bluuebunny/crossref_metadata_2025 huggingface dataset:
The Diagnostic Value of Neutrophil and Monocyte Cell Population Data Obtained From a Hematology Analyzer in Neonatal Sepsis
Authors: Unlu Ozan , Gulcan Kersin Sinem , Cevlik Tulay , Unlu Nazmiye , Bilgen Hulya Selva , Ozek Eren , Sirikci Onder , Haklar Goncagul
Published: January 2025

We aimed to investigate the diagnostic value of leukocyte cell population data (CPD) parameters obtained from an automated hematology analyzer to be able to use it in the diagnosis of neonatal sepsis. Our study was a retrospective and cross-sectional analysis. The neonates were classified into 3 groups: culture-positive sepsis (n = 20), clinical sepsis (n = 87), and control (n = 269). CPD parameters were determined during complete blood count (CBC) by volume-conductivity-scatter (VCS) technology with DxH 900 Coulter Cell Analyzer. Mean neutrophil volume (MNVNE), standard deviations of volumes of neutrophils (SDVNE), standard deviations of volumes of monocytes (SDVMO), and monocyte distribution width (MDW) were significantly increased in the culture-positive sepsis group compared with the clinical sepsis and control groups ( P < .05). We have demonstrated the diagnostic utility of leukocyte CPD parameters, especially MNVNE, MDW, and their combination, for neonatal sepsis. These parameters are advantageous because they are obtained during routine CBC analysis without the need for additional blood collection and extra costs.
Multiscale statistical progressive failure analysis of unbalanced woven composites
Authors: Jois Kumar C , Welsh Marcus R , Bednarcyk Brett A
Published: January 2025

Woven composites are widely used across various applications, characterized by the warp and weft tows that intersect perpendicularly to form a weave pattern. Often, the weave architecture is neglected during analysis. This study explicitly models the weave pattern and the undulation of the tows using the NASA Multiscale Analysis Tool, incorporating statistical constituent material properties and measurements of unbalanced composite microstructures. Experimental data and multiscale modeling results were compared for carbon fiber composites manufactured with different tow sizes in the two in-plane directions, resulting in four distinct unbalanced reinforcement patterns. Multiple tensile tests were conducted for each pattern. Using statistical input data, 1000 random model instances were created for each unbalanced composite, predicting distributions of the composite’s Young’s modulus and tensile strength. The predictions demonstrated good agreement with test data, highlighting unique aspects of the modeling approach.
Strategizing sustainable food security in Saudi Arabia: A policy and scenario approach to agricultural resilience
Authors: Yusuf Nadia , Kooli Chokri , Khoj Haitham , Bajnaid Nada Omar
Published: January 2025

Saudi Arabia confronts major challenges in ensuring food security amid sustainability constraints that are exacerbated by freshwater scarcity and a dependency on food imports. This study seeks to holistically assess the Kingdom's agricultural landscape in light of its Vision 2030 objectives as well as broader global sustainability initiatives such as the Sustainable Development Goals. Drawing from a review of agricultural reports, including the 2015 Agricultural Census and Agricultural Production Survey Publications spanning 2025–2021, the research relies on a two-pronged methodology focused on scenario and policy analyses. By envisioning possible future agricultural scenarios grounded in present-day data and contrasting Saudi Arabia's efforts with global examples, we provide comprehensive policy and extension service recommendations. A separate focus has been placed on technological modernization and the key role of agricultural extensions in actualizing policy directives. The study culminates by discussing areas of concern for Saudi Arabia's agricultural sector, complemented with constructive suggestions for deeper research pursuits. Our findings stress the significance of water-saving technology like hydroponics and greenhouse farming for efficient Saudi agriculture. Moreover, a strengthened, science-based extension system integrating policies with global sustainability goals is vital for climate-resilient food security. This research serves as a foundation for scholars and stakeholders aiming to navigate Saudi Arabia's path toward a sustainable and resilient food future.
Microstructure development and dynamic-mechanical properties of polybutadiene rubber/nanoclay: Effect of curing system
Authors: Tavakoli Mitra , Keshavarzzadeh Seyed Malek
Published: January 2025

This study investigates the fabrication and characterization of polybutadiene rubber (BR) nanocomposites incorporating organoclay (OC) through melt mixing with a focus on the microstructure development and properties of the cured materials using sulfur curing and electron beam irradiation. The role of epoxidized natural rubber (ENR50) as a compatibilizer to improve interfacial interactions is explored. X-ray diffractometer (XRD) and scanning electron microscopy (SEM) analyses confirm the intercalation structure of clay nanoplates within the nanocomposites. Mechanical properties measurements highlight the enhancement of tensile strength and elongation at break with increasing nanoclay content in sulfur-cured nanocomposites while in the case of the irradiated samples the tensile strength increased as the nanoclay content increased from 3 to 7 wt% up to a dose of 150 kGy after which it decreased with further dose increments and exhibit a dose-dependent behavior. Dynamic Mechanical Analysis (DMA) reveals a strong chain-nanoparticle interaction with irradiated samples at 150 kGy displaying superior storage modulus and reduced loss factor compared to sulfur-cured counterparts. Furthermore, the incorporation of ENR50 as a compatibilizer proved beneficial in enhancing the interaction between the BR chains and the modified nanoclay. These findings offer valuable insights into the design and performance of rubber nanocomposites for advanced applications.
Unpacking Organizational Agency in Institutional Change: The role of executives’ political connections and shareholders’ investment horizons
Authors: Ren Shenggang , Yan Ji , Yao Nengzhi , Du Lei
Published: January 2025

In studies where institutional changes are initiated outside of the organization, two key actors are identified: the institutional entrepreneur, who initiates the change, and the affected organization, which is impacted. This study highlights the crucial role of the affected organization’s agency in adopting new practices in response to normative institutional changes, shifting the focus beyond external initiators. We develop a novel theoretical framework that highlights the interplay between organizational agency and external institutional changes, demonstrating how strategic responses are shaped by both affected organizations and external pressures. Using the Pollution Information Transparency Index (PITI) project as a vehicle for normative institutional change, this study conducts a thorough analysis of its effect on firms’ new practices – environmental innovation – employing longitudinal data (2006–2018) covering 1,988 Chinese listed industrial firms. Our findings reveal that the outcome of normative changes in fostering the adoption of new practices significantly depends on the agency of the affected organizations, moderated by executives’ political connections and shareholders’ investment horizons. Specifically, firms led by executives with weaker political connections or supported by shareholders with long-term investment horizons are more likely to embrace these changes, while those with stronger political connections or a short-term focus tend to resist them. This research not only bridges a significant gap in the literature by highlighting the critical role of affected organizations’ agency but also expands the scope of analysis in institutional change, providing deeper insights into the complex relationship between organizational agency and institutional change.
Less democracy, more inequality: the effect of perceived democracy on inferred economic inequality / Menos democracia, más desigualdad: el efecto de la democracia percibida sobre la desigualdad económica inferida
Authors: Montoya-Lozano Mar , Byrd Willis Guillermo , Rodríguez-Bailón Rosa
Published: January 2025

Previous research has shown that an increased perception of economic inequality in a country was associated with a lower perception of democracy. Building on these findings, our study aimed to test this relationship in the opposite direction by experimentally manipulating the democracy level of a society and examining the effect on inferred economic inequality of it. We expected that perceiving a low democracy level within a country would lead to inferring higher levels of economic inequality. Two experimental studies were conducted ( N1 = 253, N2 = 534) using a unifactorial between-groups design. Participants were randomly assigned to the high or low democracy condition. In the high-democracy condition, the country was portrayed as having free and fair elections, civil liberties, political pluralism, regulated functioning of its institutions, and equality before the law, whereas in the low-democracy condition, these characteristics were not preserved. As predicted, inferred economic inequality was higher when the country was presented as less (vs. more) democratic. In sum, exposure to a low-democratic context may increase the inference of economic inequality.
Study on the effectiveness and safety of artificial intermittent infusion hemodiafiltration in MHD patients with intradialytic hypotension
Authors: Fan YanNa , Wang Fen , Zou Menglin , Luo Laimin , Wang Ying
Published: January 2025

Objective:

To evaluate the effectiveness and safety of artificial intermittent infusion hemodiafiltration (I-HDF) in maintenance hemodialysis (MHD) patients with intradialytic hypotension (IDH), and to determine the optimal infusion dosage.

Methods:

This single-center, prospective, self-controlled study included 30 MHD patients with IDH, treated from December 2022 to July 2023. Patients underwent three sessions of I-HDF as treatment group and conventional hemodialysis as control group. Comparisons were made between the two groups regarding changes in blood pressure, hypotension symptoms, changes in body water content, and achievement of infusion doses.

Results:

1. The fluctuation amplitude of SBP in the treatment group was 18.96 ± 10.400, while in the control group it was 27.4 ± 11.796. There was a significant difference between the two groups ( p < 0.05). 2. During 90 sessions of dialysis, 39 interventions were needed in the treatment group, compared to 59 interventions in the control group. The treatment group required fewer interventions, with a significant difference ( p < 0.05). 3. No hypotension symptoms occurred in the treatment group, whereas six cases were observed in the control group, which was significantly higher ( p < 0.05). 4. One patient in the 250 ml infusion group experienced chest tightness. Among the three infusion groups, the 250 ml group had the greatest fluctuation in DBP, with a significant difference ( p < 0.05). 5. Among the three infusion volumes groups, there was a significant difference between the theoretical and actual infusion volumes in the 150 and 200 ml groups ( p < 0.05).

Conclusion:

The artificial I-HDF mode effectively improves the occurrence of IDH. An infusion dose of 150–200 ml is deemed appropriate.
Generative AI as a Coach to Help Students Enhance Proficiency in Question Formulation
Authors: Kim Paul , Wang Wilson , Bonk Curtis J.
Published: January 2025

Following the launch of the generative AI Web application, Ask.SMILE, designed to evaluate the cognitive levels of questions asked, 2559 educators generated 25,973 question-feedback sets over a three-month period, with an average of over 10 questions per participant. Analyses revealed a significant improvement in question quality from initial submissions to later stages. Specifically, participants progressed from Level 1 questions (simple recall) to Level 5 questions (creative and evaluative), based on Bloom’s Taxonomy. However, participants who began with lower-quality questions showed varied progression paths to higher levels. To analyze the data, a Linear Mixed Model (LMM) was used to account for both fixed and random effects, revealing a statistically significant improvement in question quality over time ( p < .01). ANOVA results further confirmed the significance of question stage on quality, and a Least Squares Means (LSMEANS) analysis indicated a precise and significant improvement in later-stage questions. Additionally, survey responses highlighted participants’ appreciation for the ongoing development of AI-driven educational tools like Ask.SMILE. Several implications and future research directions are explored, including the potential to expand the platform’s features beyond question evaluation.
Unpacking the globalization-welfare nexus. A meta-analysis of comparative evidence, mechanisms and effects of openness on social spending
Authors: Giuliani Marco , Madama Ilaria
Published: January 2025

The article engages with the comparative literature on the highly debated globalization-welfare nexus by conducting an extended meta-analysis on the relationship between openness and social spending. By means of a series of meta-regressions, we investigate methodological and substantive elements responsible for the heterogeneity of the empirical findings, and the support for the opposite compensation and efficiency hypotheses. Amongst others, our findings suggest that the conceptualization and measurement of the independent and dependent variable systematically affect the results obtained by researchers, whereas the period and the geographical scope do not have the leverage that is sometimes claimed in the literature.
Using HALO digital image analysis for automated detection of bovine viral diarrhea virus antigen in ear-notch specimens
Authors: Lin Susanne Je-Han , Magstadt Drew R. , Derscheid Rachel J. , Burrough Eric R.
Published: January 2025

Detecting calves that are persistently infected with bovine viral diarrhea virus (BVDV) is essential to disease prevention. Immunohistochemistry (IHC) performed on formalin-fixed, paraffin-embedded ear-notch samples is commonly used for surveillance detection of BVDV antigens. However, due to the low percentage of positive samples in most submissions, the current workflow often entails considerable time reviewing negative results. Herein we aimed to utilize digital pathology and whole-slide imaging, coupled with advanced image analysis software, to enhance the efficiency of positive IHC detection in surveillance. Despite some challenges encountered during the implementation phase, the benefits of the reduced potential for human error and significant time savings for technicians and pathologists are evident. The screening of 518 slides, containing 2,884 ear notches, reached 97.4% sensitivity and 89.4% specificity compared to the gold standard of direct human assessment. The time taken for the personnel to operate the software and organize results was significantly shorter than the time needed for technicians and pathologists to manually examine the slides. Future refinements in software integration, staining protocols, and QC measures promise to further optimize this approach.
Investigating the Effect of Counseling to Promote Spiritual Health Skills Enhanced With Cognitive-Behavioral Techniques on Extramarital Relationships in Women: A Randomized Clinical Trial
Authors: Yousefi Setareh , Ahmadi Atefeh , Joulaei Hassan , Bolhari Jafar , Mirzaee Moghaddame
Published: January 2025

Background

The impact of extramarital relationships, as a serious latent social pathology, on the health and safety of people, especially women, is of great importance. Therefore, proper interventions must be identified and designed to reduce its harmful effects.

Objectives

The present study aimed to determine the effect of spiritual well-being improvement skills education enhanced with cognitive-behavioral techniques on extramarital relationships.

Methods

Women with extramarital relationships were selected using convenience sampling and randomly selected by card into two groups of intervention ( n = 16) and control ( n = 16) received spiritual therapy education using the cognitive-behavioral technique in 6 sessions of 120 min. The participants completed the Spiritual Well-Being Scale, Spirituality in Behavior, and the Infidelity Questionnaire. Before the intervention and after 1 month.

Results

There were significant differences between all posttest scores of the questionnaire between the two groups ( P < .05). Moreover, in the follow-up, the intervention group showed significant differences in variables of extramarital relationships (21.09 ± 63.25), (19 ± 58.93), (19.13 ± 57.45) and Spirituality in Behavior and the control group only in extramarital relationships compared with the pretest score ( P < .05).

Conclusions

Therapies based on improved spirituality using cognitive-behavioral techniques can be employed to implement interventions in extramarital relationships and improve spiritual well-being.

Trial registration

IRCT20170611034452N8
PITYRIASIS ROSEA – A REVIEW OF THE SPECIFIC TREATMENTS
Authors: Chuh A.A.T. , Au T.S.
Published: January 2025

Objectives: To evaluate the evidence for using ‘specific’ treatments in pityriasis rosea (PR), to discuss mechanisms of their action and to recommend a strategy for using them.

Methods: MEDLINE search for specific treatments for PR, with ranking of evidence into four levels and sublevels.

Results and discussion: Six specific treatments (erythromycin, artificial ultraviolet radiation, systemic corticosteroids, dapsone, rivanol and streptomycin) were reviewed. Their possible mechanisms of action were discussed. A strategy of using specific treatments is recommended.

Conclusions: Most specific treatments for PR are not supported by adequate evidence. Mechanisms of action of these treatments are largely unknown. Most patients do not require specific treatments. Erythromycin should be reserved for patients with severe pruritus unresponsive to non-specific treatments, and systemic corticosteroids should only be used as a last resort.
NON-STEROIDAL ANTI-INFLAMMATORY DRUG COLOPATHY: CASE REPORTS AND REVIEW OF LITERATURE
Authors: Malone G , Kaushik VY , Morris JA , Gangopadhyay M , Brown CM
Published: January 2025

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medication worldwide. Clinicians prescribing these drugs are aware of the contraindications and potentially serious side-effects on the upper gastrointestinal (GI) tract but there is a need for increased awareness and understanding of the effects of NSAIDs on the GI tract distal to the small bowel. Two cases of NSAID-related adverse effects on the colon are reported with a review of the literature. These patients suffered significant morbidity and an avoidable delay in the diagnosis of the condition.
The diagnosis and treatment of thromboembolic disease in pregnancy
Authors: Adamson DL , Nelson-Piercy C
Published: January 2025

Pulmonary thromboembolism remains the most common direct cause of maternal death in the UK (see Why Mothers Die by J Drife; http://www.rcpe.ac.uk/fellows/CME/maternal/drife/drife_1.html). Pregnancy is associated with prothrombotic changes in the coagulation system, and therefore the risk of VTE disease is increased at any time during the pregnancy but is highest in the puerperium and greatest in women who have undergone caesarean section.
Clinical photograph from the Royal Infirmary of Edinburgh – 1853
Authors: Malcolm-Smith NA
Published: January 2025

A child with a facial defect is presented using clinical details recorded in a ward journal of the Royal Infirmary of Edinburgh for 1853. The entry in the journal is illustrated by a clinical photograph and a pen and ink drawing. The operation for facial reconstruction is described together with an account of the post-operative course and outcome. The differential diagnoses and views on the aetiology of the patient’s disorder are considered. The photograph itself is described and the historical and social background of the patient are outlined.
Antiphospholipid syndrome in pregnancy – an update
Authors: Vashisht A , Regan L
Published: January 2025

The presence of aPL has been clearly shown to have an adverse effect on pregnancy outcome. These effects may be apparent in the first trimester, presenting as recurrent pregnancy loss, or may be associated with the later development of PET, IUGR, placental abruption, pre-term delivery, and intrauterine death. What appear to be most important in the aetiology, initially, are factors that disturb the vital interaction between the embryonic trophoblastic tissue and the host (maternal) endometrial tissue. It seems that the presence of aPL may impair trophoblastic invasion, thus interfering with implantation and subsequent placental development. As the pregnancy advances, women are more prone to thrombosis in the uteroplacental vasculature. Indeed, women with PAPS suffer from a live birth rate as low as 10% in the absence of pharmacological intervention. Dramatic improvements in pregnancy outcome can be achieved by a combination of aspirin and heparin. However, although the live birth rate is increased sevenfold, it should be acknowledged that these births are associated with an increased rate of prematurity and possible neonatal complications. The increased incidence of pregnancy-related complications necessitates the need for careful antenatal surveillance, and for delivery to be conducted in a unit with facilities for operative delivery and neonatal intensive care. For the women themselves, the significance of aPL outside pregnancy is far from clear, and the ideal management for optimising long-term health is yet to be determined.
MRSA vertebral discitis managed successfully using linezolid as a component of an oral antibiotic regimen
Authors: Inverarity D , Coia J , Neill G O , MacTier R
Published: January 2025

We describe a 71-year-old lady with end-stage renal failure on haemodialysis who developed vertebral discitis due to MRSA. She was intolerant of glycopeptide antibiotics and was treated successfully with oral linezolid for four weeks followed by oral combination therapy with doxycycline and fusidic acid for two weeks. Her antibiotic management and her clinical course is described, and we discuss the usefulness of the above antibiotics to treat MRSA infections affecting bone and vertebral discs in patients with renal failure.
Flight-related DVT
Authors: Dawson D , Mackway Jones K
Published: January 2025

Vascular thrombosis associated with long-haul air travel has attracted considerable public attention. Most research has used case control studies where selection bias can reduce reliability, but RCTs would be impracticle. Symptomatic DVT probably occurs up to 0·28% of passengers, and asymptomatic DVT in up to 10·3%. Pulmonary embolous is the feared complication. Immobility is probably a main factor in flight DVT, but other unknown factors may also be important. Passengers with risk-factors for DVT should consider prophylaxix; LMWH for those at high risk, and compression stockings in all risk groups.
Bronchopulmonary manifestations of inflammatory bowel disease: a case report and literature review
Authors: Ho GT , Innes JA , Shand AG , Satsangi J
Published: January 2025

Bronchiolitis obliterans is a rare but well-recognised bronchopulmonary manifestation associated with IBD. This case report is unusual in the severity of the respiratory disease, requiring referral for consideration of lung transplantation with further implications in the clinical management of severe UC. We have reviewed the literature concerning bronchopulmonary manifestations of IBD and discuss the difficulties in distinguishing between a primary manifestation associated with IBD and a side-effect of drug therapy.
Acquired angioedema in a case of chronic lymphocytic leukaemia
Authors: Jaggia A , Coates P
Published: January 2025

Acquired angioedema is a rare condition, which occurs usually in association with lymphoproliferative disorders. It is due to the presence of C1 inhibitor antibodies. We report here a case of chronic lymphocytic leukaemia which presented with abdominal pain and angioedema. The patient was treated with rituximab, a monoclonal antibody directed against B lymphocytes, in combination with cytotoxic chemotherapy. The C1 inhibitor levels increased and the patient’s clinical condition improved.
Diabetic ketoacidosis
Authors: Park C
Published: January 2025

Diabetic ketoacidosis remains the most important acute complication of diabetes mellitus, causing metabolic decompensation with an associated morbidity and mortality of 1–10%. Although levels of morbidity and mortality are falling with modern management protocols, a significant threat still remains. While DKA is most common in patients with type 1 diabetes mellitus, it should not be overlooked in patients with type 2 diabetes mellitus, especially in those who require insulin. In contrast to chronic management, acute complications often present to Acute Medicine rather than to specialist diabetes services. Prompt recognition, diagnosis, and treatment are therefore essential.
Unusual cause of hip pain in a patient with relapsing Henoch-Schonlein nephritis
Authors: Gupta S , Grainger AJ , Wright M
Published: January 2025

Hip pain, a common symptom, is rarely caused by pyomyositis. Here we present the case of a 58-year-old male patient with relapsing Henoch-Schonlein nephritis and diabetes, being treated with immunosuppressive agents who developed pain around the hip joint. Diagnosis was suspected after an MRI scan and confirmed when Staphylococcus aureus was isolated from aspirated purulent material. Prompt symptomatic improvement was noticed when the immunosuppressive agents were stopped and the patient was started on appropriate antibiotics. Early diagnosis and treatment is needed for prompt symptom resolution and prevention of serious complications.
Renal Medicine Symposium Report
Authors: Saweirs WWM
Published: January 2025

This renal symposium provided an overview of diverse but key areas of nephrology. Topics included the molecular basis of the glomerular filtration barrier; the clinical management of the nephrotic syndrome; the association of CKD with cardiovascular morbidity; the link between hyperuricaemia, obesity and cardiovascular disease; current immunosuppressive therapies; long-term morbidity and mortality issues in transplant recipients; electrolyte disorders; and conservative therapy for renal failure.
Etodolac-induced hypersensitivity vasculitis with digital gangrene
Authors: Ansari JK , Hussain T , Nasseem A
Published: January 2025

Non steroidal anti-inflammatory drugs are one of the most commonly prescribed drugs and can result in hypersensitivity vasculitis, sometimes with grave consequences. We report a case of a female who developed digital gangrene following the use of etodolac.
Marfan syndrome: diagnosis and management
Authors: Dean JCS
Published: January 2025

The diagnosis of Marfan syndrome requires a multidisciplinary assessment including clinical genetics, cardiology, ophthalmology, and radiology. It is caused by mutation in the fibrillin 1 gene on chromosome 15. Gene testing remains problematic, as current techniques fail to find a mutation in 10–30% of cases, while a small number of non-Marfan patients (often with MASS – mitral valve prolapse, mild non-progressive aortic dilatation, skin and skeletal features – phenotype) do have mutations. The diagnosis remains clinical and is based on the Ghent criteria. Beta-blockers or angiotensin-converting enzyme inhibitors slow the rate of aortic dilatation. Prophylactic aortic root surgery should be considered when the aortic root exceeds 5·5 cm at the sinus of Valsalva. Marfan patients require regular followup including aortic root measurement, usually by transthoracic echocardiography. Lens dislocation is not universal in Marfan, but expert ophthalmology assessment, especially in childhood, is advisable. Arthralgia and other skeletal symptoms are common,and associated with joint hypermobility. Respiratory complications include recurrent pneumothorax and sleep apnoea. Patients should be advised to avoid contact sports and scuba diving. There is an increased risk of aortic dissection in pregnancy, particularly when the aortic root diameter exceeds 4 cm. Younger patients should be assessed in the neonatal period, pre-school, at age 10, and at age 18 if they have some Marfan features, but fail to meet the Ghent criteria by one system, or if they have a family history of Marfan syndrome.
Malignant pleural mesothelioma
Authors: Hesdorffer ME , Leinwand J , Taub RN
Published: January 2025

Malignant mesothelioma is a rare tumour that arises from the mesothelial surfaces of the pleura, peritoneum, pericardium, or the tunica vaginalis, with the pleura the most commonly affected site. By 2015, mesothelioma is expected to result in approximately 2,000 deaths per annum in the UK. In the US, there are approximately 3,000 cases of malignant mesothelioma diagnosed yearly. Mesothelioma historically carried a dismal prognosis but, with the advent of new treatment options and translational research, progress is being made. This article will address pleural mesothelioma.
Underlying systemic causes of itch*
Authors: Capaldi LA , Bernhard JD
Published: January 2025

The evaluation of the pruritic patient can appear daunting at first glance. Itching can be a manifestation of an underlying disease,making a systematic approach to the itchy patient necessary. A general history and physical, along with key laboratory tests as guided by the history and physical, can yield clues to the diagnosis. Hepatobiliary, renal, endocrine and lymphoproliferative diseases are some of the most common underlying systemic causes of itch.Treatment should be guided by the diagnosis, and may include topical steroids, oral antihistamines, opioid antagonists and phototherapy. In this review we outline the steps to take when evaluating a patient with pruritus. In addition,we highlight some of the more common systemic causes of itch and discuss treatment options.
Disseminated cutaneous rhinosporidiosis
Authors: Anoop TM , Rajany A , Deepa PS , Sangamithra P , Jayaprakash R
Published: January 2025

Rhinosporidiosis is a chronic granulomatous disease of the mucocutaneous tissue, which clinically presents as polypoidal growths. Cutaneous lesions are infrequent and are generally associated with mucosal lesions. We present a case of disseminated cutaneous rhinosporidiosis in a 61-year-old male, a farmer from rural southern India who presented with generalised noduloulcerative lesions all over the body but mainly on the face, thorax and extremities. The patient had a history of a surgical excision of a nasal polyp. No mucosal lesions were detected on anterior and posterior rhinoscopy. Fine needle aspiration cytology from the nodules stained by Papanicolaou and Gomori methenamine silver showed the presence of endospores suggestive of rhinosporidiosis. The patient was treated with dapsone 100 mg daily for six months. At a six-month follow-up the cutaneous lesions were unchanged. The majority of the cases of cutaneous rhinosporidiosis described in the literature have a primary lesion inside the nose. Here we report a rare case of disseminated cutaneous rhinosporidiosis without mucosal involvement.
Improving end-of-life care in the twenty-first century
Authors: McConnell S
Published: January 2025

This symposium appealed to a wide variety of professionals. The importance of anticipatory care planning was consistently stressed as a key means of improving end-of-life care in the twenty-first century. Such planning can be difficult, not least because of the differences in illness trajectories and the problem of identifying dying. Various initiatives, frameworks and care pathways have been devised to aid this planning process. Lack of palliative care training and support compromises the quality of end-of-life care provided in many care homes.

Symptom management is obviously important and, if associated with impaired renal function, frequently necessitates modifications to drug therapy. Patient narratives were demonstrated as an invaluable insight into the patient’s perspective. Discussions surrounding ‘do not attempt resuscitation’ (DNAR) decisions are often challenging, but new guidance has been produced. The day was closed with multi-professional case presentations debated by the panel of speakers.
Health behaviour change: do we know what works and is this being implemented in Scotland?
Authors: Bray JK , McCartney G , Dunbar JK , Thoulass J
Published: January 2025

In Scotland in recent years smoking, poor diet and excess alcohol have caused major public health problems. Knowledge of what is effective in the field of health behaviour change is therefore essential in achieving improvements in health. This symposium was convened with the purpose of ensuring that public health policy is informed by the best available evidence on effective interventions. As behaviour is complex, achieving change can be difficult and it is essential that interventions are properly planned, implemented and evaluated. A variety of recommendations for progress were advocated in areas including research, knowledge transfer, health inequalities and policy. The take-home message for the public health community was that action in these areas must be prioritised if health improvement for the population is to be realised. Given the importance of this topic it is no surprise that the symposium received substantial media attention. Coverage focused on Professor Anne Ludbrook’s work on minimum pricing for alcohol. This is an excellent example of an intervention with considerable potential to improve public health. Crucially, in terms of acceptability, this measure would not reduce alcohol industry revenue, even though it should significantly reduce alcohol consumption – a win-win situation for all.
The Role of Pharmacotherapy for Smoking Cessation and Pregnancy
Authors: Srivastava Sneha Baxi
Published: January 2025

Tobacco and nicotine use is widely recognized as harmful to both the user and those exposed to the substances. Pregnant individuals face additional risks, with potential adverse outcomes for the fetus and newborn. A combination of behavioral and pharmacological interventions is recommended for smoking cessation; however, in pregnancy, there are additional considerations with the use of pharmacotherapy. This article will address the role pharmacotherapy may play in smoking cessation during pregnancy.
The fairness of the group draw for the FIFA World Cup
Authors: Csató László
Published: January 2025

Several sports tournaments contain a round-robin group stage where the teams are assigned to groups subject to some constraints. Hence, the organisers usually use a computer-assisted random draw to avoid any dead end, a situation when the teams still to be drawn cannot be assigned to the remaining empty slots. This procedure is known to be unfair: the feasible allocations are not equally likely, that is, the draw does not have a uniform distribution. We quantify the implied unfairness of the 2018 FIFA World Cup draw and evaluate its effect on the probability of qualification for the knockout stage for each national team. The official draw order of Pot 1, Pot 2, Pot 3, Pot 4 turns out to be a significantly better option than the 23 other draw orders with respect to the unwanted distortions. Nonetheless, the non-uniform draw distorts the probability of qualification by more than one percentage point for two countries. Our results call attention to the non-negligible role of draw order and make it possible for policymakers to decide whether using fairer draw mechanisms is justified.
Encountering the Obsolete Art: An Archaeological Gaze at the Contemporary Textile Tradition in India
Authors: Srivastava Akash Kumar , Chandra Vinita
Published: January 2025

Art is an essential glimpse into the history of humanity because it is often one of the few things to survive. It is a medium to express one’s feelings, which can tell us stories and relate the modes and beliefs of an era. Prehistoric art represents various aspects of the everyday life of early humans, including a diverse range of symbols and signs in multiple patterns. The present article explores how these ancient motifs can serve as the basis for decorating schemes for designers in the present fashion-oriented world. The modern generation is attracted to this pattern, and we have observed some novel design inventories that mimicked this type of artwork on their accessories. This article mainly analyses the contemporary fashion design trend in the last half-decade, which suggests the revival of such obsolete artwork in India. By correlating the past and present design motifs, the encounter of a common aesthetic sense emerged in this article, which shows a continuous artistic legacy from the yore to the present day. For this, the morphological analysis and comparative study of some current and ancient art motifs are also done. Although prehistoric art provides endless inspiration for designs as well as new ideas for art composition, we discuss the new avenues of inspiration in textiles using technology as well. Contemporary designers are also influenced by these fantastic artworks of our ancestors. So, it is necessary to show glimpses of the ancient art of India in modern fashion trends, which suggests innovation in designing practices inspired by the past.
Evidence for targeting autonomic dysfunction in systemic sclerosis: A scoping review
Authors: Cuevas Sandra , Mayer Erik , Hughes Michael , Adler Brittany L , McMahan Zsuzsanna H
Published: January 2025

Autonomic dysfunction is a common and early complication among patients with systemic sclerosis, suggesting that it may play a role in the pathogenesis of the disease and be a potential target for therapeutic interventions. Although the true prevalence of autonomic dysfunction among patients with systemic sclerosis is still unclear, it is estimated that as many as 80% of patients may be affected. Autonomic dysfunction may lead to widespread multi-organ dysfunction through its effects on the cardiovascular system, gastrointestinal tract, urinary tract, sweat and salivary glands, and pupils. Early identification of systemic sclerosis associated with dysautonomia may guide prompt diagnosis in this complex patient population and lay the groundwork for future research in this area. Furthermore, the current landscape of targeted interventions for autonomic dysfunction is rapidly expanding; therefore, prioritizing patients who may benefit from such interventions or candidates for related clinical trials is paramount. Our scoping review details timely updates in the extant literature, including findings from recent studies on autonomic dysfunction in systemic sclerosis, and integrates these updates to identify critical gaps in the field.
Urban infrastructure and migrant citizenships: Notes towards migrant-state relations in the urban peripheries
Authors: Alvarado Nikolai A
Published: January 2025

The article proposes that urban infrastructure serve as political aperture for migrant populations operating and inhabiting in the urban peripheries of south-south trajectories. It both inaugurates spaces of political participation and mediates ongoing relations with state authorities. Quite literally, self-installed infrastructure recognized as part of service networks, becomes the material evidence for the recognition of migrants’ right to dwell, regardless of their status. The article is empirically based on the experiences of Nicaraguan migrants living in La Carpio, Costa Rica. I suggest that the migrant-state relations anchored to the infrastructure necessary to sustain life and already operating in these territories as negotiated forms of governance, compel a reevaluation of the relationships between the state, noncitizen migrants and the material politics of ordinary urban spaces. By centering infrastructural citizenship in relation to noncitizen migrants, the article contributes to a broader understanding of how migrant citizenships are constructed and contested in the urban peripheries of the Global South, beyond episodic acts, and explores the role of the state in forms of urban inclusion.
Diabetic Retinopathy Disease Burden in Patients With Lower Household Incomes vs Higher Household Incomes
Authors: Patel Hemal , Allen Ariana , Karl Jamie , Weng Peter , Stinnett Sandra S. , Rosdahl Jullia A. , Schuman Stefanie G.
Published: January 2025

Purpose: To assess the differences in measures of diabetic retinopathy (DR) disease burden between patients in high-income vs low-income ZIP codes when presenting to retina specialists. Methods: This retrospective cohort study comprised patients who presented to a retina specialist at Duke Eye Center between 2014 and 2023 for the management of DR. The quartile of patients with the highest income was compared with the quartile with the lowest income. Demographic data included age, sex, and race. Clinical data included glycosylated hemoglobin A1c (HbA1c), visual acuity (VA), DR diagnostic stage, presence of diabetic macular edema (DME) or vitreous hemorrhage, and whether treatment was indicated. Measures of DR disease burden included HbA1c, VA, presence of DME or vitreous hemorrhage, severity of DR, and need for intervention. Results: The analysis included 430 eyes of 215 patients. After controlling for age, sex, race, and glycemic control, it was found that patients in the low-income group were more likely to have DME at presentation ( P < .01), to have more severe DR at presentation ( P < .001), and to require an intervention for DR ( P < .001). The VA was worse in the low-income group than in the high-income group (20/50 vs 20/32; P < .10); however, this did not reach statistical significance. Conclusions: Patients living in low-income ZIP codes have greater DR severity, prevalence of DME, and need for treatment than their high-income counterparts when first presenting to a retina specialist. These findings suggest that patients from low-income backgrounds may face additional barriers before being evaluated by a retina specialist, resulting in more clinically advanced stages of DR at presentation.
Beyond self-regulation: Autistic experiences and perceptions of stimming
Authors: Morris Isabelle F , Sykes Jesica R , Paulus Emilie R , Dameh Alharith , Razzaque Aysha , Esch Lauren Vander , Gruenig Jenna , Zelazo Philip David
Published: January 2025

Repetitive, self-stimulatory behaviors (“stimming”) are a hallmark characteristic of autism. Stimming is thought to aid in self-regulation, but autistic perspectives of stimming are underrepresented in the literature. Autistic adults (Study 1 N = 131; Study 2 N = 117) completed a survey about their autistic identity and their experiences and perceptions of stimming, as well as the functions stimming served. Participants reported stimming to be sometimes positive and sometimes negative, with stimming only being a negative experience when it was self-injurious or stigmatized. Despite frequently being a positive experience, participants purposefully suppressed stimming (“masking”), which was done almost exclusively for extrinsic reasons (e.g. to avoid judgment from others). The majority of participants felt stimming (1) was an important part of their friendship with other autistic people, (2) helped them connect with other autistic people, and (3) that when they saw other autistic people stimming, they could tell what they were feeling. Study 2 found that the degree of connection to the autistic community was the most important predictor of whether stimming served these social-communication functions.

Lay abstract

Stimming, or repetitive self-stimulatory behavior, is commonly seen in autistic people and is believed to help with self-regulation. However, the views of autistic people on stimming are not well represented in academic research. Two studies surveyed autistic adults (131 in Study 1 and 117 in Study 2) about their identity, experiences, and views on stimming, as well as its purposes. Participants reported that stimming could be both positive and negative, with negativity only arising when it caused self-injury or was stigmatized. Although stimming was often a positive experience, many participants intentionally suppressed it to avoid judgment from others. Most participants felt that stimming played a key role in their friendships and connections with other autistic individuals and that it helped them understand each other's emotions. Study 2 revealed that a strong connection to the autistic community was the most important factor in whether stimming served these social and communicative purposes. Given the potential importance of stimming as social communication within the Autistic community, interventions to enhance social and communication skills in Autistic individuals should consider ways to incorporate stimming. A better understanding of the important roles stimming plays in Autistic people's lives is beneficial for the well-being of Autistic individuals.
Comparative study between high and low dose methylene blue infusion in septic cancer patients: a randomized, blinded, controlled study
Authors: Shaker Ehab Hanafy , Soliman Ahmed Mohamed , Bedewy Ahmed Abd Elmohsen , Elrawas Mai Mohamed
Published: January 2025

Purpose

Septic shock is a common threat, and is the primary cause of death in almost all critical care units. Mortality of septic shock remains exceedingly high. The early use of methylene blue (MB) in different doses as adjunctive to vasopressors has promising results.

Methods

This double-blind, randomized, controlled trial comprised 90 patients divided into 3 groups: Group A received a 100 ml 0.9% NaCl placebo over 20 min; Group B received an MB bolus of 1 mg/kg in 100 ml 0.9% NaCl, and Group C received MB bolus of 4 mg/kg in 100 ml 0.9% NaCl during the same period. Groups B and C were given a 0.25 mg/kg/hour infusion of MB for 72 h after the bolus dose. All patients were started on noradrenaline at an infusion rate of 0.1–0.2 µ/kg/min and were adjusted accordingly to maintain MAP ≥ 65 mmHg. Time of vasopressor discontinuation was the primary outcome while total doses of vasopressors, ventilation days, vasopressors free days, total ICU stay, total hospital stay, and mortality rate were the secondary outcomes.

Results

Groups B and C exhibited significantly decreased time to vasopressor termination, and vasopressor-free days at 28 days in comparison to Group A. However, there was no significant difference between Groups B and C. Groups B and C had significantly lower noradrenaline dosages compared to Group A, however, no significant difference between Group B and Group C was found. The difference between the three groups in mortality rate was near statistical significance (p = 0.083). Using the logistic regression model, the 4 mg/kg group was protective against mortality with a hazard ratio of 0.29 (95%CI: 0.09–0.90).

Conclusion

In cancer patients with septic shock, early adjunctive MB delivery reduces the time to a vasopressor stoppage and increases the vasopressor-free days. No significant difference between high and low MB bolus doses, and no significant adverse effects were noted. Compared to placebo, the 4 mg/kg bolus dose shows a survival advantage.

Trial registration

Prospectively registered at clinicaltrials.gov [NCT 06005558]. (Date of registration 15/08/2023).