bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do Government Incentives Improve Educational Outcomes? Evidence from India
Authors: Singh Unnati , Ramakrishnan N. 
Published: February 2025

Low levels of learning outcomes persist among schoolchildren in low- and middle-income countries, despite the focus on increased access to education. This study examines the impact of two government incentives—scholarships and free tuition—on the educational outcomes of children aged 8–11 years in India using the nationally representative dataset, India Human and Development Survey-2 (IHDS 2). To estimate the effect of government incentives on children’s learning outcomes, we use propensity score weighting, with the treatment being free tuition and scholarships. Our findings indicate that scholarships are negatively associated with learning outcomes, particularly in writing and math. However, these effects are not statistically significant when controlling for socio-economic and school-related factors. Similarly, free tuition is linked to lower learning outcomes, and the negative effects increase after accounting for control variables and could reflect pre-existing deprivations or learning gaps that remain to be addressed. These findings highlight the mixed impacts of government incentives on education outcomes in India. The study also emphasises the importance of socio-economic factors and school characteristics in shaping learning outcomes, highlighting the need for a multifaceted approach when evaluating the effectiveness of government incentives. JEL Codes: I21, I24, I28
The risks of oversizing domestic water piping – Measurement of peak flows in multistory residential buildings
Authors: Kragh Jesper , Rose Jørgen , Buhl Leon Steen 
Published: February 2025

Over the past few decades, domestic water consumption in residential areas has declined significantly. This reduction can be attributed to several factors, including the widespread implementation of individual metering, rising water prices, development of more water-efficient sanitary fixtures, and an increased public awareness of water scarcity. However, there’s a growing concern that plumbing designers may be inadvertently oversizing pipe installations for domestic water due to reliance on outdated design manuals and standards that promote overly conservative methods. Traditionally, the primary standard for dimensioning domestic water pipes in Denmark has been to ensure that the installation can deliver the required water flow rate in 99.9% of outlet usage instances. To investigate this issue further, a recent project conducted by the Department of the Built Environment at Aalborg University, on behalf of The Danish Authority of Social Services and Housing, involved measuring the domestic water flow in eight multi-story apartment buildings. The findings revealed that, on average, the investigated pipe installations were oversized by a factor of 2-3. This general oversizing results in an extended retention time for domestic water within the pipes, which poses risks such as the growth of Legionella bacteria—an increasingly prevalent issue not only in Denmark. Practical application The study contributes to determine whether there was indeed an oversizing of the water pipe installation, as this could potentially lead to various adverse consequences. The conclusion based on the performed flow measurements was that the guideline for designing domestic water distribution pipes in general significantly oversized both hot and cold pipes. Two proposals that reduces the design flow rate by 25% and 50% was therefore developed to update the national Danish standard DS 439 and during 2023 it was finally agreed in the standardization committee to implement the proposal for a reduction of 25%.
Coming to terms with dying: Advance care planning as a conduit between clinicians, patients, and conversations about death and dying – a qualitative interview study
Authors: Eason Rowena Jane , Brighton Lisa Jane , Koffman Jonathan , Bristowe Katherine 
Published: February 2025

Background: Advance care planning discussions exploring future care and support needs can be beneficial to people with advanced illness. While research has focussed on barriers, outcomes, and completion, little is known about how discussions influence thoughts, feelings, and behaviours. Aim: To explore experiences of advance care planning for people with incurable life-limiting illnesses, to understand the impact of discussions on individuals, and factors influencing psychological responses. Design: Semi-structured qualitative interviews were conducted. Data were analysed using framework analysis. Reflexive journalling and discussion of coding framework and themes supported rigour. Setting/participants: Twenty purposively sampled adults receiving hospice care, aged 30–93 with cancer ( n = 15) and non-cancer ( n = 5) diagnoses were interviewed. Results: Advance care planning elicits multiple complex thoughts, emotions, and behaviours, with responses ranging from the procedural to the profound. Discussions empowered and instilled confidence, promoted openness with relatives, encouraged people to make the most of their time remaining, and sometimes contributed to coming to terms with their mortality. Factors influencing experiences of discussions reflected the complexity and diversity in participants’ lives, personalities, and life experiences, with discussions exposing the realities of living with terminal illness. Conclusion: Individuals’ unique lives and experiences shape their responses to, and the impact of advance care planning on how they think, feel and behave. Advance care planning is not simply a means to document end-of-life care preferences, but can empower and instil confidence in patients, and may form part of the process of coming to terms with mortality, allowing clinicians to shift focus from process-related outcomes.
Assessing the aggressiveness of prostate cancer using ADC and relaxation maps from synthetic MRI
Authors: Sirolu Sabri , Seker Mustafa Ege , Alis Deniz , Guroz Batuhan , Kayhan Cavit Kerem , Tokat Fatma , Argun Omer Burak , Oksuz Ilkay , Karaarslan Ercan 
Published: February 2025

Background Emerging evidence suggests multiparametric prostate MRI's role in evaluating prostate cancer (PCa) aggressiveness. Purpose To evaluate the utility of quantitative sequences in prostate MRI for assessing peripheral zone PCa aggressiveness, focusing on added value of relaxation maps to ADC. Material and Methods In total, 64 men undergoing preoperative bi-parametric prostate MRI with synthetic sequences were retrospectively enrolled. Radiologists delineated lesions on ADC maps and synthetic MRI, matched with digitized whole-mount specimens. PCa was graded as low, intermediate, or high based on Gleason grade. Statistical analyses assessed differences in T1, T2, PD, and ADC values across grades. For significant variables, AUC curves were generated. A logistic regression model evaluated the added diagnostic value of relaxation maps to ADC. Results Of the 95 PCa foci, 11 were low-grade, 45 intermediate-grade, and 39 high-grade. T1 ( P = 0.4) and PD ( P = 0.3) showed no significant differences, while T2 and ADC differed significantly ( P < 0.001). Median T2 values were 98 ms (low-grade), 81 ms (intermediate), and 73 ms (high-grade), and median ADC values were 1006 mm²/s, 836 mm²/s, and 721 mm²/s, respectively. ADC yielded AUCs of 0.888 (95% CI=0.794–0.963; P < 0.0001) for low- versus intermediate-to-high-grade PCa, and 0.825 (95% CI=0.724–0.901; P < 0.0001) for low-to-intermediate versus high-grade. T2 AUCs were 0.770 (95% CI=0.605–0.908; P = 0.021) and 0.755 (95% CI=0.648–0.864; P = 0.0051), respectively. A logistic regression model combining T2 and ADC showed no significant improvement over ADC alone in differentiating low- versus intermediate-to-high-grade and low-to-intermediate versus high-grade PCa ( P > 0.05). Conclusion T1 and PD maps from synthetic MRI showed limited utility in grading PCa. Although T2 values were effective, ADC values were superior in assessing PCa aggressiveness. The addition of T2 to ADC did not significantly improve diagnostic performance.
Public Administration Performance Data: The Case for Including Gratitude
Authors: Burgess Simon , Abid Muhammad , Fazal-e-Hasan Syed Muhammad , Dillon Anthony , Adapa Sujana , Al Farooque Omar 
Published: February 2025

There are various prima facie reasons for looking at the gratitude that citizens feel in response to government programs. Some relate to individual flourishing, others relate to moral virtue or social cohesion. We analyze survey data from 429 Australian participants (211 Indigenous and 218 non-Indigenous) in order to understand their levels of gratitude for the government support that is available to them. The data also allows us to consider their perceptions about the fairness, quality, and benevolence of government support. Such factors, according to our hypotheses, may be expected to moderate their levels of gratitude. In addition, the data enables us to see whether their levels of gratitude are associated with their levels of national pride, and whether their levels of national pride predict their levels of satisfaction with life. We find that non-Indigenous Australians are slightly more likely than Indigenous Australians to think that Australian government support is fair; Indigenous Australians, however, who perceive it as fair are more likely to be grateful for it. The fairness-gratitude relationship did not for hold non-Indigenous participants. Nonetheless, we predict that if more Indigenous Australians were to perceive Australian government support as fair, gratitude for it amongst Indigenous Australians would increase. JEL classification: I310
Polydopamine Nanoparticles-coated Curcumin Upregulates the Expression of Nrf2 Through the Keap1/ARE Signaling Pathway to Improve Liver Injury in Mice with Liver Cancer
Authors: Zhou Qingqing , Zhang Zhiyuan 
Published: February 2025

Background Liver cancer is a complex disease, and the upregulation of Nrf2, a key molecule in the Keap1/ARE signaling pathway, is expected to become a new method for liver cancer and prevention. Curcumin is a natural anti-oxidant, and polydopamine nanoparticles, as a new type of nano-drug carrier, have excellent biocompatibility and drug-loading performance and can improve the targeting and efficacy of drugs. Purpose: This study aims to explore the effect of polydopamine nanoparticle-encapsulated curcumin on upregulating the expression of Nrf2 through the Keap1/ARE signaling pathway, thereby improving liver damage in mice with liver cancer and providing new strategies and basis for the treatment and prevention of liver cancer. Methods After the H22 cell culture and liver cancer mouse model were established, they were divided into groups for the study of the mechanism of action of the prepared polydopamine nanoparticles-coated curcumin (CUR-PDA NPs), and the effect of CUR-PDA NPs expression on inhibition of cell proliferation and migration, promotion of apoptosis, and delaying liver cancer progression was studied through animal experiments. This process is related to the Keap1/ARE signaling pathway and Nrf2 expression. The mechanism is further verified by Add-Nrf2, Nrf2-shRNA, Keap1-shRNA, and other methods. Results CUR-PDA NPs upregulate the expression of Nrf2 through the Keap1/ARE signaling pathway to improve liver injury in mice with liver cancer. There is an interaction between the expression of CUR-PDA NPs and Keap1. Increasing the expression of Keap1 can inhibit the activation of Nrf2, thereby inhibiting the anti-oxidant and detoxification mechanisms, resulting in reduced cell survival rate, increased apoptosis rate, reduced migration, and reduced levels of IL-1β and TNF-α. Conclusion CUR-PDA NPs upregulates the expression of Nrf2 through the Keap1/ARE signaling pathway to improve liver injury in mice with liver cancer. This provides new strategies and a basis for liver cancer treatment and prevention.
Assessing the impact of Long COVID on healthcare workers’ work – role functioning in tertiary hospitals in Singapore
Authors: Aribou Zeenathnisa Mougammadou , Tan Alvin Kian Wei , Lim See Ming , Lim John Wah , Gan Wee Hoe , Ng Wee Tong , Koh David Soo Quee 
Published: February 2025

Background Understanding Long COVID's impact on healthcare workers (HCWs) is vital for patient safety and care quality. However, research on its prevalence among HCWs in Singapore and its work impact is lacking. Objective This study aims to assess Long COVID prevalence and its impact on work role functioning among HCWs in two Singapore tertiary hospitals, filling a critical gap in the literature. Methods Conducted from January to April 2023, this study evaluated Long COVID prevalence and its impact on HCWs’ work-role functioning in two Singapore tertiary hospitals. HCWs over 21, having experienced ≥1 COVID-19 infection, participated in an online survey. Long COVID, defined by NICE criteria, entailed symptoms persisting for 4 or more weeks. Work-related functioning was assessed using WRFQv2.0. Descriptive analyses were conducted using STATA software. Results Out of 15,882 eligible participants, 573 responded (3.6% response rate). Long COVID prevalence (symptoms persisting for ≥4 weeks) was 47.5%, notably higher among younger HCWs (<40 years old), those with moderate/severe infections, and multiple infections. HCWs with Long COVID had significantly lower WRFQv2.0 mean scores compared to those without (85.1 vs. 74.3, p < 0.05). Additionally, HCWs with symptoms for ≥12 weeks had significantly lower scores than those without Long COVID (85.6 vs. 74.3, p < 0.05). Conclusion This study underscores Long COVID's potential impact on HCWs’ work role functioning, especially among those with prolonged symptoms. Tailored work adjustments are crucial for their successful return to pre-illness levels, highlighting the importance of addressing Long COVID in healthcare settings.
Enhancing medication adherence with blister-packed oral oncolytics: A case example in chronic lymphocytic leukemia
Authors: Borrelli Eric P. , Barnes Nathan , Nelkin Heather , Saad Peter , Dumitru Doina , Lucaci Julia D. 
Published: February 2025

Introduction Medication nonadherence is a prevalent issue in the oncology population and can be costly on the healthcare system while leading to worsened outcomes, including increased mortality. One intervention that has been shown to help promote medication adherence to oral therapies for chronic conditions is blister-packaging. However, no literature is available assessing the potential impact of blister-packaging in oncology. Therefore, we aimed to quantify the impact of blister-packaging oral oncolytics on medication adherence and healthcare costs. Methods An economic model was designed to assess the potential impact of blister-packaging oral oncolytics for chronic lymphocytic leukemia (CLL) patients in the U.S. The model took the perspective of the U.S. healthcare system and assessed newly diagnosed CLL cases initiating therapy, utilizing a one-year time horizon. The intervention of interest was blister-packaging oral therapies in the treatment of CLL, while the model evaluated the impact of this intervention on healthcare costs through improved patient adherence based on peer-reviewed literature. Results This analysis consisted of 20,700 newly diagnosed patients with CLL initiating therapy. Initiating blister-packed oral therapies saw adherence increase by 1004 patients from 12,979 patients (62.7%) to 13,983 patients (67.5%). While an increase in pharmacy costs by $61,589,670 (+$247.95 per-patient per-month (PPPM)) was seen for the population, medical costs decreased by $82,285,847 (-$331.26 PPPM). Overall, this led to a net reduction in total healthcare costs of $20,696,177 (-$83.32 PPPM). Conclusions Blister-packaging oral oncology drugs in CLL has the potential to reduce total healthcare expenditures by increasing medication adherence. Future studies are needed to evaluate the direct effects of blister-packaging oral oncolytics on clinical, healthcare resource utilization, and financial outcomes.
Privacy Matters: Experiences of Rural and Remote Emergency Department Patients – A Mixed-Methods Research Conducted in Newfoundland and Labrador, Canada
Authors: Geetha Manukumar Aswathy , Miller Matthew , Patey Christopher , Mariathas Hensley H , Rahimipour Anaraki Nahid , Walsh Anna , Hurley Oliver , Senior Dorothy , Etchegary Holly , Norman Paul , Wang Peter , Asghari Shabnam 
Published: February 2025

Objectives: This study aims to investigate patients’ privacy experience when receiving care in emergency departments (EDs) in Newfoundland and Labrador, Canada. We aim to assess the level of satisfaction with privacy and to assess for factors that improve or worsen the privacy experience, not limited to patient demographics, length of stay, and hospital location. Methods: This study used a mixed-methods design, gathering quantitative and qualitative data using a telephone survey and semi-structured interviews. Our primary outcome measure was patients’ privacy experience in the ED. The independent variables in our study were age, gender, ED location, patient-reported wait times, reason for ED visit, and healthcare provider involved in care. Results: Among the 821 patients who participated in the interviews, 1 in 4 patients (24%) did not have satisfactory ED privacy experiences. Multinominal logistic regression showed patients who waited 4+ hours before being examined by a provider [aOR = 0.34, 95% CI: 0.17-0.69] and those who visited the urban EDs [aOR = 0.17, 95% CI: 0.09-0.35] reported low levels of privacy. Furthermore, those whose overall length of stay was 4 to 8 hours [aOR = 0.44, 95% CI: 0.23-0.84] and 8+ hours [aOR = 0.36, 95% CI: 0.17-0.78] also reported dissatisfaction with ED privacy experience. Our qualitative analysis found privacy concerns in waiting rooms, triage areas, and curtain rooms, with females voicing more concerns than males. Conclusion: Patients with longer wait times and who have been seen in urban EDs experience less privacy. Our qualitative data shows that women also raised more privacy concerns than men and that waiting rooms and triage areas are the locations with the most reported privacy concerns. Patient experience and outcomes would benefit from improving patient privacy when receiving care in EDs.
Rhytmic Mid-Temporal Discharges in a Mother and Daughter with Psychogenic Non-Epileptic Seizures
Authors: Erkent Irem , Gurses Candan 
Published: February 2025

Psychogenic non-epileptic seizures (PNES) are complex episodes that outwardly resemble epileptic seizures but are not caused by any underlying neurological disease. Unlike true epileptic seizures, PNES are more likely to be linked to psychological factors and do not show any abnormal activity on electroencephalography (EEG) recordings. This differentiation is crucial for accurate diagnosis and treatment, as misdiagnosing can lead to unnecessary treatments. Diagnosis of PNES might become difficult in the presence of particular benign EEG variants such as Rhythmic Midtemporal Discharges (RMTD). RMTD is a rare benign variant of normal EEG, characterized by rhythmic 5-7 Hz discharges in the temporal regions. This pattern could be present in normal individuals, in patients with psychiatric disorders or epilepsy. It could mimic interictal epileptiform discharges. Recognition of this pattern is essential to avoid misinterpretation of EEG findings that might eventuate in inappropriate treatment and adverse effects on a patient's medical condition, especially when there is a recent suspicious event in terms of an epileptic seizure. Among patients with PNES, the occurrence of benign variants might be much harder to interpret and physicians may mistakenly interpret RMTD on the EEG as indicative for epilepsy, especially in the absence of clear clinical criteria for PNES. This report is the first to document RMTD in first-degree relatives with PNES, suggesting a possible genetic predisposition and the need for further research into the interaction between RMTD and PNES. Our aim is to raise awareness that will enable accurate EEG reading and correct diagnosis.
Protective role of Aronia (Aronia melanocarpa) against doxorubicin-induced testicular damage: A comprehensive study of short- and long-term effects
Authors: Korkmaz Fırat , Balkan Burcu M. , İpek Volkan , Güngör Şükrü , Enes İnanç M. , Ayözger Leyla E.Ö. , Özalkan Doğuş 
Published: February 2025

Background Doxorubicin (DOX) is a potent chemotherapeutic drug used against cancer but is known to have adverse effects on male reproductive health. Objective This study investigated the protective effects of aronia (Aronia melanocarpa) against DOX-induced testicular damage in male rats, examining both short-term (2 weeks) and long-term (9 weeks) exposure. Methods In this study, 36 male Wistar albino rats were divided into two main groups: short-term (ST) and long-term (LT). Each group was further subdivided into three groups: control, DOX, and DOX + Aronia, with 6 rats per group. The control and DOX groups received tap water, while the DOX + Aronia group received tap water mixed with Aronia fruit juice. DOX was administered to the DOX and DOX + Aronia groups to assess the protective effects of Aronia fruit juice against DOX-induced toxicity. Biochemical assays, histopathological analyses, and immunohistochemical staining were performed to assess testicular health and apoptotic activity. Sperm quality parameters were also evaluated. Statistical analysis was conducted to determine significant differences among groups. Results In the long-term DOX group, significant decreases in sperm motility and plasma membrane integrity were observed. However, aronia supplementation with DOX improved these parameters. Biochemical analyses indicated variations in antioxidant response. Histopathological changes were found in the long-term DOX group but were accentuated with aronia co-administration. Caspase-3 immunopositivity showed no significant differences between groups. The decline in sperm quality in the DOX group compared to the DOX + Aronia group suggested potential subclinical effects of DOX and protective effects of aronia. Conclusions Aronia appeared to benefit sperm quality and antioxidant markers, especially in long-term exposure. This study suggests that aronia supplementation may mitigate DOX-induced testicular damage, particularly concerning sperm quality and antioxidants. However, additional investigations are necessary to fully explore its potential as a protective agent against DOX-induced reproductive toxicity.