Research Gaps Research Articles

Factors Influencing Obstructive Sleep Apnea Among Employees With Metabolic Syndrome: An Example of a District Hospital in Northern Taiwan

Obstructive sleep apnea (OSA) is a common sleep disorder shown to be significantly correlated with metabolic syndrome (MS). Healthcare professionals affected by both MS and OSA may suffer from poor sleep quality, raising potential concerns about patient safety. Currently, there remains a gap in research specifically addressing the relationship between MS and OSA in healthcare professionals. This study was conducted to examine the prevalence of employees with MS concomitant with OSA and to identify the factors of influence affecting MS employees with OSA in the workplace. A cross-sectional study design and convenient sampling were used, and participants were recruited from a district hospital in northern Taiwan. Data were collected using a structured questionnaire and a home sleep apnea test. Multiple logistic regression analysis was used to determine the significant factors influencing OSA in employees with MS. A total of 89 participants completed the assessment, with 65.2% of those with MS also found to have OSA. The main factors found to be associated with these employees with MS having OSA as well include gender, job position, body mass index, neck circumference, waist circumference, oxygen desaturation index, and snoring frequency. In light of the high percentage (65.2% in this study) of MS employees affected by OSA, regular health screenings should include a home sleep apnea test for high-risk employees to assess their risk of developing OSA. In addition, promoting a healthy lifestyle to improve MS and prevent OSA is needed.

Patient-reported outcomes in sarcopenia: An ICFSR task force report.

The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force convened in March 2024 to address patient-reported outcomes measures (PROMs) in the field of sarcopenia. PROMs are crucial to enhance healthcare services at both individual and societal levels. PROMs complement objective outcome measures by capturing insights that patients are best suited to judge. In recent years, there has been an increase in the recognition of PROMs' importance within clinical trials by pharmaceutical industries and regulatory agencies. Consequently, it has become imperative to develop valid and reliable tools tailored to capture various aspects of patient's experience and health status. This report aims to present the state-of-the-art available and validated PROMs for sarcopenia that can be used within clinical settings by various stakeholders, and to highlight several research gaps and barriers that need to be addressed to expedite and improve the use of these outcome measures within the context of clinical trials.

Crab urine as biomonitoring tools for pollution: A state-of-the-art review of methods, organic contaminant levels, and comparisons between spilled and unspilled areas.

This study constitutes a systematic review endeavoring to elucidate the methodologies pertinent to the extraction and analysis of organic contaminants, specifically focusing on crab urine. Although research is limited, crabs serve as invaluable bioindicators and biomonitors due to their unique habitat in sediment-rich areas where aquatic contaminants commonly accumulate. Despite the well-documented harmful effects of substances like PCBs, OCPs, PBDEs, and pesticides on the nervous and endocrine systems, our review found that existing studies have predominantly focused on PAHs such as pyrene, benzo(a)pyrene, and naphthalene oi spilled and unspilled areas. One reason for this research gap is the misconception that collecting crab urine is challenging, a notion perpetuated by the lack of detailed methodologies in the literature. The research gap hinders comparing contamination levels and trends. Limited, infrequent studies highlight the urgent need for comprehensive investigations to enhance understanding of ecological impacts and improve environmental monitoring.

Thermodynamic and economic performance comparison between reverse Brayton cycles and cascade refrigeration cycles with eco-friendly refrigerants

In the post-pandemic era, there is still a high demand for ultra-low temperature storage of vaccine, plasma and biological samples, which can be realized by cascade refrigeration cycles or reverse Brayton cycles. As there is still a research gap on the comprehensive evaluations on reverse Brayton systems using air and cascade refrigeration systems using eco-friendly refrigerants, the thermodynamic and economic analysis models are established for the parallel air cycles and cascade cycles in this study. Based on validated models, the comprehensive performance of the novel reverse Brayton-cascade cycle is studied under different cooling temperatures and cooling capacities. The results show that adding an internal heat exchanger in parallel air cycles could increase the COP and exergy efficiency by 27.12 % and 2.3 %, and save > 31.38 % of total annual cost. However, the comprehensive performance of the composite cycle is inferior to that of cascade refrigeration cycle. The novelty of the paper is to further confirm the superiority of cascade refrigeration systems and the differences between reverse Brayton cycles and cascade cycles, which has not been involved in other studies. This work may supply some technique references for the generation of ultra-low temperature zones and the selection of environmental-friendly refrigerants on CRC establishment.

The influence of multicultural experience on attitudes towards new foods in the U.S.

Many people are resuming overseas sojourns for tourism, studying abroad, and emigration to foreign countries, contributing to the increasingly diverse population in the United States. Thanks to the growing ethnic and racial diversity, American consumers can access global cuisine and are exposed to different cultures and media influences. Previous studies have highlighted the significance of comprehending the cultures of ethnic minorities and their cultural dimensions in the context of marketing context. There is still a research gap in discussing the effect of multicultural experience on attitudes towards foods. This study evaluates the role of sociocultural factors, such as traveling and sojourning and multicultural sensitivity, on consumers' attitudes toward new foods in the United States. The results show significant effects of sociocultural factors and consumers' perceptions of cultural differences on consumers' openness to new foods. The findings provide insights into the food industry and policymakers regarding approvals and market strategies for introducing new and foreign imported foods. Additionally, the results help retail and restaurant entrepreneurs better target their intended market and consumers.

Microalgae - bacteria based wastewater treatment systems: Granulation, influence factors and pollutants removal.

Wastewater treatment based on microalgae and bacteria symbiosis is an environmentally friendly, sustainable technology that has attracted attention recently because of its high efficiency in treating pollutants, saving energy, and short-term biomass recovery. Among them, the granular microalgae and bacteria combination emerges with the advantages of rapid gravity settling, good resistance to adverse environmental conditions, outstanding wastewater treatment performance, and easy biomass recovery. This review aims to clarify the microalgal-bacterial granule (MBG) - based process for wastewater treatment. In particular, MBG characteristics, granulation mechanism, and influence factors on the process are also discussed. The review contributes to the knowledge system related to MBG research in recent years, thereby pointing out research gaps that need to be filled in the future.

Stressor fluctuations alter mechanisms underpinning seagrass responses to multiple stressors.

Multiple anthropogenic stressors degrade ecosystems globally. A key knowledge gap in multiple stressor research is how variability in stressor intensity (i.e., fluctuations) and synchronicity (i.e., timing of fluctuations) affect biological responses, and the mechanisms underpinning responses. We evaluated the mechanistic effects of reduced light and herbicide contamination on seagrass, and determined how variations in stressor intensity and synchronicity influence the underlying mechanisms of responses. We used structural causal modelling and structural equation modelling to elucidate direct and mediating effects. Out-of-phase introduction (i.e., asynchronous fluctuations) altered the mechanistic pathways of how stressors affect seagrass relative to static stressors, and resulted in the greatest biomass loss (under the most intense stressor combination, ∼50% reduction). Therefore, previous experiments that predominantly test only static stressor intensities might underestimate detrimental impacts in nature. Future experiments should explore mechanistic effects across realistic stressor intensities and synchronicities to improve our understanding and management of multiple stressors.

Closing the gap in dementia research by community-based cohort studies in the Chinese population

Closing the gap in dementia research by community-based cohort studies in the Chinese population

Disparities in clinical trial enrollment among LGBTQ+ individuals and its impact on cancer treatment and management: A systematic review.

805 Background: There is a significant gap in oncologic research, which arises from the exclusion of LGBTQ+ individuals from cancer clinical trials, compromising the development of personalized cancer therapies and limiting the generalizability of findings. Despite known health disparities in this population, including higher cancer risk factors and unique psychosocial stressors, data on clinical trial participation remains sparse. This study aims to elucidate the extent of underrepresentation of LGBTQ+ individuals in cancer clinical trials and examine its impact on treatment efficacy, safety, and overall management. Methods: We conducted a systematic review of literature and clinical trial databases, including PubMed, ClinicalTrials.gov, and other registries, focusing on cancer trials from 2010 to 2024. We extracted data on LGBTQ+ enrollment, analyzed demographic inclusivity criteria, and identified barriers to participation. Subgroup analyses evaluated the correlation between LGBTQ+ representation and treatment outcomes, considering variables such as trial design, recruitment strategies, and data collection on sexual orientation and gender identity. The review also examined policy changes and inclusivity initiatives aimed at improving trial access for this community. Results: The review identified a significant underrepresentation of LGBTQ+ individuals in cancer trials, with sexual orientation and gender identity data reported in only 6.2% of trials. Structural and sociocultural barriers, including heteronormative trial designs, lack of inclusive recruitment strategies, and pervasive discrimination, were frequently cited as impediments. Trials that included LGBTQ+ participants rarely conducted stratified analyses to assess differential treatment responses, leading to a paucity of data on drug safety, efficacy, and toxicity profiles specific to this population. The absence of these data may contribute to suboptimal therapeutic decision-making and potential adverse outcomes in clinical practice. Conclusions: The substantial underrepresentation of LGBTQ+ individuals in cancer clinical trials impairs the ability to develop inclusive, evidence-based oncology care. Addressing this gap requires systematic changes, including the integration of sexual and gender minority data collection, implementation of LGBTQ+-specific recruitment frameworks, and stratified analyses of treatment outcomes. Enhancing trial inclusivity will not only improve the external validity of oncologic research but also support the development of tailored therapeutic approaches that address the unique needs of LGBTQ+ cancer patients, ultimately advancing health equity in cancer care.

Use of the chronic illness research recruitment taxonomy to evaluate recruitment strategies in an eHealth feasibility study.

Chronic illness research has many challenges making research recruitment difficult. Despite reports of facilitators and barriers to research recruitment challenges remain. The reporting of research strategies and their impact on recruitment and subsequent randomised control trials is not sufficient. A newly developed chronic illness research recruitment taxonomy (CIRRT) details factors and elements observed to impact recruitment around the components of Project, People, and Place. This paper aims to use the chronic illness research recruitment taxonomy to report and evaluate the recruitment strategies, impact they had on recruitment, and alterations to an eHealth feasibility study. Retrospective mixed method approach was used to inductively code the research team meeting minutes during the recruitment period. The coding was then abductively matched to the chronic illness research recruitment taxonomy and gaps in the CIRRT noted. Dated coding data were integrated with recruitment progress to explore the impact of research recruitment strategies. Meeting minutes (n=66) were analysed, recruitment strategies identified and matched to CIRRT. The reporting and identification of the recruitment strategies was aided by CIRRT use. By integrating the codes that aligned with CIRRT with recruitment progress was observed to be impacted by staffing and researcher visits. CIRRT may be a useful tool in the evaluation and reporting of research recruitment strategies. Altering the roles of nurses involved and researcher visits to recruiting sites may positively impact on chronic illness research recruitment.

Predictive biomarkers of radiotherapy- related dermatitis, xerostomia, mucositis and dysphagia in head and neck cancer: A systematic review.

Radiotherapy is essential for treating head and neck cancer but often leads to severe toxicity. Traditional predictors include anatomical location, tumor extent, and dosimetric data. Recently, biomarkers have been explored to better predict and understand toxicity. This review aims to summarize the current literature, assess data quality, and guide future research. Two reviewers independently screened EMBASE and PubMed for studies published between 2010 and 2023. Endpoints were dermatitis, mucositis, sticky saliva/xerostomia, and dysphagia. Statistical analysis was performed using R, and bias assessed via a modified QUIPS questionnaire. Pathway analysis was conducted using gProfiler. The study adhered to PRISMA and COSMOS-E guidelines and was registered in the PROSPERO database (#CRD42023361245). Of 2,550 abstracts, 69 publications met the inclusion criteria. These studies involved a median of 81 patients, primarily male (75 %), with common primary tumors in the nasopharynx (32 %) and oropharynx (27 %). Most patients (84 %) had advanced disease (stage III/IV). The most frequently studied biomarkers were DNA-based single-nucleotide polymorphisms (SNPs, 59 %), salivary proteins (13 %), and bacteria (10 %). Ten statistically-significant biomarkers (all SNPs) in low-bias publications were identified, particularly in DNA repair and cell detoxification pathways. Data quality was often poor and few validation studies were present in the dataset. This review provides an overview of the research landscape, highlights research gaps and provides recommendations for future research directions. We identified several potential biomarkers, particularly in DNA repair pathways, that align with current understanding of radiation-induced cell damage. However, the overall data quality was poor, with key clinical variables often missing. Overall, rigorous standardization of reporting, validation studies and multi-center collaborations to increase study power and sample sizes are necessary to build high-level evidence for clinical application.

Towards harmonized ecotoxicological effect assessment of micro- and nanoplastics in aquatic systems.

Micro- and nanoplastics are globally important environmental pollutants. Although research in this field is continuously improving, there are a number of uncertainties, inconsistencies and methodological challenges in the effect assessment of micro- and nanoparticles in freshwater systems. The current understanding of adverse effects is partly biased by the use of non-relevant particle types, unsuitable test setups and environmentally unrealistic dose metrics, which does not take into account realistic processes in particle uptake and consequent effects. Here we summarize the current state of the art by compiling the most recent research with the aim to highlight research gaps and further necessary steps towards more harmonized testing systems. In particular, ecotoxicological scenarios need to mirror environmentally realistic particle diversity and bioavailability. Harmonized test setups should include different uptake pathways, exposures and comparisons with natural reference particles. Effect assessments need to differentiate direct physical particle effects, such as lesions and toxicity caused by the polymer, from indirect effects, such as alterations of ambient environmental conditions by leaching, change of turbidity, food dilution and organisms' behavior. Implementation of these suggestions can contribute to harmonization and more effective, evidence-based assessments of the ecotoxicological effects of micro- and nanoplastics.

Crossing borders to meet cardiac surgical needs: A scoping review on patients seeking cardiac surgery abroad.

Over 100 countries do not have a local cardiac surgeon, whereas capacity, coverage, or cultural constrains may limit access to cardiac surgical care in-country. This scoping review aims to summarize the current literature of patients seeking cardiac surgical care abroad and determine research gaps for this understudied aspect of global surgical care. A scoping review was conducted on patients seeking cardiac surgery outside of their home country using MEDLINE, EMBASE, CINAHL, SCOPUS, WHO Global Index Medicus, and PubMed databases. Relevant articles were descriptively and quantitatively summarized. Out of a total of 49 articles and 6351 patients, the most common procedures were coronary artery bypass grafts & valve procedures (N​=​3948; 62​%) and congenital heart disease repairs (N​=​2049; 32​%). The most prevalent countries of origin were Japan, Nigeria, and the United Arab Emirates. The United States, France, and the United Kingdom were the most common destination countries. Most patients (N​=​1483; 23​%) sought care abroad due to limited therapeutic options in the home country. Funding sources stemmed comparably from government funding, non-governmental organization funding, and out-of-pocket payments. The extent of and reasons for individuals traveling abroad for cardiac surgery are poorly described. Localizing cardiac care, while requiring significant resources, may lead to substantial cost savings and improved access to care. Until then, improving access to international travel for cardiac surgery remains an important strategy.

The moderating role of social media motives in the relationship between screen usage and cybervictimization.

Screen time is on the rise among youth, and as a result, cyberbullying victimization has become increasingly prevalent. While prior research has established a positive correlation between screen usage and cyberbullying victimization, a paucity of research has explored how motives for screen usage are associated with cyberbullying victimization and moderate the positive association between screen usage and cyberbullying victimization. The present study sought to address these research gaps by exploring the association between motives for screen usage and cyberbullying victimization and examining whether these motives moderate the association between screen time and cyberbullying. Data from 332 participants (mean age=16.27years; 25% male) were collected in a longitudinal study. Participants were required to be aged 12-18, proficient in English, not currently in treatment for psychological issues, and own a smartphone. Participants installed a mobile sensing app to measure their screen usage over a four-week period objectively. Motives for screen usage were assessed using an adapted version of the Internet Motive Questionnaire for Adolescents. Cyberbullying experiences were self-reported during a follow-up assessment. Coping (p<0.01), conformity (p<0.001), and enhancement motives (p<0.05) were positively associated with cyberbullying victimization. Conformity motives moderated the relationship between screen time and victimization, with the association being strongest among youth with low conformity motives (p<0.01). These findings indicate that risky motives for screen usage are associated with a higher likelihood of experiencing cyberbullying victimization and that they moderate the association of screen time with cyberbullying.

Linking household members and defining relational networks using routine health data.

The growth of rich electronic health record (EHR) data and large health databases has introduced new opportunities to link individuals together into households and relational networks. These 'linked relational networks' hold promise for providing family-level care and studying intergenerational epidemiology and clinical outcomes. However, as linked relational networks become more commonly available in EHRs and research databases, it is critical to understand their challenges and limitations. Matching algorithms are being used to create linked relational networks in EHR and health databases. Clinically, these algorithms have been most useful to provide dyadic maternal-newborn care. In research, studies using these algorithms investigate topics ranging from the pharmacoepidemiology of parental drug exposure on childhood health outcomes, to heritability of chronic conditions, to associations between parental and child healthcare access and service delivery. However, ethical and technical challenges continue to limit use of these algorithms. There is also a critical research gap in the external validity of these matching algorithms. Linked relational networks are in widespread use in pediatric clinical care and research. More research is needed to understand the scope, limitations, and biases inherent in existing matching strategies.

Unravelling the moderating roles of environmental regulations on the impact of foreign direct investment on environmental sustainability.

In the era of economic globalization, China attracts significant foreign direct investment (FDI) to accelerate economic prosperity. FDI inflows could have ramifications on environmental degradation (ED) despite the enactment of different environmental regulations (ERs) such as market-incentive, command-and-control as well as informal regulations. Though some studies have shown that FDI and ED have significant relationship, the moderating roles of different ERs on the environmental impact of FDI has not been empirically unraveled. This study fills this research gap by analyzing the direct impact of FDI on ED (i.e., carbon dioxide emissions, ecological footprint) using the provincial panel data. Second, it unravels the moderating roles of different ERs on the environmental impact of FDI in the provinces and regions. The results indicate that FDI directly mitigates ED, verifying the pollution halo hypothesis while ERs directly alleviate ED in China. However, the interaction between FDI and ERs do not alleviate ED in China albeit regional heterogeneity exist. The economic implication is that FDI is not a channel through which ERs enhance environmental sustainability in China. This study recommends some policy options arising from the findings.

The Belt and Road Initiative and China's diversifying food imports: A perspective on the "Five-pronged approach"

The diversification of imported food varieties is essential for ensuring China's food security. Since the inception of the Belt and Road initiative (BRI), there has been a significant increase in agricultural trade cooperation between China and participating countries, facilitated by the "Five-pronged approach" (FPA). However, existing research regarding the BRI's impact on imports has not yet fully addressed the complexities inherent in agricultural trade, such as stringent logistics, customs regulations, inspection and quarantine procedures, and the varying trade costs associated with different agricultural commodities. This underscores a research gap in understanding the BRI's effectiveness in promoting diversified food imports, particularly across distinct food categories. Utilizing the Difference-in-Differences model, this research evaluates the BRI's contribution to China's diversified food imports and the heterogeneity of food types. The empirical findings suggest the initiative significantly promotes diversification in China's food imports, notably in the case of vegetable products, while the expansion of animal product imports continues to require sustained support from the FPA. The mechanism analysis indicates the FPA effectively reduces both direct and implicit trade costs, thereby fostering the growth of diversified food imports in China. Additionally, this study examines the initiative's effect on food and nutrition security among participating countries, highlighting a marked promotion of diversified food imports and dietary diversity. This research reinforces the BRI's pivotal role in advancing food security, both within China and across the participating nations.

Neuromodulatory techniques in eating disorders: From electroconvulsive therapy to transcranial magnetic stimulation and beyond: A mixed method systematic meta-review.

Psychosocial and pharmacological interventions can effectively treat eating disorders (EDs), but improvements are often short-term and modest. Neuromodulation, altering nerve activity through targeted neurological stimulation, is an emerging intervention in neuropsychiatric disorders. This meta-review synthesizes evidence on neuromodulatory techniques in ED patients, identifying research gaps and future directions. PubMed/Medline, EMBASE, and PsycINFO were searched using relevant terms. Only systematic reviews or meta-analyses reporting on neuromodulatory techniques in ED patients were included. Three evaluators extracted data, resolving discrepancies with two experienced researchers. Study quality was assessed using AMSTAR-2. Defined outcomes and effect sizes were reported for systematic reviews, and pooled effect sizes and heterogeneity information for meta-analyses. Eighteen systematic reviews (five meta-analyses) were included, with minimal primary study overlap (<5%). Most focused on anorexia nervosa (AN), some on treatment-resistant cases, and others on bulimia nervosa (BN) and binge eating disorder (BED). The quality of most systematic reviews was critically low, and they often combined observational studies with randomized-controlled trials (RCTs). Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) showed promising results in RCTs, managing binge eating and craving levels more effectively than body mass index in AN. Side effects included headaches, nausea, and drowsiness for rTMS and tDCS, and rare instances of seizures and infection with deep brain stimulation. Neuromodulation holds promise for treating EDs. Future studies should prioritize RCTs, objective outcome measures, longer follow-up for stability assessment, and comprehensive adverse event monitoring.

Accumulation, translocation and transformation of artificial sweeteners in plants: A critical review.

Artificial sweeteners (ASs) have become an increasingly significant concern as an emerging contaminant. The widespread utilization has given rise to environmental consequences that are progressively harder to disregard. ASs infiltrate both aquatic and terrestrial ecosystems through the discharge of wastewater effluents and the application of manure and biosolids. These compounds can be absorbed and accumulated by plants from soil, water and the atmosphere, posing potential risks to ecological systems and human health. However, limited data available on plant absorption, translocation, and metabolism of ASs hinders a comprehensive understanding of their impact on ecosystem. This study aims to comprehensively summarize the global distribution of ASs, along with elucidating patterns of their uptake and accumulation within plants. Furthermore, it seeks to elucidate the pivotal factors governing ASs absorption and translocation, encompassing hydrophilicity, ionic nature, plant physiology, and environmental conditions. Notably, there remains a significant knowledge gap in understanding the biodegradation of ASs within plants, with their specific degradation pathways and mechanisms largely unexplored, thereby necessitating further investigation. Additionally, this review provides valuable insights into the ecotoxicological effects of ASs on plants. Finally, it identifies research gaps and outlines potential avenues for future research, offering a forward-looking perspective on this critical issue.

Can memantine treat autism? Answers from preclinical and clinical studies.

Autism Spectrum Disorder (ASD) represents a clinical challenge due to its diverse behavioral symptoms and complex neuro-pathophysiology. Finding effective treatments that target the fundamental mechanisms of ASD remains a top priority. This narrative review presents the potential of the NMDA-receptor blocker memantine in managing ASD symptoms. Preclinical studies indicate that memantine could abrogate excitotoxicity, GABA/glutamate imbalance, reduced levels of brain-derived neurotrophic factor (BDNF), blood-brain barrier (BBB) leakage, and neuroinflammation, offering hope for managing core deficits associated with ASD like impaired social interaction and repetitive behaviors. However, clinical trials yield conflicting results, with some showing slight improvements in symptom severity and cognitive function, while others demonstrate limited efficacy. Further exploration of memantine's neurobiological mechanisms and refinement of treatment approaches are crucial for comprehensively tackling ASD complexities. Drawing from both animal models and clinical data, this review examines memantine's impact on core ASD symptoms, cognitive function, and potential mechanisms of action. Lastly, it identifies research gaps and proposes avenues for future investigations to enhance our understanding and utilization of memantine in ASD management.