Search Results (445)

(1) Background: Medication shortages have become increasingly common in the UK. However, there is limited evidence regarding the experiences of people with epilepsy and their caregivers during these shortages. The aim of this study is to explore the extent and impact of ASM shortages on people with epilepsy and their caregivers across the UK. (2) Methods: A cross-sectional online survey was distributed between January and April, 2024 by epilepsy charities. Participants included people with epilepsy and caregivers. The survey collected demographic information, types of ASM respondents were prescribed, experiences of shortages, and the impact of shortages. Data were analysed descriptively, and subgroup analyses were conducted by medication type. (3) Results: A total of 1549 responded, of whom 1312 were people with epilepsy and their carers who were included in the analysis with a mean age of 43 years. A total of 941 respondents (71.7%) reported difficulty obtaining their prescribed ASM in the past year. Shortages were most frequently reported for sodium valproate (60.8%), lamotrigine (65.2%), carbamazepine (92.6%), clobazam (82.6%), topiramate (81.5%), zonisamide (74.0%), levetiracetam (62.8%), lacosamide (71.0%), and brivaracetam (70.5%). A total of 529 (40.4%) of the participants reported that stress and/or anxiety caused by medication shortages was associated with recurrent seizures. We did not ask whether patients missed medications because of these difficulties. (4) Conclusions: ASM shortages are a widespread issue for people with epilepsy in the UK, leading to treatment disruptions and psychological distress. Addressing supply change limitations and identifying effective approaches to preventing the substitution of ASMs brands by clinicians may potentially reduce this problem. Full article

This article commences from a transdisciplinary research setting where students, artists, activists, and researchers come together to investigate medieval travelling accounts. The article is structured in two main parts. The first part presents an exploration of the theoretical framework of an hermeneutics of charity and suspicion as well as a development of a methodology that probes at the “cracks” of colonial pedagogical and scholarly structures. In the second part, the article uses critical inquiry and shared learning experiences to examine Marco Polo’s The Travels, focusing on his descriptions of dancing. Specifically, it investigates what Polo’s text conveyed—and omitted—about the relationship between intimacy, eroticism, and dance for a European audience. Combining auto-ethnographic reflections with stories from the communal learning process, the article invites readers to consider how collective inquiry reshapes our understanding of historical texts. In addition to questioning Polo/Rustichello’s portrayal of religious dance through his mercantile and sexualised gaze, the author also challenges some previous scholarly interpretations of Polo as an agent of European colonial endeavours. Finally, the paper offers a method for rethinking how researchers approach dance and university education, as well as practical tools for how historical accounts can be explored in a way that prevents discernment from overshadowing what can be gained from attunement. 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

Patients on hemodialysis (HD) often experience changes in body composition due to metabolic disorders. Phase angle (PhA) is a marker of tissue integrity and may reflect overall functional condition. This study evaluated body composition and its relationship with PhA in 53 HD patients (27 women, 26 men) over 40 years old, compared with 106 age- and sex-matched healthy controls. Body composition was assessed using bioelectrical impedance analysis (BIA), measuring skeletal muscle mass (SMM), fat tissue, total bone mass (BM), and PhA. HD patients had significantly lower fat mass and PhA than controls (p < 0.001). The prevalence of low SMM and BM was higher in patients, though not statistically significant. Sex differences were generally not significant, except for a higher prevalence of low BM in female controls (p < 0.001). After adjusting for age and sex, PhA was positively associated with SMM% (p = 0.021) and BM (p = 0.035) in HD patients only. These results indicate that PhA–body composition relationships differ between HD patients and healthy individuals, highlighting PhA as a potential marker of body composition disturbances in HD. Full article

Charitable giving plays a vital role in advancing sustainable development, yet little is known about its determinants in transitional economies. This study addresses this gap by examining the socioeconomic and psychological drivers of prosocial financial behavior in Uzbekistan, integrating the Theory of Planned Behavior (TPB), Norm Activation Theory (NAT), and Well-Being Theory. Data from a sample of 348 individuals reveal two distinct pathways of giving: one shaped by resources (income, age) and another by subjective well-being (happiness). While income, age, and happiness emerged as significant positive predictors of charitable behavior, traditional TPB factors such as attitude, subjective norms, and perceived behavioral control were not supported in this context. A surprising finding was the negative association between personal norms and charitable giving, challenging assumptions of Western-centric models and pointing to the importance of cultural and institutional conditions, such as trust in charities and informal giving practices. The study contributes to sustainability research by showing that fostering well-being and targeting specific demographic groups can enhance philanthropy, while also emphasizing the need for culturally sensitive approaches in understanding prosocial behavior within emerging economies. Full article

This methodological review identifies challenges in the development of health economic evaluations of newborn bloodspot screening (NBS) interventions and their consideration in NBS policy making. A systematic review of health economics methodological studies in NBS and stakeholder consultation was undertaken. The intervention under examination was defined as health economic decision analytic modelling used as decision support to NBS policy makers. An iterative search strategy was used to identify studies, and a data extraction framework was based upon a simple decision analytic model structure for the NBS decision problem. Synthesis was facilitated by two stakeholder workshops, which focused on ensuring the complete identification of challenges and developing recommendations. Sixteen methodological studies were identified. Data were extracted on challenges in decision criteria, decision variables, decision problem scope, defining model structure, selecting modelling method, the target condition, the screening test/protocol, outcome nodes, and other categories. Recommendations are made concerning supporting NBS decision making, NBS economic model structure and methods, data and estimation of model parameters, and overarching considerations. Recommendations for decision processes and methods research are put forward for the consideration of NBS policy makers and commissioners of research. Full article

Background: Remote ischemic conditioning (RIC) has shown promise as a neuroprotective strategy, but its application in children with cerebral palsy (CP) remains unexplored. We conducted a randomized controlled trial to evaluate the feasibility, safety, and tolerability of repeated, 6–7 sessions of RIC in children with unilateral CP. Methods: Fifty-one children aged 6–16 years with unilateral CP were randomized (1:1) to receive RIC or sham conditioning on the more affected arm. Primary feasibility outcomes included recruitment metrics, intervention adherence, retention, and protocol fidelity. Safety endpoints included continuous monitoring of oxygen saturation, blood pressure, heart rate, and adverse event incidence. Tolerability was assessed via child-reported pain ratings, conditioning pressure tolerance, skin integrity evaluations, and session adherence. Results: Of 148 children screened, 51 were randomized to RIC (n = 25), sham (n = 26) groups; 48 (94.1%) completed the intervention as allocated. Recruitment yielded 2.04 participants/month. Intervention adherence was 100% in both groups. RIC was well tolerated, with mean pain scores 2.8 ± 3.1 during inflation in RIC and 0.3 ± 0.8 in Sham group. No serious adverse events occurred. Physiological parameters remained stable across 314 conditioning sessions; no clinically significant hypoxemia, blood pressure derangements, or arrhythmias were detected. Minor adverse events (transient erythema, mild discomfort) were rare (2.22%) and self-limiting. Skin integrity was preserved, and no participants required session termination. Conclusions: Repeated RIC is feasible, safe, and tolerable in children with unilateral CP. These findings support the design of future trials using RIC as a priming agent to enhance pediatric neurorehabilitation outcomes. Full article

With 2.3 million people in the UK having experienced domestic abuse (DA) in the year ending March 2024, DA represents a severe public health issue. Public interest in DA remains high, with its importance and impact re-emphasised through recent legislative changes. Thus, educating the public about the predictors and consequences of DA and barriers to gaining support can both empower potential victims and enable them to recognise and support others. The CEASE Educational Programme is one such intervention, provided by UK-based DA charity RemediUK. This study employed semi-structured interviews and interpretative phenomenological analysis to explore the experiences of staff (n = 6) who had facilitated the CEASE Educational Programme. Two overarching themes relating to barriers to delivery were highlighted: (1) understanding participants’ lack of engagement, and (2) a desire to fill the gaps. Our findings indicate a need to explore how DA education can best target those who would benefit from it the most, and in doing so, identify attitudes and beliefs endorsing DA, and how to best educate those with personal experiences of abuse. Full article

Background/Objectives: Beetroot supplementation is a rich source of inorganic nitrate and has been proposed to enhance nitric oxide bioavailability and support cardiovascular recovery after exercise. This study aimed to evaluate the effects of beetroot supplementation on post-exercise cardiovascular and autonomic recovery in postmenopausal women. Methods: A systematic review and meta-analysis were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches were performed in PubMed, Scopus, and Web of Science databases from inception to July 2025. Ten trials involving postmenopausal women were included. Outcomes assessed included cardiovascular measures (blood pressure and vascular function), autonomic parameters derived from heart rate variability (HRV)—specifically the root mean square of successive differences (RMSSD), the standard deviation of normal-to-normal intervals (SDNN), and high-frequency power (HF)—as well as physical performance (peak oxygen uptake [VO_2peak or VO_2max] and functional fitness tests). Four independent reviewers extracted data, assessed risk of bias, and evaluated the certainty of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Results: Pooled analyses from two trials (n = 54) revealed a statistically significant improvement in RMSSD with beetroot supplementation (mean difference: 6.68 ms; 95% CI: 0.86 to 12.50; p = 0.02), suggesting enhanced parasympathetic reactivation after exercise. No significant effects were detected for HF (mean difference: 61.75 ms²; 95% CI: −70.92 to 194.43; p = 0.36) or SDNN (mean difference: 6.20 ms; 95% CI: −9.69 to 22.09; p = 0.44). Substantial to considerable heterogeneity was identified across outcomes (I² = 73–86%). Certainty of evidence was rated moderate for RMSSD, low for SDNN, and very low for HF. Conclusions: Beetroot supplementation may enhance post-exercise autonomic recovery in postmenopausal women, primarily through improvements in RMSSD. However, further trials with standardized protocols, larger samples, and longer intervention durations are required to clarify its impact on broader HRV domains, cardiovascular function, and clinical outcomes. Full article

Background: Tuberculous meningitis (TBM) is the most severe form of tuberculosis and is associated with high morbidity and mortality, especially in resource-limited settings. In Mozambique, where both tuberculosis and HIV are highly prevalent, TBM poses significant diagnostic and therapeutic challenges. This study aimed to describe the clinical characteristics and to identify predictors of TBM mortality among persons living with HIV (PLWH) in a rural hospital in Mozambique. Methods: We conducted a retrospective cohort study at Carmelo Hospital of Chokwe (CHC) between 2015 and 2020. We included 372 PLWH diagnosed with TBM (PTBM); data on demographics, clinical presentation, and laboratory findings were extracted from patient records. TBM diagnosis was considered for confirmed cases based on a hospital-adapted algorithm incorporating clinical features, cerebrospinal fluid (CSF) analysis, TB-LAM, and Xpert MTB/RIF testing. Cox proportional hazard models were used to identify independent predictors of mortality, and Kaplan–Meier survival curves with log-rank tests were used to assess survival differences across clinical subgroups. Significance was considered at a p value ≤ 0.05 with an adjusted hazard ratio (AHR) 95% CI in the multivariate analysis. Results: Overall, 372 PTBM contributed to a total of 3720 person-months (PM) of treatment follow-up, corresponding to a mortality incidence of 3.76 deaths per 100 person-months. Factors independently associated with increased mortality included male sex (adjusted hazard ratio [aHR]: 1.80; 95% CI: 1.21–2.68; p = 0.004), BMI < 18.5 kg/m² (aHR: 2.84; 95% CI: 1.46–5.55; p = 0.002), Immunovirological failure to ART (aHR: 2.86; 95% CI: 1.56–5.23; p = 0.001), CSF opening pressure >40 cmH₂O (aHR: 2.67; 95% CI: 1.46–4.86; p = 0.001), and TBM severity grading III (aHR: 4.59; 95% CI: 1.79–11.76; p = 0.001). TBM involving other organs also significantly worsened survival (aHR: 2.03; 95% CI: 1.27–3.25; p = 0.003). Conclusions: TBM mortality in PLWH was driven by ART failure, high CSF pressure, and malnutrition. Male sex and severe neurology also increased risk. Urgent interventions are proposed: optimize ART, manage intracranial pressure, provide nutritional support, and use corticosteroids. An integrated care approach is essential to improving survival in resource-limited settings. Full article

Concussions significantly impact sleep quality among adolescents. Despite increasing recognition of these effects, the complex relationship between adolescent concussions and sleep disturbances is still not fully understood and presents mixed findings. Here, we conducted a systematic review and meta-analysis to assess how concussions affect sleep-related symptoms in adolescents. We included papers presenting Pittsburgh Sleep Quality Index (PSQI) differences following concussion in high school and collegiate patients, with sleep measures recorded following concussion. Animal studies, research on participants with conditions other than concussion, non-English articles and papers failing to present PSQI data were excluded. We searched MEDLINE^®, Embase^®, CINAHL, Web of Science™, PsycINFO^®, Google Scholar, and Cochrane Central Register of Controlled Trials databases until 23 August 2024. In addition, we performed hand-searching of relevant reference lists and conference proceedings to identify further studies. Risk of bias was assessed using the Newcastle–Ottawa scale. In total, we considered 4477 studies, with nine meeting the inclusion criteria. Our analysis involved 796 participants, 340 of whom had experienced a concussion. Analysis was carried out using the meta and metafor packages in R (version 4.0.0). We showed a deterioration in sleep quality post-concussion, as evidenced by increased PSQI (standardised mean difference 0.84; 95% CI 0.53–1.16; p < 0.0001). Subgroup and quality assessments confirmed the consistency of these findings. Since poor sleep quality impacts daytime activities, we analysed the relationship between concussion and daytime dysfunction. We showed that concussion is associated with a significant worsening of the daytime dysfunction score by 0.55 (95% CI 0.24–0.70; p = 0.006). We conclude that concussions impair both sleep quality and daytime functioning in adolescents. Our research underscores the need for systematic inclusion of sleep quality assessments in post-concussion protocols and calls for targeted interventions to manage sleep disturbances post-concussion to mitigate their broader impacts on daily functioning. Full article

Aim: In sub-Saharan Africa, approximately 40 million pregnant women are exposed to parasitic diseases such as malaria caused by Plasmodium falciparum, Schistosome parasites, and soil-transmitted helminths (STHs). When parasitic diseases share the same habitat and overlap in distribution, then high co-infection rates occur. The co-infection can lead to consequences for the child, such as intrauterine growth retardation, low birth weight, pre-term delivery, and neonatal mortality. Methods: The objective of the study was to determine the nature and extent of coinfection from 100 samples collected from the Battor (50) and Adidome (50) towns of Ghana in collaboration with the Noguchi Memorial Institute for Medical Research, University of Ghana. Results: Out of 50 for the Adidome towns determined for P. falciparum by Rapid Diagnostic Test (RDT), Malaria Pan-specific Antigen (PAN), and Malaria Pf kit, 39 were true positive (TP), 8 were true negative (TN), and 30 were false negative (FN). For Battor, 19 were TP, 12 TN, and 20 FN. For S. mansoni in Adidome via polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP), 21 tested positive, and 29 were negative, with 52.5% sensitivity and 100% specificity. For S. haematobium, 28 were positive and 22 negative using PCR with 70% sensitivity and 100% specificity. In LAMP, 28 were positive, and 22 negatives, with 70% sensitivity and 100% specificity. In Battor PCR for S. mansoni, 28 positives and 22 negatives with 68.3% sensitivity and 100% specificity. In LAMP, 32 were positive, and 18 were negative, with 80% sensitivity and 100% specificity. For S. haematobium, PCR showed 30 positive and 20 negative, with 73.2% sensitivity and 100% specificity. With LAMP, 21 were positive, and 29 negatives, with 51% sensitivity and 100% specificity. In both towns, 20–30 years had the highest infection prevalence for P. falciparum, S. mansoni, S. haematobium, and Strongyloides stercoralis. Conclusion: The results will be utilized as a part of the continuous surveillance for future research aiming at gathering nationally representative data in Ghana on the prevalence of coinfection and proposing interventions based on that for the vulnerable pregnant women population. Full article

Food loss and waste are critical global issues, particularly in developing economies where they exacerbate food insecurity and environmental degradation. This study focuses on fruit and vegetable loss (FVL) in retail and wholesale markets in North Lebanon, a region marked by socio-economic challenges and infrastructural deficiencies. The research aims to identify the underlying drivers of FVL, assess current management practices, and identify aspects impacting it. Data was collected through surveys of seventy wholesalers and retailers employing descriptive statistics and multinomial logistic regression for analysis. The findings reveal that 85.7% of the sample generate little or no FVL. Being a retailer or wholesaler, operating on a small or large scale, or being open 24/7 or part-time does not affect FVL. Conversely, inadequate display and storage, hot weather, and pricing practices significantly impact FVL. The market faces challenges such as low consumer purchasing capacity, financial difficulties, legal constraints, and lack of knowledge. Various practices are used to prevent FVL, including strategic supply chain decisions, price reductions, and donations to charities. The study underscores the need for improved infrastructure, financial support, and regulatory frameworks to mitigate FVL, thereby enhancing food security and environmental sustainability in North Lebanon. Full article

Sports teams increasingly use nostalgia-based marketing to spark fan engagement and boost merchandise sales. Yet these efforts can also provoke backlash, especially when they resurrect contested imagery. This article examines how one such campaign—the New York Islanders’ 2015 revival of their controversial fisherman logo—was framed across team broadcasts and interpreted by fans on social media. Drawing on a qualitative textual analysis of television and radio coverage alongside a quantitative content analysis of 563 tweets, the study reveals a divide between institutional messaging and grassroots reaction. While team broadcasts emphasized charity and sentimental appeal, fan discourse was notably more critical, mocking the jersey’s design and recalling past failures. By positioning nostalgia not only as a branding asset but as a reputational risk, the article contributes a novel perspective to debates about commercialization, mediatization, and fan co-production in sports. It also demonstrates the value of mixed methods for analyzing how branding narratives are negotiated in real time. Full article

Limited surveillance and laboratory testing for non-influenza viruses remains a challenge in Uganda. The World Health Organization (WHO) designated National Influenza Center (NIC) tested samples from patients with influenza-like illness (ILI) and severe acute respiratory infections (SARIs) during August 2022–February 2023. We leveraged the influenza sentinel surveillance system to detect other respiratory viruses (ORVs). Samples were tested using the US Centers for Disease Control and Prevention (CDC) influenza and SARS-CoV-2 multiplex and the FTD^TM Respiratory Pathogens 21 assays using real-time reverse transcription polymerase chain reaction (RT-qPCR). A total of 687 (ILI = 471 (68.6%) and SARI = 216 (31.4%) samples were tested. The median age was 2 years (IQR: 1–25) for ILI and 6 years (IQR: 1–18) for SARI case definitions (p-value = 0.045). One or more respiratory pathogens were detected in 38.7% (n = 266) of all samples; 33 (12.4%) were selected for metagenomics sequencing and 8 (3%) for SARS-CoV-2 targeted sequencing. Respiratory pathogens were detected by sequencing in 23 of 33 (69.7%) samples. Our study provides insight into the usefulness of this surveillance system in conducting virological testing for other viruses and provides tools and evidence to monitor patterns and characteristics of viruses causing ILI/SARI, which will guide public health decisions and interventions in Uganda. Full article