bluuebunny/crossref_metadata_2025 huggingface dataset:
Empowering women in emergency care: The roles of work-life balance and equal opportunity in navigating success in the paramedic profession
Authors: Al Jumaan Mohammed , Al Haliq Samer , Abuzeid Rateb , Kandil Mohamed , AlShammari Talal , Hajjaj Manal , Qawwas Lutfiah , Al Bahri Essa Ojaim
Published: February 2025

Background

Despite efforts to boost female workforce participation, there remains a shortage of female paramedics relative to Saudi Arabia's female population.

Objective

This study explores how work-life balance and equal opportunities empower women in the paramedic profession, focusing on their roles in achieving success and overcoming challenges in emergency care settings.

Methods

Cross-sectional descriptive research was employed using a questionnaire survey conducted among paramedics in Saudi Arabia (n = 250) and a sample of the research (n = 197; response rate: 78.8%). An adapted instrument of the Culture Conducive to Women's Academic Success survey was used to collect data. Using statistical software (SPSS 29), data were coded numerically, and statistical analysis was performed for both descriptive and inferential purposes. In addition, independent samples t-test was used to analyzed data on variables including age, gender, job title, level of education, and years of experience.

Results

Descriptive statistics revealed high agreement overall, particularly regarding salaries and professional social events. However, there was moderate disagreement about protected time for research. An independent t-test indicated significant gender differences, with female paramedics reporting less favorable experiences in access to opportunities and work-life balance support. Yet, demographic characteristics like age, gender, job title, education level, and experience did not significantly influence success factor scores.

Conclusion

While female paramedics perceive high equality in career access and work-life balance support, areas for improvement exist, such as research time and reducing stigma around family responsibilities. Policymakers may consider interventions to address gender disparities and enhance female paramedics’ experiences.
The difference in C7 to wall distance in a group of software developers with and without moderate chronic neck pain
Authors: Kovac Dimitrije , Krkeljas Zarko
Published: February 2025

Background

As the prevalence of non-traumatic neck pain (NTNP) increases, particularly among computer workers, identifying contributing factors is essential for developing preventative strategies.

Objective

This study investigates the association between c7-to-wall distance and chronic NTNP in software developers, a population characterized by prolonged sedentary behavior and high computer usage.

Methods

The study employed the C7-to-wall distance (C7WD) test, recognized for its reliability and ease of use, to measure the kyphotic curve as an indicator of spinal posture. Ninety software developers (age = 35.3 ± 5.4 yrs; male = 56, female = 34;) with an average working experience of 9.2 ± 4.5 yrs as a full-time software developer (40.7 ± 1.8 h/week) were examined for postural pathologies and allocated to two groups based on presence of neck pain.

Results

The key finding was a significant correlation between increased C7WD and the presence of moderate chronic NTNP in software developers, revealing that those with neck pain tended to have a greater C7WD. It was observed that all participants exhibited mild kyphotic posture irrespective of pain presence.

Conclusion

The results suggest that although a relationship exists, the clinical significance of the difference in C7WD between those with and without chronic NTNP is debatable. The findings emphasize the need for further comprehensive research that encapsulates biomechanical, functional, and psychosocial factors to holistically understand and manage NTNP in the software developer population.
Navigating the crossroads: A case study on legal values perspectives of religious attire expression in the workplace
Authors: Duan Zhizhuang , Chen Bowen , Xie Ziyi
Published: February 2025

Background

The phenomenon of prohibiting employees from expressing religious attire in the workplace involves a complex interplay of different parties and issues related to human rights protection. Addressing and resolving this issue holds significant implications for advancing the cause of global religious freedom.

Objective

Through an analysis of common features in eleven representative cases from English and American legal systems, the author further discusses the challenges faced by employees expressing their religious attire in the workplace, and the institutional and societal issues reflected through these decisions.

Methods

Through the application of a case study approach, this study analyzes eleven representative cases from both English and American legal systems in the early twenty-first century, probing into the persistent nature of religious discrimination in the workplace.

Results

The research reveals that the ways in which managers prohibit employees from expressing religious attire in the workplace are categorized into direct and indirect prohibitions, and the related systems of religious discrimination evolve over time. However, when employees oppose the managers’ discriminatory policies based on religion, they often face the dilemma of dismissal and difficulty in seeking legal redress.

Conclusion

To confront this challenge, governments need to prioritize safeguarding equal rights among different religious and non-religious individuals when refining legislation. Furthermore, adhering to the principle of state neutrality, legal obligations shall not be arbitrarily attached to religious expression unless such expression poses a concrete threat to specific public interests. Managers, in formulating workplace management policies, should likewise adhere to these principles.
Comparative Analysis of AI Integration in Media and Communication Curricula: Case Studies From Australia and Egypt
Authors: Imran Muhammad Asim
Published: February 2025

This study compares how universities in different cultural and educational contexts prepare media and communication graduates for an artificial intelligence (AI)-driven future, focusing on publicly available course information. It evaluates the integration of generative AI technologies into the media and communication curricula at the University of Melbourne and the University of Sydney in Australia and assesses the readiness of the American University in Cairo (AUC) and Cairo University in Egypt. Using systematic document analysis of course descriptions, syllabi, and curriculum guides, the study highlights the integration of practical AI applications and pedagogical methods. The findings underscore the need for enhanced AI education to prepare graduates for the evolving media landscape, offering recommendations for curriculum development and educational strategies. This research informs future advancements in media and communication education in the era of AI.
Changes in physical activity among overweight and obese Norwegian children aged 6–12: A non-randomized cluster-controlled trial
Authors: Meland Eivind , Abildsnes Eirik , Samdal Gro B. , Tonje Holte Stea , Haugen Tommy , Berntsen Sveinung , Jahanlu David
Published: February 2025

Aims:

To explore whether a family-based intervention with playful activities among overweight and obese Norwegian children promoted moderate to vigorous and light physical activity compared with a waiting list control group, and to examine whether gross motor competence, isometric body mass index and motivational factors, as reported by the children and their parents, could explain changes observed during a six-month observation.

Methods:

A non-randomized cluster-controlled trial with 131 participants, 76 in the intervention group. Participants were aged 6–12 years, and 55 were boys. We performed linear regressions to compare the intervention and the control groups and adjusted linear models to examine predictors for outcomes with the groups merged into one cohort.

Results:

We could not demonstrate any intervention effect from the family-based activities. Moderate to vigorous physical activity levels were satisfactory at the start and were maintained during the observation period. None of the predictors could explain outcome status at six months, nor residual change of moderate to vigorous physical activity during the observation. We revealed that parental educational attainment, parental autonomous motivation and the participants’ experience of social support impacted light physical activity negatively after six months. Parental education also impacted the residual change of light physical activity negatively during the observation.

Conclusions:

The present family-based intervention to improve physical activity among overweight and obese children was ineffective. Baseline activity levels were already satisfactory. Paradoxically, factors such as parental socioeconomic status, autonomous motivation and self-reported support from parents and peers may be associated with diminished physical activity in such contexts. These unexpected findings need to be validated in further studies.
Application of Bayesian networks in adaptive listening assessment system in flipped English learning environment
Authors: Zheng Chao
Published: February 2025

This study investigates the application of Bayesian networks in adaptive listening assessment systems within flipped English learning environments. The research begins with an exploration of the adaptive listening assessment system, including its student and testing models, followed by the construction of a visual interface diagram. The paper then introduces Bayesian networks, a probabilistic graphical model renowned for its ability to represent and infer uncertain knowledge, and demonstrates how it can be effectively integrated into adaptive listening assessment systems. By leveraging real-time adjustments to Bayesian network parameters based on students’ historical learning data, the system enables accurate and dynamic evaluations of listening proficiency. Additionally, the system offers personalized learning advice and feedback tailored to individual differences and progress, thereby enhancing students’ listening skills more efficiently. To assess the effectiveness of the proposed system, an experiment was conducted with two classes of second-year high school students. Class 1 used the proposed adaptive assessment system, while Class 2 relied on traditional evaluation methods. The results showed a significant improvement in Class 1’s average score, which increased from 68.2 to 76.4, a rise of 8.2 points, outperforming Class 2 by 7.2 points. These findings underscore the effectiveness of the proposed system in the flipped English learning context and provide valuable insights for innovative listening instruction in the era of educational informatization.
The Impact of Reich’s Vegetotherapy on Emotional Regulation and Postural Balance in Military Personnel: A Non-Pharmacological Approach to Combat Stress
Authors: Khadhrani Sana , Touhemi Imed , Hammami Amri , Goumni Chiraz , Khalfoun Jihen , Omar Mohanad , Haithem Rebai , Abderrahman Abderraouf Ben
Published: February 2025

Military operations subject soldiers to intense stress, which can adversely affect both their emotional regulation and physical balance. This study examines the effectiveness of Reich’s vegetotherapy (VGT), an alternative non-pharmacological intervention, in improving these critical areas among military personnel. A total of 29 soldiers, with an average age of 30, were randomly assigned to either an experimental group (EG; 15 soldiers) or a control group (CG; 14 soldiers). Over a period of 6 weeks, the EG participated in twice-weekly VGT sessions, while the CG received no intervention. The intervention group showed a significant reduction in anxiety levels, with scores improving from the beginning to the end of the test ( p = .001) and a significant time × group interaction ( p = .003). The EG experienced a greater improvement (-68%) compared to the CG (−9%) ( p = .036). In the open-eyes postural balance test, the EG showed a significant improvement ( p = .029), with a time × group interaction effect ( p = .04), although no significant difference was found between the groups ( p > .05). The EG improved more (−36%) compared to the CG (24%). In addition, anger levels significantly improved post-intervention ( p = .001), with a significant time × group interaction ( p = .001). These findings suggest that Reich’s VGT may serve as an effective method for mitigating stress-related impairments in military personnel. Further research with larger sample sizes is necessary to validate these results and explore its broader applications.
Step, shift, short – a simple treatment algorithm for the initial management of distal radial fractures
Authors: Johnson Nick A , Dias Joseph J
Published: February 2025

Distal radial fractures are common, but questions remain regarding their optimum management. We describe a simple three-step management algorithm based around assessment and treatment of articular step, alignment, and length.
Elexacaftor/tezacaftor/ivacaftor and inflammation in children and adolescents with cystic fibrosis: a retrospective dual-center cohort study
Authors: Pepe Angela , Fevola Cristina , Dolce Daniela , Campana Silvia , Ravenni Novella , Taccetti Giovanni , Salvatore Donatello , Terlizzi Vito
Published: February 2025

Background:

Cystic fibrosis (CF) is characterized by chronic neutrophilic inflammation in the airways. Elexacaftor/tezacaftor/ivacaftor (ETI) therapy has demonstrably improved clinical outcomes and quality of life in people with CF (pwCF), but its effects on systemic inflammatory parameters remain unclear.

Objective:

To evaluate the impact of ETI on systemic inflammation in children and adolescents with CF.

Design:

Retrospective, dual-center observational, propensity score-matching study of pediatric pwCF on ETI.

Methods:

PwCF aged ⩽ 18 years treated with ETI at two Italian reference centers were included in this study. Data on immunoglobulins (Ig) (A, G, and M), γ-globulin, leukocyte levels, percent predicted forced expiratory volume in the first second (ppFEV1), sweat chloride (SC) concentration, and sputum cultures were collected at baseline, 12, and 24 months of treatment. Laboratory data of a control group (pwCF, not in ETI therapy, same demographic characteristics as the study group) were also collected.

Results:

Sixty-six patients (30 males, median age: 12 years, F508del homozygous: 23) were included. Mean IgG levels (SD) significantly decreased ( p = 0.001) from 1168.20 mg/dl (344.41) at baseline to 1093.05 mg/dl (258.73; 12 months) and 1092.87 mg/dl (232.42; 24 months). Similar reductions were observed for IgA and γ-globulin; IgM reduction was not statistically significant. Leukocyte levels also decreased significantly from 8.04 × 103/µl (3.23 × 103) at baseline to 6.61 × 103/µl (1.74 × 103) (12 months) and 6.45 × 103/µl (1.70 × 103; 24 months). As for the control group, no significant changes in the levels of Ig, leukocytes, and γ-globulin were detected throughout the study period ( p > 0.05). The mean (SD) ppFEV1 and the overall mean (SD) SC concentration significantly decreased during the follow-up. Regarding cultures, 18 (27%) of the 27 patients positive (41%) for Staphylococcus aureus at baseline became negative during treatment. Three patients (4%) with persistently positive cultures for Pseudomonas aeruginosa during the first 12 months, became negative after 24 months. One patient (1.5%), with a baseline positive culture for Pseudomonas Aeruginosa, showed negative cultures after 12 months.

Conclusion:

ETI treatment improved respiratory outcomes and significantly reduced values of IgG, IgA, γ-globulin, and leukocytes, suggesting an effect on the systemic inflammatory response. Further research is warranted to elucidate the role of inflammatory parameters in monitoring response to therapy.
The Art of Reading Widely Within and Beyond Academia
Authors: Bigelow Shanita
Published: February 2025

ire’ne lara silva wrote “everything must be a little wild.” Reading should also be done with the entirety/wideness of being. In this article—which seeks to showcase/highlight the promise and responsibilities inherent in reading and writing—I chronicle what it can mean to read widely and wildly for academic purposes and beyond. I argue that scholarship is and can be an inherently creative endeavor, one that asks us to question and seek from a wide variety of sources, external and internal—for example, academic journals and publications, poetry, creative nonfiction, personal writing, etc. In this view of my reading practices, how they engender writing, I hope to demonstrate the possibilities inherent in reading widely with intention and care to (re)present one’s work, all that entails. It requires letting go just a bit, letting the reading and writing process unfurl in less mediated, though still purposeful ways. This work follows those assumptions. It follows that track, meandering between personal experience and the potential of writing with both clarity and creativity, because it must be, in a sense, a little wild.
Comprehensive geriatric assessment, frailty and sarcopenia in elderly surgical patients: a narrative review of evidence
Authors: Yip King Fan , Mathur Sachin , Seow Chuen Chai Dennis
Published: February 2025

Background: As the number of elderly undergoing surgical procedures increases with our aging population, the risk of adverse surgical outcomes also increases with reduced physiological reserve, multiple comorbidities, frailty and functional disability. Objectives: As Comprehensive Geriatric Assessment (CGA) is increasingly being integrated as part of good surgical care for older patients owing to better patient outcomes, this review aims to provide an overview of the current evidence regarding its benefit on geriatric surgical patients among different surgical specialties, with additional focus on patients with frailty and/ or sarcopenia. Methods: Using chosen keywords, searches were conducted using Pubmed, Google scholar and Cochrane Library. Inclusion criteria were surgery of various specialties with the exception of orthopaedic surgery, and studies published in English only. Exclusion criteria were orthopaedic surgery, and non-English articles. Prospective, retrospective, randomized controlled and cohort studies were considered given the limited number of studies published thus far. Relevant journal articles referenced in the chosen articles were also referenced in writing this narrative review. Only the most relevant articles from 2010 onwards were used as earlier ones were outdated. Results & Conclusion: There is evidence of good outcomes after performing CGA and screening for frailty and sarcopenia in elective surgical patients while evidence on the usage of CGA for emergency surgical patients perioperatively is limited. Future studies could focus on the challenges to integrating CGA (including screening for frailty and sarcopenia) as part of routine surgical care and healthcare outcomes.
A Qualitative Exploration of the Factors Contributing to Elementary School Counselor Job Stress and Job Satisfaction
Authors: Rhames Alexis , Lee Jisu , Haberski Jenny , Slaten Christopher D.
Published: February 2025

This study investigated the factors contributing to job stress and job satisfaction among elementary school counselors. Utilizing a social constructivist approach, the research explored the lived experiences of 13 practicing elementary school counselors in the Midwest region of the United States. The study identified two primary themes: barriers to job satisfaction and contributors to job satisfaction. Barriers include time constraints, role ambiguity, and emotional exhaustion, which are exacerbated by the multifaceted nature of the school counselors’ roles and the high demands placed on them. Conversely, contributors to job satisfaction encompass stakeholder buy-in, prevention work, and emotional rewards derived from supporting students. The findings highlight the critical role of positive collegial relationships and administrative support in enhancing job satisfaction. The study also underscores the importance of preventive measures in addressing students’ needs and the emotional fulfillment counselors experience from their work. By providing a nuanced understanding of the factors influencing job stress and satisfaction, this research offers valuable insights for school administrators and policymakers to improve the working conditions and retention of elementary school counselors. The study’s implications suggest that addressing role ambiguity and providing adequate support can significantly enhance job satisfaction and reduce burnout among school counselors.
Microbial reduction of Fe(III)-bearing solids recovered from hydraulic fracturing flowback water: Implications for wastewater treatment
Authors: Hernandez-Becerra Natali , Nixon Sophie L. , Boothman Christopher , Lloyd Jonathan R.
Published: February 2025

Hydraulic fracturing generates large volumes of flowback and produced water, composed of complex mixtures of organic and inorganic constituents. The solids associated with these fluids are Fe-rich and can contain toxic organics, heavy metals and naturally occurring radioactive materials (NORMs). Despite this, only a few studies have analysed their composition and there is a lack of understanding about their interactions with microbial communities and their long-term fate in the environment. In this study, we analysed the solids associated with flowback water derived from a hydraulically fractured well in the Bowland Shale, UK. We also investigated the microbial reduction of these Fe(III)-rich materials under anaerobic conditions using anthraquinone-2.6-disulfonate (AQDS) as an electron shuttle and identified the resulting bioreduced mineral phases. XRD characterization indicated that the solids contained akaganeite (β-FeOOH, Cl) and Ba-bearing celestine (SrSO4). These Fe(III)-containing solids served as an electron acceptor for Shewanella frigidimarina and a flowback-derived Fe(III)-reducing enrichment culture. The bioreduced Fe(II)-bearing mineral phase was identified as ankerite [Ca(Fe,Mg,Mn)(CO3)2]; however, the presence of amorphous mineral phases is not ruled out. Microbial community composition was analysed using 16S rRNA gene sequencing. Amplicon sequence variants (ASVs) most closely related to Chromohalobacter, Caminicella and putative Fe(III)-reducing genera were dominant across treatments. Our findings highlight the potential of these Fe(III)-bearing sludges to be harnessed for the development of wastewater treatment strategies; for example, coupling the oxidation of toxic organics with Fe(III) reduction through either the introduction of microbial inocula or biostimulation of the native microbial communities. Furthermore, microbial processing can also be optimized to transform the Fe(III) sludges into denser materials, which are easier to handle and can immobilize toxic metals, thereby reducing the toxicity of this waste.
Late-Onset Telomere Biology Disorders: Clinical Insights and Treatment Outcomes from a Retrospective Registry Cohort
Authors: Tometten Mareike , Beier Fabian , Kirschner Martin , Schumacher Yannic , Walter Jeanette , Vieri Margherita , Kricheldorf Kim , Röth Alexander , Platzbecker Uwe , Radsak Markus P. , Schafhausen Phillippe , Corbacioglu Selim , Höchsmann Britta , Balabanov Stefan , Hinze Claas Heinrich , Chromik Jörg , Heuser Michael , Kreuter Michael , Wlodarski Marcin W , Elbracht Miriam , Kurth Ingo , Koschmieder Steffen , Panse Jens Peter , Meyer Robert , Brümmendorf Tim H.
Published: February 2025

Pathogenic germline variants affecting proper telomere maintenance result in premature telomere shortening and cause telomere biology disorders (TBDs). While classical dyskeratosis congenita in children is rather well defined, late-onset ("cryptic") TBDs remain underrecognized, resulting in underdiagnosis and inadequate treatment in affected adults. Here, we present a series of adult TBD cases collected through the German TBD reference center between 2014 and 2024. Patients ≥18 years with an age-matched telomere length (TL) < 10th percentile in lymphocytes and detection of either a variant of uncertain significance, a pathogenic or a likely pathogenic variant in TBD-associated genes, and available clinical data were included in this analysis. On this basis, a novel point-based algorithm for categorization into proven, probable and suspected-only TBD cases, respectively, was developed. Out of a total of 1,537 TL analyses, 42 patients with proven (n=29) or probable (n=13) TBD were identified. Median age at first clinical manifestation and at diagnosis was 20.0 years and 34.1 years, respectively. Bone marrow failure (BMF) was the most frequent manifestation observed in our cohort (73.8%), followed by liver or interstitial lung diseases (50.0% and 41.5%, respectively). Immunosuppressive therapy was carried out in six patients with BMF, none of them responded. In comparison, eight of eight evaluable patients treated with androgen derivatives showed hematologic response. Our data provide novel real-world insight into the clinical manifestation spectrum, diagnosis as well as clinical course and treatment of TBD in adult, late-onset cases of this hereditary disease.
Licochalcone A prevents cognitive decline in a lipopolysaccharide-induced neuroinflammation mice model
Authors: Carrasco Marina , Guzman Laura , Olloquequi Jordi , Cano Amanda , Fortuna Ana , Vazquez-Carrera Manuel , Verdaguer Ester , Auladell Carme , Ettcheto Miren , Camins Antoni
Published: February 2025

Inflammation plays a key role in the development of neurodegenerative disorders that are currently incurable. Licochalcone A (LCA) has been described as an emerging anti-inflammatory drug with multiple therapeutical properties that could potentially prevent neurodegeneration. However, its neuroprotective mechanism remains unclear. Here, we investigated if LCA prevents cognitive decline induced by Lipopolysaccharide (LPS) and elucidated its potential benefits. For that, 8-week-old C57BL6/J male mice were intraperitonially (i.p.) treated with saline solution or LCA (15 mg/kg/day, 3 times per week) for two weeks. The last day, a single i.p injection of LPS (1 mg/kg) or saline solution was administered 24 h before sacrifice. The results revealed a significant reduction in mRNA expression in genes involved in oxidative stress (Sod1, Cat, Pkm, Pdha1, Ndyfv1, Uqcrb1, Cycs and Cox4i1), metabolism (Slc2a1, Slc2a2, Prkaa1 and Gsk3b) and synapsis (Bdnf, Nrxn3 and Nlgn2) in LPS group compared to saline. These findings were linked to memory impairment and depressive-like behavior observed in this group. Interestingly, LCA protected against LPS alterations through its anti-inflammatory effect, reducing gliosis and regulating M1/M2 markers. Moreover, LCA-treated animals showed a significant improvement of antioxidant mechanisms, such as citrate synthase activity and SOD2. Additionally, LCA demonstrated protection against metabolic disturbances, downregulating GLUT4 and P-AKT, and enhanced the expression of synaptic-related proteins (P-CREB, BDNF, PSD95, DBN1 and NLG3), leading all together to dendritic spine preservation. In conclusion, our results demonstrate that LCA treatment prevents LPS-induced cognitive decline by reducing inflammation, enhancing the antioxidant response, protecting against metabolic disruptions and improving synapsis related mechanisms.
A qualitative evaluation of the effectiveness of behaviour change techniques used in the Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) intervention
Authors: Moore A. P. , Rivas C. , Harding S. , Goff Louise M.
Published: February 2025

Background

Type 2 diabetes (T2D) is up to three times more common in people of Black African and Black Caribbean heritage living in the UK, compared to their White British counterparts. Structured education is the cornerstone of care but is less successful for people from minority ethnic groups. Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) was developed to support diabetes self-management in people of Black African and Caribbean heritage living with T2D in the UK. The intervention was designed using COM-B/behaviour change wheel methodology to specify the theory of change. In a process evaluation study, we explored how the selected behaviour change techniques (BCTs) supported behaviour change in the intervention.

Methods

Focus groups and interviews were conducted with participants who were randomised to receive the HEAL-D intervention in a feasibility trial. A topic guide directed discussions to explore experiences of HEAL-D, key learnings and impact, and behaviour change; the interviews gave the opportunity to probe further the focus group themes and areas requiring clarification. Sessions were audio-recorded and transcribed. Framework analysis was used to explore how the selected BCTs supported behaviour change in those attending HEAL-D.

Results

Thirty-six participants took part in one or both activities (44% Black African, 50% Black Caribbean, 6% Mixed race; 61% female, 83% first-generation; mean age 59.5 years, SD 10.02). Participants reported increased physical activity, reduced carbohydrate portion size and engagement in weight monitoring behaviour. BCTs to increase social opportunity (social comparison, social support) and overcome motivational barriers (credible sources and modelling) were effective in addressing cultural barriers relating to diet, stigma and health beliefs. BCTs to develop capability (demonstration, instruction, information on health consequences) were effective because of the cultural salience of the developed components. Less impactful BCTs were problem solving, graded tasks, goal setting, and feedback on outcomes.

Conclusions

BCTs in the HEAL-D intervention were effective in supporting behaviour change, particularly those promoting social opportunity, as normative cultural habits and beliefs can conflict with diabetes self-management guidance. In addition, lifestyle interventions should include opportunity for experiential learning alongside culturally salient information provision.

Trial registration

number: NCT03531177, May 18th 2018.
Asthma control after recovery from mild to moderate COVID-19: from Omicron BA.2 to XBB– from a cohort in a university hospital in Hong Kong
Authors: Kwok Wang Chun , Tsui Chung Ki , Tam Terence Chi Chun , Lam David Chi Leung , Ip Mary Sau Man , Ho James Chung Man
Published: February 2025

Background

At the time of Omicron BA.2 outbreak, it was shown that mild to moderate COVID-19 was associated with worsening of asthma control after recovery. Whether the same phenomenon was also observed at a later phase of COVID-19 pandemic by other variants have not been reported.

Methods

We conducted a follow-up study on patients with asthma who received clinical care in Queen Mary Hospital. The patients were first recruited in the study entitled “Worsening of asthma control after recovery from mild to moderate COVID-19 in patients from Hong Kong”. The primary outcome was the asthma control test (ACT) score difference among the patients who never had COVID-19 (no COVID-19 group), patients who had COVID-19 diagnosed in the initial study (past COVID-19 group) and patients who had COVID-19 diagnosed in the follow-up period (new COVID-19 group) of the current study.

Results

189 patients were included. The change of ACT score from the last visit in the previous study to the last follow-up visit in current study was − 0.34 ± 3.7 in the no COVID-19 group, -0.0 ± 5.0 in the past COVID-19 group and − 0.17 ± 4.5 in the new COVID-19 group (p = 0.94). There were 10 (24.4%), 24 (25.5%) and 12 (22.2%) patients in the no COVID-19, past COVID-19 and new COVID-19 group who had worsening of asthma control by an increase in ACT score ≥ 3 from the last visit in the previous study to the last follow-up visit in current study (p = 0.90).

Conclusion

Patients who had COVID-19 in 2023 with Omicron XBB as the dominant strain did not have worsening of asthma control seen in previous study done in 2022 with Omicron BA.2 as the circulating strain. Patients who had worsening of asthma control after COVID-19 in 2022 had subsequent improvement of asthma control with longer follow-up interval.
Effect of aging on the marginal fit of milled and printed zirconia crowns: an in-vitro study
Authors: Elsayed Mahmoud S. , El-Kouedi Ahmed Y. , Shokry Tamer E.
Published: February 2025

Background

The additive manufacturing is one of the promising methods for fabrication of zirconia based restorations: However, studies on the marginal fit of zirconia restorations fabricated with this technique are sparse. This in vitro study was to measure and compare the marginal fit of milled and printed zirconia based crowns.

Methods

Twenty-two human premolars were prepared to receive zirconia crowns. Each tooth preparation was scanned by a laboratory scanner. Digitally designed crowns were divided into two groups (n = 11) according to the method of fabrication either via 3D with a commercial 3Y-TZP slurry or a 5-axis milling machine using a multilayer zirconia blank. The marginal gaps were measured before, after cementation, and after thermomechanical accelerated aging. Kolmogorov-Smirnov and Shapiro-Wilk tests were conducted. Mann-Whitney U test was used to compare between the two techniques. Friedman’s test was used to compare between marginal gap distances before, after cementation and after aging. Dunn’s test was used for pair-wise comparisons when Friedman’s test is significant. The significance level was set at P ≤ 0.05.

Results

Marginal discrepancies between the groups showed significant variations. In comparison to milled, 3D printing demonstrated a statistically significant greater marginal gap distance before, after cementation, and after aging (P < 0.001, Effect size = 2.361), (P = 0.011, Effect size = 1.28), and (P = 0.014, Effect size = 1.234), per respective.

Conclusion

Significant differences were found between the two technologies used for fabricating zirconia crowns. The least discrepancies values were found with the milling technique.
Audit and group feedback in nursing home physician groups: lessons learned from a qualitative study
Authors: Yeung Gary Y. C. , Albers Charlotte A. W. , Smalbrugge Martin , de Bruijne Martine C. , Jepma Patricia , Joling Karlijn J.
Published: February 2025

Background

Audit and group feedback (A&F) is an instrument used to encourage healthcare professionals to improve the quality of care. Clinical practice was audited against a set of criteria and fed back to a group by a facilitator. The aim of this study was to gain a better understanding of how physician group feedback sessions in nursing homes were conducted and to what extent they resulted in action planning.

Methods

Fifteen group feedback sessions of the antibiotic A&F program within a nursing home network were audio-recorded, transcribed, and analyzed via the Framework Method for thematic analysis. The coding was performed using the existing Calgary A&F Framework and Cooke’s conceptual model of physician behaviors, and open inductive codes were added.

Results

Elements of the conceptual model and the Calgary A&F Framework occurred within all group feedback sessions. The relationships within the group and with the facilitators were important elements when moving a group from interpreting the results to formulating action plans. Physician groups responded positively to the audit data, particularly if they were among the best performing. The data were met with doubt by physicians who did not recognize their own practice. When exploring potential reasons for lower guideline adherence, groups often considered data quality or external factors such as the choice of non-adherent treatment by locum staff. The degree of reflection on personal factors as explanations for low adherence and the extent to which groups identified learning and improvement opportunities varied: some groups were able to formulate action plans to address data problems and knowledge gaps, whereas others scheduled a follow-up meeting to develop action plans for treatment or prescribing practice changes.

Conclusions

The facilitator was crucial in supporting the group in interpreting the results, steering the conversation towards sharing change cues, and helping the physician group in developing action plans. The degree of reflection and action planning varied by group. By implementing the lessons learned from this study, group feedback sessions can be refined, supporting participants in action planning.
PEX11B palmitoylation couples peroxisomal dysfunction with Schwann cells fail in diabetic neuropathy
Authors: Yang Yu Mei , Ma Hang Bin , Xiong Yue , Wu Qian , Gao Xiu Kui
Published: February 2025

Background

Diabetic neuropathy (DN) is a prevalent and painful complication of diabetes; however, the mechanisms underlying its pathogenesis remain unclear, and effective clinical treatments are lacking. This study aims to explore the role of peroxisomes in Schwann cells in DN.

Methods

The abundance of peroxisomes in the sciatic nerves of mice or Schwann cells was analyzed using laser confocal super-resolution imaging and western blotting. The RFP-GFP-SKL (Ser-Lys-Leu) probe was utilized to assess pexophagy (peroxisomes autophagy) levels. To evaluate the palmitoylation of PEX11B, the acyl-resin assisted capture (acyl-RAC) assay and the Acyl-Biotin Exchange (ABE) assay were employed. Additionally, MR (Mendelian randomization) analysis was conducted to investigate the potential causal relationship between DN and MS (Multiple sclerosis).

Results

There was a decrease in peroxisomal abundance in the sciatic nerves of diabetic mice, and palmitic acid (PA) induced a reduction in peroxisomal abundance by inhibiting peroxisomal biogenesis in Schwann cells. Mechanistically, PA induced the palmitoylation of PEX11B at C25 site, disrupting its self-interaction and impeding peroxisome elongation. Fenofibrate, a PPARα agonist, effectively rescued peroxisomal dysfunction caused by PA and restored the peroxisomal abundance in diabetic mice. Lastly, MR analysis indicates a notable causal influence of DN on MS, with its onset and progression intricately linked to peroxisomal dysfunction.

Conclusions

Targeting the peroxisomal biogenesis pathway may be an effective strategy for preventing and treating DN, underscoring the importance of addressing MS risk at the onset of DN.
Alpha-1 antitrypsin reduces inflammation and vasculopathy in mice with oxygen-induced retinopathy
Authors: Suphapimol Varaporn , Liu Yu-Han , Prato Sandro , Karnowski Alexander , Hardy Charles , Morelli Adriana Baz , Jayasimhan Abhirup , Deliyanti Devy , Wilkinson-Berka Jennifer L.
Published: February 2025

Background

Damage to the retinal vasculature is a major cause of vision loss and is influenced by a pro-inflammatory environment within retinal tissue. Alpha-1 antitrypsin (AAT) is a potent inhibitor of serine proteases and has anti-inflammatory properties. We hypothesised that AAT could reduce inflammation and vasculopathy in neovascular retinopathies including oxygen-induced retinopathy (OIR).

Methods

Litters of C57BL/6J mice were randomised to develop OIR by exposure to high oxygen between postnatal days 7 to 12 resulting in vaso-obliteration (phase I OIR), and then room air from postnatal days 12 to 18 resulting in neovascularisation (phase II OIR). Control mice were exposed to room air. Separate cohorts of mice were administered control vehicle or human AAT (120 mg/kg) by intraperitoneal injection every second day in phase I or phase II OIR.

Results

In phase I OIR, plasma levels of AAT were reduced compared to room air controls, and AAT treatment reduced vaso-obliteration. In phase II OIR, AAT treatment influenced inflammation by reducing the density of ionised calcium binding adaptor protein 1 + cells (microglia/macrophages) and modulating their cell process length and reducing mRNA levels of tumour necrosis factor and monocyte chemoattractant protein-1, but not interleukin-1b and interleukin-6 in retina. Furthermore, AAT treatment reduced retinal neovascularisation, gliosis, vascular endothelial growth factor mRNA and protein expression, and vascular leakage, compared to OIR controls.

Conclusions

This research demonstrates the vasculo-protective actions of AAT, and thereby the potential of AAT as a therapeutic option for neovascular retinopathies.
TGF-β1 Induces Mucosal Mast Cell Genes and is Negatively Regulated by the IL-3/ERK1/2 Axis
Authors: Meurer Steffen K. , Bronneberg Gina , Penners Christian , Kauffmann Marlies , Braunschweig Till , Liedtke Christian , Huber Michael , Weiskirchen Ralf
Published: February 2025

Mast cells develop from the myeloid lineage and are released from the bone marrow as immature cells, which then differentiate at the destination tissue based on cues from the local environment. In the liver, mast cells are recruited in diseased states to fibrogenic surroundings rich in TGF-β1. The aim of this study was to investigate TGF-β1 signaling in primary and permanent mast cells to identify common and unique mechanisms. The TGF-β receptor repertoire is similar among mast cells, with high expression of type I and type II receptors and very low expression of type III receptors (Betaglycan and Endoglin). Downstream, TGF-β1 activates the SMAD2/3 signaling axis and also SMAD1/5 with target genes Smad6 and Id1 in a transient manner. Initially, TGF-β1 upregulates the transcription of mucosal mast cell effectors Mcpt1 and Mcpt2 in all analyzed mast cells. This upregulation is reduced in the presence of IL-3, which promotes proliferation. Inhibition of ERK1/2 activation reduces proliferation and mitigates the negative effect of IL-3 on Mcpt1 mRNA and protein expression in the immortalized mast cell line PMC-306 but not in bone marrow-derived mast cells. Therefore, extracellular signal-regulated kinases ERK1/2 are identified as a mutual switch between IL-3-driven proliferation and TGF-β1-promoted mucosal mast cell differentiation in PMC-306. In conclusion, TGF-β1 promotes a mucosal gene signature and inhibits proliferation in mast cells, with these effects being counter-regulated by IL-3/ERK1/2.

Graphical Abstract
Depression and anxiety in childhood-onset systemic lupus erythematosus: prevalence, associated factors, and impact on quality of life and family
Authors: Duangmala Pitsamai , Sontichai Watchareewan
Published: February 2025

Background

Depression and anxiety are common psychiatric manifestations in childhood-onset systemic lupus erythematosus (cSLE). This study aimed to determine the prevalence of clinically significant depression and anxiety, identify associated factors, and assess their impact on health-related quality of life (HRQOL) and family in patients with cSLE.

Methods

We conducted a cross-sectional study of cSLE patients, aged 8–18 years. Patients completed the Children’s Depression Inventory (CDI), Screening for Child Anxiety Related Disorders (SCARED), Pediatric Quality of Life Inventory Generic Core Scale (PedsQL-GC), and Visual Analog Scale of pain intensity. Their parents completed the Pediatric Quality of Life Family Impact module (PedsQL family impact).

Results

Of 91 patients, the median disease duration was 3.4 years (IQR 3.5), and the median SLE disease activity index 2000 score was 2 (IQR 6). The prevalence of clinically significant depression (CDI > 15) and clinically significant anxiety (SCARED ≥ 25) were 31.9% and 49.5%, respectively. Coexisting clinically significant depression and anxiety were found in 26 patients (28.6%). In multivariable analyses, older age at diagnosis was associated with clinically significant depression (OR 1.56, 95% CI 1.12–2.16, p = 0.008), while organ damage (OR 4.27, 95% CI: 1.19–15.31, p = 0.026) and pain score (OR 1.61, 95% CI: 1.11–2.32, p = 0.012) were associated with clinically significant anxiety. Patients with clinically significant depression or anxiety had significantly lower PedsQL-GC and PedsQL family impact scores compared to those without these symptoms.

Conclusions

These results suggest that depression and anxiety are prevalent in cSLE and have negative impacts on HRQOL and family. Physicians should be aware of the presence of these psychological symptoms, particularly in patients with risk factors. Providing psychological counseling and prompt referral to psychiatrists could enhance HRQOL and family functioning.
Impact of intravenous immunoglobulin treatment on peripheral blood cells in children with Kawasaki disease complicated with coronary artery lesion
Authors: Zhao Junshan , Ma Yingying , Xin Li , Wang Lijun , Gao Hongliang
Published: February 2025

Background

Kawasaki disease (KD) primarily affects young children and can lead to coronary artery lesions. Intravenous immunoglobulin (IVIG) treatment is essential; however, it may fail in 10-20% of cases, increasing the risk of complications. Complete blood count (CBC) tests can help assess disease severity and predict risks. This study investigated the impact of IVIG on peripheral blood cells, including neutrophil count, platelet-lymphocyte ratio, hemoglobin level, mean platelet volume (MPV), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), in children with KD complicated by coronary artery lesions (CALs).

Methods

This retrospective analysis included children diagnosed with typical KD. The neutrophil count, hemoglobin level, platelet-lymphocyte ratio, MPV, ESR, and CRP were compared between those with (CAL+) and without (CAL−) CALs during the acute phase, as well as at 7 days, 1 month, and 2 months after normalizing body temperature with IVIG.

Results

A total of 76 children with KD were analyzed, including 30 with CAL+. CAL+ and CAL− patients exhibited elevated neutrophil counts during the acute phase, with no significant differences (P > 0.05) between groups. After IVIG treatment, CAL− patients demonstrated a more pronounced reduction in neutrophil count (P < 0.05) than CAL+ patients. Hemoglobin levels differed significantly during the acute phase (P < 0.05) but were comparable post-treatment (P > 0.05) between CAL+ and CAL− patients. The platelet-lymphocyte ratio varied significantly between groups during the acute phase and 1-month post-treatment (P < 0.05). Mean ESR and CRP levels were significantly elevated at all time points in the CAL+ group compared with the CAL− group. No significant differences in MPV were observed between groups.

Conclusions

After IVIG treatment, CAL− patients demonstrated a more important reduction in neutrophil count than CAL+ patients after IVIG. Pediatric patients with KD and CAL+ showed lower hemoglobin and platelet-lymphocyte ratio and higher ESR and CRP compared with CAL−, suggesting that they may serve as indicators for CAL in pediatric patients with KD.