bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breaking the Hybrid Myth of Paphiopedilum wenshanense: Double Bifurcated Divergence Followed by Adaptive Introgression Formed a Morphological Intermediate
Authors: Jiang Hong , Chang Jui‐Tse , Liao Pei‐Chun , Lee Yung‐I 
Published: December 2024

ABSTRACTSpecies with intermediate phenotypes are usually hypothesised to have originated from hybrid speciation. However, other mechanisms, such as double bifurcated speciation with introgression may create the same phenotypes. Clarifying the underlying process generating the observed intermediate morphology is important for conservation efforts, as it provides insights into the species' evolutionary background and adaptability. Here, we utilised genome‐wide single nucleotide polymorphism data to test evolutionary history models for Paphiopedilum wenshanense Z. J. Liu & J. Yong Zhang, an orchid species that is widely considered to be a hybrid with intermediate morphology of other two closely related species, P. concolor Pfitzer and P. bellatulum Pfitzer, distributed in Indochina. Our results rejected the hybrid speciation hypothesis and ascribed the intermediate floral phenotypes of P. wenshanese to introgression from P. concolor after it diverged from P. bellatulum during the last glacial maximum. Excluding the geographic covariate, the current genetic mixing rate of P. wenshanense from P. concolor is stronger in the south part of its range and is associated with precipitation in the early summer, indicating that population divergence in P. wenshanense is being driven by adaptive introgression. These genetic patterns also correspond to the observed floral variation across P. wenshaense populations. The introgression from P. concolor, along with the intermediate and varying floral morphologies, may expand the ecological opportunities for P. wenshanense, providing an explanation for why high genetic diversity has been maintained despite a high level of inbreeding and small census population size. Our study provides a framework for future research to investigate the characteristics and underlying mechanisms of intermediate morphologies in general.
Digital Healthy Diet and Health Literacy as Determinants of Physical Activity Level in Adults: A Descriptive Correlational Study
Authors: Selçuk Tosun Alime , Duran Büşra , Akgül Gündoğdu Nurcan , Lök Neslihan 
Published: December 2024

ABSTRACTObjectiveThis study was conducted to determine the level of health literacy, digital healthy diet literacy, and physical activity of adult individuals to evaluate the relationship of physical activity with health literacy and digital healthy diet literacy and to examine the determinants of physical activity level.Design and MethodIt is a descriptive and correlational study. The sample of the study consists of 404 individuals aged 18–65. Personal Information Form, International Physical Activity Questionnaire—Short Form, Health Literacy Scale—Short Form, and Digital Healthy Diet Literacy Scale were used to collect the study data. Number, percentage, mean and standard deviation, t test in independent groups, one‐way analysis of variance, and multiple regression analysis were used in the analysis of the study data.ResultsParticipants' gender (β = 0.572, p = 0.000), educational status (β = 0.630, p = 0.000), employment status (β = 0.573, p = 0.000), perceived economic situation (β = 0.774, p = 0.000), cohabitants (β = 0.609, p = 0.000), perceived health (β = 0.580, p = 0.000), smoking status (β = 0.639, p = 0.045), health literacy total score (β = 0.603, p = 0.000), and digital health literacy (β = 0.782, p = 0.000) were found to be predictors of physical activity level (p < 0.001). It was determined that these determinants explained 57.3% (adjusted R2 = 0.573) of the change in physical activity level.ConclusionThe mean scores of the participants' physical activity level were at a medium level. Increasing the participants' awareness of health literacy and digital healthy diet literacy may be effective in increasing the level of physical activity.
Unexpected sounds induce a rapid inhibition of eye‐movement responses
Authors: Vasilev Martin R. , Ozkan Zeynep G. , Kirkby Julie A. , Nuthmann Antje , Parmentier Fabrice B. R. 
Published: December 2024

AbstractUnexpected sounds have been shown to trigger a global and transient inhibition of motor responses. Recent evidence suggests that eye movements may also be inhibited in a similar way, but it is not clear how quickly unexpected sounds can affect eye‐movement responses. Additionally, little is known about whether they affect only voluntary saccades or also reflexive saccades. In this study, participants performed a pro‐saccade and an anti‐saccade task while the timing of sounds relative to stimulus onset was manipulated. Pro‐saccades are generally reflexive and stimulus‐driven, whereas anti‐saccades require the generation of a voluntary saccade in the opposite direction of a peripheral stimulus. Unexpected novel sounds inhibited the execution of both pro‐ and anti‐saccades compared to standard sounds, but the inhibition was stronger for anti‐saccades. Novel sounds affected response latencies as early as 150 ms before the peripheral cue to make a saccade, all the way to 25 ms after the cue to make a saccade. Interestingly, unexpected sounds also reduced anti‐saccade task errors, indicating that they aided inhibitory control. Overall, these results suggest that unexpected sounds yield a global and rapid inhibition of eye‐movement responses. This inhibition also helps suppress reflexive eye‐movement responses in favor of more voluntarily generated ones.
Sanan rai wisdom in Atauro's tourism transformation
Authors: Oliveira Ana Carolina Ramos 
Published: December 2024

AbstractThis paper examines the history and activities of the Timorese NGO Empreza Di'ak, focusing on its role in revitalising traditional pottery (sanan rai in Tetum) on Atauro Island. Traditionally a form of women's knowledge, pottery has been reimagined in the post‐independence era as cultural heritage at risk of extinction, now transformed into commodities primarily targeting the tourist market. The paper explores the interplay of social, economic, and generational factors driving the revival of sanan rai production within the broader context of positioning Atauro as an international tourism destination. It delves into the complexities, challenges, and subjectivities that arise, alongside the unexpected situations and evolving expectations of local communities as they navigate this process of (re)engaging with and revaluing a nearly lost tradition.
Relationship Between Body Weight and Leukopenia in Non‐Kidney Solid Organ Transplant Recipients With Normal Renal Function Who Are Receiving Valganciclovir for CMV Prophylaxis
Authors: Haddad Sara , Dee Kevin , Chiang Augusto Dulanto , Feller Fionna , Ding Tan , Ayers Gregory D. , Potts Marissa , LaRue Richard W. 
Published: December 2024

ABSTRACTBackgroundCytomegalovirus (CMV) disease causes significant morbidity among solid organ transplant (SOT) recipients. To prevent CMV disease, eligible recipients are frequently started on valganciclovir (VGC) prophylaxis post‐transplant. Leukopenia has been documented as a primary adverse events of the drug (1). This study's primary aim was to determine whether a patient's weight at the start of VGC prophylaxis was associated with the development of leukopenia.MethodsThis was a single center, retrospective cohort study that included adults > 18 years of age, who had received an organ transplant (heart, liver, or lung) at an academic transplant center from January 1, 2018 through December 31, 2022. A creatinine clearance of > 60 mL/min was required.ResultsAll 294 included patients received 900 mg/day of VGC for CMV prophylaxis, without dose adjustment. Fifty‐two percent of the patients developed leukopenia while receiving VGC prophylaxis. The mean weight at initiation of VGC was higher in patients who did not develop leukopenia (97.9 kg) compared to those who did (90.7 kg; p = 0.0112). It was found that with each 1 kg increase in body weight, the likelihood of developing leukopenia decreased by 1.7% (p = 0.004, odds ratio = 0.983, 95% confidence interval [CI], 0.972–0.994). Patients with a baseline body‐mass index (BMI) > 25 had a longer median freedom time from leukopenia after initiation of VGC as compared to the group with baseline BMI < 25 (log‐rank p = 0.035).ConclusionThese data suggest that in SOT recipients with normal renal function, receiving a fixed dose of VGC resulted in a significant, inverse relationship between body weight and the development of leukopenia.
Genital bleeding in prepubertal girls: a systematic review
Authors: Moore Yasmin , Hopkinshaw Bryony , Arrowsmith Briony , White Catherine , Gabriel Lily 
Published: December 2024

IntroductionThis systematic review aims to collate evidence of the causes of genital bleeding, other than child sexual abuse and accidental injuries, presenting in prepubertal girls. It provides an update to the 2015 Royal College of Paediatrics and Child Health publication ‘The Physical Signs of Child Sexual Abuse’, an evidence-based review also known as the Purple Book.MethodsMEDLINE, EMBASE and Scopus databases were searched for studies published between March 2014 and June 2023. Eligible studies were primary studies reporting on genital bleeding with extractable data for prepubertal girls.Results99 studies, describing a total of 672 prepubertal girls, met the inclusion criteria. The most common medical conditions with genital bleeding as a presenting feature were lichen sclerosus, infections and infestations, hormonal causes, urethral prolapse, vaginal foreign bodies and tumours. Meta-analysis was not possible due to the large heterogeneity of the studies.ConclusionThis review added further evidence to the 2015 edition of the Purple Book, describing the multiple medical conditions that may present with genital bleeding. Several of these conditions can mimic the presentation of child sexual abuse or may coexist with child sexual abuse.
Metastatic conjunctival melanoma: a multicentre international study
Authors: Jain Puneet , Finger Paul T , Filì Maria , Damato Bertil , Coupland Sarah E , Heimann Heinrich , Kenawy Nihal , Brouwer Niels J , Marinkovic Marina , van Duinen Sjoerd , Caujolle Jean-Pierre , Maschi Celia , Seregard Stefan , Pelayes David E , Folgar Martin , Yousef Yacoub , Krema Hatem , Gallie Brenda , Calle Vasquez Carlos Alberto 
Published: December 2024

BackgroundTo reveal clinical findings related to metastatic conjunctival melanoma.Methods10 ophthalmic oncology centres (9 countries and 4 continents) shared data to create a large clinical case series. The main outcome measures were the incidence and cumulative risk of systemic metastasis, study mortality rates and Kaplan-Meier patient mortality after developing conjunctival melanoma metastasis.ResultsOf 288 patients, 29 developed metastasis. Five had metastasis at presentation, were American Joint Committee on Cancer (AJCC) cT3-category and exhibited tumour-surface ulceration. Four of five (80%) had melanotic tumours with plical and/or caruncular involvement and died within 1 year. One survived 21 months. In contrast, 24 developed metastases during follow-up (mean 4.6±3.2 years). Their primary tumours were cT1 (n=13/24, 54.1%), cT2 (n=6/24, 25%), cT3 (n=2/24, 8.3%) and 3 cTx (12.5%) at presentation. Death had occurred in 17 patients (n=17/24, 71%) by the end of the study. The cumulative risk of systemic metastasis after treatment was 0.4% (95% CI 0.6% to 2.9%) at 1 year, 8.6% (95% CI 5.1% to 14.3%) at 5 years and 22.3% (95% CI 14.5% to 33.5%) at 10 years. Each increase in AJCC cT category was associated with an 89% higher risk for metastasis (HR=1.89, p<0.001). Among all 29 patients who developed metastasis, those who presented with AJCC cT3 disease were at highest risk (p<0.001). Liver and lung (n=13 each) were the most reported metastatic sites.ConclusionMetastatic conjunctival melanoma was found in 10% of conjunctival melanoma patients. Tumour-specific characteristics including AJCC cT3-category, conjunctival location and surface ulceration were associated with metastatic risk. Survival durations were shorter for those presenting with metastasis.
Sonographic bleb visualisation after PAUL glaucoma implant surgery
Authors: Weber Constance , Weinhold Leonie , Walz Wolfgang , Petrak Michael , Holz Frank G , Liegl Raffael , Mercieca Karl 
Published: December 2024

Background/aimsBleb characteristics in the area around the plate following glaucoma drainage device (GDD) surgery are difficult to evaluate on slit lamp examination. Ultrasound sonography could be used for more detailed visualisation. The aim of this study was to describe bleb configuration after PAUL glaucoma implant (PGI) surgery and evaluate the possible correlation with intraocular pressure (IOP) in order to derive new markers for evaluating GDD function.MethodsPatients underwent a 15 MHz ultrasound examination (Compact Touch, Quantel Medical) after undergoing PGI implantation. The filtering bleb dimensions were measured and bleb configuration was assessed along with documentation of all clinical data.ResultsA total of 70 eyes from 65 patients were included. 55 eyes (78.6%) had a double-layered bleb whereas 15 eyes (21.4%) had a bleb with only one compartment (six eyes, 8.6% above; nine eyes, 12.9% below the plate). The total height of both compartments averaged 3.52 mm. The average IOP was 13.03 mm Hg. There was a significant correlation between single and double-layered blebs (p<0.01) with regard to IOP (one compartment: 16.47 mm Hg vs two compartments: 12.09 mm Hg). There was no significant correlation between total bleb height (p=0.143) or bleb extension (T: p=0.629; L: p=0.742). However, total bleb height showed an inverse association with IOP. Blebs with a height >2 mm had significantly lower mean IOP than those having <2 mm bleb heights (p=0.041).ConclusionsSonography is a suitable modality to evaluate bleb characteristics after PGI implantation. Blebs with a double fluid layer are significantly correlated with lower IOP values. Bleb height has an inverse association with IOP, with higher blebs (>2 mm) showing a significantly lower IOP.
Medication use and risk of reflux oesophagitis
Authors: Ueta Ren , Komori Shiori , Umemoto Kumiko , Hata Masahiro , Masuda Erika , Seto Kana , Nishiie Yuriko , Suzuki Keigo , Hisada Yuya , Yanai Yuka , Otake Yuki , Okubo Hidetaka , Watanabe Kazuhiro , Akazawa Naoki , Yokoi Chizu , Akiyama Junichi 
Published: December 2024

ObjectiveReflux oesophagitis (RO) is one of the most common diseases encountered by gastroenterologists and primary care physicians. However, few epidemiological studies have investigated the association of medication use and RO. This study aimed to investigate the prevalence of RO and its risk factors, particularly with respect to medication use.MethodsThis retrospective, cross-sectional study included consecutive patients who underwent oesophagogastroduodenoscopy (OGD) and were assessed using questionnaires at the National Center for Global Health and Medicine (Shinjuku, Tokyo, Japan) between October 2015 and December 2021. The questionnaire collected data on patient characteristics, medical history, smoking and alcohol consumption, and medications that patients were taking at the time of OGD.ResultsAmong the 13 993 eligible patients, the prevalence of RO was 11.8%. Multivariate logistic regression analysis indicated that male sex (OR=1.52 (95% CI 1.35 to 1.72), p<0.001); obesity (OR=1.57 (95% CI 1.40 to 1.77), p<0.001); smoking (OR=1.19 (95% CI 1.02 to 1.38), p=0.026); alcohol consumption (OR=1.20 (95% CI 1.07 to 1.35), p=0.002); diabetes (OR=1.19 (95% CI 1.02 to 1.39), p=0.029); hiatal hernia (OR=3.10 (95% CI 2.78 to 3.46), p<0.001); absence of severe gastric atrophy (OR=2.14 (95% CI 0.39 to 0.56), p<0.001); and the use of calcium channel blockers (CCBs) (OR=1.22 (95% CI 1.06 to 1.40), p=0.007), theophylline (OR=2.13 (95% CI 1.27 to 3.56), p=0.004), and non-steroidal anti-inflammatory drugs (NSAIDs) (OR=1.29 (95% CI 1.03 to 1.61), p=0.026) were independent predictors of RO.ConclusionRO was present in 11.8% of patients. Use of CCBs, theophylline, and NSAIDs were independent predictors of RO.
Epidemiology of chronic and acute pancreatitis in India (EPICAP-India): protocol for a multicentre study
Authors: Krishnan Anand , Pillai Divya , Amarchand Ritvik , Agarwal Ashish , Ahuja Vineet , Baloni Vineeta , Basu Subhra Samujjwal , Bhardwaj Pankaj , Choudhury Bikash , Chowdhury Sudipta Dhar , Dabar Deepti , Das Soumi , Deshmukh Pradeep , Devadas Krishnadas , Dhali Gopal Krishna , Gunjan Deepak , Gupta Anmol , Jain Saransh , Kedia Saurabh , Kumar Rakesh , Kumar Sanjeev , Makharia Govind K , Monga Nitika , Rungta Sumit , Saraya Anoop , Sarkar Rajib , Shalimar  , Sharma Brij , Singh Shivendra , Sujatha Chintha , Wadhwa Nitya , Garg Pramod Kumar 
Published: December 2024

IntroductionAcute and chronic pancreatitis (CP) are inflammatory conditions of the pancreas that cause local and systemic complications. The epidemiology of these conditions are not well-known in India.Methods and analysisWe describe the protocol and procedures of a multicentre study for delineating the epidemiology of pancreatitis in India. We plan to cover 110 000 people across 10 geographically distributed sites in 10 states of India to estimate the burden and risk factors of CP. Trained investigators will make house visits and screen for abdominal pain requiring hospitalisation or pre-diagnosed CP. The screened positive participants will be reviewed by a gastroenterologist to confirm the diagnosis of CP based on radiological imaging. For each case, four controls will be selected and data on risk factors for CP (tobacco, alcohol, family history, metabolic causes) and blood for genetic markers will be collected. Information on the cost of treatment and quality of life will be collected from patients with CP. For estimating incidence of acute pancreatitis (AP), hospital-based sentinel surveillance will be conducted in 10 districts across these 10 states. All hospitals in the district will be contacted to provide a line list of admissions due to acute abdomen including AP for 2 years. The spread of acute abdomen cases will be used to define the catchment area and estimate the denominator population. The line-listed cases with AP living in the catchment area will form the numerator to calculate the incidence. The study will provide critical information for planning pancreatitis-related services in the country.Ethics and disseminationThe institutional ethics committee (IECs) at all the participating sites have given their approval for the study. All the participants whose data will be collected will be included after written informed consent. The results may be presented at national or international conferences and will be reported in peer-reviewed publications.
A qualitative study of the government’s engagement of the private health sector in the delivery of Ghana’s COVID-19 emergency response
Authors: Abekah-Nkrumah Gordon , Abor Patience Aseweh , Addai Frimpong Kingsley , Martey Maureen M , Asrat Sofonias Getachew , Kasolo Francis Chisaka 
Published: December 2024

IntroductionThere is a growing literature on the significance of private sector engagement and collaboration for optimal response to health emergencies. The current study examines how the private sector was engaged by the Ghanaian government to implement effectively the national COVID-19 emergency response.MethodsThe study drew on a qualitative research design, interviewing 20 respondents in 15 unique organisations. Interviews were recorded, transcribed and analysed using a thematic analytical approach.FindingsThe findings of the study suggest that the government demonstrated leadership in mobilising, resourcing, and collaborating with the private health sector to deliver its pandemic response via a defined emergency response plan, a coordinated pandemic response structure and a robust platform for information gathering and sharing. However, the government fell short of providing the enabling environment for the private health sector to expand their capacity to meet increased demand for health services during the pandemic. There were also challenges related to the over concentration of resources in the public health response and national level structures to the detriment of clinical care and sub-national level structures. Generally, the findings also indicate a fragmented private health sector that is not only unattractive for the government to engage and collaborate with, but also weak in terms of capacity (financial and human resources) to partner government and respond to any major health emergency.ConclusionThere is a need for policymakers to put in place an appropriate policy framework that will help in organising, engaging and collaborating with private health entities. The gaps identified and lessons learnt from implementing the pandemic response should be addressed as a matter of urgency to improve the readiness of Ghana’s health system for future health emergencies.
Changing power narratives: an exemplar case study on the professionalisation of community health workers in Liberia
Authors: Neumann Anne , Subah Marion , van der Westhuizen Helene-Mari 
Published: December 2024

Despite their central role in achieving health equity and Universal Health Coverage, only a minority of community health workers (CHWs) is formally recognised as health workforce and receives a salary. Community health policies are formed within the power dynamics of global health practice. We argue that critical investigations of the power dynamics that influence the design of CHW programmes can contribute system-level insights to strengthen their roles.We present a national-level case study of the Liberian Community Health Assistant programme as an exemplar case of successfully introducing a nationwide CHW policy that professionalises CHWs. Using a theory of how power is exercised (Steven Lukes) for our analysis, we argue that Liberia’s success in overcoming external funder push-back on the payment of CHWs was enabled by strong political commitment and (re-)claiming government authority in and outside of decision-making processes. Consensus-building across government departments strengthened the government’s decision-making power. The availability and strategic use of suitable and contextualised evidence focused on the rights of CHWs allowed for proactive engagement with external funders’ concerns. To draw on learnings from the experience of Liberia, we recommend looking beyond the common effectiveness-oriented narratives in academic literature that focus on CHW’s functional role. By focussing on how power is exerted through policy negotiations around professionalisation, it could be possible to reframe conventional approaches to the role of CHW in other contexts as well.