Long-term Success Research Articles

Unlocking the potential of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in revolutionizing type 2 diabetes management: A comprehensive review

Diabetes mellitus (DM) is a long-term metabolic disorder caused by inadequate production and resistance to insulin. The prevalence of DM is rapidly increasing, with type 2 diabetes (T2D) accounting for more than 90% of cases. Despite new treatments, many patients with T2D do not meet their glycemic targets due to clinical inertia. This review provides an overview of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in the management of T2D. The review synthesizes data from clinical trials and meta-analyses on the efficacy, safety, and cost-effectiveness of GLP-1 RAs. It also discusses the mechanisms of action, classification, and barriers to adherence and persistence in therapy. GLP-1 RAs improve glycemic control by lowering A1C levels and promoting weight loss. They have cardioprotective effects and may reduce endothelial inflammation, oxidative stress, and blood pressure. Adherence to GLP-1 RAs is better with once-weekly injections, though gastrointestinal side effects and cost can affect persistence. Semaglutide and liraglutide have shown significant weight reduction, with semaglutide being particularly effective. GLP-1 RAs are cost-effective due to reduced healthcare costs associated with fewer hospitalizations and lower mortality rates. Safety concerns include gastrointestinal issues, pancreatitis, and rare cases of diabetic retinopathy and thyroid C-cell tumors. For clinical practice, GLP-1 RAs represent a valuable option not only for glycemic control but also for weight management and cardiovascular protection. Incorporating GLP-1 RAs into treatment plans can improve patient outcomes, and optimizing dosing regimens and addressing barriers such as cost and side effects are crucial to enhancing patient adherence and long-term treatment success.

The Effectiveness of the Inclusion of Governance as a Part of the Binding Articles of Association

This study investigates the efficacy of introducing governance as binding articles in the Articles of Association (AOA) of family businesses in Saudi Arabia, given the legislative reforms provided by the new Saudi Companies Law of 2022. The research points out that advantages will be brought by such enhanced transparency, accountability, and professional management practices, bringing family businesses up to international standards. Despite challenges such as resistance from family members, implementation complexity, and balancing traditional values with modern governance, the reforms provide substantial advantages. The case study of Saudi stock market companies illustrates the positive impact of phased governance reforms. Recommendations for successful implementation include engaging family members, leveraging external advisors, developing clear governance articles, providing training, and continuous monitoring. In all, these reforms serve as a giant stride toward ensuring that there is a strong, transparent, and sustainable business environment. This guarantees the long-term success and competitiveness of family businesses in Saudi Arabia.

Tracing the Success of QRIS Policy Implementation in Surabaya City’s Parking Levy System

This research explores the effectiveness of the Surabaya City Government’s policy on parking levy payments via the Quick Response Code Indonesian Standard (QRIS). The study aims to analyze the policy’s success in increasing Regional Original Income (Pendapatan Asli Daerah or PAD) and enhancing community welfare by improving the payment experience for parking users and supporting efficient management by parking attendants. Using Van Meter and Van Horn’s policy implementation framework, which includes six critical factors—policy standards and objectives, resource allocation, characteristics of implementing organizations, inter-organizational communication, implementer disposition, and socio-political and economic environment—the study evaluates both the facilitating and hindering elements of the policy. A qualitative descriptive methodology was employed, with data gathered through literature reviews, field observations, and structured interviews with key stakeholders, including government officials, parking service providers, and users. Analysis revealed that QRIS implementation has been beneficial in promoting transparency and efficiency in revenue collection, supporting PAD growth. However, challenges such as varying levels of digital literacy among users, limited internet access in certain areas, and reluctance among some parking attendants to adopt digital systems were identified as barriers to optimal implementation. Key findings suggest that the policy’s long-term success hinges on consistent inter-agency coordination, community engagement initiatives to raise digital payment awareness, and ongoing training for parking attendants to improve digital proficiency. The study concludes that achieving sustainable success in implementing non-cash transactions for parking levies requires a holistic approach, integrating community awareness, inter-organizational support, and policy adaptability. This research offers valuable insights for policymakers seeking to improve public service delivery through digital transactions. It highlights the importance of adaptive management in fostering community welfare alongside regional revenue growth.

Collaborations between health services and educational institutions to develop research capacity in health services and health service staff: a systematic scoping review

BackgroundParticipation of health service staff in research improves health outcomes and adherence to clinical guidelines. To increase research participation, many health services seek to build research capacity which adds to the development of individual and organisational skills and abilities in order to conduct health research. Numerous approaches to research capacity building have been trialed with inter- and intra-institutional, or university-health service collaborative approaches being frequently described strategies. University-health service research collaborations have potential for high impact and mutual benefit, by harnessing respective strengths across both organisations. However, the range and scope of research capacity building approaches, including their relative value and success have not been consolidated. The aim of this review was to examine and describe the collaborative strategies employed by health services in conjunction with educational partners to enhance the research capability of health service staff.MethodsThe scoping review framework by Arksey and O’Malley was used to inform the review method. A systematic search was conducted of four major databases: Medline, CINAHL, Embase, and Cochrane, focusing on publications after 1995. Inclusion and exclusion criteria were established through iterative team discussions. The two-stage screening process and data extraction was managed in Covidence. Collaboration, Research Capacity, Health Services, and Health workforce were the primary concepts, contexts and populations guiding the search.ResultsOf the 1462 studies identified, 61 were selected for the review. These studies reported on partnerships between universities and health services with a specific focus on building research capacity of health service staff. Studies predominantly hailed from Australia, USA, UK, and Canada. Collaboration approaches varied and leveraged different activities to build research capacity included training, mentoring, shared funding, and networking. Training partnerships emerging as the most prevalent. Findings emphasised the importance of localisation in approaches, with some studies indicating the intrinsic value of such collaborations for both partners involved. Despite the emphasis on individual interventions like training and mentoring, team-level interventions were notably scarce.ConclusionThis review highlights the diverse range of approaches in research capacity building collaborations between health services and educational partners. It advocates for a shared understanding of goals, highlighting the critical nature of relationship-building and the pivotal role of sustainable infrastructure in long-term collaboration success. Future directions should consider the tangible impacts of these models on clinical outcomes.

Students’ Perceptions on Chemistry Education Programme: A Qualitative Inquiry in Faculty of Education

This article examines the efficacy of the Chemistry Education program offered by the Department of Science and Environment Education, Central Department of Education, Tribhuvan University. It also explores students' perceptions and experiences regarding the program, focusing on its strengths and challenges. Using purposive sampling, ten students enrolled in the Science Education program were selected for data collection through face-to-face interviews and conversations. Verbatim and conversational analyses were employed to analyze the data. The findings indicate that the culture of teaching and learning has shifted from traditional, teacher-centered approaches to student-centered pedagogies, with a strong emphasis on research-based and project-oriented learning. Students appreciated the comprehensive coverage of theoretical concepts in the Chemistry Education program. However, they expressed concerns about the limited opportunities for practical laboratory work, which they felt hindered their ability to fully grasp and apply the concepts learned in class. Additionally, the study found that while the program integrates theoretical constructs with real-world applications through experiential learning modalities, doubts persist regarding its effectiveness in cultivating skills essential for long-term professional success. It is strongly recommended to elevate the Chemistry Education program by integrating more dynamic and interactive pedagogical approaches to more effectively nurture the skills critical for sustained professional success.

Exploring successes, barriers, and enablers in the one-year digital Healthy Weight Coaching

IntroductionHealthcare professionals’ perspectives are often overlooked in the evaluation of digital weight loss interventions. Thus, we examined how healthcare professionals perceive patient success in a one-year web-based weight management program, the Healthy Weight Coaching, aiming to identify key success factors and common challenges within the coaching process.MethodsThematic analysis was conducted on ten semi-structured interviews with healthcare professionals from the Healthy Weight Coaching. Interviewees included individuals of both sexes, with an average age of 41 years, ranging from 10 months to 5 years of coaching experience, and treating 90 to 500 patients.ResultsThree main themes emerged from the analysis: (1) Positive progress during the Healthy Weight Coaching, (2) Factors facilitating success, and (3) Barriers hindering progress. The coaches noted significant positive changes among patients, including increased self-compassion, reduced weight-related stress, and a shift toward holistic well-being. Improvements in eating habits, physical activity, and vegetable consumption were observed, along with reductions in binge eating behaviors. Personal factors such as internal motivation and engagement with the program were crucial for success. Additionally, aspects of the Healthy Weight Coaching program, such as its individualized and supportive environment, flexible coaching approach, and the pivotal role of coaches, were seen as facilitators of success. Patients valued being treated equally and acceptingly and fostering trust and collaboration. However, challenges such as burdensome life situations, limited resources, and inadequate support posed significant barriers to progress. Unrealistic goals and societal pressures were also observed to hinder successful weight management efforts.ConclusionA comprehensive, individualized approach addressing resource limitations and societal norms can enhance long-term success in weight management programs like the Healthy Weight Coaching, ultimately promoting overall well-being.

Atrial arrhythmia and heart failure in adult patients with congenital heart disease: a retrospective cohort study

BackgroundAtrial arrhythmias (AA) and heart failure (HF) are major causes of hospitalisation in adult congenital heart disease (ACHD). This study aimed to evaluate the temporal relationship between AA and HF...

Digital Gig Work Under Unstable Energy Infrastructures: Invisible Workarounds and Alternative Imaginaries

Digital upskilling and remote work are frequently presented as pathways for displaced communities who face political, economic crises and employment barriers. The viability and stability of available energy infrastructures for these communities is critical to the long-term success of these proposed job trajectories. In this paper, we investigate how 17 Syrian refugees living in Lebanon navigate their local unstable energy infrastructures to conduct digital gig work and receive digital training. We found that digital gig work and training are workarounds to the political and social inaccessibility of local labor markets for refugees and that participants rely on a series of material energy strategies to optimize their electricity access. We argue that to support refugees conducting digital gig work and training, we must recognize and account for ecological, social, and technological limitations and frailties in the development of technological solutions and draw our attention to how infrastructures are perpetually undergoing processes of breakdown, repair, and renewal. We argue that this attention to ongoing transformation and renewal creates new opportunities for productive and creative reconfiguration as well as modes through which CSCW may intervene in unstable energy contexts. From this perspective, we emphasize the importance of better resourcing displaced communities with information regarding energy access and supporting them in establishing and strengthening their own visions for alternative energy systems and employment pathways.

Effectiveness of Peer-Led Education in Reducing HIV Transmission among Youths in Urban Areas: A Comprehensive Review

HIV transmission among urban youths remains a significant public health concern, driven by factors such as risky sexual behaviors, limited access to healthcare, and high social connectivity. Peer-led education has emerged as a promising intervention to reduce HIV transmission by utilizing the influence of social networks and delivering relatable, accessible information on HIV prevention. This review assessed the effectiveness of peer-led education programs in urban areas by examining their impact on HIV-related knowledge, behavior change, and HIV testing rates. Studies revealed that peer-led education significantly improves HIV knowledge, promotes condom use, and encourages HIV testing among urban youths, contributing to a reduction in high-risk behaviors. Additionally, the social and emotional benefits of peer-led education create supportive environments for discussing sexual health, reducing stigma, and fostering empowerment among participants. However, challenges such as variability in program quality, sociocultural barriers, and sustainability issues limit the long-term success of these interventions. To address these challenges, future strategies should focus on integrating digital health platforms, personalizing peer education, and employing rigorous program evaluation methods. The methodology for this review included a comprehensive analysis of existing literature, including randomized controlled trials, systematic reviews, and observational studies, to provide a holistic understanding of peer-led education’s effectiveness in reducing HIV transmission among urban youths. Keywords: Peer-led education, HIV prevention, Urban youths, Behavioral change, HIV transmission.

Three-dimensional finite element analysis of occlusal stress on maxillary first molars with different marginal morphologies restored with occlusal veneers

BackgroundThere are differences in the research results regarding which edge design of occlusal veneers can achieve the best long-term success rate as a relatively new fixed prosthesis restoration method. Further research is needed. The three-dimensional finite element method was used to conduct stress analysis on occlusal veneers of maxillary first permanent molars with different thicknesses and margin preparation designs. The aim of this study was to provide mechanical research evidence and a reference for exploring standardized clinical protocols for the design of occlusal veneer restorations of maxillary first molars.MethodA 3Shape (Intraoral Scanner) was used to scan the maxillary first molar teeth in vitro, after which 3D printing was carried out. Three different edge designs were applied to identical teeth: straight-beveled finishing line(SFL), chamfer finishing line(CFL), and standard cuspal inclination(SCI). Preparation was carried out with a thickness of 0.5 mm. Using the surface deformation feature, the occlusal veneer was thickened to 0.5 mm and 1.0 mm, and periodontal ligaments were added. They were then placed into the upper and lower jaws and dental arches. Finite element analysis was performed after applying bite force dispersion to the loading area on the mandible following dynamic contact.Results(1) As the thickness increased, the maximum Von Mises stress in the occlusal veneers SFL and CFL also increased, while the SCI exhibited the opposite trend. (2). The trend of the maximum Von Mises stress in the adhesive layer decrease gradually with increasing thickness of the occlusal veneer. The stresses of the SFL and CFL is concentrated primarily at the edge position below the functional cusp, resulting in relatively low adhesive stress. However, in the SCI group, the maximum stress at the edge of the adhesive layer exceeds the maximum shear strength of commonly used adhesives.ConclusionsUnder the experimental conditions, the mechanical properties of the maximum Von Mises stress in the SFL, CFL, and SCI occlusal veneers meet clinical needs. Incorporating the minimally invasive concept of tooth preservation, a thickness of 1.0 mm are optimal for glass ceramic occlusal veneers on maxillary first molars.

Seven Years of Monitoring the Development of an Oyster Reef Living Shoreline

The implementation of nature-based solutions (NbS), including living shorelines, to mitigate estuarine habitat loss is increasing at a pace exceeding the evaluation of their long-term success. Constructed oyster reefs (CORs) made of shell, concrete, stone, and other materials are one living shoreline tactic that is widely utilized, yet few studies have been conducted to understand the development of CORs within the context of both physical and ecological parameters over longer time scales (4 + years). A COR-based living shoreline project at the Gandy’s Beach Preserve (GBP) in Delaware Bay, NJ, USA, had dual goals of coastal protection and habitat provisioning, which prompted the development of a goal-driven monitoring framework to track project objectives. Methods were developed to quantify the following multi-disciplinary metrics over 7 years: elevations of CORs, waves (height, period, and direction), shoreline elevations, change in extent of vegetation patches, oyster density and size, nekton richness and community composition, and horseshoe crab impingement. The CORs met most of their habitat provisioning objectives as they were colonized by a multi-generational population of shellfish and created habitat for nekton, while posing negligible hazards to horseshoe crabs. However, none of the coastal protection objectives was fully achieved including material stability, wave attenuation, and sediment elevation increase. Results highlight the value of longer-term monitoring to understand performance and the need to match the scale and type of NbS tactic(s) with both the scale of the landscape and the site-specific hydrodynamic conditions to meet project goals.

Gender Bias in Residents’ Perceptions and Support of Rally Event Tourism: The Sierra Morena Rally of Córdoba, Spain

Motorsports have become a tourism resource for certain territories. Knowledge about the perception of impact and the support residents provide for their celebration contributes to ensuring their long-term success. The academic literature has so far focused on large-scale events, leaving a gap in knowledge regarding small-scale events. This study addresses the case of the Sierra Morena Rally in Córdoba, Spain. It is based on the principles of Social Exchange Theory (SET) and Social Representation Theory (SRT) to explore a gender bias in the perception of impact and support for the event. Using a sample of 753 residents, an Exploratory Factor Analysis is conducted, and Mann–Whitney U and Hedges’ G statistics are applied. The results confirm the existence of a gender bias in perception, which is discussed in the context of previous case studies.

Business Strategy for Geonusa in Facing Price Competition in Geospatial Information System Industry

In an increasingly competitive market, Geonusa, a geospatial service provider in Indonesia, faces challenges from price-sensitive competitors and low barriers to entry. This paper explores strategies to position Geonusa as a thought leader in the industry, enabling the company to differentiate itself and move beyond competing on price. By leveraging its expertise, fostering innovation, and strengthening its marketing and government relations, Geonusa can secure a competitive edge and improve its market presence. The paper discusses how adopting a thought leadership strategy can help Geonusa address current challenges in market visibility and customer retention. However, the strategy focuses primarily on marketing and does not comprehensively address cost optimization and operational efficiency, which are essential for long-term success.

Cloud Cost Management for Startups : Strategies for Success

This research article explores the critical importance of cloud cost management for startups, presenting a comprehensive analysis of both successful strategies and cautionary tales. As cloud computing becomes increasingly integral to startup operations, the challenge of managing associated costs effectively has emerged as a key factor in determining long-term success. Through case studies of companies like TechNova and FinEdge, the article highlights successful approaches such as automation-driven optimization and the adoption of FinOps culture. Conversely, it examines the pitfalls of poor cost management practices through the experiences of E-Commerce Express and SwiftApp. The study identifies five key strategies for effective cloud cost management: early implementation of automation, adoption of a FinOps culture, continuous monitoring of cloud usage, regular right-sizing of resources, and planning for scalability. By providing actionable insights and quantitative data on the impact of these strategies, this article aims to equip startup leaders with the knowledge to optimize their cloud expenditure while maintaining the agility and scalability necessary for growth in competitive markets.

Learning From Failure: How Founders Transform Startup Setbacks into Success

This study explores how startup founders can transform early failures into long-term success. The research aims to identify key strategies and practices employed by founders to address and overcome failures. A Systematic Literature Review (SLR) methodology is utilized to analyze existing studies on startup failures and the recovery efforts undertaken by founders. The findings indicate that successful founders leverage strong business networks, continuous innovation, and personal motivation to propel their companies forward. Additionally, the development of a competent and diverse team, along with effective communication with investors, significantly enhances the likelihood of success. The study concludes that although early failures are common among startups, such failures can become valuable experiences that contribute to future success when managed strategically.

One-Step Cartilage Repair of Full-Thickness Knee Chondral Lesions Using a Hyaluronic Acid-Based Scaffold Embedded With Bone Marrow Aspirate Concentrate: Long-term Outcomes After Mean Follow-up Duration of 14 Years.

One-step cell-based techniques of cartilage repair that lead to restoration of durable chondral tissue and long-term maintenance of joint function are cost-effective and ideal for routine use. To examine the long-term clinical outcomes, after a mean follow-up duration of 14 years, of cartilage repair in the knee using a hyaluronic acid-based scaffold in association with bone marrow aspirate concentrate (HA-BMAC) and to evaluate the effect of age, lesion characteristics, and associated treatments on the outcome of this cartilage repair method. Case series; Level of evidence, 4. Patients were followed prospectively for a mean duration of 14.0 years after undergoing treatment of knee full-thickness articular cartilage injury using HA-BMAC. Clinical evaluation consisted of the patient-reported scoring tools of the visual analog scale and the Knee injury and Osteoarthritis Outcome Score, which were completed preoperatively and at the time of final follow-up. A total of 26 patients with a mean age of 48.3 years (17 male, 9 female) and median chondral lesion size of 6.6 cm2 (range, 1-27 cm2) were followed prospectively. There were 3 treatment failures, and 1 patient who underwent medial compartment unicompartmental arthroplasty 12 years after HA-BMAC treatment of patellar chondral injury. Of the 22 remaining patients, after a mean final follow-up duration of 14.0 years (range, 12-16 years), the median visual analog scale score of 0.6 was significantly decreased from the preoperative median score of 5.0 (P < .001). The median Knee injury and Osteoarthritis Outcome Score Pain (92), Symptoms (86), Activities of Daily Living (96), Sports (85), and Quality of Life (88) subscale values were all increased compared with the preoperative scores (P≤ .001). There was no correlation of clinical outcome score and body mass index. One-step cartilage repair of full-thickness chondral defects in the knee using an HA-BMAC led to successful long-term clinical outcomes and maintenance of joint junction after a mean follow-up duration of 14 years. Long-term clinical success in active, nonobese patients has been uniformly demonstrated across a wide range of patient ages and lesion types, including cases of multicompartment involvement, treatment of associated conditions, and large or bipolar chondral lesions.

Safety and Efficacy of Lumen-Apposing Metal Stents for Management of Late Refractory Gastro-jejunal Structures in Patients with Roux-en-Y Gastric Bypass (with Video).

Roux-en-Y gastric bypass (RYGB) related late gastro-jejunal (GJ) strictures are often resistant to endoscopic balloon dilations. Lumen-apposing metal stents (LAMSs) have been used to treat benign strictures with favorable results. However, the data remains limited to justify LAMS use for management of post-RYGB late GJ strictures. We aim to evaluate the safety and efficacy of LAMS placement for the management of late GJ strictures that are refractory to balloon dilations in post-RYGB patients. This was a single center retrospective study that included all post-RYGB patients who underwent LAMS placement for management of late GJ strictures that had previously failed balloon dilations. Primary outcomes were technical and clinical success, and secondary outcomes were LAMS-related adverse events. A total of 28 patients underwent LAMS placement for management of GJ strictures. Median age was 60.5 (IQR 50.5, 67.0) years and majority were females (27, 96.4%). Median interval between surgery and first diagnosis of GJ stricture was 13 years (IQR 7, 17.5). 20 × 10 mm LAMS was the most used stent (n = 24, 85.7%). The median procedure time was 23.5 (IQR 14.5, 32.0) minutes. Technical and short-term clinical success of LAMS placement was 100% (95% CI 87.9-100.0). Long-term success was achieved in 19 out of 25 patients (76.0%, 95% CI 56.6-88.5) that had over 3 months follow-up after LAMS removal. Stent migration was noted in 2 (7.1%) patients, and 1 (3.6%) patient each experienced pain and minor bleeding without the need for additional interventions. No patient in our cohort required surgical revision of GJ anastomosis. Placement of LAMS is safe, technically feasible, and associated with a high clinical success rate in patients with late GJ strictures after RYGB who have failed prior balloon dilations. Placement of LAMS can be considered early in patients requiring multiple balloon dilations.

Two-decade battle with myasthenia gravis: A breakthrough case report on the long-term success with eculizumab and ravulizumab treatment.

This unique case of generalized myasthenia gravis shows sustained stability of a patient's condition for 3 years with eculizumab/ravulizumab treatment following 16 years of refractory disease. It highlights the long-term effectiveness of C5 inhibitors in a real-world setting, aiding physicians in their decision-making for refractory cases and treatment discontinuation scenarios.

Materials Sustainability in the Pharmaceutical Industry

Sustainable materials development is becoming crucial in the pharmaceutical industry due to the significant environmental impacts of medications across their life cycle. While early production stages have seen efforts to minimize these effects, reducing environmental impacts from drug consumption and disposal remains challenging. Growing environmental concerns and regulatory requirements are pressuring the industry to adopt sustainable practices. Material sustainability, which emphasizes responsible resource use and minimal environmental impact, is a key focus. Strategies include green chemistry principles to reduce hazardous substances and waste during drug development and manufacturing. Additionally, biodegradable materials and eco-friendly packaging designs are gaining traction to lessen landfill and ecosystem impacts. Despite progress, challenges such as complex regulatory frameworks and the need for stakeholder collaboration persist. This review examines materials sustainability in the pharmaceutical industry, highlighting its shift toward environmentally responsible practices driven by innovation and regulation. It investigates current environmental initiatives, perspectives, and strategies to address environmental challenges. Achieving sustainability requires a holistic, integrated approach involving all aspects of the business, from supply chain management to product development. By prioritizing sustainability, the pharmaceutical industry can contribute to global climate goals, ensuring its resilience and long-term success.

Outcomes of Concurrent Balloon Eustachian Tuboplasty and Tympanostomy Tube Placement in Children.

Balloon dilation eustachian tuboplasty (BDET) has been proven to be a safe treatment option for children with eustachian tube dysfunction (ETD). This study aims to analyze the long-term outcomes of children who underwent concurrent BDET and tympanostomy tube (TT) placement. We hypothesize that patients who underwent simultaneous therapy have experienced a low overall rate of middle ear pathology and have consistent hearing quality at subsequent office visits. Retrospective chart review of 19 pediatric patients (36 ears) who previously underwent concurrent BDET and TT placement. Patient charts within the extended postoperative period were reviewed. Specific data points included need for reoperation, rates of middle ear pathology, audiological outcomes, and number of previous TT placements. Pediatric patients who underwent concurrent BDET and TT placement had long-term success in 34/36 ears (94.4%). All postoperative tympanograms and audiograms (100%) were normal when performed within 12 months after the procedure. Notably, 34/36 ears (94.4%) had history of tube placement in the past. Patients had an average of three sets of tympanostomy tubes prior to undergoing concurrent BDET and TT. Concurrent BDET and TT placement may be an effective treatment option for pediatric patients with persistent eustachian tube dysfunction. Specifically, BDET may be a useful adjunct tool in pediatric patients with refractory ETD despite having multiple sets of tympanostomy tubes. This study aims to strengthen the argument of performing multimodal therapy in pediatric patients with recurrent middle ear disease. 4 Laryngoscope, 134:4799-4802, 2024.