bluuebunny/crossref_metadata_2025 huggingface dataset:
Cross-country analysis of aggregate markups and their impact on income inequality.
Authors: Malliaros Peter , Pacheco-Jaramillo W Alejandro
Published: February 2025

Background This study investigates the connection between aggregate markups and income inequality, exploring how market power affects inequality in developed, emerging, and developing economies. The analysis aims to reveal how institutional differences and economic systems shape this relationship. Method The study examines data from 12 countries from 1997 to 2016 using a panel data approach. The analysis focuses on key variables such as the Gini index (measuring inequality), lagged markups, trade openness, GDP per capita, tax revenue, poverty, and R&D expenditure. A two-way fixed-effects model is applied to account for country and year-specific differences, while robust standard errors ensure reliability. Results The results show that higher markups are closely linked to greater income inequality, with the impact being particularly pronounced in emerging and developing economies. Integrating tax policies, trade openness, and GDP growth into the analysis indicates the limitations of relying solely on economic growth to achieve equity. The research highlights taxation and trade as effective levers for mitigating inequality and raises important questions about the role of innovation in this dynamic. Conclusion This study shows the interaction between market power and inequality across diverse economic systems. We examine how factors like market concentration and institutional quality drive inequality provides practical insights and policy recommendations for effectively addressing income disparities.
Hesitant Fuzzy Subalgebras, Ideals and Congruences on Autometrized Algebras
Authors: Tilahun Gebrie Yeshiwas
Published: February 2025

This paper introduces the study of hesitant fuzzy subalgebras of autometrized algebras, obtains some of their properties, and gives some examples. Next, we introduce the concept of the hesitant fuzzy ideal and examine some of its properties. Finally, we introduce a hesitant fuzzy congruence on autometrized algebras and discuss some of its properties. We also introduce the characteristic equations and level subsets of hesitant fuzzy sets and relations on autometrized algebras.
Atacama Large Aperture Submillimeter Telescope (AtLAST) science: Our Galaxy
Authors: Klaassen Pamela , Traficante Alessio , Beltrán Maria , Pattle Kate , Booth Mark , Lovell Joshua , Marshall Jonathan , Hacar Alvaro , Gaches Brandt , Bot Caroline , Peretto Nicolas , Stanke Thomas , Arzoumanian Doris , Duarte Cabral Ana , Duchêne Gaspard , Eden David , Hales Antonio , Kauffmann Jens , Luppe Patricia , Marino Sebastian , Redaelli Elena , Rigby Andrew , Sánchez-Monge Álvaro , Schisano Eugenio , Semenov Dmitry , Spezzano Silvia , Thompson Mark , Wyrowski Friedrich , Cicone Claudia , Mroczkowski Tony , Cordiner Martin , Di Mascolo Luca , Johnstone Doug , van Kampen Eelco , Lee Minju , Liu Daizhong , Maccarone Thomas , Saintonge Amélie , Smith Matthew , Thelen Alexander , Wedemeyer Sven
Published: February 2025

As we learn more about the multi-scale interstellar medium (ISM) of our Galaxy, we develop a greater understanding for the complex relationships between the large-scale diffuse gas and dust in Giant Molecular Clouds (GMCs), how it moves, how it is affected by the nearby massive stars, and which portions of those GMCs eventually collapse into star forming regions. The complex interactions of those gas, dust and stellar populations form what has come to be known as the ecology of our Galaxy. Because we are deeply embedded in the plane of our Galaxy, it takes up a significant fraction of the sky, with complex dust lanes scattered throughout the optically recognizable bands of the Milky Way. These bands become bright at (sub-)millimetre wavelengths, where we can study dust thermal emission and the chemical and kinematic signatures of the gas. To properly study such large-scale environments, requires deep, large area surveys that are not possible with current facilities. Moreover, where stars form, so too do planetary systems, growing from the dust and gas in circumstellar discs, to planets and planetesimal belts. Understanding the evolution of these belts requires deep imaging capable of studying belts around young stellar objects to Kuiper belt analogues around the nearest stars. Here we present a plan for observing the Galactic Plane and circumstellar environments to quantify the physical structure, the magnetic fields, the dynamics, chemistry, star formation, and planetary system evolution of the galaxy in which we live with AtLAST; a concept for a new, 50m single-dish sub-mm telescope with a large field of view which is the only type of facility that will allow us to observe our Galaxy deeply and widely enough to make a leap forward in our understanding of our local ecology.
The genome sequence of a carabid beetle, Carabus problematicus Herbst, 1786
Authors: Sivell Duncan , Sivell Olga , Mitchell Ryan ,   Natural History Museum Genome Acquisition Lab,   Darwin Tree of Life Barcoding collective,   Wellcome Sanger Institute Tree of Life Management, Samples and Laboratory team,   Wellcome Sanger Institute Scientific Operations: Sequencing Operations,   Wellcome Sanger Institute Tree of Life Core Informatics team,   Tree of Life Core Informatics collective,   Darwin Tree of Life Consortium
Published: February 2025

We present a genome assembly from an individual female specimen of Carabus problematicus (carabid beetle; Arthropoda; Insecta; Coleoptera; Carabidae). The genome sequence has a total length of 254.00 megabases. Most of the assembly (97.1%) is scaffolded into 14 chromosomal pseudomolecules, including the X sex chromosome. The mitochondrial genome has also been assembled and is 21.42 kilobases in length. Gene annotation of this assembly on Ensembl identified 12,311 protein-coding genes.
Pelophylax ridibundus complex as bioindicator of the level of anthropogenic pollution of the environment
Authors: Bazarbayeva Zhannat , Ilderbayev Oralbek , Suleimenova Ainash , Nurmukhambetova Gaziza , Olzhayeva Rauza , Dukenbayeva Asiya , Issina Ayzhan
Published: February 2025

The work presents the relationship between the degree of pollution of water bodies and changes in the structure of internal organs of the marsh frogs, Pelophylax ridibundus complex, inhabiting these bodies of water. To determine this relationship, two natural lakes and one artificial water reservoir located in an industrialised area near the city of Astana in Kazakhstan were investigated and conclusions were drawn regarding the gradient of anthropogenic pollution. In addition, histological examinations of the gastrointestinal tract of frogs caught from these water bodies differing significantly in the gradient of heavy metal concentration were carried out. It was found that of the analyzed organs, the stomach and liver were the most sensitive to pollution. The concordance of the intensity of damage to these organs with the degree of pollution of the lakes and the reservoir, as determined by physicochemical analysis of the water, indicate that the studied species can be considered a bioindicator of early pollution of aquatic biotopes.
Movement in the Shadow of Sadness: How Physical Activity Supports the Fight Against Depression
Authors: Ossolińska Agata , Marta Patrycja , Huzarski Filip , Ferfecka Gabriela , Pawełek Klaudia , Stolarska Lucyna , Rosa-Bończak Magdalena , Morawiecka Natalia , Carlton Olivier , Weronika Kłosowicz
Published: February 2025

Physical activity plays a critical role in promoting physical and mental health, positively influencing the prevention of non-communicable diseases (NCDs) and enhancing brain function. Research indicates that regular physical exercise, such as aerobic or strength training, aids in the prevention and treatment of mental disorders such as depression, schizophrenia, and Alzheimer’s disease. The biological mechanisms associated with physical activity include improved cerebral blood flow, modulation of neurotransmitter systems, and increased levels of neurotrophic factors like BDNF. Exercise also affects the balance of neurotransmitters, such as serotonin, dopamine, and GABA, contributing to improved mood, cognitive abilities, and quality of life. Additionally, physical effort reduces inflammation and oxidative stress, supporting brain health and countering neurodegenerative processes. Regular moderate exercise is an effective method to prevent central fatigue and enhance the adaptability of the central nervous system. This paper explores the complex impact of physical activity on mental health and cognitive function, emphasizing its vital role in supporting the therapy of neurological and psychiatric disorders.
Autism spectrum disorder: definition, global epidemiology, prevalence in Poland and worldwide, and heredity
Authors: Zakrocka Martyna , Gruszka Marta , Polańska Paulina , Kubicka Maria
Published: February 2025

Introduction: The understanding of autism spectrum disorder (ASD) has evolved significantly. First mentioned in 1911, autism was described as "early childhood autism" by Leo Kanner in 1943, and a milder form, Asperger syndrome, was outlined by Hans Asperger in 1944. Expanding diagnostic criteria have led to increased recognition, with prevalence rising from 1 in 2,000 children in the 1980s to about 1 in 100 today. This growth is attributed to improved diagnostics, awareness, and healthcare access. While its exact causes remain unknown, ASD risk is influenced by genetic, environmental, prenatal, and perinatal factors, with genes like SHANK3, CHD8, and FMR1 playing key roles.
The aim of the study: This study aims to provide a comprehensive overview of autism spectrum disorder by examining its definition, historical context, epidemiology, and heredity. Special attention is given to global prevalence rates, with a focus on comparative trends in Poland, as well as genetic advancements shaping our understanding of this condition.
Material and method: In our article we used English databases such as PubMed and Google Scholar. We selected the articles according to keywords such as “ASD”, “autism”, “history of autism”, “epidemiology”, “inheritance”, “genetic”. The articles we used were published from 1943, mainly 2019-2024.
Conclusions: ASD is a complex condition influenced by genetic and environmental factors. Advances in diagnostics and awareness have led to increased prevalence rates globally. Genetic studies highlight key hereditary components, offering insights for early intervention. Ongoing research and culturally tailored strategies are essential to improve diagnosis, support, and quality of life for individuals struggling with this condition.
The COVID-19 pandemic and its impact on mental health. Causes and consequences - an overview
Authors: Cioch Michał Jakub , Kaczmarska Urszula , Woźniak Aleksandra , Nowak Julia , Hermanowicz Kamil , Doman Katarzyna , Najdek Agnieszka , Oleksy Daria , Mycyk Marcin , Komada Dawid
Published: February 2025

Introduction:This article provides an overview of the COVID-19 pandemic, which lasted from 2019 to 2023, and its impact on mental health. It will discuss risk factors leading to mental health disorders during the pandemic. Attention will also be given to the risk factors and possible causes, groups most affected and the ways to deal with mental disorders during a pandemic will also be discussed. Aim of study:The aim of the study is to assess the impact of the COVID-19 pandemic on mental health, identify risk factors and possible causes of mental disorders during this period, and identify groups that are particularly vulnerable to the negative psychological effects of the pandemic.Materials and methods:A comprehensive literature review was conducted using the PubMed database, focusing on articles published up to the end of 2024. The search included the keywords “COVID-19”, “mental health”, “pandemic”, “depression” in different combinations. Relevant studies were selected based on criteria such as causes and risk factors. Special attention was paid to vulnerable groups (e.g., children and the elderly, etc.) and how changes in the pandemic (e.g., social isolation) affected mental health. Conclusion:The pandemic of COVID-19  has affected not only people's physical health but also their mental health. Studies indicate that during the COVID-19 pandemic, the incidence of mental illnesses increased, and the symptoms of people with mental disorders were exacerbated including symptoms of general anxiety, sleep disorders, depressive disorders, etc. The study discussed risk factors such as social isolation, etc. and how they caused an increase in mental disorders
The Impact of Menstrual Cycle Phases on Athletic Performance: A Comprehensive Review
Authors: Rosińska-Lewandoska Dominika , Lewandowska Dominika , Ufnal Julia , Podraza Anna , Strep Dominika , Grabowska Julia , Kwiatkowski Maciej , Romańczyk Patryk , Białczak Julia , Kanownik Weronika
Published: February 2025

Introduction
The menstrual cycle influences various physiological systems, including energy metabolism, neuromuscular function, and psychological states, which collectively impact athletic performance. Despite increased research in this area, findings remain inconsistent due to individual variability and methodological differences. This review synthesizes current evidence on the effects of menstrual cycle phases on athletic performance to identify actionable strategies for female athletes.
Materials and Methods
A systematic review of 35 studies published between 2019 and 2025 was conducted using PubMed and PMC databases. Inclusion criteria focused on studies examining the physiological, psychological, or performance-related effects of menstrual cycle phases. Each study was evaluated for its methodology, population, and outcomes to ensure a comprehensive analysis.
Analysis of the Literature
This review explores the influence of hormonal fluctuations during the menstrual cycle on energy metabolism, neuromuscular function, endurance, strength, and psychological aspects. It highlights individualized recovery strategies and long-term adaptations to phase-specific training.
Conclusions
Menstrual cycle phases exert significant, though variable, effects on athletic performance. While the follicular phase favors carbohydrate metabolism and high-intensity activities, the luteal phase supports fatigue resistance and fat utilization. Personalized training protocols informed by hormonal profiling can optimize outcomes, though further research is needed to standardize methodologies and evaluate long-term adaptations.
Immunodeficiency, Centromeric Instability, and Facial Dysmorphism (ICF) Syndrome: How HSCT alters the impairment of the DNA methylation process
Authors: Homa Wojciech , Wanat Joanna , Dzikowska Izabela , Siejka Agata , Stefaniak Daria , Warunek Aleksandra , Gronowicz Gabriela , Chról Michał , Zielińska Weronika
Published: February 2025

Introduction and purposeIn 2024, the EBMT Inborn Errors Working Party published a study that confirmed the beneficial role of hematopoietic stem cell transplantation (HSCT) in patients with immunodeficiency, centromeric instability, and facial dysmorphism (ICF) syndrome. In this article, we aim to present the characteristics of ICF in an accessible way, including its genetic background, clinical presentation, immunological alterations, and treatment options. A brief description of the state of knowledgeIn recent years, published reviews and series of cases have expanded the range of known symptoms and complications occurring in patients with ICF. Our understanding of immunological alterations in ICF evolved from isolated defects of immunoglobulin production to a comprehensive model, which involves impairment of cellular immunity. Advances in molecular biology and genetics enabled insights into the DNA methylation machinery, which allowed us to gain a more precise understanding of the pathogenesis of ICF and also opened up opportunities for the development of new therapeutic options.
Summary Inborn errors of immunity (IEI), such as ICF, are diagnosed at an early stage of life. It enables effective treatment with longer survival of the patients. It means that healthcare professionals are increasingly likely to encounter such patients in their clinical practice. Thus, it is crucial to inform about the usage of the HSCT in ICF syndrome and spread awareness of potential new treatment options, that may emerge in the near future.
Mental health challenges faced by professional athletes
Authors: Szczepanek Dawid , Szczurek Katarzyna , Biecka Adrianna , Wyrzykowski Mikołaj
Published: February 2025

Background: Sport psychiatry is a dynamic and constantly developing discipline of medicine. Professional athletes may experience a variety of mental health problems that influence their everyday life and sport performance. Therefore, the potential risk factors for developing mental disease should be known to coaches and physicians to provide adequate help for athletes.
Materials and methods: We reviewed publications obtained from PubMed and Google Scholar. Articles were selected on the basis of keywords such as “sport psychiatry”, “mental health in athletes”, and “depression in professional sport”. For the final analysis, the eligible articles were published from 2015--2024.
Results: The prevalence of mental disorders varied across the analyzed studies. The presence of symptoms depends on the type of sport performed by the individual, past history of psychiatric diseases or sex. Additionally, studies have used different types of evaluation tools, which may influence the results.
Conclusions: Mental health diseases are present in this group, in some cases more frequently than in the general population. Professional athletes should be watched carefully for the potential development of psychiatric symptoms, especially in the most vulnerable groups. There is also a need for further studies with validated athlete research tools for more reliable results.
Modelo de internacionalización de negocios culturales
Authors: Redondo Méndez Andrea Carolina , Jiménez Olivera Vicente Alejandro , Pinzón Muñoz Carlos
Published: February 2025

El sector cultural viene enfrentando desafíos y situaciones problemáticas asociadas con la falta de financiamiento, piratería, limitaciones en la formación y educación, falta de políticas públicas adecuadas, competencia internacional e informalidad. Ello ha dificultado el posicionamiento directo de las empresas culturales en los mercados internacionales. Objetivo: proponer un modelo de internacionalización para los negocios del sector cultural, nacional e internacional, que no solo permita a las empresas generar mayores beneficios económicos sino, además, ampliar su mercado y mejorar su competitividad, partiendo de sus particularidades al manejarlas como fortalezas dentro del proceso. Metodología: descriptiva con método explicativo-analítico, debido a que se utilizó la observación y la descripción de un fenómeno. Además, con un enfoque propositivo que permitió el establecimiento de un modelo que no existe en el mundo. Resultados principales: se elaboró un modelo de internacionalización para el sector cultural, a partir de las características particulares de las empresas que componen el sector. Conclusiones: este modelo posee la interacción tripartita entre la relación con el ecosistema creativo, la selección del modelo y el esquema del proceso de internacionalización.
Exámenes europeos. Sección de Medicina del Trabajo de la UEMS
Authors: Rodríguez-Jareño Maria Cruz
Published: February 2025

El quinto examen europeo de la Especialidad de Medicina del trabajo tendrá lugar el 21 de octubre de 2024 en Bruselas.
El examen lo puede realizar cualquier especialista en Medicina del Trabajo, pero está especialmente dirigido a residentes de último año o que han terminado recientemente la especialidad. El contenido del examen se ajusta a los Requisitos de Formación Europeos. En la página web de la Sección de Medicina del Trabajo de la UEMS2 se puede encontrar la bibliografía recomendada para preparar el examen, testimonios de los propios candidatos, así como otra información detallada sobre inscripción, tasas de examen y alojamiento en Bruselas, sitio donde se realiza presencialmente la prueba3.
Mediante este artículo se procede a hacer difusión de la convocatoria del examen para darlo a conocer a los posibles interesados. Dado que los principales destinatarios son los residentes de último año, también se ha informado a las diferentes Unidades Docentes, a la Comisión Nacional de la Especialidad de Medicina del Trabajo, y a las Sociedades Científicas de Medicina del Trabajo.
Trabajo nocturno y cáncer de endometrio
Authors: Costas Laura
Published: February 2025

Entrevista a Laura Costas
Cuidadores en salud: perspectivas, motivaciones, intereses y desafíos laborales
Authors: Grande Ratti Maria Florencia , Hongn Diana , Ichazo Inés , Rossetti Sofía , Murature Delfina , Martinez Bernardo Julio , Perez Manelli Romina Yasmin
Published: February 2025

Introducción: El envejecimiento de la población conlleva enfermedades crónicas y dependencia en actividades diarias, volviendo imprescindibles a los cuidadores/s. Nos propusimos explorar percepciones y preocupaciones de estos/as trabajadores/as.
Método: Estudio cualitativo que incluyó diez entrevistas individuales y semiestructuradas a cuidadores/as, realizadas durante 2023 en un hospital de tercer nivel en Buenos Aires (Argentina). El material obtenido fue sometido a análisis de contenido temático, y mediante triangulación se codificó el texto por dimensiones emergentes.
Resultados: Predominaron mujeres (90%), de mediana edad (52 años), con bajo nivel educativo y formación a través de la experiencia. Surgieron cinco grandes tópicos: (a) responsabilidades y funciones; (b) condiciones laborales; (c) emociones y cuestiones vinculares; (d) problemas de comunicación; y (e) visión y experiencia sobre el sistema sanitario. Las tareas laborales incluyeron apoyo emocional, comunicación con el equipo (médico y familia), y delegación de tareas domésticas. Se destacaron problemas de comunicación debido a lenguaje técnico, falta de tiempo y de reconocimiento sobre su rol. La falta de continuidad en el seguimiento post-externación fue sistemática, aunque valoraron positivamente la información en la epicrisis. Las dificultades laborales incluyeron largas jornadas, episodios de violencia (física, verbal, psicológica y/o emocional), bajos honorarios y métodos de contratación informal (sin derechos que protejan descanso o salud). A pesar de esto, expresaron dedicación y empatía hacia los/as pacientes.
Conclusiones: Los resultados de este estudio aportan información valiosa para mejorar las condiciones laborales y la seguridad de los/as cuidadores/as en salud, resaltando la necesidad de mejorar tanto su entorno laboral como su reconocimiento social.
Characterisation (and mischaracterisation) of occupational injuries in portuguese jurisprudence. An analysis from 2011 to 2021
Authors: Rebelo Glória , Almeida António
Published: February 2025

Based on Portuguese case law, this study examined the characterisation and mischaracterisation of occupational injuries in the Portuguese court system. A content analysis was carried out, namely on how the Portuguese courts understand the characterisation and mischaracterisation (requirements) of occupational injury sentences. Case law was collected and analysed from listed decisions by the higher courts (Supreme Court of Justice and the Portuguese Courts of Appeal), between 2011 and 2021. A total of 330 judicial decisions were identified and analysed; groups of descriptors were categorised and sub-themes were identified. The sub-theme ‘concept and scope of the injury’ was identified in 80 decisions and ‘mischaracterisation of injuries’ in 46 decisions. This analysis reflects the Portuguese courts' understanding of the extent to which occupational injuries are characterised, which will be important to safeguard the system of compensation for occupational injuries in Portugal.
Salud mental en los profesionales sanitarios tras la irrupción de la pandemia por COVID-19
Authors: Talavera-Velasco Beatriz
Published: February 2025

Entrevista con Beatriz Talavera-Velasco
Identificación de trabajadores especialmente sensibles en el ámbito sanitario mediante un cuestionario de salud laboral
Authors: Sol Vidiella Josep , Pelechano-Valcarcel Sonia , Lapeira-Figueres Carme , Verdera-Benedicto Susana
Published: February 2025

Objetivo: Facilitar la identificación de trabajadores/as especialmente sensibles (TES) frente a riesgos laborales y la priorización de los exámenes de salud iniciales y periódicos de trabajadores de centros sanitarios.
Método: Estudio transversal realizado en profesionales sanitarios/as de once equipos de atención primaria y un centro hospitalario de la Gerència de Terres de l’Ebre del Institut Català de la Salut. Se utilizó un cuestionario de salud laboral que incluía variables que definían las vulnerabilidades de los/as TES, junto con una analítica básica con serologías adaptadas a los riesgos del ámbito sanitario. En una primera fase dicha metodología se aplicó a trabajadores de nueva incorporación durante el periodo pandémico 2020-2022, y posteriormente, en una segunda fase se amplió a la totalidad de los/as TES registrados en el periodo 2013-2023.
Resultados: Se identificaron 10 TES en la primera fase y 598 TES en la segunda. El grupo de vulnerabilidad asociada más frecuente fue el embarazo/lactancia materna (n=271; 45,3%), seguido de osteomuscular (n=145; 24,3%), las alergias (n=55; 9,2%), salud mental (n=38; 6,4%), inmunológicas (n=33; 5,5%), otras vulnerabilidades (n=32; 5,4%) y discapacidades sensoriales (n=24; 4,0%). En las dos fases de nuestro estudio el 100% de las variables definitorias de TES podían identificarse a través de este método. 
Conclusiones: La implementación de un cuestionario de salud laboral, complementado con una analítica y serologías es una herramienta útil para facilitar la identificación inicial de TES, priorizar los exámenes de salud de los TES de nueva incorporación y mejorar el seguimiento laboral del resto de trabajadores.
Beyond banding: recognising the true value of nurses
Authors: Parkin Chloe
Published: February 2025

In this comment, Chloe Parkin discusses the detriments of referring to nurses by their agenda for change bands, and calls for change to the traditional hierarchical structures in the nursing profession.
Neurological observations
Authors: Hill Barry , Daby Sunny , Wilcox Heather , Berry Harri , Newman Marie , Amoateng Geoffrey
Published: February 2025

The fundamentals series is a collection of articles that present key procedures and competencies, as outlined in the Nursing and Midwifery Council's Future nurse: standards of proficiency for registered nurses. In this article, Barry Hill and colleagues outline how to perform neurological observations and special considerations for a mental health setting.
Measuring and interpreting blood glucose levels
Authors: Loader Katie
Published: February 2025

The fundamentals series is a collection of articles that present key procedures and competencies, as outlined in the Nursing and Midwifery Council's Future nurse: standards of proficiency for registered nurses. In this article, Katie Loader outlines how nurses can measure and interpret blood glucose levels.
Psychological, behavioural and relevant factors affecting wound healing, and the buffering role of interventions
Authors: Irani Masoud , Kordestani Soheila Salahshour
Published: February 2025

Wound healing is a complex process accompanying numerous health conditions, and millions of people across the world experience deleterious impacts caused by wounds. There are many non-biological factors that can directly or indirectly affect the health outcomes of patients with wounds. The purpose of this review was to investigate the effects of psychological, behavioural and other relevant factors on wound healing. In addition, as the possible associations among these factors have, in the authors' view, not been addressed appropriately, we also aimed to examine if there were specific relationships among these factors and between these factors and health outcomes. Finally, we reviewed the role of various interventions in buffering negative impacts during health procedures.
The role of a caregiver of a patient with venous leg ulcers in recurrence prevention: a case study
Authors: Karafová Anna , Siemieniecka Agnieszka , Karafa Marian
Published: February 2025

Objective:

Venous leg ulcer (VLU) is a common complication which significantly reduces the patient's quality of life. Despite many effective treatment methods, such as compression therapy, which allow the wound to heal in a short time, it is important to maintain the long-term effects of the therapy. We present the case of a 67-year-old male patient with a trophic ulcer of his left leg.

Method:

The patient was treated with inelastic multicomponent compression bandages applied every day under Kikuhime pressure-measuring device (HPM-KH-01; TT Meditrade, Denmark) control and advised to wear a compression stocking.

Results:

The patient's wound closed within eight weeks. After five months, the patient returned to our clinic with a one-month-old wound due to non-adherence with medical recommendations.

Conclusion:

Key roles in recurrence prevention seem to be played not only by the patient's motivation and perseverance, but, more importantly, by the approach of the therapist. Health professionals should focus not only on one-time closure of the patient's wound, but on cooperation with the patient's family and caregivers, and instructing them on how to look after the patient on a daily basis, including with help to put on compression garments and with motivation to move and exercise. In many cases, with unaccompanied patients, rapid VLU recurrence is observed.
The efficacy and safety of acids as topical antimicrobial agents: a review
Authors: Nagoba Basavraj S , Rayate Abhijit S , Gavkare Ajay M , Rao Arunkumar
Published: February 2025

Objective:

Infected wounds, refractory to conventional therapy, are a major burden on the healthcare system. Available data show that many commonly used antiseptic agents may be toxic to the cells involved in the healing process and may affect the normal tissue repair. The topical use of different acids to control wound infections effectively and promote healing is well known. The present review aims to summarise the safety and efficacy of various acids as topical agents for treating wound infections.

Method:

A literature search was performed in PubMed and manually from other sources (cross references and journal sites).

Results:

We reviewed 116 articles, from which data from 86 relevant articles were analysed. The studies showed that various organic acids were clinically effective in treating wound infections.

Conclusion:

This study found that various organic acids can act as a substitute for antiseptics to control wound infections refractory to conventional antibiotic therapy and local wound care. Various organic acids differ in efficacy, safety and limitations as topical agents to control wound infections and promote healing. Some acids deliver better results than others, particularly in those cases in which antibiotics and routine antiseptic agents yield little lasting success, especially in controlling hospital strains with multiple antibiotic resistance. Among topically used acids, citric acid and acetic acid are associated with better results.
Relationship of opioid tolerance to patient and wound factors, and wound micro-environment in patients with open wounds
Authors: Bae Jaewon , Campbell Amy , Hein Maria , Hillis Stephen L , Grice Elizabeth , Rakel Barbara A , Gardner Sue E
Published: February 2025

Objective:

Opioid tolerance is a criterion for opioid use disorder, which is currently an epidemic in the US. Individuals with open wounds are frequently administered opioids; however, the phenomenon of opioid tolerance has not been examined in the context of wounds. The purpose of this exploratory study was to compare patient/wound factors, wound microbiome and inflammatory mediators between individuals who were opioid-tolerant versus those who were not opioid-tolerant.

Method:

Patients with acute open wounds were enrolled in this cross-sectional study. All study data were collected before and during a one-time study dressing change.

Results:

The study included a total of 385 participants. Opioid-tolerant participants were significantly younger (p<0.0001); had higher levels of depression (p=0.0055) and anxiety (p=0.0118); had higher pain catastrophising scores (p=0.0035); reported higher resting wound pain (p<0.0001); had a higher number of wounds of <30 days' duration (p=0.0486); and had wounds with lower bacterial richness (p=0.0152) than participants who were not opioid-tolerant. A backward elimination logistic regression model showed that four predictors—resting wound pain, age, bacterial richness and depression—were the most important variables in predicting opioid-tolerance status.

Conclusion:

These findings provide the first insights into the phenomenon of opioid tolerance in the context of open wounds. This study provides findings from which to guide hypothesis-driven research in the future.
Pressure injury detection using alternate light: a proof-of-concept study
Authors: Scafide Katherine N , Arundel Linda , Assas Ghadeer , King Erica L
Published: February 2025

Objective:

Identification of early-stage pressure injuries (PIs) during visual skin assessment may be subjective and unreliable. An alternate light source (ALS) has been shown to increase the probability of detecting evidence of bruises on individuals with darker skin tones. Bruises and early-stage PIs are often difficult to identify, especially in those with darker skin tones, where melanin concentration is high. Given the effect skin pigmentation has on detecting both types of cutaneous injuries, this proof-of-concept study aimed to describe the characteristics of Stage 1 PIs and deep tissue PIs as viewed under an ALS.

Method:

Eligible participants were first examined by a certified wound ostomy continence nurse using environmentally available white light. A blinded second examiner then evaluated the size of the potential tissue impairment using violet (406nm) and blue (448nm) ALS viewed through yellow and orange goggles, respectively. Portable ultrasound was used to confirm tissue involvement. Data were summarised using descriptive statistics.

Results:

The study included 10 participants (40% of whom were from minority racial/ethnic groups) with a mean Braden Scale score of 11.1. The majority of PIs (80%) involved deep tissue and were located on lower extremities (60%). The median PI size was larger by 17.5cm2 and 13.7cm2, respectively, using ALS compared with white light when viewed under violet and blue wavelengths. Ultrasound data were limited to non-extremity regions (n=3 participants) with hypoechoic areas noted as being 10–13mm in thickness and up to 16.7mm deep.

Conclusion:

Evidence of tissue damage that extended beyond that visualised under white light was noted with ALS. Usefulness of ultrasound was limited over bony prominences where there was too little subcutaneous tissue. Further research is warranted to investigate the potential application of ALS for the early detection of PIs.
Cutting Costs & Errors
Authors: Abbott Phil
Published: February 2025

End-to-end data exchange through ERP integration can streamline multi-entity manufacturing organisations making them more efficient and cost effective to manage.
LONG-TERM CONSEQUENCES OF TOTAL ANKLE ARTHROPLASTY VERSUS ANKLE FUSION: A 25-YEAR NATIONAL POPULATION STUDY OF 41,000 PATIENTS
Authors: Hennessy Conor , Abram Simon , Loizou Con , Brown Rick , Sharp Bob , Kendal Adrian
Published: February 2025

Introduction

Definitive treatment for ankle arthritis is either Total Ankle Replacement (TAR) or Ankle Fusion (AF). AF may pre-dispose to hindfoot fusion resulting in a debilitatingly rigid ankle-hindfoot complex. In comparison, TAR may protect against adjacent joint disease but is associated with high revision rates. We do not know the life-time risks of further surgery, adjacent joint disease progression and rare but serious complications of TAR versus AF.

Methods

An England population cohort study was performed using the ONS mortality linked Hospital Episode Statistics database (1998–2023). The primary outcome was Kaplan-Meier curve analysis of revision surgery free survival of TAR versus AF. Secondary outcome measures were the rates of any re-operation to the ankle/hindfoot, including hindfoot fusion rate, 90-day complications, and peri-operative mortality.

Results

10,335 TAR and 30,704 AF were analysed. The revision rate of TAR was significantly higher than AF at all time points, including 5 years (6.7% vs 2.1%), 10 years (11.1% vs 2.9%) and 20 years (13.1% vs 3.1%).

There was no significant difference in 20-year risk of hindfoot fusion following AF (5.94%, 95% CI 5.15 to 6.8%) versus TAR (4.80%, 95% CI 3.4% to 6.6%).

TAR was associated with higher risks of intra-operative fracture (0.42% vs 0.10%, RR = 4.35) and re-operation for wound infection (0.26% vs 0.15%, RR 1.74) but fewer pulmonary emboli (0.23% vs 0.58%, RR = 0.40).28.9% of TAR resulted in a further operation; 60% of which were for exploration/debridement, infection, aspiration and/or revision.

Conclusions

Both TAR and AF are safe definitive treatments of ankle arthritis with low peri-operative risk. The risk of subsequent hindfoot fusion after AF is very low and not significantly higher than after TAR. England TAR revision rates are lower than reported globally with many smaller operations performed before the more complex revision surgery.
SUPRAMALLEOLAR OSTEOTOMY FOR ANKLE ARTHRITIS: SINGLE TERTIARY REFERRAL CENTRE. A 12-YEAR OVERVIEW COMPARING STANDARD AND CUSTOM IMPLANTS
Authors: Ali Seyed Ashgar , Mubark Islam , Weerasinghe Konara
Published: February 2025

The aim was to demonstrate that Supramalleolar osteotomy is a valuable treatment method in eccentric ankle arthritis in young and middle aged since it is an under-utilised procedure. We retrospectively analysed the outcome of it performed over 12 year period. We also compared the results of recently introduced computer-assisted PSI Integrated custom-made implants with standard implants.

Data was analysed from 48 patients over a period of 12 years of which 40 were by standard implant and 8 by computer assisted custom implant. 31 varus, 18 valgus deformity. The mean age was 57 (26–79 y/o), male:female ratio was 27:19. Mean follow-up was 15.25 months for standard implants; For the computer-assisted procedures the follow up range is 24 to 2 months. TAS, TTS and TT angels were measured pre and post-operatively. Fixation using a plate with/without bone graft or custom-made implant was performed by a single surgeon. MOXFQ and AOFAS questionnaires were completed pre and post-operatively. All followed similar rehabilitation programme.

Average radiological healing time was 24.3 weeks. MOXFQ score improved from 55.17 to 25.11 and AOFAS from 20.16 to 56.21. Complications were 2 non-unions, 1 delayed union, 1 stress fracture. 8 patients require fusion/replacement between 3–5 years.

The PSI Integrated computer-assisted technique gave improved accuracy than standard freehand method with better scores and a smoother approach for the surgeon. Early results with this technique are encouraging as we were able achieve 3 dimentional correction compared to the 2 dimentional correction achieved by the freehand method.

Our results are comparable to similar studies. Being a joint preserving technique, Supra Malleolar Osteotomy should be considered either as an interim or definitive procedure especially with the development of computer assisted technologies which makes the technique easier to reproduce.
A NATIONAL SURVEY OF BOFAS MEMBERS ON THE TREATMENT OF PRIMARY OSTEOCHONDRAL DEFECTS OF THE TALUS
Authors: Khan Murtaza , Ankers Thomas , Mangwani Jitendra , Makwana Nilesh
Published: February 2025

Introduction

Osteochondral defects (OCDs) of the talus were identified as a “TOP 10” research priority in foot and ankle surgery by the James Lund Alliance in partnership with BOFAS, BOA and NIHR. To develop a research strategy, the views of BOFAS members regarding OCDs of the talus were surveyed. The results are reported here.

Methods

A questionnaire concerning the presentation, investigation and management of OCDs was formulated with input from the BOFAS National Clinical Study Group and ratified by the Scientific Committee. It concerned primary OCDs of the talus that had failed non-surgical management. It was distributed to BOFAS members via email using _Microsoft Forms_.

Results

There were 90 responses. Data on presenting symptoms, investigations, initial management and decision making was collected. Surgical treatment was grouped according to defect size: small or large and shallow or deep. This gave 4 categories. For the purposes of the study a large defect had a width >15mm and a deep defect had a depth >5mm. For small, shallow lesions 85 respondents chose microfracture as the first line surgical treatment. For large shallow lesions 59 respondents chose microfracture, 18 chose bone marrow stimulation plus scaffold e.g. AMIC or ACIC and 6 chose bone marrow stimulation plus a biological agent e.g. cBMA or PRP. For small deep lesions microfracture was again most popular (69 respondents). For large deep lesions microfracture was chosen by 43 respondents, AMIC/ACIC by 23 and OATs by 7. Further data was collected on post op rehabilitation.

Discussion

The study demonstrates that microfracture is the most popular first line treatment for primary OCDs of the talus of any size. That said, a wide range of treatments are in practice. This information will facilitate the development of high-quality studies to identify the most appropriate evidence-based treatment for OCDs of the talus.
Association between vaspin rs2236242 gene polymorphism and atherosclerosis in ischemic stroke patients with diabetes mellitus in the Indonesian population
Authors: Danuaji Rivan , Suroto  , Purwanto Bambang , Indarto Dono , Muhammad Faizal , Mirawati Diah Kurnia , Widyaningsih Vitri , Soetrisno  , Subandi  , Budianto Pepi , Hambarsari Yetty , Hamidi Baarid Luqman , Prabaningtyas Hanindia Riani , Hutabarat Ervina Arta Jayanti , Ristinawati Ira , Tejomukti Teddy , Tedjo Raden Andi Ario
Published: February 2025

BACKGROUND Stroke is the third leading cause of morbidity and second in mortality worldwide. Diabetes mellitus (DM) is a risk factor for stroke. Vaspin and single nucleotide polymorphism (SNP) rs2236242 involved DM pathogenesis. This study aimed to explore the correlation between SNP rs2236242, serum vaspin levels, and atherosclerosis in patients with ischemic stroke and DM.
METHODS This study was conducted in Dr. Moewardi Hospital from 2022 to 2023. The case group included patients with ischemic stroke and DM, while the controls were those with ischemic stroke only. Tetra-primer amplification refractory mutation system-polymerase chain reaction was used to determine the genotypes.
RESULTS There were 31 cases and 33 control. SNP rs2236242 showed that odds ratio (OR) (95% confidence interval [CI]) for AA-TT was 0.273 (0.241–0.305) and for TA-TT was 0.315 (0.298–0.341). The OR (95% CI) for allele A to T was 0.789 (0.373−1.669). The mean (standard deviation) serum vaspin level in the case group compared to the control was 1,570 (2,108) ng/ml versus 1,630 (1,428) ng/ml (p = 0.064). Higher vaspin levels were found in T allele of the TT (1,523 [2,269] ng/ml, p = 0.021) and TA (1,760 [1,349] ng/ml, p = 0.004) genotype groups than the A allele of the AA genotype group (0.914 [0.329] ng/ml).
CONCLUSIONS Vaspin gene polymorphism AA genotype or A allele significantly reduces vaspin levels in patients with ischemic stroke with DM.
Developing an online reproductive health module on sexually transmitted infections for Indonesian adolescents: a qualitative mixed methods study
Authors: Nilasari Hanny , Indriatmi Wresti , Gunardi Hartono , Kayika I Putu Gede , Kekalih Aria , Siregar Kemal Nazaruddin , Kurniawan Kristian , Lesmana Elvira , Haswinzky Rose Amalia
Published: February 2025

BACKGROUND A notable rise in sexually transmitted infection (STI) cases among youth correlates with a lack of reproductive health awareness, affecting nearly 80% of Indonesian adolescents. Additionally, sociocultural taboo acts as a challenge to reproductive health implementation in Indonesia. Therefore, this study aimed to develop an online reproductive health module focused on STIs for Indonesian adolescents.
METHODS This research was a mixed methods approach, integrating quantitative study using univariate analysis (survey and questionnaire) and qualitative study using the Delphi method (open discussion and focus group discussion). The study was conducted between March 2 and July 28, 2022. We began by conceptualizing a literature-based module, an online survey, and virtual discussions involving students, teachers, and parents. Then, we consulted with clinical psychologists and dermatovenereologists. Additionally, students completed an assessment to establish a baseline of their knowledge, attitudes, and behaviors (KAB) regarding reproductive health and STIs.
RESULTS Of 327 high school students across Jakarta, analysis of the 129 completed KAB surveys showed that only 56.6% and 65.1% attained acceptable scores (>65) for knowledge and behavior, respectively, with 24.8% being at risk for STIs. Key recommendations included incorporating multimedia elements, ensuring clarity and simplicity in language, adopting non-judgmental tone, providing comprehensive explanations of STIs and their long-term impact, and supporting learning with face-to-face sessions and ongoing access to concise, cost-effective educational resources.
CONCLUSIONS Adolescents need a comprehensive, interactive, instructive, accessible, non-discriminatory reproductive module that strengthens the self-concept that upholds Indonesian values and norms.
Computational mechanism underlying switching of motor actions
Authors: Zhong Shan , Pouratian Nader , Christopoulos Vassilios
Published: February 2025

Survival of species in an ever-changing environment requires a flexibility that extends beyond merely selecting the most appropriate actions. It also involves readiness to stop or switch actions in response to environmental changes. Although considerable research has been devoted to understanding how the brain switches actions, the computations underlying the switching process and how it relates to the selecting and stopping processes remain elusive. A normative theory suggests that switching is simply an extension of the stopping process, during which a current action is first inhibited by an independent pause mechanism before a new action is generated. This theory was challenged by the affordance competition hypothesis, according to which the switching process is implemented through a competition between the current and new actions, without engaging an independent pause mechanism. To delineate the computations underlying these action regulation functions, we utilized a neurocomputational theory that models the process of selecting, stopping and switching reaching movements. We tested the model predictions in healthy individuals who performed reaches in dynamic and uncertain environments that often required stopping and switching actions. Our findings suggest that unlike the stopping process, switching does not necessitate a proactive pause mechanism to delay movement initiation. Hence, the switching and stopping processes seem to be implemented by different mechanisms at the planning phase of the reaching movement. However, once the reaching movement has been initiated, the switching process seems to involve an independent pause mechanism if the new target location is unknown prior to movement initiation. These findings offer a new understanding of the computations underlying action switching, contribute valuable insights into the fundamental neuroscientific mechanisms of action regulation, and open new avenues for future neurophysiological investigations.