bluuebunny/crossref_metadata_2025 huggingface dataset:
Why the Delay? A Quality Improvement Initiative for Delayed Cord Clamping in Preterm Infants
Authors: Mohamad Ahmad , Navidad Ana , Edwards Lindsay , DePaoli Antonio , Jackson Hamish , Walsh Joey , Spotswood Naomi
Published: January 2025

Aim

To improve delayed cord clamping (DCC) rates for preterm infants (≤ 34 + 0 weeks' gestation) and establish DCC as standard practice using quality improvement (QI) methods.

Methods

A multi‐departmental initiative was undertaken. An audit of DCC for preterm infants born at or before 34 + 0 weeks was performed. Using this data and feedback from multidisciplinary staff meetings, barriers to DCC implementation were identified and targeted QI interventions were introduced. Ongoing data surveillance monitored the effects of these interventions.

Results

DCC rates were evaluated for 862 preterm infants from January 2014 to August 2022. This QI project commenced in February 2018, with a detailed audit of 225 preterm infants across three time periods: epoch 1 (immediately prior to QI initiative), epoch 2 (QI implementation phase), and epoch 3 (immediate post‐implementation surveillance). Inconsistent documentation of cord clamp time and admission hypothermia were identified as potential barriers to implementation of DCC. Over the course of the initiative, the documentation rate increased from 16% to 92.6%. Hypothermia at admission decreased from 76% in epoch 1 to 43.2% in epoch 3. The baseline rate of DCC was low in epoch 1 (12%), but improved to 70% in epoch 3, with this change sustained in ongoing DCC rate evaluation to August 2022.

Conclusions

There has been a significant and sustained improvement in DCC for preterm infants at our centre. A structured approach to QI and collaboration between multiple departments were each integral in effecting this improvement in clinical care.
“Everything cannot be handled virtually”: Understanding intention and use of digital health technologies among rural adults and rural cancer survivors
Authors: Shi Jenna , Robinson Ty A. , Loomba Preena , Murley Brittany , Strong Larkin L. , Basen‐Engquist Karen , Mama Scherezade K.
Published: January 2025

Purpose

This qualitative study assessed internet access and use, barriers and facilitators to participating in digital health interventions or programs, and the engagement experience in virtual versus in‐person health interventions among rural adults and rural cancer survivors.

Methods

Rural adults (n = 10) and rural cancer survivors (n = 10) were recruited from previous studies to participate in an in‐depth interview. The interview guide contained eight open‐ended questions related to participation in technology‐based programs. Interviews were recorded and transcribed, and transcripts were analyzed for emergent themes using a thematic content analysis approach.

Findings

Rural adults were younger (M age = 37.9 ± 11.8 years), more likely to be non‐Hispanic Black (90.0%), and reported higher educational attainment (50.0% earned a master's or doctoral degree) compared with rural cancer survivors (M age = 63.0 ± 9.1 years, 70.0% non‐Hispanic White, and 20.0% earned a master's or doctoral degree). Participants discussed performance and effort expectancies related to using digital health technologies or participating in virtual programs and cited positive and negative aspects of in‐person and virtual platforms. Participants emphasized the need for social connections and missed opportunities in current virtual offerings along with factors that influence their use of technologies (e.g., prior experience, tech anxiety).

Conclusions

Findings from this qualitative study provide an in‐depth understanding of the intricate experiences of rural adults and rural cancer survivors when engaging with digital health technologies. Integrating the experiences of rural adults and rural cancer survivors may aid in developing clinical and community‐based interventions and policies that support increasing access to digital health services and programs for rural communities.
Theory‐Refuting Findings in Psychology: How Much Should They Matter?
Authors: Trafimow David
Published: January 2025

To a naïve falsificationist, one theory‐refuting finding falsifies a theory. In contrast, sophisticated science philosophers have emphasised larger research systems that include theories and auxiliary assumptions. Theory‐refuting findings can be accommodated by blaming poor auxiliary assumptions, refining theories, improving auxiliary assumptions, or pronouncing that the benefits of the research system render theory‐refuting findings unimportant. Popper, Kuhn, Lakatos, and Laudan have proposed research systems, with many disagreements between them. The present thesis is that each proposal is subject to two caveats. None of these philosophers sufficiently considered the opportunity costs associated with ignoring theory‐refuting findings. Secondly, it is not clear that previous pronouncements about how research systems work in the hard sciences necessarily apply well to modern psychological science. The interaction of these issues suggests that theory‐refuting findings may have more potential for mattering in modern psychology than would seem apparent from sophisticated research system perspectives.
Genomic Footprints of Hybridisation in North Atlantic Eels (Anguilla anguilla and A. rostrata)
Authors: Tengstedt Aja Noersgaard Buur , Liu Shenglin , Jacobsen Magnus W. , Ulmo‐Diaz Gabriela , Jónsson Bjarni , Pujolar Jose Martin , Hansen Michael M.
Published: January 2025

Understanding interspecific introgressive hybridisation and the biological significance of introgressed variation remains an important goal in population genomics. European (Anguilla anguilla) and American eel (A. rostrata) represent a remarkable case of hybridisation. Both are panmictic and spawn in partial sympatry in the Sargasso Sea, occasionally producing viable, fertile hybrids, primarily found in Iceland. We studied introgressive hybridisation from American into European eel using whole‐genome sequences of 78 individuals, including European, American and 21 putative hybrid eels. Previous studies using few genetic markers could not resolve whether hybridisation involved simple unidirectional backcrossing or a more complex hybrid swarm scenario. However, local ancestry inference along individual chromosomes revealed that Icelandic hybrids were primarily F1 or first‐generation backcrosses towards European eel, with some showing more complex backcrossing. All European eels outside Iceland contained short chromosomal blocks from American eel, indicating a porous genome. We found no evidence for previously hypothesised geographical gradients of introgression in European eel outside Iceland. Several chromosomal regions showed high interspecific divergence, but haplotype blocks introgressed from American eel were identified both within and outside these regions. There was little correspondence between regions of high relative (FST) and absolute divergence (dXY), with the former reflecting selective sweeps within species or reduced recombination rather than barrier loci. A single genomic region showed evidence of repeated introgression from American into European eel under positive selection in both species. The study illustrates that species can maintain genetic integrity despite porous genomes and that standing variation in one species can potentially be available for future adaptive responses in the other species.
Recommendations for Improving Surveillance of Congenital Anomalies in Europe Using Healthcare Databases
Authors: Loane Maria , Morris Joan K. , Garne Ester
Published: January 2025

Background

Although accessing administrative data in healthcare databases may be a more time‐efficient and cost‐effective method of conducting surveillance, there is evidence suggesting that administrative data alone are not sufficient for population‐based surveillance of congenital anomalies.

Objective

To propose recommendations to maximise the potential use of healthcare databases for surveillance of congenital anomalies based on our data linkage experiences and results from the EUROlinkCAT study.

Methods

EUROlinkCAT is a population‐based cohort study of 99,416 children with anomalies born between 1995 and 2014. The congenital anomaly case records of children in 11 European congenital anomaly (EUROCAT) registries (eight countries) were linked to standardised administrative healthcare data (birth records, death records and hospital discharge records) to evaluate mortality and morbidity outcomes in these children. Overall, 97% of children with anomalies were successfully matched to their records in their national or regional administrative databases. Recommendations to improve surveillance of anomalies when using healthcare data were developed through establishing and analysing data from this cohort.

Results

The primary recommendation is to develop systems to report anomalies diagnosed in foetuses who undergo a termination and link these data to their mothers. Each liveborn baby must be assigned a permanent unique identification number at birth to enable accurate linkage across healthcare databases. Implementing and improving existing algorithms to discriminate between major anomalies and suspected or minor anomalies will improve accuracy in coding. Heterogeneity in coding anomalies will improve by avoiding the use of ‘unspecified’ or ‘other specified’ codes in hospital databases. Relaxation of country‐specific regulations concerning the suppression of small numbers are necessary to enable data to be combined across European countries.

Conclusion

Implementation of these recommendations will enable the information in electronic healthcare databases, in conjunction with Congenital Anomaly registries, to be fully exploited and hence will improve the surveillance of anomalies in children.
Geological Significance for the Lateral Migration of the Late Triassic Black Shales in the Sichuan Basin, the Western Yangtze Block (South China)
Authors: Yan Zhaokun , Huang Yuying , Yan Chenyu , Shao Chongjian , Ren Cong , Nie Zhou , Zhang Zili , Zhao Shaoze , Bai Haotian , Zhang Daizhu , Ye Tingting
Published: January 2025

The Upper Triassic black shales in the Sichuan Basin are formed in three stages and are predominantly situated at the forefront of the Longmenshan (LMS) thrust belt. These formations are a result of three rapid subsidence events in the foredeep and the development of an underfilled foreland basin, triggered by three intense thrust nappe movements of the LMS orogenic wedge during the Late Triassic. The lateral migration of black shales in the LMS foreland basin, from the northeast to the southwest, suggests that thrust nappe movements of the LMS orogenic wedge predominantly occurred in the northeastern region during the early Late Triassic and gradually shifted toward the southwestern region in the later Late Triassic. The ongoing convergence between the North China Craton and the Yangtze Block at this time likely influenced this migration process.
Industrial Chain Risk Exposure and Economic Volatility: A Framework Incorporating Foreign‐Invested Enterprises
Authors: Peng Siyi , Zhong Daocheng
Published: January 2025

We introduce a novel accounting framework to assess the risk exposure on both the demand and supply sides of industrial chains incorporating foreign direct investment. The new framework considers the role of foreign‐invested enterprises, their interactions with domestic‐owned firms and their involvement in international trade. Using the AMNE‐ICIO data, we conducted an in‐depth analysis of risk exposure for China's industrial chain and its correlation with economic volatility. Our study yielded four key findings. (1) The trajectories of China's industrial chain risk exposure on both the demand and supply sides generally align, exhibiting a downward trend. Conventional methods without distinction between foreign‐invested enterprises and domestic‐owned firms significantly underestimate China's industrial chain risk exposure. (2) There exists a marked disparity in risk exposure across different countries and sectors, with developed countries and high‐tech manufacturing sectors facing substantially higher risks. (3) As pivotal actors in the global production network, China and the United States hold critical positions in the global industrial chains. (4) Empirical results indicate that, compared to country sectors with lower risk exposure, those facing higher risk exposure prior to the global financial crisis experienced greater economic volatility following the crisis.
Cognition, Lifestyle, and Gender: An Umbrella Review of Esport Performance, Participation, and Well-Being
Authors: Hayburn Jessica , Jowett Gareth E. , Gledhill Adam
Published: January 2025

Background: The recent exponential rise in esports participation has stimulated growing interest in the performance, participation, and well-being of esports players. This research has culminated in several systematic reviews that provide an initial biopsychosocial perspective of esports players. The aim of our umbrella review was to synthesize and quality appraise these systematic reviews to provide a coherent understanding of the biopsychosocial factors affecting esports players’ performance and well-being. Methods: An umbrella review was conducted on literature published from 2010 onward from six online databases to identify and examine systematic reviews within esports literature related to mental health and performance. A MeaSurement Tool to Assess Systematic Reviews-2 was used to critically appraise systematic reviews. Results: Fourteen systematic reviews were identified examining player performance (n = 5), player mental health (n = 4), and a combination of both factors (n = 5). Four key themes were identified on esports player lifestyle, cognition, physical health, and gender-based concerns. Twelve of the 14 systematic reviews were rated low or critically low quality. Discussion: The results highlight the biopsychosocial factors related to esports participation showing a positive impact on cognitive functioning, a mixed-to-negative impact on sleep outcomes and physical activity, and discrimination toward female players. The low-quality reviews show a need for more rigorous methodology in esports research.
Weight-Inclusive Physical Activity: A Systematic Evaluation of Virtual Resources
Authors: Sutton Megan , Stanley Sara , Doherty Alison , Driediger Molly , Calogero Rachel , Sabiston Catherine M , Meadows Angela , Maharaj Aryel , Pila Eva
Published: January 2025

Background: Higher-weight individuals report lower rates of physical activity behavior and poorer physical activity experiences compared with their normative-weight counterparts, likely owing to the pervasiveness of weight stigma in physical activity contexts. Employing weight-inclusive strategies may improve physical activity outcomes, though little is known about the practical application of weight-inclusive principles in physical activity contexts. Furthermore, given the prominence of virtual methods of information dissemination, exploring online weight-inclusive resources is valuable. Methods: Using Google, Instagram, and snowball searches, a virtual environmental scan was conducted to collect publicly available weight-inclusive physical activity resources. Two independent coders applied an a priori codebook to all eligible resources to evaluate the application of weight-inclusive principles. Results: N = 80 weight-inclusive physical activity resources were identified, offering a range of educational materials (40%) and/or provision of physical activity services (76.3%). Virtual resources generally adhered to weight-inclusive principles by showcasing diversity in body size, using weight-inclusive language, and centering physical activity that honors the body’s signals and cues; however, some also included weight-normative content. Provisional physical activity resources primarily targeted diverse-bodied end users, offered a range of physical activity types (eg, yoga, weight training, and dance), were membership-based, and offered asynchronous access. Conclusions: This study utilizes a systematic approach to collect and evaluate virtual, publicly available, and weight-inclusive physical activity resources. Virtual physical activity resources that adhere to weight-inclusive principles may be important for increasing accessible physical activity opportunities for higher-weight individuals.
Tracing the inner edge of the habitable zone with sulfur chemistry
Authors: Jordan Sean , Shorttle Oliver , Rimmer Paul B.
Published: January 2025

The circumstellar liquid-water habitable zone guides our search for potentially inhabited exoplanets but remains observationally untested. We show that the inner edge of the habitable zone can now be mapped among exoplanets using their lack of surface water, which, unlike the presence of water, can be unambiguously revealed by atmospheric sulfur species. Using coupled climate-chemistry modeling, we find that the observability of sulfur gases on exoplanets depends critically on the ultraviolet (UV) flux of their host star, a property with wide variation: Most M-dwarfs have a low UV flux and thereby allow the detection of sulfur gases as a tracer of dry planetary surfaces; however, the UV flux of Trappist-1 may be too high for sulfur to disambiguate uninhabitable from habitable surfaces on any of its planets. We generalize this result to show how a population-level search for sulfur chemistry on M-dwarf planets can be used to empirically define the habitable zone in the near future.
Climate change aggravates bird mortality in pristine tropical forests
Authors: Wolfe Jared D. , Luther David A. , Jirinec Vitek , Collings Jeremy , Johnson Erik I. , Bierregaard Robert O. , Stouffer Philip C
Published: January 2025

Stable understory microclimates within undisturbed rainforests are often considered refugia against climate change. However, this assumption contrasts with emerging evidence of Neotropical bird population declines in intact rainforests. We assessed the vulnerability of resident rainforest birds to climatic variability, focusing on dry season severity characterized by hotter temperatures and reduced rainfall. Analyzing 4264 individual bird captures over 27 years, we found that harsher Amazonian dry seasons significantly reduced apparent survival for 24 of 29 species, with longer-lived species being more strongly affected. Our model predicted that a 1°C increase in average dry season temperature would reduce the mean apparent survival of the understory bird community by 63%. These findings directly link climate change to declining bird survival in the Amazon, challenging the notion that pristine rainforests can fully protect their biodiversity under increasingly severe climate conditions.
Generalizing multiple memories from a single drive: The hysteron latch
Authors: Lindeman Chloe W. , Jalowiec Travis R. , Keim Nathan C.
Published: January 2025

Far-from-equilibrium systems can form memories of previous deformations or driving. In systems from sheared glassy materials to buckling beams to crumpled sheets, this behavior is dominated by return-point memory, in which revisiting a past extremum of driving restores the system to a previous state. Cyclic driving with both positive and negative strains forms multiple nested memories, as in a single-dial combination lock, while asymmetric driving (only positive strain) cannot. We study this case in a general model of hysteresis that considers discrete elements called hysterons. We show how two hysterons with a frustrated interaction can violate return-point memory, realizing multiple memories of asymmetric driving. This reveals a general principle for designing systems that store sequences of cyclic driving, whether symmetric or asymmetric. In disordered systems, asymmetric driving is a sensitive tool for the direct measurement of frustration.
VopX, a novel
Vibrio cholerae
T3SS effector, modulates host actin dynamics
Authors: Ulbrich Megan , Seward Christopher H. , Ivanov Andrei I. , Ward Brian M. , Butler J. Scott , Dziejman Michelle
Published: January 2025

Pathogenic
Vibrio cholerae
strains cause cholera using different mechanisms. O1 and O139 serogroup strains use the toxin-co-regulated pilus (TCP) and cholera toxin (CT) for intestinal colonization and to promote secretory diarrhea, while non-O1/non-O139 serogroup strains are typically non-toxigenic and use alternate virulence factors to cause a clinically similar disease. An O39 serogroup, TCP/CT-negative
V. cholerae
strain, named AM-19226, uses a type III secretion system (T3SS) to translocate more than 10 effector proteins into the host cell cytosol. Effectors VopF and VopM directly interact with the host actin and contribute to colonization. Our previous studies using the
Saccharomyces cerevisiae
model system identified VopX as a third effector that alters cytoskeletal dynamics. Herein, we used complementary approaches to translate yeast findings to a mammalian system and determined the target and mechanism of VopX activity. VopX overexpression in HeLa cells caused dramatic cell rounding. Co-culture of strain AM-19226 with polarized Caco-2/BBE monolayers increased formation of stress fibers and focal adhesions, as well as Caco-2/BBE adherence to extracellular matrix in a VopX-dependent manner. Finally, we demonstrate
in vitro
that VopX can act as a guanine nucleotide exchange factor for RhoA, which functions upstream of a mitogen-activated protein kinase (MAPK) signaling pathway regulating cytoskeletal dynamics. Our results suggest that VopX activity initiates a signaling cascade resulting in enhanced cell-extracellular matrix adhesion, potentially preventing detachment of host cells, and facilitating sustained bacterial colonization during infection. VopX function is therefore part of a unique pathogenic strategy employed by T3SS-positive
V. cholerae
, which involves multiple cytoskeletal remodeling mechanisms to support a productive infection.

IMPORTANCE

Despite different infection strategies, enteric pathogens commonly employ a T3SS to colonize the human host and cause disease. Effector proteins are unique to each T3SS-encoding bacterial species and generally lack conserved amino acid sequences. However, T3SS effectors from diverse pathogens target and manipulate common host cell structures and signaling proteins, such as the actin cytoskeleton and MAPK pathway components. T3SS-encoding
Vibrio cholerae
strains and effectors have been relatively recently identified, and the mechanisms used to mediate colonization and secretory diarrhea are poorly understood. Two
V. cholerae
effectors that modify the host actin cytoskeleton were shown to be important for colonization. We therefore sought to determine the target(s) and mechanism of a third actin-reorganizing effector, VopX, based on results obtained from a yeast model system. We recapitulated actin-based phenotypes in multiple mammalian model systems, leading us to identify the molecular function of the
V. cholerae
VopX effector protein.
Two new enzymes that liberate undecaprenyl-phosphate to replenish the carrier lipid pool during envelope stress
Authors: Roney Ian J. , Rudner David Z.
Published: January 2025

The 55-carbon isoprenoid, undecaprenyl-phosphate (UndP), is a universal carrier lipid that ferries most glycans and glycopolymers across the cytoplasmic membrane in bacteria. In addition to peptidoglycan precursors, UndP transports O-antigen, capsule, wall teichoic acids, and sugar modifications. How this shared but limited lipid is distributed among competing pathways is just beginning to be elucidated. We recently reported that in the bacterium
Bacillus subtilis
, the stress-response sigma factor SigM and its cognate anti-sigma factor complex respond to changes in the free UndP pool. When levels are low, SigM activates genes that increase flux through the essential cell wall synthesis pathway, promote the recycling of the lipid carrier, and liberate the carrier from other polymer pathways. Here, we report that two additional enzymes under SigM control help maintain the free pool of UndP. One, UshA (YqjL), resembles alpha-beta hydrolases and liberates UndP from undecaprenyl-monophosphate-linked sugars. The other, UpsH (YpbG), resembles metallophosphoesterases and releases UndP from undecaprenyl-diphosphate-linked wall teichoic acids polymers but not lipid-linked peptidoglycan precursors. UshA becomes critical for growth when UndP-linked sugars are sequestered, and the carrier lipid pool is depleted. Similarly, UpsH becomes essential for viability when UndPP-linked intermediates accumulate. Mutations in the predicted catalytic residues of both putative hydrolases abrogate their function arguing that they act directly to release UndP. These findings define two new enzymes that liberate the carrier lipid from UndP- and UndPP-linked intermediates and bolster the model that the SigM stress-response pathway maintains the UndP pool and prioritizes its use for peptidoglycan synthesis.

IMPORTANCE

Motivated by the success of naturally occurring glycopeptide antibiotics like vancomycin, one arm of recent antibiotic discovery efforts has focused on compounds that bind lipid-linked precursors used to build extracytoplasmic polymers. Trapping these precursors depletes the universal carrier lipid undecaprenyl-phosphate, which is required for the synthesis of virtually all surface polymers, including peptidoglycan. Understanding how cells respond to this stress to restore the carrier lipid pool is critical to identifying effective drugs. Here, we report the identification of two new enzymes that are produced in response to the depletion of the carrier lipid pool. These enzymes recover the carrier lipid but cleave distinct lipid-linked precursors to do so.
Identification of near full-length human pegivirus type 2 (HPgV-2) genomes in blood donor samples co-infected with hepatitis C virus (HCV)
Authors: Ragupathy Viswanath , Kelley Kylan , Hewlett Indira
Published: January 2025

Human pegivirus (HPgV) identified from an HCV-infected plasma sample through nanopore metagenomics. The analysis revealed a nearly complete HPgV-2 genome. Phylogenetic analysis confirmed its classification within the HPgV-2 genotype, providing insights into viral co-infection dynamics. The metagenomics approach advances the understanding of viral diversity and supports the development of accurate diagnostics.
Supplemental Material: Cretaceous to Oligocene deformation and exhumation history of the southern Qiangtang terrane and implications for the topographic evolution of Central Tibet
Authors: Li Yalin , al. et
Published: January 2025

The analytical methods and procedures for the samples of this work (Text S1); zircon U-Pb dating results for volcanic rocks in the Duoma-Eyacuo area (Table S1); apatite fission-track results of the analytical samples (Table S2).
Leflunomide-induced drug reaction eosinophilia systemic symptoms and haemophagocytic lymphohistiocytosis overlap syndrome with rheumatoid arthritis
Authors: Sebastian Anjely Pulparampil , Tirlangi Praveen Kumar , Saravu Kavitha , Acharya Roopa
Published: January 2025

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and haemophagocytic lymphohistiocytosis (HLH) are rare but severe immune-mediated diseases with overlapping clinical manifestations. We present a case of a woman in her late 40s with rheumatoid arthritis who developed DRESS/HLH overlap syndrome after starting hydroxychloroquine and leflunomide therapy. Despite corticosteroid treatment, her condition worsened, necessitating etoposide therapy. The persistent pancytopenia required supportive measures, including transfusions of blood products and administration of growth factors. Tofacitinib was successfully used as a steroid-sparing agent and resulted in the resolution of symptoms without relapse during a 2 month follow-up. This case emphasises the diagnostic and therapeutic challenges posed by the co-occurrence of DRESS and HLH and highlights the importance of tailoring treatment strategies to achieve good outcomes.
Starfield’s 4Cs of NCD management in primary healthcare: a conceptual framework development from a case study of 19 countries
Authors: Foo Chuan De , Logan Krishaa , Eu Elliot , Erlangga Darius , Rivillas Juan Carlos , Kosycarz Ewa , Pholpark Aungsumalee , Ritthisirikul Natchaya , Hanvoravongchai Piya , Putri Likke Prawidya , Marthias Tiara , Schenck Marcela , Benia Wilson , Turk Eva , Giang Kim Bao , Duong Doan Thi Thuy , Shrestha Supri , Esandi Maria Eugenia , Antonietti Laura , Xiong Shangzhi , Shrestha Pami , Tromp Jasper , Legido-Quigley Helena
Published: January 2025

Introduction

Faced with a backdrop of an increasing chronic disease burden from an ageing global population compounded with rising healthcare costs, health systems are required to implement cost-effective, safe and equitable care through efficient service delivery models. One approach to achieving this is through Starfield’s 4Cs of primary healthcare (PHC), which delineates the key attributes of a high-performing PHC system that upholds the pillars of care coordination, first contact of care, continuity of care and comprehensive care. Therefore, this study aims to explore and elucidate the key themes and subthemes related to and extending beyond Starfield’s 4Cs of PHC by integrating findings from a comprehensive literature review and a qualitative study.

Methods

In this case study analysis, case studies of PHC systems from 19 countries were purposefully selected to represent a range of income levels and diversity in health systems and PHC landscapes. A review of existing literature of peer-reviewed articles, policy documents and technical reports made publicly available data on PHC was complemented with data obtained from 61 in-depth interviews with health systems experts from a larger study. The research team thematically analysed the data and organised the key themes and subthemes into a conceptual framework that is anchored on Starfield’s 4Cs of PHC.

Results

Broadly, we developed a conceptual framework with the 4Cs, placing providers and patients at the centre. The key subthemes that manifested from Starfield’s 4Cs included maximising the use of existing fiscal resources, leveraging technology, improving accessibility to health services and task sharing. Other relevant and overarching themes were the deployment of national frameworks, equity, healthcare provider retention, service integration, emergency preparedness and community engagement.

Discussion

The subthemes derived point health systems in the right direction based on the trialled and tested PHC models of various countries. Their strong points were highlighted in our case studies to depict how Starfield’s 4Cs are leveraged to strengthen PHC, and the themes we identified that went beyond the 4Cs are necessary considerations for modifying PHC policies going forward.

Conclusion

As the world enters an era of ageing populations and acute system shocks, PHC needs to be fortified and integrated into the more extensive system to protect the health of the population and safeguard the well-being of providers. Our conceptual framework offers health systems a glimpse of how this can be achieved.
Gender-based violence and child nutrition in fragile settings: exploring intersections and opportunities for evidence generation
Authors: Meyer Sarah R , Vahedi Luissa , Bhatt Carreno Silvia , Roesch Elisabeth , Heckman Christine , Beckingham Andrew , Gayford Megan , Orjuela-Grimm Manuela
Published: January 2025

Gender-based violence (GBV) is disproportionately perpetrated against women and girls, due to harmful gender and social norms, structural gender-based power inequalities and pervasive discrimination against women and girls globally. In settings of fragility (eg, weak governance and humanitarian emergencies), risk factors for GBV are exacerbated while protective factors are eroded. Adequate nutrition is critical for mental and physical health and ensuring adequate nutrition for children in fragile settings is particularly critical. Fragile settings include heightened risk for GBV and malnutrition, but the combined impact of these two health contributors has rarely been examined together. Based on a rapid evidence assessment, we present evidence for associations between GBV against women and girls and child nutrition outcomes, identifying gaps in the evidence base and discussing key conceptual and methodological issues concerning research on this intersection. Improved understanding of the intersections between GBV and nutrition outcomes can help further highlight the linkages between these two public health issues and help inform programming and policy in both sectors.
Assessing the feasibility of measuring residents’ quality of life in English care homes and the construct validity and internal consistency of measures completed by staff proxy: a cross-sectional study
Authors: Towers Ann-Marie , Rand Stacey , Allan Stephen , Webster Lucy Anne , Palmer Sinead , Carroll Rachael , Gordon Adam L , Akdur Gizdem , Smith Nick , Burton Jennifer , Killett Anne , Hanratty Barbara , Meyer Julienne , Spilsbury Karen , Goodman Claire
Published: January 2025

Objectives

To assess the feasibility of capturing older care home residents’ quality of life (QoL) in digital social care records and the construct validity (hypothesis testing) and internal consistency (Cronbach’s alpha) of four QoL measures.

Design

Cross-sectional data collected in wave 1 of the DACHA (Developing resourcesAnd minimum dataset forCareHomes’Adoption) study, a mixed-methods pilot of a prototype minimum dataset (MDS).

Setting

Care homes (with or without nursing) registered to provide care for older adults (>65 years) and/or those living with dementia. All homes used a digital record system from one of two suppliers.

Participants

Data were extracted from 748 residents. All permanent residents, aged 65 years or older, were eligible to participate, including those lacking capacity to consent. Temporary residents and residents in their last weeks of life were excluded.

Outcome measures and analysis

The English language versions of Adult Social Care Outcomes Toolkit (ASCOT)-Proxy-Resident, ICEpop CAPability measure for Older people (ICECAP-O), EQ-5D-5L proxy and the QUALIDEM were added to the digital record. As there have not been any previous studies of the structural validity of the English language version of the QUALIDEM, ordinal exploratory factor analysis (EFA) was applied for this measure only. Feasibility (% missing by software provider and measure), % floor/ceiling effects (>15% at lower/upper end of the scales), convergent or divergent construct validity (criterion of >75% of hypotheses accepted) and internal consistency (Cronbach’s alpha ≥0.7) were assessed for all four measures.

Results

The ordinal EFA of QUALIDEM did not replicate the findings of previous research. A six-factor (36 item) solution was proposed and used in all subsequent analyses. There were low rates of missing data (<5%) for all items, except ASCOT-Proxy-Resident Control (5.1%) and Dignity (6.2%) and QUALIDEM item 35 (5.1%). Ceiling effects were observed for the ASCOT-Proxy-Resident and two of the QUALIDEM subscales. None of the scales had floor effects. Cronbach’s alpha indicated adequate internal consistency (α ≥0.70) for the ASCOT-Proxy-Resident, ICECAP-O and EQ-5D-5L proxy. There were issues with two QUALIDEM subscales. Construct validity for all measures was adequate.

Conclusions

The findings support the use of EQ-5D-5L, ASCOT-Proxy-Resident and the ICECAP-O in care homes for older people. The choice of measure will depend on the construct(s) of interest. More research is needed to establish the psychometric properties of the QUALIDEM in an English care home setting.
Work loss in patients with rheumatoid arthritis treated with abatacept, rituximab, tocilizumab or TNF inhibitors: a nationwide direct drug-to-drug comparison
Authors: Bruze Gustaf Magnus , Frisell Thomas , Turesson Carl , Forsblad-d'Elia Helena , Soderling Jonas , Askling Johan , Neovius Martin
Published: January 2025

Objective

To compare work loss after starting tumour necrosis factor inhibitors (TNFi), rituximab, abatacept or tocilizumab in patients with rheumatoid arthritis (RA).

Methods

We used data from the Swedish Rheumatology Quality Register to identify patients aged 19-62 years who were treated with TNFi (n=15 093), rituximab (n=2123), abatacept (n=1877) or tocilizumab (n=1720) between 2007 and 2020. Data on work loss (0–365 days per year) from sick leave and disability pension were retrieved from linkage to the Social Insurance Agency. Patients in the different treatment arms were balanced regarding baseline covariates using inverse probability weighting (IPTW).

Results

Work loss increased for patients with RA until drug treatment initiation, reached a peak in the month after treatment initiation and then levelled off. Following IPTW, at 3 years before starting the treatment, there were no statistically significant differences in the mean annual adjusted work loss days between rituximab, abatacept or tocilizumab vs TNFi (mean difference vs TNFi: rituximab 1.1 days, 95% CI −4.5 to 6.7; abatacept 3.3, 95% CI −2.6 to 9.2; tocilizumab 1.2, 95% CI −4.9 to 7.3). At 3 years after starting the treatment (latest January 2021), there were also no statistically significant differences in the mean annual adjusted work loss days (mean difference: rituximab −4.8 days, 95% CI −11.3 to 1.7; abatacept 5.3, 95% CI −1.8 to 12.3; tocilizumab −0.6, 95% CI −7.7 to 6.5).

Conclusions

Taking channelling into account, patients with RA treated with TNFi, rituximab, abatacept or tocilizumab had similar trajectories of work loss from sick leave and disability pension until treatment initiation, and similar trend breaks and plateau 3 years thereafter.
Design and Testing of a Pulsed Laser System for Single Event Effects Analysis on Semiconductor Devices
Authors: Elash Christopher J. , Pour Momen Peiman , Shi Shuting , Belev George , Sammynaiken R. , Chen Li
Published: January 2025

Single event upsets (SEUs) are a critical concern for reliability in semiconductor devices, particularly as technology nodes shrink and devices become more susceptible to cosmic rays and other radiation sources. Understanding and mitigating these effects are crucial for ensuring the reliability of electronic systems. By leveraging pulsed laser charge injection, researchers can achieve results comparable to traditional methods like heavy ion testing but at a lower cost and with better control over spatial and temporal parameters. The photogeneration effect in semiconductor devices due to single photon absorption and two-photon absorption is introduced and the test system designed to make use of both type of charge photogeneration is implemented. The design and development of the pulsed laser system at the Saskatchewan Structural Sciences Centre is described. The system's capabilities, such as precise control over pulse parameters and spatial targeting, make it a valuable tool for Single Event Effect (SEE) analysis. The testing of a Static Random Access Memory (SRAM) using this newly developed system provides valuable insights into the device's behavior under radiation-induced faults. By quantifying overall error rates, including multiple-bit errors and faults in memory and control circuitry, researchers can assess the device's susceptibility to SEUs. Comparing the pulsed laser results of SRAM testing with those obtained from heavy ion testing demonstrates the effectiveness of the pulsed laser system. Overall, the new and unique Pulsed Laser System at the SSSC represents a significant advancement in SEE testing capability. Its ability to provide results comparable to traditional methods while offering greater accessibility and control has the potential to drive further innovation in the field of radiation effects analysis in semiconductor devices.
Assessment of viable Enterobacteriaceae and Enterococcus spp. across the agro-ecosystem of an antibiotic-free swine farm
Authors: Langlois Alexandra , Vincent Antony T. , Petri Renée M. , Lauzon Karoline , Poulin-Laprade Dominic
Published: January 2025

Agricultural practices, specifically the use of antibiotics and other biocides, have repercussions on human, animal and plant health. The aim of this study was to evaluate the levels of Enterobacteriaceae and Enterococcus, as antibiotic resistant marker bacteria, in various matrices across the agro-ecosystem of an antibiotic-free swine farm in Quebec (Canada), namely pig feed, feces, manure, agricultural soil, water and sediment from a crossing stream, and soil from nearby forests. Samples were collected in fall 2022, spring and fall 2023 and spring 2024. All samples were subjected to counts of total, cefotaxime- and ciprofloxacin-resistant Enterobacteriaceae as well as total and vancomycin-resistant Enterococcus spp. The frequency of total and cefotaxime-resistant Enterobacteriaceae along with the vancomycin-resistant Enterococcus decreased with age in pig feces, from weaning to the end of the fattening period. High proportions of the Enterobacteriaceae recovered from feces and environmental samples were resistant to cefotaxime. Application of manure on fields contributed a significant input of Enterococcus, but those resistant to vancomycin were under the detection limit. This study shows the prevalence of antibiotic-resistant bacteria in a farm agro-ecosystem even without the administration of antibiotics to the animals, and highlights the complexity of components influencing antimicrobial resistance in the environment.
Burrowing crayfish (Crustacea: Decapoda: Parastacidae) as a tool for biomonitoring groundwater quality in South America.
Authors: Pérez-Espinoza Samuel A. , Rivera-Vera Lorena A. , Neira José Y. , Arumí José L. , Barra Ricardo O.
Published: January 2025

Groundwater-dependent ecosystems are among the most important and least understood natural environments on the planet and are currently known as components of the connected groundwater systems that are in turn a part of complex socioecological systems. In these ecosystems in South America, contamination processes are little studied, but contamination infiltration can be fast and hard to manage, which makes them particularly vulnerable and puts their ecological structure and function at risk. Ecotoxicological studies in groundwater environments are few and scattered, with most assessing the occurrence of trace elements in crustaceans of subterranean habitats. Therefore, the implementation of biological indicators as a tool to assess the ecological impacts of human associated environmental risks is an important step for the management of these vulnerable ecosystems. Here we use a combination of literature review and the compilation of distribution information to build a case for the suitability of the burrowing crayfish of the family Parastacidae as a candidate biological indicator of groundwater associated environments in South America. Our investigation found that these burrowing crayfish meet a number of criteria for their utility in this context, including their key role in the transfer of energy between different trophic groups, serving as a good model to assess the levels of bioaccumulation of trace elements and other contaminants and their consequent effects on the food chain and the food security and economy of human communities that depend on this crayfish as a resource. Therefore, these burrowing crayfish can serve as valuable tools for understanding complex socioecological systems, biomonitoring groundwater quality, and improving management of ecosystem services provided by groundwater-dependent ecosystems. We conclude by outlining a framework for moving toward implementation of this biomonitoring tool into surveillance and conservation efforts for these native and endemic species in South America.
Report from the Summer School on Software Engineering andArtificial Intelligence
Authors: Parra Esteban , Aponte Jairo
Published: January 2025

This report summarizes the curriculum and academic outcomes of the Summer School on Software Engineering and Artificial Intelligence (AI) held at the Universidad de Los Andes in Bogot´a, Colombia. The summer school offered an in-depth introduction to the fields of Machine Learning (ML), Artificial Intelligence (AI), and Natural Language Processing (NLP); their role and applications in Software Engineering (SE) and the software development process. The feedback we received from the participants indicates that the program successfully enhanced their knowledge and the skills needed for them to navigate the role of AI in the current landscape of software engineering.

The students of the summer school were engaged in the development of a full software system using AI-based tools as part of the development process. We found that the project was successful in providing the students with experience regarding how to incorporate AI-based tools as part of their software development process but not all students showed the same level of proficiency when leveraging AI tools.
Causes of Stability in Dynamic Coalition Formation
Authors: Boehmer Niclas , Bullinger Martin , Kerkmann Anna Maria
Published: January 2025

We study the formation of stable outcomes via simple dynamics in cardinal hedonic games, where the valuations of agents change over time depending on the history of the coalition formation process. Specifically, we analyze situations where members of a coalition decrease their valuation for a leaving agent (
resentment
) or increase their valuation for a joining agent (
appreciation
). We show a series of convergence results for dynamics for resentful or appreciative agents which do not hold for classic dynamics. In particular, resentment turns out to be a strong stability-driving force. We complement our theoretical analysis with simulations that shed some light on the average running time of the dynamics and on the structure of the produced outcomes. From an algorithmic perspective, we obtain general hardness results for determining the fastest convergence time, results which also carry over to classic dynamics under static valuation functions. Finally, we explore a related model for preference updates where resentment is expressed by the deviator. We find a more nuanced picture, but still a broad possibility of convergence.
GFairHint: Improving Individual Fairness for Graph Neural Networks via Fairness Hint
Authors: Xu Paiheng , Zhou Yuhang , An Bang , Ai Wei , Huang Furong
Published: January 2025

Given the growing concerns about fairness in machine learning and the impressive performance of Graph Neural Networks (GNNs) on graph data learning, algorithmic fairness in GNNs has attracted significant attention. While many existing studies improve fairness at the group level, only a few works promote individual fairness, which renders similar outcomes for similar individuals. A desirable framework that promotes individual fairness should (1) balance fairness and performance, (2) accommodate two commonly-used individual similarity measures (externally annotated and computed from input features), and, (3) generalize across various GNNs. Unfortunately, none of the prior work achieves all the desirables. In this work, we propose a novel method,
GFairHint
, which promotes individual fairness in GNNs and achieves all aforementioned desirables. GFairHint learns fairness representations through an auxiliary link prediction task, which is inspired by a theoretical analysis of the definition of individual fairness. We then concatenate the representations with the learned node embeddings in original GNNs as a
“fairness hint”
. Through extensive experimental investigations on five real-world graph datasets under three prevalent GNNs covering both individual similarity measures above, GFairHint achieves the best fairness results in almost all combinations of datasets with various backbone models, while generating comparable utility results, with much less computational cost compared to the previous state-of-the-art (SoTA) method.

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