Search Results (259)

Background: Neurogenic bowel dysfunction (NBD) is a major chronic sequela of spinal cord injury (SCI) with substantial implications for rehabilitation and long-term management. However, population-level evidence describing how gastrointestinal (GI) diagnostic codes are used following SCI, particularly within administrative healthcare systems, remains limited. Methods: We conducted a nationwide retrospective cohort study using administrative claims data from the Korean National Health Insurance Service (NHIS). A total of 584,266 adults with trauma-related SCI encounters between 2009 and 2019 were identified. GI diagnostic codes—paralytic ileus (K56), irritable bowel syndrome (K58), and functional bowel disorders (K59)—were evaluated as administrative proxies for bowel dysfunction. Demographic characteristics, disability status, regional factors, and health behaviors were analyzed using multivariable logistic regression. Results: GI diagnostic codes were frequently recorded after SCI, most commonly irritable bowel syndrome (approximately 30%) and functional bowel disorders (approximately 37%), whereas paralytic ileus was uncommon. Greater disability severity, female sex, older age, and rural residence were consistently associated with higher odds of GI diagnostic coding. Physical activity showed robust inverse associations across all models. Inverse associations observed with smoking and alcohol consumption were interpreted as reflecting residual confounding or health-related selection, rather than biological protective effects. Conclusions: Patterns of GI diagnostic coding after SCI likely reflect the clinical burden and management needs of neurogenic bowel dysfunction within healthcare systems, rather than the development of new gastrointestinal diseases. These findings underscore the importance of individualized bowel management, incorporation of structured physical activity into rehabilitation programs, and equitable access to SCI rehabilitation services, particularly for individuals with greater disability or those living in rural areas. Full article

As treatments for multiple myeloma (MM) evolve, there is a need for real-world insights into treatment patterns and outcomes. The treatment practices and clinical outcomes in patients with MM (TOTEMM) was a database study (2018–2024) of newly diagnosed transplant-ineligible patients with MM in Argentina (TOTEMM-A) and Brazil (TOTEMM-B) in a private healthcare setting. In TOTEMM-A (n = 72) and TOTEMM-B (n = 892), 37 and 92 different drug regimens were reported, respectively. In each country, treatment duration reduced across lines of therapy (LOT) (TOTEMM-A: range, 6.2–3.4 months; TOTEMM-B: range, 4.4–3.5 months); attrition rates increased across LOT (TOTEMM-A: range, 52.8–86.1%; TOTEMM-B: range, 41.9–88.0%); triplet regimens (mainly bortezomib based) were used most frequently in first-line (1L); >75% relapsed within 12 months, regardless of the drug prescribed; over 90% of relapses occurred between 1L and second-line, and up to half of patients were rechallenged with the same drug; >65% of patients experienced disease progression after 1L; and the 1- to 5-year adjusted cumulative risk of progression or death increased across LOT (TOTEMM-A: range, 47.1–88.5%; TOTEMM-B: range, 40.4–91.7%). The rapid and marked progression underscores the urgent need for novel treatments and regimens. Full article

Background: Adolescents and young adults (AYAs) with cancer have unique needs as they transition from childhood to adulthood. This study explored the patterns of health service use and the related costs incurred by the health care system and out-of-pocket (OOP) costs for AYAs diagnosed with cancer in Queensland, Australia. Methods: A linked administrative dataset (CancerCostMod) containing all AYA cancer survivors (n = 871; aged 15–24) diagnosed between July 2011 and June 2015 from the Queensland Cancer Registry (QCR) linked these records to Queensland Health Admitted Patient Data Collection (QHAPDC), Emergency Department Information System (EDIS), Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) records from July 2011 to June 2018. We quantified total and average health service use, associated costs, OOP costs, and costs variations across sociodemographic characteristics. Results: The public hospital costs incurred for AYAs diagnosed with cancer were higher (AUD 33.7 M) compared to private hospitals (AUD 12.6 M). The median cost per person for public admissions (AUD 9759, IQR = AUD 0–37,245). AYAs claimed 215,900 MBS items and 58,321 PBS items over a five-year period. First Nations Australians and individuals living in regional and mostly disadvantaged areas had higher public hospital admissions, associated costs, and ED admissions compared to their counterparts. Conclusions: This study revealed significant variations in healthcare costs for AYAs diagnosed with cancer. Public hospital costs were higher, with notable differences observed across sociodemographic characteristics. Full article

This research conducts a comparative analysis of the Environmental Impact Assessment’s (EIA’s) legal frameworks in Laos and China, utilising a qualitative methodological approach rooted in comparative law. This research systematically examines primary legal documents, case studies from the hydropower and mining sectors, and recent government data to evaluate the two systems based on three core criteria: the robustness of the legal structure, the effectiveness of enforcement mechanisms, and the depth of public participation. The analysis indicates that although both countries require Environmental Impact Assessments (EIAs), China’s framework is more structured and efficient, as demonstrated by its clearer legal hierarchy, strict penalties for non-compliance, and established public disclosure procedures. In contrast, Laos’s framework, although established, is marked by its early stage of development, evident in fragmented legislation, limited enforcement due to capacity constraints, and reduced public engagement. The study contributes by providing a direct bilateral comparison and empirically demonstrating how institutional divergences account for disparities in environmental outcomes and foreign investment. Recommendations are provided to improve transparency, enforcement capabilities, and substantive public engagement in both nations. This research is based on comparative legal theory and institutional analysis to transcend a mere descriptive narrative. It utilises a qualitative comparative methodology that combines doctrinal research of legal texts with practical case studies from the hydropower and mining industries. This method enables us to systematically investigate how differing institutional capacity, enforcement mechanisms, and governance models between an emerging and a developed system account for variations in EIA outcomes. The study questions are formulated to evaluate theoretical claims regarding the influence of legal frameworks and administrative authority on the attainment of good environmental governance, providing a transferable analytical model for analogous developing environments. Full article

This study examined how visual attention to specialty coffee label elements relates to consumers’ stated purchase intention. A total of 105 regular specialty coffee consumers viewed the front and back panels, simultaneously, of six commercially available labels while their eye movements were recorded with an eye tracker. Areas of Interest (AOIs) were defined for the label’s content, and a Normalized Fixation Ratio (NFR; proportional fixation time scaled by AOI area) was calculated. Purchase intention was measured on a seven-point structured scale, and the association between NFR and purchase intention was modeled using Landscape Segmentation Analysis (LSA). Heatmaps showed that central regions of the front and back panels were attentional “hot zones”, particularly when they contained sensory claims, cupping score, origin and traceability, roast level, coffee variety, and the “specialty coffee” designation. In contrast, weight, best-before date, grain or ground, and contact information consistently received little attention. Higher NFR values for sensory and origin-related cues were positively associated with purchase intention; labels that gave these attributes visual prominence achieved the highest intention scores. These findings indicate that consumers prioritize sensory and traceability-related information over technical or administrative cues and that both the content and graphic salience of label elements are critical for driving perceived value and choice. Results provide evidence-based guidance for structuring specialty coffee labels to optimize communication. Full article

Background/Objectives: In populations with type 2 diabetes mellitus (T2DM), it is unknown whether the survival benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RA) differ by estimated glomerular filtration rate (eGFR). To address this question and in the absence of definitive randomized controlled trials, we performed a retrospective observational study of US Veterans with T2DM to evaluate mortality hazard ratios associated with GLP-1 RA use at different eGFR levels. Methods: This administrative claims-based cohort included 1,188,052 U.S. Veterans with T2DM as of 1 January 2020. Initiation of GLP-1 RA was treated as a time-dependent variable and vital status of Veterans was followed until 31 December 2023. Results: A total of 31,676 Veterans met inclusion criteria. Over the study timeframe, 6.1% initiated treatment with GLP-1 RA and 57.7% died. Older age and eGFR < 15 mL/min/1.73 m² were associated with a decreased likelihood of GLP-1 RA initiation. In contrast, younger age and lower comorbidity burden were associated with decreased mortality, a finding that persisted even after adjustment for several baseline covariates. Conclusions: Among those with T2DM and eGFR < 25 mL/min/1.73 m², initiation of GLP-1 RA was associated with improved survival. This association remained significant with decreasing levels of kidney function, as well as among those receiving kidney replacement therapy (KRT). In conclusion, longer survival was observed both in participants on KRT and in those with eGFR 15–24 mL/min/1.73 m² not on KRT, but these findings were not observed among those with eGFR ≤ 15 mL/min/1.73 m². Full article

This article examines the sacred narrative traditions surrounding Nūr Atā, a small town in present-day Uzbekistan, to explore how Muslim communities in Central Asia expressed their religious history. Drawing on seven manuscripts preserved at the Beruni Institute of Oriental Studies in Tashkent, six in Persian and one in Turkic, the study identifies two distinct traditions that portray the town’s sanctity through prophetic miracle stories, hadith transmission chains, and Sufi cosmology. It explores how narrative form, linguistic variation, and intertextual references shape distinct devotional and historiographical claims. The topics addressed include the relationship between sacred narrative and historiography, the role of ritual practice in sacralizing space, and the textual transmission of spiritual authority. The sacred history of Nūr Atā offers a compelling vision of the town’s religious significance, communicated through both the content and structure of its narratives. These accounts position the town not merely as a local pilgrimage site but as a locus of divine favor embedded within the sacred geography of Islam. By linking the Prophet’s Miʿrāj, angelic testimony, and Sufi initiatic traditions to the landscape of Nūr Atā, the texts construct a genealogy of sanctity that aligns the local with the universal. In doing so, they articulate a vision of communal identity rooted in divine election, prophetic blessing, and spiritual legitimacy. The case of Nūr Atā thus underscores the need to treat sacred narratives, pilgrimage guides, and genealogical traditions as forms of historiography in their own right. These sources do not merely supplement court chronicles or administrative histories; they constitute vital modes through which Central Asian Muslim communities preserved collective memory, asserted religious authority, and inscribed themselves within the broader landscape of the Islamic world. Full article

This study examines how Israel’s legal and institutional arrangements, including migration policies, health-insurance eligibility rules, and safety enforcement mechanisms, shape health risks for Thai migrant agricultural workers, and identifies policy levers to mitigate preventable harm. Using a legal policy analysis informed by syndemics and labor frameworks, we mapped laws, regulatory oversight, and enforcement chains, and synthesized evidence from worker surveys, affidavits, and civil society reports to link institutional structures with barriers experienced in workplaces and healthcare settings. The findings reveal that health inequalities stem from structural design rather than isolated failures, including exclusion from public insurance, dependence on employer-based plans, employer-tied visas, opaque injury-claim procedures, fragmented oversight, absence of occupational-health surveillance, limited language access, poor housing conditions, and weak inspections. These interlocking features reinforce one another, resulting in under-reporting, delayed medical attention, and cumulative physical and psychological harm. The study concludes that structural legal and administrative reforms—rather than individual adaptation—are required to address these inequities. Policy priorities include integrating migrant workers into public insurance or ensuring equivalent coverage, decoupling residency from single employers, guaranteeing multilingual access, establishing independent health monitoring, and enforcing safety, housing standards and other social determinants of health through transparent inspections, positive incentives and meaningful sanctions. Full article

Background/Objectives: Sodium polynucleotide (PN) injection has recently been considered as a potential intra-articular therapy for knee osteoarthritis (OA); however, there is limited evidence regarding the long-term consistency of repeated PN cycles. To evaluate the clinical effectiveness of repeated intra-articular PN injections after the initial 6 months of therapy in patients with knee OA, using nationwide claims data. Methods: We conducted a retrospective cohort study using data from the Korea Health Insurance Review and Assessment Service collected between 2020 and 2023. Patients who received PN injections for knee OA were classified into two groups based on the treatment cycle: Group 1 (single cycle) and Group 2 (re-administration). Surgical outcomes and symptomatic indicators, including pain-related hospital visits, arthrocentesis, nonsteroidal anti-inflammatory drug prescriptions, and antidepressant prescriptions, were analyzed. Results: A total of 142,322 patients were included in this study. Readministration of PN was associated with significantly lower rates of total knee arthroplasty (2.31% vs. 4.92%, p < 0.0001) and delayed time to surgery (252.0 vs. 176.6 days, p < 0.0001). Similar trends were observed for hemiarthroplasty, with a lower incidence (0.28% vs. 0.55%, p < 0.0001) and longer time to surgery (240.7 vs. 162.2 days, p < 0.0001) in the readministration group. All groups showed a timewise reduction in pain-related hospital visits and instances of arthrocentesis. Safety outcomes were not assessed in this claim-based dataset. Conclusions: Repeated cycles of PN injections provide sustained clinical benefits and may effectively delay the need for surgical intervention in patients with knee OA, supporting their possible role as a long-term conservative treatment option. Radiographic severity and safety outcomes were unavailable in this claims dataset, limiting the adjustment for baseline OA severity and restricting causal interpretation. Full article

Despite much interest in the flow experienced by English as a Foreign Language (EFL) teachers, there is less research on flow re-engagement and pre-service teachers at the crucial phase of career development. This study aims to examine flow dynamics among pre-service and in-service EFL teachers in China during teaching. Six Chinese EFL teachers (three pre-service and three in-service) engaged in two rounds of interviews over the course of one year, which were analyzed using a thematic narrative approach. The findings indicate that immediate feedback, clear goals, and a challenge-skill balance were key antecedents of flow. In-service teachers highlighted principal’s teaching-focused philosophy, technology support, teaching experience and curiosity. All participants reported a sense of control, deep absorption, and time distortion. Two experienced teachers further claimed a loss of self-consciousness. The flow of participants was impeded by student-related factors, strong self-consciousness, and technological breakdowns. In-service teachers noted more complicated causes. To re-enter a state of flow, pre-service teachers favored avoidance strategies, whereas in-service teachers employed more flexible approaches. Flow enhanced instructors’ teaching confidence, shifted pre-service teachers’ career motivation and fostered in-service educators’ professional well-being, post-class reflection, and self-improvement. Administrators and teacher educators should provide a teaching-oriented working environment for in-service teachers and offer flow-focused training to pre-service teachers, thus promoting their flow experiences and fostering sustainable professional development. Full article

Claims are a significant cause of delays and increased costs in international construction projects, yet contract provisions on claims remain inconsistent, narrative, and difficult to apply in practice. This study presents a concise, knowledge-driven checklist for effective claim management in major standard forms, including International Federation of Consulting Engineers (FIDIC), the New Engineering Contract (NEC4), the American Institute of Architects (AIA), and Singapore’s Public Sector Standard Conditions of Contract (PSSCOC). The research mapped 22 entitlement clauses and 12 procedural clauses, then prioritized items through expert interviews and surveys. The final checklist comprises 16 items selected through transparent criteria (mean scores ≥ 4.0 or above group averages) that address critical risk areas. Application to two complex projects demonstrates that a few key clauses, such as those governing variations and timing requirements for requests, supporting documents, and decisions, account for most claim-related risks. Experts indicate that practical periods for submitting claim requests and proofs, and making decisions, are approximately 31, 65, and 61 days, respectively. The proposed checklist converts fragmented contract requirements into an actionable and auditable tool. It enhances clarity, transparency, and fairness in both pre-award reviews and daily project administration, which supports better risk management and minimizes disputes in global construction projects. Full article

The Nationality and Borders Act 2022 was enacted despite significant opposition from refugee charity and legal sectors. It is without question that the Act changes the domestic landscape of the refugee status determination system and has the potential to also negatively influence refugee status determinations in other jurisdictions. There are several sections of the Act that are particularly problematic for women’s claims of asylum. The Act reverses well-established international and regional human rights and refugee law principles and standards. The reversal, in some cases, of decades of jurisprudence on the interpretation of the Refugee Convention poses a concern for the integrity of the law and administrative justice. While the Act imposes barriers for all claimants, it disproportionately affects some of the most complex cases, including refugee women fleeing gender-based persecution. Of the various changes brought about by the Act, this article focuses on three that are particularly relevant to women asylum seekers: first, the regressive way in which membership of a particular social group has been framed; second, the heightened standard of proof now required; and third, the associated evidential burdens in relation to trauma and disclosure. Ultimately, these changes are likely to have a disproportionate and discriminatory impact on women seeking asylum, particularly those fleeing gender-based persecution. Full article

Background/Objectives: This study aimed at evaluating the association between maternal pre-pregnancy glycemic status and growth delay in offspring using nationwide health screening data. Methods: A retrospective cohort of 258,367 mother–child dyads born between 2014 and 2021 was analyzed. Maternal glycemic status was categorized as normal (<100 mg/dL), impaired fasting glucose (IFG, 100–125 mg/dL), or diabetes mellitus (DM, ≥126 mg/dL). Growth delay was defined as measurements below the 10th percentile of height, weight, and head circumference at 18–24 and 30–36 months. Visual and auditory development were assessed using caregiver questionnaires. Inverse probability of treatment weighting was applied, and weighted relative risks (RRs) were estimated. Results: The prevalence of growth delay was 3.5% for height, 3.8% for weight, and 4.3% for head circumference; visual and auditory problems were reported in 1.2% and 8.2% of children, respectively. Both the DM (1.2%) and IFG (9.3%) groups showed increased risks of growth delay across both age periods. Maternal hyperglycemia was also associated with offspring’s visual and auditory development, with age- and period-specific differences observed. Conclusions: Maternal pre-pregnancy glycemic status was significantly associated with delayed growth in Korean children aged 18–36 months. These findings highlight the importance of optimizing maternal glycemic control prior to pregnancy for favorable child developmental outcomes. Full article

Background: Hydromorphone is a semi-synthetic opioid agonist and a hydrogenated ketone of morphine. This study examined hydromorphone use in the United States (US) using three databases. Methods: The distribution of hydromorphone in the US (in grams) was provided by the US Drug Enforcement Administration’s Automated Reports and Consolidated Orders System (ARCOS) by state, zip code, and business type (pharmacies, hospitals, providers, etc.). Hydromorphone prescription claims were also examined using the Medicaid and Medicare Part D programs from 2010 to 2023. Results: Hydromorphone increased by +30.6% by 2013, followed by a decrease of −55.9% by 2023 in ARCOS. Medicaid prescriptions increased by +39.6% by 2015 and decreased by −48.9% by 2023. Medicare Part D claims increased by +8.5% by 2015 and decreased by −31.9% by 2023. There were also pronounced regional disparities in hydromorphone use identified in ARCOS (158.7-fold), Medicaid (17.5-fold), and Medicare Part D (13.7-fold). Conclusions: Hydromorphone use in the US has decreased substantially from 2010 to 2023. Additionally, these findings highlight considerable regional disparities, which may inform targeted opioid stewardship initiatives and guide policymakers to ensure safe and equitable opioid prescribing practices. Full article

Disputes are common in the intricate professional setting of the construction sector. When claims cannot be resolved kindly, they often escalate into conflicts that result in litigation. Identifying the root reasons of these claims and understanding their effects on project timelines, costs, and quality can help prevent poor performance in construction contracts. This study makes a unique contribution by developing a cause of claims breakdown structure (CCBS) that systematically categorizes the most frequent roots of claims identified in the building sector through an extensive literature review, and by subsequently assessing these categories using expert-based relative importance indices (RII). Using relative importance indices derived from specialist opinions, the research provides likelihood and influence quantities for 15 typical claim sources in the building sector. These values offer stakeholders in public construction projects a framework for assessing risks and planning mitigation strategies for construction claims. The study reveals the five most significant risk factors for contractual claims in the Kuwait building sector. These issues are ambiguities in contract language, followed by weather-related disruptions, ineffective communication among stakeholders, inadequate planning, and regulatory changes. Full article