bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of relational antecedents in government and foreign public relationships
Authors: Ertem-Eray Tugce , Ki Eyun-Jung
Published: February 2025

Purpose

This study aims to identify potential relational antecedents, the initial stage of the three-stage model of OPRs, in the public diplomacy context by focusing on a government organization and foreign public relationships.

Design/methodology/approach

This study conducted in-depth interviews with Fulbright scholars and students from various countries to gain insights into the motivations underlying the initiation of relationships with the Bureau of Educational and Cultural Affairs (ECA) within the Fulbright program.

Findings

This study identified common expectations among foreign publics regarding their relationships with ECA within the Fulbright program. Moreover, this study reveals that the foreign publics are primarily motivated by their educational needs, laying the foundation for their emotional and financial requirements. These needs propel foreign publics to build relationships with government organizations. The fulfillment of these antecedents contributes to stronger government organizations and foreign public relationships, underscoring the importance of relational antecedents in theorizing about OPRs.

Originality/value

This study is one of the first empirical investigations to investigate the relational antecedents in the public diplomacy context.
Sustainability of employee ownership: the role of capital structure in ESOP plan terminations
Authors: Gonza Tej
Published: February 2025

Purpose

The paper studies the relationship between central features of the capital structure and terminations of ESOP plans in the US.

Design/methodology/approach

The research methodology is primarily based on reviewing the existing literature and includes elements of original comparative analysis.

Findings

We find that externally imposed repurchase obligation, the stochastic element to repurchase obligation and the discontinuous vesting of ICA shares undermines the sustainability of employee ownership in the Employee Stock Ownership Plan model.

Research limitations/implications

Strengthening employee-owned firm the structural architecture of employee-owned firms (EOF) can help to improve sustainability of the socially preferable alternative in the market economy.

Practical implications

In light of the increasing global interest in employee ownership, our research underscores the need for institutional learning to adapt EOFs to contemporary economic environments.

Social implications

Strengthening employee-owned firm the structural architecture of employee-owned firms (EOF) can help to build the case for the socially preferrable business ownership model for the market economy.

Originality/value

This paper contributes to the employee ownership literature by providing understanding of the role of capital structure in the US ESOP model and terminations of ESOP plans and suggesting some novel ideas in addressing the challenges.
Foreign Inflows, Governance and Health Outcomes in Nigeria
Authors: Oyefusi Aderoju , Nnadozie Obianuju O.
Published: February 2025

Foreign financial inflows to Nigeria have risen in the last two decades. Currently, the country receives over one‐third of remittance flows to sub‐Saharan Africa and is one of Africa's top recipients of foreign aid with the health sector being a major target. Despite the substantial foreign inflows, health outcomes in Nigeria have not remarkably improved. This raises important questions about the effectiveness of foreign inflows in achieving better health outcomes in Nigeria. This article examines the effects of foreign inflows on health outcomes utilising different components of foreign inflows—aid and remittance. It also investigates the role of governance in the foreign inflows‐health outcomes nexus using time series data from Nigeria covering the period 1984–2021. Results from the Autoregressive Distributed Lag (ARDL) model suggest that health aid has a limited impact on health outcomes, while remittance has been ineffective in driving improvements in health outcomes. Other factors, such as growth in real income per person, reduction in the emission of pollutants, such as carbon dioxide and improvements in governance, appear to be critical for improving health outcomes in the country.
Influence of food availability on water and alcohol consumption in murine models
Authors: Emous Thaynnam Arcebispo , Eduardo Paula Mendonça Camargo , Melo Mariana Cardoso , Pichinin Letícia S. , Abrahao Karina Possa
Published: February 2025

Background

Alcohol use disorder remains a global issue. Thus, understanding the factors that contribute to alcohol abuse, including how food availability can influence drinking behavior, is critical.

Methods

Female and male C57Bl/6 and Swiss mice underwent a two‐bottle choice Intermittent Overnight Drinking (IOD) protocol consisting of 12 sessions on alternate nights, three times per week, using lickometer devices. Mice had access to two bottles, containing either water or 10% ethanol, for 16 hours, starting 2 hours before the dark cycle. Animals were initially assigned to two groups: one with access to water, ethanol, and standard rodent chow (FOOD group), and another with access only to water and ethanol (NFOOD group). After six sessions, half of the mice in the second group were reassigned to a new group with delayed access to chow (NFOOD‐FOOD group).

Results

Food availability led to increased drinking, but the modulation was liquid dependent for each strain. The presence of food primarily increased ethanol intake in C57Bl/6 mice, while it enhanced water intake in Swiss mice. Microstructure analysis revealed that food heightened ethanol licks in C57Bl/6 mice, whereas it elevated water licks in Swiss mice, without altering numbers of bouts. Additionally, overnight analysis showed that C57Bl/6 mice with access to food had a peak in ethanol licks between 20:00 and 22:00, while Swiss mice exhibited an increase in water licks starting at 20:00 to 2:00, highlighting a strain‐specific response to the dark cycle.

Conclusions

This study provides normative data on the temporal patterns of water and ethanol consumption in C57Bl/6 and Swiss female and male mice, contributing valuable insights to the field of voluntary drinking behaviors in murine models.
Unobserved Individual and Population Level Impacts of Fishing Gear Entanglements on North Atlantic Right Whales
Authors: Crum Nathan J. , Gowan Timothy A. , Hostetler Jeffrey A. , Schick Robert S. , Knowlton Amy R. , Pettis Heather M. , Hamilton Philip K. , Rolland Rosalind M.
Published: February 2025

Fishing gear entanglements can compromise health and lower survival and reproductive output of wildlife, which can slow population growth or cause population declines. However, entanglements may go unobserved, making it difficult to quantify their effects on individuals' vital rates and a population's trajectory. Fishing gear entanglements are a leading cause of death for North Atlantic right whales, Eubalaena glacialis, an endangered species whose population has declined substantially over the last decade. Key sources of observation error have not been addressed when quantifying the effects of entanglement on this species. We formulated a hidden Markov model that integrated 28 years of photo identification records, visual health assessments, entanglement assessments, and hormone assays to estimate body condition dynamics, and entanglement, survival, and reproductive rates of female North Atlantic right whales. The model also accounted for observation errors, including entanglements and reproductive events that were unobserved. Whales entangled in fishing gear were drastically more likely to experience declines in body condition and had lower survival rates than whales that were not entangled. Additionally, only whales in good body condition became pregnant. Between 1994 and 2021 entanglements reduced the expected number of calves born by 12.9% (95% credible interval: 8.2%–19.6%) and the expected number of females alive at the end of 2021 by 18.5% (95% credible interval: 8.6%–29.4%). Fishing gear entanglements have reduced the North Atlantic right whale population's capacity to recover and have increased the importance of the health and survival of the remaining living whales. Therefore, reducing the risk of fishing gear entanglements is likely necessary for the population to recover.
In Suspected Fetal Growth Restriction, sFlt‐1/PlGF and PlGF May Have Value in Risk Stratification for Preterm Birth and Birthweight < 3rd Centile: A Blinded Cohort Study
Authors: Hughes Ruth C. E. , Kyle Pippa , Phillips Ian , Florkowski Chris M. , Gullam Joanna
Published: February 2025

We investigated the value of measuring sFlt‐1/PlGF in people with suspected fetal growth restriction (sFGR) without signs of preeclampsia at recruitment. Angiogenic biomarkers were considered positive when sFlt‐1/PlGF > 38 or PlGF < 100 pg/mL. Clinicians were blinded to the sFlt‐1/PlGF results. In sFGR presenting < 32 weeks, but not ≥ 32–37 weeks, positive angiogenic biomarkers vs. NZ FGR criteria had increased risk of preterm birth RR 5.32 [2.04–13.88] vs. 2.19 [0.89–5.37], respectively, and birthweight < 3rd centile RR 2.11 [1.24–3.58] vs. 1.83 [0.92–3.63], respectively. Larger studies are needed to establish whether routine testing of angiogenic biomarkers in sFGR is recommended for risk stratification.
Be happy and effective? Incorporating emotional design into multimedia learning in elementary science education
Authors: Lang Yueru , Gong Shaoying , Wu Yanan , Liu Qingtang , Deng Wei
Published: February 2025

Background

In recent years, the endeavour to stimulate positive emotions, regulate negative emotions, and facilitate the learning of elementary school students through emotional design has attracted a lot of attention.

Aims

The purpose of this study was to investigate the effects of warm colours and anthropomorphism as emotional design elements on multimedia learning, and whether combining a positive pedagogical agent with positive learning materials would be better.

Samples

Experiment 1 recruited 203 elementary school students. Experiment 2 recruited 140 elementary school students.

Methods

Experiment 1 employed a 2 (Colours: warm vs. grayscale) × 2 (Anthropomorphism: with vs. without) between‐subjects design. Experiment 2 employed a 2 (Learning materials: positive vs. neutral) × 2 (Pedagogical agent: positive vs. neutral) between‐subjects design.

Results

Results of Experiment 1 showed that warm colours reduced boredom and anxiety; anthropomorphism increased enjoyment, intrinsic motivation, and mental effort, and reduced boredom; their combination facilitated retention and transfer performance. Results of Experiment 2 revealed that combining a positive pedagogical agent with positive learning materials ameliorated learners' overall emotional experiences, but did not significantly affect retention and transfer performance.

Conclusions

Incorporating both warm colours and anthropomorphism as emotional design elements yielded the most favourable impact in designing positive learning materials. Integrating emotional design approaches to both learning materials and pedagogical agents could be conducive to happy and effective learning, showing the importance of holistic approaches to emotional design in educational settings.
STAT3 Inhibition Prevents Adaptive Resistance and Augments NK Cell Cytotoxicity to KRASG12C Inhibitors in Nonsmall Cell Lung Cancer
Authors: Pan Zehao , Qian Yuxian , Wang Yajing , Zhang Te , Song Xuming , Ding Hanling , Li Rutao , Zhang Yijian , Wang Zi , Wang Hui , Xia Wenjie , Wei Lei , Xu Lin , Dong Gaochao , Jiang Feng
Published: February 2025

KRASG12C inhibitors exhibit conspicuous clinical response in KRASG12C‐mutant lung cancer, yet adaptive resistance, the rapid onset of intrinsic resistance, dampens their therapeutic success. Rational combination strategies could tackle this challenging problem. A high‐throughput screening of a pharmacological library with 423 compounds revealed that napabucasin, a signal transducer and activator of transcription 3 (STAT3) inhibitor, synergistically potentiated the growth inhibition effect of the KRASG12C inhibitor sotorasib in sensitive and resistant KRASG12C NSCLC cell lines. Functional assays further revealed that the coordinated targeting of KRAS with STAT3 improved the inhibitory effect on tumor growth and augmented the infiltration and activation of natural killer (NK) cells within the tumor microenvironment. Mechanistically, KRASG12C inhibition induced compensatory activation of STAT3, contingent on concomitant suppression of downstream ERK signaling, abrogated by napabucasin. Moreover, we unveiled and verified the binding site of phosphorylated STAT3 at the HLA‐B promoter, an inhibitor ligand for NK cells. Our study dissected an unknown mechanism of adaptive resistance to KRASG12C inhibitors, with the STAT3 activation sustaining the regrowth of tumor cells under KRAS inhibition and up‐regulating HLA‐B transcription to dampen the cytotoxicity of infiltrated NK cells.
Wait a Minute? Hiding Behavior of Burrowing Crabs and an Oversized Bill Explain Why Crab Plovers Prefer Armored Swimming Crabs
Authors: Bom Roeland A. , Piersma Theunis , Fijen Thijs P. M. , van Gils Jan A.
Published: February 2025

In the Indo‐West Pacific biogeographical region, a suite of shorebirds searches for crabs as food. While the majority of these shorebirds hunt on burrowing crabs, the endemic crab plover Dromas ardeola additionally feeds on swimming crabs with “fast and powerful claws”. Here, we examined the trade‐off made by crab plovers between foraging for swimming crabs and burrowing crabs on the intertidal mudflats of Barr Al Hikman in the Sultanate of Oman during four winters (2012–2015). Foraging on burrowing crabs requires waiting for the occupant to emerge, whereas foraging on swimming crabs involves searching and extensive handling. We found that crab plovers strongly preferred swimming crabs. In fact, diet composition was exclusively a function of the densities of swimming crabs, that is, crab plovers stopped waiting for burrowing crabs above threshold densities of swimming crabs even if burrowing crabs were abundant. Using a two‐prey functional response model, we could explain diet composition from an energy‐maximization perspective, but only if waiting time was added as an identification phase independent of prey densities. This suggests that crab plovers exhibit selective attention and can only wait for a limited number of burrowing crabs at a time. We conclude that the preference for swimming crabs emerges from both the efficient handling of swimming crabs by the crab plover and the long hiding times of the burrowing crabs. Undoubtedly, it is the crab plovers' specialized bill which makes handling of swimming crabs profitable. We speculate that this bill uniquely evolved in the “escalated” environment of the Indo‐West Pacific.
Factors Related to Negative Transfer of Training in Safety‐Critical Professions: An Interview Study
Authors: Pennings Helena J. M. , Landman Annemarie , Groen Eric
Published: February 2025

Literature on transfer of training largely deals with positive transfer. Only few studies exist on negative transfer, and these were often performed in (laboratory) environments with low ecological validity. This study's objective is to identify factors that contribute to negative transfer in safety‐critical professions. The primary focus of the study is on aviation, but investigated principles also apply to other domains with high‐performing professionals. Semi‐structured interviews were performed with training experts from commercial and military aviation (n = 8), as well as the medical (n = 1) and maritime (n = 1) domain. The experts were asked to list examples of negative transfer that they have observed or experienced themselves. Follow‐up questions addressed training approaches and solutions regarding these examples. Answers were categorized using a transfer framework. The experts' most salient concerns involved: Time pressure, which leads to rushed training; Instructors with insufficient understanding of the limitations of the (simulator) training; and the way in which trainees should be placed into hazardous situations in a realistic manner. The experts provided several factors and recalls of experiences which may lead to negative transfer. These results may be relevant for instructors and can provide input for further experimental research regarding negative transfer.
Lower Urinary Tract Symptoms and Quality of Life in Obese Women: A Qualitative Study
Authors: Malak Arzu , Aslan Ergul
Published: February 2025

This study was conducted to determine lower urinary tract symptoms (LUTS) and their impact on the quality of life in obese women with LUTS. This study was conducted using a qualitative method at a university hospital. In‐depth interviews were conducted with 30 obese women who had LUTS and no chronic illnesses using a semi‐structured interview form. The interviews were evaluated through content analysis, and themes were identified and findings were interpreted. Qualitative analysis revealed that LUTS significantly affected women's lives, with complaints increasing as the degree of obesity increased. Most women reported searching for a restroom when going out, being unable to perform religious practices such as prayer, and experiencing negative effects on their sexual lives. Most women indicated that the causes of urinary tract symptoms were pregnancy/birth, excess weight and ageing. In conclusion, it was observed that obesity causes LUTS in women and negatively affects their quality of life.
Procreative Liability and Equality before the Law
Authors: Gheaus Anca
Published: February 2025

Pallikkathayil argues that restrictions on abortion are inconsistent with the usual demands that states place on their citizens. States don't require their citizens to make their bodies available for the protection of other people's interests. Yet, when abortion is restricted, women who can be pregnant are less entitled than other citizens to decide on how their bodies are to be used; then, states fail to treat women as equal before the law. The argument is supposed to hold even if one assumes that fetuses at various stages of development are as morally considerable as (already born) children, and even if, moreover, fetuses have passive citizenship status – that is, if they have claims to state protection. Pallikkathayil's argument comes at excessive theoretical costs, rulling out (a) general duties to help others in the protection of vital interests via relatively non‐burdening donation, e.g. of blood, and (b) plausible although demanding special duties of procreative parents. Nevertheless, I agree with Pallikkathayil's conclusion that existing legal restrictions on abortion violate the state's duty to treat its citizens as equal, and are hence illegitimate; namely, because they fail to hold all procreators ‐ whether or not gestational ‐ equally liable.
The Current Status and Factors Influencing the Discharge Readiness of Parents of Children With Pneumonia: A Cross‐Sectional Survey
Authors: Wang Yue , Zhang Chuan Ying , Ma Gui Yue , Wei Wei
Published: February 2025

Background

Pneumonia is the primary cause of pediatric hospitalization and the most frequent cause of death among children under the age of five in China. The parental discharge teaching quality and discharge readiness have a significant impact on children's health outcomes and readmission.

Research Aim

The study was conducted to assess the discharge readiness and the quality of discharge teaching of parents of children with pneumonia, examine their relationship, and identify key influencing factors.

Methods

A cross‐sectional study was conducted from May to October 2023. Participants, a total of 202 parents, were given anonymous questionnaires on the day of discharge, including the Readiness for Hospital Discharge Scale—Parent Form and the Quality of Discharge Teaching Scale—Parent Form.

Results

The results showed a medium level of discharge readiness and a low level of discharge teaching quality. Additionally, there was a strong positive association between the aforementioned. The quality of discharge teaching, parents' perceived severity of the child's illness, the child's age and the child's disease status were the main factors determining discharge readiness.

Conclusions

Pediatricians are encouraged to consider this outcome to develop targeted interventions that improve parental discharge teaching, discharge readiness and post‐discharge outcomes for children with pneumonia.
Circumcision‐Associated Penile Papules: A Novel Complication With Unclear Etiology
Authors: Zhang Mingshuang , Yang Rongqing , Huang Jie
Published: February 2025

Objective

To report six patients with penile papules after circumcision to attract the attention of clinicians and patients to the complication associated with circumcision.

Methods

We reported several clinical cases presenting with these papules following circumcision. Cases were reassessed for clinical characteristics, histopathological features, and potential risk factors.

Results

A series of six adult male cases were identified, with papules appearing asymptomatically months to years after circumcision. The papules were larger, exhibited uneven distribution, and lacked the typical arrangement of pearly penile papules, posing a cosmetic concern and a risk of misdiagnosis as genital warts.

Conclusion

This study presents a previously unreported complication of circumcision with significant implications for patient care. Further investigation is warranted to understand the etiology and develop strategies for prevention and management.
How to Interpret what is Given: Revelation and Hermeneutics in Jean‐Luc Marion
Authors: Jones Tamsin , Horner Robyn
Published: February 2025

The most significant gift of Jean‐Luc Marion's work to the worlds of phenomenology, theology, and religious studies is the provision of a thinking which begins with givenness: the thought of a given which, arriving from “elsewhere,” escapes the determining limits of the one who receives it and, thus, a gift which reveals itself starting from itself. Given this starting point, the question of this article is whether there is a genuine role for hermeneutics in Marion's understanding of phenomenology, especially as seen in his most recent discussions of revelation. If so, can it be made to cohere with his more fundamental phenomenological methodology, specifically the reduction to “pure givenness” which is meant to deliver phenomena without the constituting influence of a subjective knower? Can he make room for the role of interpretation without jeopardizing that which he seeks to guarantee: the appearance (or arrival) of the given on its own terms?
“Candidatus Liberibacter asiaticus” Infection Induces Citric Acid Accumulation and Immune Responses Mediated by the Transcription Factor CitPH4
Authors: Hu Bin , Yuan Tao , Lu Zhihao , Huang Rongyan , He Jiaxian , Yang Kun , Wu Qinchun , Ai Wanqi , Zhang Wang , Zheng Weikang , Wu Xiaoxiao , Wang Xia , Xu Yuantao , Deng Xiuxin , Xu Qiang
Published: February 2025

Citrus huanglongbing (HLB), caused by “Candidatus Liberibacter” spp., is one of the most disastrous citrus diseases worldwide. HLB‐affected citrus fruits are significantly more acidic than healthy fruits. However, the molecular mechanism behind this phenomenon remains to be elucidated. Here, we report that HLB‐affected fruits have higher levels of citric acid (CA) than healthy fruits. Moreover, Citrus PH4 (CitPH4), which encodes a MYB transcription factor that functions as a key regulator of CA accumulation, was upregulated in HLB‐affected fruits relative to healthy fruits. Heterologous overexpression of CitPH4 in tobacco (Nicotiana tabacum) plants enhanced tolerance to HLB. Subsequently, overexpression and gene‐editing experiments indicated that CitPH4 can affect the salicylic acid (SA) pathway, which directly binds to and activates the promoter of CsPBS3, a key gene of SA biosynthesis. HLB‐affected fruits had higher SA levels than healthy fruits. Furthermore, application of SA activated CA biosynthesis and application of CA activated SA biosynthesis and signalling in citrus fruits and decreased “Candidatus Liberibacter asiaticus” (CLas) titres in infected leaves. This work suggests that CitPH4 is a key node between CA and SA, thus revealing crosstalk between defence responses and fruit quality in citrus.
Care at the Crossroads: How Policy Feedback Shaped Competing Feminist Advocacy for Parental Leave Reform in Spain
Authors: Alvariño Manuel
Published: February 2025

Growing attention to “degenderization” reforms that aim to encourage men's caregiving roles may generate opposition from groups advocating to prioritize mothers' right to care. This article seeks to understand the politics of degenderization through the case of Spain, the only state with equal non‐transferable parental leave entitlements for mothers and fathers. It argues that policy feedback effects from changes in family policy and gender representation shape feminist advocacy for leave reform. Methodologically, the study combines a historical review, document analysis, and interviews with policy makers and activists. Results show that the institutionalization of equality feminism, initially a reaction against Francoism, generated positive feedback effects. Namely, it fostered the emergence and success of the PPiiNA organization by making elites responsive to its advocacy for equal and non‐transferable parental leave. However, this provoked a negative feedback effect, mobilizing mothers' groups into a competing organization, named PETRA, that demands transferable or mother‐exclusive leave rights.
Difficult management of abnormal uterine bleeding in Glanzmann thrombasthenia
Authors: Mandal Mita , Sarkar Subhankar , Paul Sayanti , Samantaray Subha Ranjan
Published: February 2025

Glanzmann thrombasthenia (GT) is a rare haematological disorder with abnormal platelet surface receptor glycoprotein IIb/IIIa, resulting in faulty platelet aggregation. Patients with GT may present with spontaneous bleeding after trauma or surgery. As the disease is rare, controlling and preventing bleeding in such patients is challenging. We report two cases of previously diagnosed GT presented with abnormal uterine bleeding. The first case was managed medically with tranexamic acid and hormonal therapy to control menstrual bleeding. In contrast, the second case involved a tubo-ovarian endometrioma presenting with heavy menstrual bleeding (HMB) and dysmenorrhoea, which was treated with laparoscopic adhesiolysis and cyst aspiration. Management of HMB and endometriosis is challenging, especially when using invasive procedures such as laparoscopy. Physicians should be familiar with the characteristics of the disease and all possible treatment options to halt the bleeding to avoid morbidity in patients.
Left renal vein transposition using autologous gonadal vein graft in patient with combined anterior nutcracker and May-Thurner syndromes
Authors: Kouyialis Theoklis Andrea , Zertalis Marios , Charalambous Nikolas , Papoulas Michail
Published: February 2025

Anterior nutcracker syndrome (ANCS) and May-Thurner syndrome (MTS) are part of a rare group of vascular compression syndromes where extrinsic compression of arteries or veins results in non-specific clinical presentation posing diagnostic and management challenges. We present the case of a female patient in her early 40s with a 3 year history of left flank and pelvic pain, left leg swelling and microscopic haematuria attributed to a rare combination of ANCS and MTS. Compression of the left common iliac vein (MTS) was managed with left common iliac stenting and compression of the left renal vein (LRV; ANCS) was managed surgically with a novel modified technique of LRV transposition using an autologous gonadal vein graft with subsequent resolution of all symptoms. To our knowledge, this is the fourth case presenting the coexistence of the two syndromes in the literature and the first presenting the modified treatment approach.
Contextual factors influencing implementation of tuberculosis digital adherence technologies: a scoping review guided by the RE-AIM framework
Authors: Bahukudumbi Shruti , Chilala Chimweta I , Foster Nicola , Patel Barbie , Mohamed Mona S , Zary Miranda , Kafie Cedric , Gore Genevieve , Schwartzman Kevin , Fielding Katherine L , Subbaraman Ramnath
Published: February 2025

Introduction

Digital adherence technologies (DATs) may enable person-centred tuberculosis (TB) treatment monitoring; however, implementation challenges may undermine their effectiveness. Using the reach, effectiveness, adoption, implementation and maintenance framework, we conducted a scoping review to identify contextual factors informing ‘reach’ (DAT engagement by people with TB) and ‘adoption’ (DAT uptake by healthcare providers or clinics).

Methods

We searched eight databases from 1 January 2000 to 25 April 2023 to identify all TB DAT studies. After extracting qualitative and quantitative findings, using thematic synthesis, we analysed common findings to create meta-themes informing DAT reach or adoption. Meta-themes were further organised using the Unified Theory of Acceptance and Use of Technology, which posits technology use is influenced by perceived usefulness, ease of use, social influences and facilitating conditions.

Results

66 reports met inclusion criteria, with 61 reporting on DAT reach among people with TB and 27 reporting on DAT adoption by healthcare providers. Meta-themes promoting reach included perceptions that DATs improved medication adherence, facilitated communication with providers, made people feel more ‘cared for’ and enhanced convenience compared with alternative care models (perceived usefulness) and lowered stigma (social influences). Meta-themes limiting reach included literacy and language barriers and DAT technical complexity (ease of use); increased stigma (social influences) and suboptimal DAT function and complex cellular accessibility challenges (facilitating conditions). Meta-themes promoting adoption included perceptions that DATs improved care quality or efficiency (perceived usefulness). Meta-themes limiting adoption included negative DAT impacts on workload or employment and suboptimal accuracy of adherence data (perceived usefulness); and suboptimal DAT function, complex cellular accessibility challenges and insufficient provider training (facilitating conditions). Limitations of this review include the limited studies informing adoption meta-themes.

Conclusion

This review identifies diverse contextual factors that can inform improvements in DAT design and implementation to achieve higher engagement by people with TB and healthcare providers, which could improve intervention effectiveness.
Burden of oesophageal cancer attributed to alcohol use in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019
Authors: Yan Dongqing , Wei Li , Liang Hongsen , Zhang Junhang , Shi Donglei , Wang Zhaojun
Published: February 2025

Objectives

This study aimed to assess the global burden of oesophageal cancer (EC) attributable to alcohol consumption across 204 countries and territories from 1990 to 2019. Alcohol use is a major modifiable risk factor for EC, with unique biological and epidemiological effects compared with other contributors such as smoking, necessitating a focused analysis of its global impact.

Design

We analysed trends in EC attributable to alcohol consumption from 1990 to 2019 using data from the Global Burden of Disease (GBD) 2019 study.

Setting

Data were obtained from the GBD Results Tool, covering 204 countries and territories across 21 GBD regions.

Participants

Patients with EC attributable to alcohol consumption.

Main outcomes and measures

The number and age-standardised rates of deaths and disability-adjusted life-years (DALYs) due to EC attributable to alcohol consumption are presented by region for 1990 and 2019, along with the number of deaths, age-standardised mortality rates (ASMR) and age-standardised DALY rates (ASDR) in 204 countries and territories in 2019. Geographical variations were visualised using maps, and linear regression analyses were performed to assess the association between the Socio-Demographic Index (SDI) and EC mortality and DALY rates.

Results

In 2019, there were 113 600.3 deaths (95% uncertainty intervals (UIs): 84 062.5–144 685.6), contributing to 2818.2×103DALYs (95% UI: 2109.6–3573.6). From 1990 to 2019, total deaths and DALYs associated with EC increased, while age-standardised rates decreased. ASMR and ASDR decreased in high SDI populations but plateaued in low-middle or low SDI populations for both genders. China recorded the highest death toll (61 887.7, 95% UI: 42 882.6–84 201.3), while Uganda had the highest ASMR (4.48, 95% UI: 3.06–6.26) and ASDR (119.21, 95% UI: 80.72–167.22). Males accounted predominantly for EC attributed to alcohol use.

Conclusions

Globally, there was a decline in ASMR and ASDR but an increase in overall deaths and DALYs related to EC from 1990 to 2019. The burden of EC varied across regions and countries, with Uganda exhibiting the highest ASMR, and China having the highest fatalities. The association between alcohol and EC was more pronounced in males than females.
Association between elevated serum REG Iα levels and eGFR decline in patients with chronic kidney disease: a cross-sectional study in eastern China
Authors: Huang Nan , Zhu Xiangyun , Shu Zhiyi , Chen Sheng , Wu Xiaodong , Wang Hui , Huang Xi , Hu Xiuxiu , Sun Jinfang , Chen Pingsheng , Graf Rolf , Bai Jianling , Wang Bin , Li Ling
Published: February 2025

Objectives

This study aimed to investigate the relationship between serum regenerating protein Iα (REG Iα) levels and estimated glomerular filtration rate (eGFR) and to evaluate the diagnostic efficiency of REG Iα in chronic kidney disease (CKD).

Design

This is a cross-sectional study.

Setting

The study was conducted in eastern China between August 2022 and August 2023.

Participants

A total of 880 participants aged over 18 years were enrolled, with 220 non-CKD participants (111 males, 50.45%) and 660 patients with CKD (366 males, 55.45%). CKD was diagnosed based on the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines. Exclusion criteria included participation in other trials, acute kidney injury, end-stage kidney disease undergoing renal replacement therapy, pregnancy, active infections, gastrointestinal or pancreatic inflammation, history of gastrointestinal or pancreatic resections, cancer and mental disorders.

Results

Serum REG Iα was significantly higher in the CKD group (125.54 (60.28–303.39) ng/mL) compared with those in the non-CKD group (24.62 (14.09–37.32) ng/mL, p<0.001). Positive correlations were observed between serum REG Iα and serum creatinine, cystatin C (Cys-C), and kidney injury molecule 1 (KIM-1), while a negative correlation was identified with eGFR. After adjusting for sex, diabetes, hypertension and fasting blood glucose, the multivariate regression analysis demonstrated a significant association between serum REG Iα and eGFR (OR=1.737 (1.263–2.388), p=0.001). Furthermore, serum REG Iα levels increased progressively with declining kidney function categorised by eGFR (p<0.001). In CKD screening, serum REG Iα demonstrated strong diagnostic performance, with an area under the receiver operating characteristic curves (AUC) of 0.860 (0.813–0.899), providing a sensitivity of 71.63%, a specificity of 86.89%, a positive predictive value of 94.30% and a negative predictive value of 46.85%. Additionally, serum REG Iα exhibited an AUC of 0.769 (0.712–0.819) for identifying high- and very-high-risk CKD based on KDIGO risk stratification. Its sensitivity significantly outperformed serum Cys-C and KIM-1 (82.80% vs 75.16% and 36.94%, respectively).

Conclusions

This study provided compelling evidence that serum REG Iα levels were notably elevated in patients with CKD and closely associated with kidney function. REG Iα may serve as a promising biomarker for CKD detection and risk stratification.

Clinical trial registration

The study was approved by the Ethics Committee of Zhongda Hospital (approval number: 2022ZDSYLL204-P01) and conducted in compliance with the Helsinki Declaration. The clinical trial was registered under ChiCTR2300072247.
Incidence of tuberculosis and its predictors among children on antiretroviral therapy in Amhara Region, Ethiopia: a multicentre institution-based retrospective follow-up study
Authors: Mekonnen Gebrehiwot Berie , Legesse Bruck Tesfaye , Baye Fikadie Dagnew , Wondie Wubet Tazeb
Published: February 2025

Introduction

Tuberculosis (TB) continues to be a significant public health issue, particularly in low-income and middle-income countries. Globally, the End TB Strategy targets an 80% reduction in TB incidence by 2030. Despite this strategy, there remains limited evidence on the incidence of TB among HIV-infected children after the test-and-treat strategies in Amhara Region. Hence, this study aimed to assess the incidence of TB and its predictors among children on antiretroviral therapy (ART) in Amhara Region, which is the second largest region in Ethiopia and located in the northwestern, northeastern and north-central parts of Ethiopia.

Methods

A multicentre institution-based retrospective follow-up study was conducted on 421 HIV-infected children receiving ART from July 2014 to March 2022. The study participants were selected using simple random technique. National antiretroviral intake and follow-up forms were used to gather data through the KoBo Toolbox. Stata V.17 was used for data analysis. The Kaplan-Meier curve was applied to estimate failure time, and the log-rank test was employed to compare groups of predictors. To identify TB predictors, Gompertz regression models, both bivariable and multivariable, were constructed. Ultimately, a 95% CI adjusted HR (AHR) was calculated, and variables with a p value less than 0.05 were considered statistically significant.

Results

A total of 421 children with a record completeness rate of 97.9% were analysed in the study. The TB incidence rate in children on ART was 2.16 (95% CI 1.52, 3.05) per 100 child-year observations. Anaemia at baseline (AHR: 3.83; 95% CI 1.46, 10.04), never taking TB preventive treatment (TPT) (AHR: 3.78; 95% CI 1.44, 9.94), wasting (AHR: 2.53; 95% CI 1.19, 5.38) and not initiating ART within 7 days (AHR: 2.35; 95% CI 1.15, 4.78) were significant predictors of TB in children.

Conclusion

The incidence of TB in children on ART was relatively high. HIV-positive children presenting with anaemia, those who never took TPT, wasted children and those with late initiation of ART were prone to the occurrence of TB. Therefore, prioritising anaemia treatment, TB preventive therapy, nutritional counselling and timely initiation of ART are essential to curb the TB burden.
Volunteer responders’ experience of attending a paediatric out-of-hospital cardiac arrest in Denmark: a qualitative study
Authors: Kjærholm Sofie Have , Kragh Astrid Rolin , Juul Grabmayr Anne , Borch-Johnsen Liv , Folke Fredrik , Poulsen Ingrid , Malta Hansen Carolina , Guldager Rikke
Published: February 2025

Objective

To explore the experiences of volunteer responders attending a paediatric out-of-hospital cardiac arrests (POHCAs) in Denmark.

Design

This qualitative study used the Reflective Lifeworld Research theoretical framework. Data were generated through nine in-depth, in-person or virtual semistructured interviews conducted with volunteer responders.

Setting

The study was conducted in Denmark. We recruited volunteer responders from all of Denmark enrolled in the nationwide volunteer responder programme.

Participants

Nine volunteer responders who were dispatched in response to a POHCA from 2020 to 2023 were included in the study.

Results

The experiences of attending a POHCA were categorised into three key themes: the mission, the situation and the aftermath. The mission refers to the altruistic drive of volunteer responders to contribute to life-saving efforts. The situation reflects the profound shock experienced when volunteer responders realise that the patient is a child, alongside their ability to act decisively and initiate cardiopulmonary resuscitation in the situation. The aftermath reveals the deep sense of fulfilment derived from being present and actively involved in attempting to save a child’s life, as well as the various emotions and reactions that the volunteer responders process after the event.

Conclusion

Attending a POHCA is a profoundly intense experience that can leave an emotional impact on the volunteer responders. On arriving at the location, despite the initial shock upon realising that the patient is a child, the volunteer responders engage in the resuscitation attempt and offer support to the child’s family. However, alerting the volunteer responders beforehand that the patient is a child may help mitigate the initial shock. Volunteer responders find significant meaning in their roles and express a strong commitment to saving lives, irrespective of the age of those in need.
Minimally invasive glaucoma surgery: comparison of Hydrus microstent with iStentinjectin primary open-angle glaucoma
Authors: Komzak Krishna , Allen Penelope L , Toh Tze’Yo
Published: February 2025

Background

To evaluate and compare the efficacy of a single Hydrus and double iStentinjectboth combined with cataract surgery for the treatment of primary open-angle glaucoma (POAG).

Methods

The study was designed as a prospective comparative case series. Patients with POAG undergoing trabecular microbypass stent insertion in addition to cataract surgery were recruited and consent was obtained. Baseline demographic information and preoperative, intraoperative and postoperative outcomes including intraocular pressure (IOP), visual acuity and topical glaucoma medication use were recorded and analysed. Treatment outcomes were analysed after propensity score matching to adjust for baseline differences between the two groups. Primary success was defined as an IOP of ≤18 and ≥20% IOP reduction at 12 months; other outcomes included IOP ≤15 mm Hg and ≤21 mm Hg. These were measured against complete success (no medications) and qualified success (one or more medications).

Results

The study comprised 85 eyes in the Hydrus group and 100 eyes in the iStentinjectgroup at commencement, with 12-month follow-up for 85 and 78, respectively. When correcting for baseline differences between the two groups using propensity score matching, Hydrus eyes were not more likely to achieve primary success (average treatment effect −0.79, p=0.15).

Conclusion

After adjusting for baseline differences, there was no statistically significant difference between combined Hydrus microstent implantation and cataract surgery when compared with the iStentinjectin reducing IOP at 12-month follow-up. This study was limited by statistically significant baseline differences between the two study groups, adjusted for with propensity score matching.
Improving follow-up visits among individuals with hypertension: Quality Improvement project in the District Hospital, Seoni, Madhya Pradesh, India, 2021–2022
Authors: Bharadwaj Rupali , Kaviprawin Mogan , Neelkanth Namita , Navkar Vinod Kumar , Azarudeen Mohamed Jainul , Parasuraman Ganeshkumar , Ramalingam Archana , Kaur Prabhdeep
Published: February 2025

Background

In India, to achieve a 25% relative reduction in the prevalence of raised blood pressure (BP) by 2025, approximately 4.5 crore additional people with hypertension will need to have their BP effectively treated. We conducted a Quality Improvement (QI) initiative to improve follow-up and reduce missed visits among individuals with hypertension registered under India Hypertension Control Initiative, District Hospital, Seoni, Madhya Pradesh, India, in 2022.

Methods

We conducted a quasiexperimental study from January to September 2022 in the District Hospital in Seoni, Madhya Pradesh. Following the Ishikawa diagram, the major root causes for missed visits were identified, and countermeasures were developed. The packages under Plan-Do-Study-Act (PDSA) included (i) training urban Accredited Social Health Activists to conduct house visits for individuals with missed visits and (ii) triangulating the follow-up records from various information systems. The review meetings for QI initiatives were conducted fortnightly to follow-up PDSAs. We calculated the proportion of individuals who were followed-up monthly, and the proportion of missed visits among those registered quarterly.

Results

Cumulatively, 2850 individuals were registered with hypertension till September 2022. Following the intervention, the monthly follow-up proportion increased from 21% in January to 37% in September 2022. Missed visit proportion decreased from 66% (228/345) in quarter four, 2021, to 22% (40/180) in quarter three, 2022. Of the 1438 individuals counselled by ASHA home visits, 74.9% returned for follow-up.

Conclusion

In our setting, QI initiatives suggested that missed visits decreased during the intervention period. However, the interventions must be implemented continuously for better monitoring and use in similar settings.
Effect of lifestyle interventions on cognitive function, physical fitness and activity over 2 years in primary school children: results from the fit4future intervention programme
Authors: Schoenfeld Julia , Kaiser Michaela , Rieger Barbara , Haller Bernhard , Halle Martin , Siegrist Monika
Published: February 2025

Objectives

Physical activity is associated with positive health effects and improved cognitive function in children. However, these data are primarily based on cross-sectional studies. We investigated changes in cognitive function, physical fitness and physical activity in children following a school-based intervention.

Methods

The ‘fit4future’ study is a prospective, interventional, long-term study conducted in Germany to evaluate the impact of a comprehensive school-based health promotion programme in children. The aims of the programme have been to increase the amount of physical activity, to support a healthy diet and to improve attention and concentration performance as well as coping strategies. Schools received equipment to support physical activity, for example, action cards, brochures as well as online materials containing information regarding physical activity, nutrition, cognitive function and stress management. Teachers were trained in six workshops to enable them to promote a systematic health promotion process at schools. Parents received brochures about healthy lifestyles with practical advice for everyday family life. Additional information was provided on the programme’s homepage. At the beginning of the second and the end of the third grade, children completed a differential performance test (Concentrated Task) for the assessment of concentration and attention in which they had to cross predetermined pictorial symbols on preprinted test sheets (average marked signs). Changes in the average marked signs were investigated and compared with age-specific and sex-specific norms. Physical fitness and activity were assessed using a six-item fitness test and questionnaire.

Results

A total of 839 children (mean age 7.5±0.6 years, 48% girls) from 32 schools participated in this study. Over 2 years, average marked signs increased from 91.6±20.7 to 138.0±27.6 (p<0.001) (n=553 children, mean age 7.5±0.6 years, 51% girls). This improvement was greater than expected compared with the age-specific and sex-specific norms. The children showed significant improvements in all fitness test items and a significant increase in physical activity (p<0.001). Age, baseline average marked signs and changes in the jump-and-reach test were associated with changes in cognitive function (regression coefficient β=0.95, SE=0.23, p<0.001).

Conclusion

A school-based health promotion programme improved cognitive function, physical activity and physical fitness beyond the age-related improvements expected over 2 years in a large cohort of primary school children.

Trial registration number

German Clinical Trials Register (DRKS-ID: DRKS00020894, Date of registration: 2020-02-26).