical Evidence From China
Authors: Zhou Zhifang , Dai Yixiang , Han Shangjie , Zhang Tao , Liu Jinhao , Chen Xiaohong
Published: November 2024

Although existing research emphasizes the importance of internal carbon management (CM) in influencing firm risk, the impact of external stakeholder CM on firm risk remains unclear. This study employs signaling theory to explore how supplier CM affects firm idiosyncratic risk (IR), alongside the moderating roles of the supply chain information environment and the criticality of firm–supplier relationships. The findings of this study demonstrate that supplier CM can reduce firm IR. The risk reduction effect is strong when the information environment between a firm and its suppliers is rich and when the dependency between the firm and its supplier is strong. Path analysis reveals that supplier CM primarily reduces firm IR by alleviating information asymmetry. Moreover, the risk reduction effect increases for firms with small sizes. This research extends the application of signaling theory to supply chain research and bridges the gap between the CM and firm IR literature within the context of supply chain management.
Approach to Complementary Feeding and Infant Language Use: An Observational Study
Authors: Farrow Claire , Blissett Jacqueline , Islam Shefu , Batchelor Rachel , Norman Rebecca , Webber Charlotte , Addessi Elsa , Bellagamba Francesca , Galloway Amy T. , Shapiro Laura
Published: November 2024

Emerging research suggests that a more infant‐led approach to complementary feeding may confer benefits for child language, but these findings are based on parent report studies. Using an observational approach this study examines whether different complementary feeding experiences relate to infant language exposure and language use. Fifty‐eight parents recorded a typical infant mealtime in the home (mean infant age = 14 months, SD = 4.15). Observations were coded to measure the prevalence of infant‐led and parent‐led feeding using the Family Mealtime Coding Scheme. Caregiver language use (word types and token directed at the child, mean length of utterances in child‐directed speech, responsiveness and initiations) and the number of infant vocalisations were coded in ELAN using CHAT conventions and parents completed the MacArthur Communicative Development Inventory short form as a measure of child language. Greater observed infant self‐feeding was significantly associated with greater observed exposure to language from caregivers (r = 0.312 percentage of infant self‐feeding correlated with caregiver word types directed at the child) and a greater number of infant vocalisations (r = 0.320 percentage of infant self‐feeding correlated with number of child vocalisations produced). Structural Equation Modelling showed the relationship between infant self‐feeding and infant vocalisations to be significantly mediated by enhanced quality and quantity of caregiver child‐directed speech (model fit: χ2 [5] = 5.01, p = 0.415, CFI = 1.00 [NF = 0.98], RMSEA = 0.006). Differences in the approach to complementary feeding may shape infant's experiences in ways that support language exposure and use. Autonomy associated with infant self‐feeding may enhance opportunities for social interaction.
Successful Invasion Into New Environments Without Evidence of Rapid Adaptation by a Predatory Marine Gastropod
Authors: Bentley Blair P. , Cheng Brian S. , Brennan Reid S. , Swenson John D. , Adkins Jamie L. , Villeneuve Andrew R. , Komoroske Lisa M.
Published: November 2024

Invasive species with native ranges spanning strong environmental gradients are well suited for examining the roles of selection and population history in rapid adaptation to new habitats, providing insight into potential evolutionary responses to climate change. The Atlantic oyster drill (Urosalpinx cinerea) is a marine snail whose native range spans the strongest coastal latitudinal temperature gradient in the world, with invasive populations established on the US Pacific coast. Here, we leverage this system using genome‐wide SNPs and environmental data to examine invasion history and identify genotype–environment associations indicative of local adaptation across the native range, and then assess evidence for allelic frequency shifts that would signal rapid adaptation within invasive populations. We demonstrate strong genetic structuring among native regions which aligns with life history expectations, identifying southern New England as the source of invasive populations. Then, we identify putatively thermally adaptive loci across the native range but find no evidence of allele frequency shifts in invasive populations that suggest rapid adaptation to new environments. Our results indicate that while these loci may underpin local thermal adaptation in their native range, selection is relaxed in invasive populations, perhaps due to complex polygenic architecture underlying thermal traits and/or standing capacity for phenotypic plasticity. Given the prolific invasion of Urosalpinx, our study suggests population success in new environments is influenced by factors other than selection on standing genetic variation that underlies local adaptation in the native range and highlights the importance of considering population history and environmental selection pressures when evaluating adaptive capacity.
Abscisic acid‐, stress‐, ripening‐induced 2 like protein, TaASR2L, promotes wheat resistance to stripe rust
Authors: Wang Qiao , Tang Yaqi , Li Ying , Ren Jun , Zuo Hongxu , Cheng Peng , Li Qiang , Wang Baotong
Published: November 2024

Wheat stripe rust, caused by Puccinia striiformis f. sp. tritici (Pst), is one of the most destructive wheat diseases. The plant hormone abscisic acid (ABA) plays a key regulatory role in plant response to stress. ABA‐, stress‐, ripening‐induced proteins (ASR) have been shown to be abundantly induced in response to biotic and abiotic stresses to protect plants from damage. However, the function of wheat ASR2‐like protein (TaASR2L) in plants under biotic stress remains unclear. In this study, transient silencing of TaASR2L using a virus‐induced gene silencing system substantially reduced wheat resistance to Pst. TaASR2L interaction with serine/arginine‐rich splicing factor SR30‐like (TaSR30) was validated mainly in the nucleus. Knockdown of TaSR30 expression substantially reduced wheat resistance to Pst. Overexpression of TaASR2L and TaSR30 demonstrated that they can promote the expression of ABA‐ and resistance‐related genes to enhance wheat resistance to Pst. In addition, the expression levels of TaSR30 and TaASR2L were substantially increased by exogenous ABA, and the resistance of wheat to Pst was increased, and the expression of PR genes was induced. Therefore, these results suggest that TaASR2L interacts with TaSR30 by promoting PR genes expression and enhancing wheat resistance to Pst.
Seduction and Fidelity: Cunning and Power Relationships an Ethnographic Exploration in an Intensive Care Unit During the Covid‐19 Crisis
Authors: Philippe Bonneels
Published: November 2024

Sedufidelity—the contraction of seduction and fidelity—offers an interesting perspective for reflecting on the role of relationships and the ethics of care in highly technical healthcare settings. Understanding sedufidelity could help mitigate the observed social ruptures and promote a more humane approach to healthcare. However, challenges remain regarding its implementation, particularly in terms of building trust and loyalty towards management and healthcare policymakers. Furthermore, initiatives such as the ‘haie de déshonneur’ (‘hedge of dishonour’) can highlight the need and form of recognition sought by caregivers, given their strong symbolism. However, other actions can also be considered to strengthen relationships and attention paid to caregivers, such as a prior consultation.
Atrial Fibrillation in Young Patients: Insights From the National Inpatient Sample
Authors: Kotta Prasanti A. , Patel Tusharbhai J. , Nambi Vijay , Misra Arunima , Afshar Hamid , Chelu Mihail G. , Saeed Mohammad , Abramov Dmitry , Minhas Abdul Mannan Khan
Published: November 2024

Background

The burden of atrial fibrillation (AF) hospitalizations in young patients is not well characterized. We aimed to study the burden, comorbidities, outcomes, and resource utilization of AF hospitalizations in young patients.

Methods

We conducted a retrospective analysis of all primary AF hospitalizations in patients 18–45 years of age using the National Inpatient Sample data from January 1, 2008 to December 31, 2019. We collected data on various clinical and socioeconomic features including demographics and clinical outcomes.

Results

AF hospitalizations decreased over time from 18.7 per 100,000 in 2008 to 13.0 per 100,000 in 2019 (p < 0.001). AF hospitalizations were higher amongst males compared to females (24.0 vs. 7.5 per 100,000), and higher in Black patients compared to other ethnicities (20.4 for Black vs. 15.6 for White vs. 8.5 Hispanic per 100,000). The utilization of electrical cardioversion increased from 17.6% in 2008 to 21.9% in 2019 (p < 0.001), and catheter ablation decreased from 7.1% in 2008 to 4.3% in 2019 (p < 0.001). Men were more likely to undergo electrical cardioversion than women (20.1% vs. 14.8%, p < 0.001). White patients were more likely to undergo electrical cardioversion (20.8% vs. 14.3% vs. 15.5%, p < 0.001) and catheter ablation (6.1% vs. 3.3% vs. 4.2%, p < 0.001) compared to Black and Hispanic patients, respectively. Patients in the highest income residence quartile were more likely to undergo electrical cardioversion (21.9% vs. 16.4%, p < 0.001) and catheter ablation (8.0% vs. 3.7%, p < 0.001) compared to patients in the lowest income residence quartile.

Conclusions

We found significant differences in inpatient AF management based on sex, ethnicity, and SES.
A grounded theory of cognitive analytic reflective practice groups
Authors: Priddy Sasha , Kellett Stephen , Goodall Shona , Cotton Rachael
Published: November 2024

Objectives

Whilst cognitive analytic therapy (CAT) is increasingly used as an indirect intervention, there is little evidence of how the approach can be applied to reflective practice. This study sought to develop a process model of cognitive analytic reflective practice (CARP) groups.

Design

Constructivist grounded theory approach supplemented by quantitative measures of helpfulness and group cohesion.

Methods

Twenty‐four participants, working within four staff teams in a secure children's home, attended four CARP groups over a 1‐year period. Sessions were audio recorded, transcribed and checked for model fidelity and then analysed using grounded theory. Theoretical sampling was achieved via conducting focus groups with teams informed by the emergent categories, and using sessional measures of group cohesion and helpfulness to confirm theoretical saturation.

Results

The model constructed had three interrelated main categories: ‘facilitator processes: establishing a reflective space’, ‘group processes: widening awareness of the self, others, and system’ and ‘outcomes: changing relational dynamics and finding exits.’ The model was validated by evidence from the measures.

Conclusions

The model offers an empirical understanding of how CAT informs reflective practice through a better understanding of reciprocity in the dynamics of care systems.
Enhanced CO2 Coordinates the Spatial Recruitment of Diazotrophs in Rice Via Root Development
Authors: Zhao Junwen , Chen Yuting , Tao Qi , Schreiber Lukas , Suresh Kiran , Frei Michael , Alam Muhammad Shahedul , Li Bing , Zhou Yaping , Baer Marcel , Hochholdinger Frank , Wang Changquan , Yu Peng
Published: November 2024

Understanding the reciprocal interaction between root development and coadapted beneficial microbes in response to elevated CO2 (eCO2) will facilitate the identification of nutrient‐efficient cultivars for sustainable agriculture.

Here, systematic morphological, anatomical, chemical and gene expression assays performed under low‐nitrogen conditions revealed that eCO2 drove the development of the endodermal barrier with respect to L‐/S‐shaped lateral roots (LRs) in rice.

Next, we applied metabolome and endodermal‐cell‐specific RNA sequencing and showed that rice adapts to eCO2 by spatially recruiting diazotrophs via flavonoid secretion in L‐shaped LRs. Using the rice Casparian strip mutant Oscasp1‐1, we confirmed that reduced lignin deposition selectively recruits the diazotrophic family of Oxalobacteraceae to confer tolerance to low nitrogen availability.