Clinical and Experimental Pediatrics

Original Article

Infection

Construction and validation of predictive models for intravenous immunoglobulin–resistant Kawasaki disease using an interpretable machine learning approach (2,745 times)

Linfan Deng, Jian Zhao, Ting Wang, Bin Liu, Jun Jiang, Peng Jia, Dong Liu, Gang Li

Clin Exp Pediatr. 2024;67(8):405-414. Published online July 23, 2024

Web of Science 5 Crossref 1

Question: Is there a reliable model to predict intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD)?
Finding: We constructed 5 machine learning models to predict IVIG-resistant KD. Extreme gradient boosting (XGBoost) model was superior to logistic, support vector machine, light gradient boosting machine and multiple layers perception models. The SHAP (SHapley Additive exPlanations) value interpreted the contribution of each feature in XGBoost model.
Meaning: XGBoost model showed the excellent performance to predict IVIG-resistant KD with explainable and visualizable machine learning algorithm.

DOI: https://doi.org/10.3345/cep.2024.00549

Other

Comparing ethyl chloride and 10% lignocaine spray for pediatric intravenous cannulation pain relief (2,744 times)

Susmitha Vellanki, Malavika Kulkarni, H.D. Arun Kumar, Deepali Shetty, Nikhil Karthik B, Mathew Tom

Clin Exp Pediatr. 2026;69(1):65-72. Published online November 21, 2025

Background: Intravenous cannulation (IVC) is a routine yet distressing procedure in pediatric patients, often provoking significant anxiety and procedural pain. Although eutectic mixtures such as eutectic mixture of local anesthetic cream are widely used, their delayed onset limits their applicability in time-sensitive settings. Ethyl chloride vapocoolant spray and 10% lignocaine spray have been proposed as rapid-onset alternatives, yet direct comparative...

DOI: https://doi.org/10.3345/cep.2025.00010

General Pediatrics

Role of proper postnatal care in continued exclusive breastfeeding among young Indonesian mothers (2,710 times)

Wahyu Triadmajani, Shinta Prawitasari, Abdul Wahab

Clin Exp Pediatr. 2024;67(12):686-693. Published online September 12, 2024

Web of Science 1 Crossref 1

Question: Is proper postnatal care (PNC) associated with exclusive breastfeeding (EBF) practice among young Indonesian mothers?
Finding: Proper PNC elevates the likelihood of EBF among Indonesian adolescent mothers aged 15–19 years.
Meaning: Breastfeeding services should be provided during the early postnatal period to support EBF practice among adolescent mothers. High-quality PNC is a tailored intervention for vulnerable populations.

DOI: https://doi.org/10.3345/cep.2024.00815

Review Article

Other

Children’s health affected by parent’s behavioral characteristics: a review (2,698 times)

Sung Eun Kim, Jongin Lee

Clin Exp Pediatr. 2024;67(5):232-239. Published online August 21, 2023

Web of Science 1 Crossref 2

· Parents’ occupational hazards, long working hours, and smoking behaviors should be modified adequately to minimize adverse health effects on their children.
· As of 2023, several diseases from fetal exposure to occupational hazards can be compensated with Industrial Accident Compensation Insurance in South Korea.
· A directed acyclic graph is recommended for medical research to control the effects of parents’ behaviors on children’s health.

DOI: https://doi.org/10.3345/cep.2023.00115

Original Article

General Pediatrics

Global and regional burden of neonatal disorders (preterm birth, encephalopathy, jaundice, and sepsis), 1990–2021 and projections to 2050 (2,696 times)

Yuseon Kang, Jeongseon Oh, Dongjin Yeo, Jaeyu Park, Sooji Lee, Na Yun Kim, Jungmin Park, Seung Ha Hwang, Tae Hyeong Kim, Dong Keon Yon

Clin Exp Pediatr. 2026;69(2):171-181. Published online October 30, 2025

Web of Science 1 Crossref 1

This study provides the first comprehensive estimated global burden of neonatal disorders attributable to risk factors in 1990–2021 stratified by sex, cause, sociodemographic index (SDI), and region. We identified persistent disparities across SDI levels, with low birthweight and short gestation contributing most to the age-standardized disability-adjusted life year rate of neonatal disorders. These findings highlight the urgent need for targeted context-specific interventions to reduce infant mortality and improve neonatal health equity.

DOI: https://doi.org/10.3345/cep.2025.01480

Genetics and Metabolism

Interleukin (IL)-1B and IL-1 receptor antagonist gene polymorphisms in children with primary immune thrombocytopenia (2,695 times)

Seham Mohamed Ragab, Wafaa Moustafa Abo ElFotoh, Mahmoud Ahmed El-Hawy, Eman Abdelfatah Badr, Saara Khairat Ali Mostafa, Mai El-Sayad Abd El-Hamid

Clin Exp Pediatr. 2024;67(9):465-473. Published online July 24, 2024

Web of Science 1

· Polymorphisms in interleukin (IL)-1B and IL-1 receptor (IL-1R) antagonists may significantly affect the pathogenesis of immune thrombocytopenia (ITP).
· IL-1B and IL-1R antagonist gene polymorphisms are correlated with severity and susceptibility to primary ITP in children.

DOI: https://doi.org/10.3345/cep.2024.00577

Correspondence

Nephrology (Genitourinary)

Authors' reply: a commentary on “COVID-19 vaccine hesitancy among parents of children with systemic lupus erythematosus” (2,661 times)

Karnchanit Sausukpaiboon, Nuanpan Penboon, Pornpimol Rianthavorn

Clin Exp Pediatr. 2025;68(8):626-627. Published online July 18, 2025

DOI: https://doi.org/10.3345/cep.2025.01200

Original Article

Adolescence Medicine

Relationship between inflammatory biomarkers and insulin resistance in excess-weight Latin children (2,618 times)

Mariano Nicolás Aleman, María Constanza Luciardi, Emilce Romina Albornoz, María Cristina Bazán, Adela Victoria Abregú

Clin Exp Pediatr. 2024;67(1):37-45. Published online December 21, 2023

Web of Science 5 Crossref 6

Question: What is the prevalence of insulin resistance (IR) in excess-weight Latin children, and can proinflammatory biomarkers predict it?
Finding: IR prevalence was elevated and tumor necrosis factor- α, interleukin-6, monocyte chemoattractant protein- 1, soluble CD40 ligand, and high-sensitivity C-reactive protein levels were increased in excess-weight Latin children. However, none predicted IR status.
Meaning: These inflammatory biomarkers were unable to predict IR status. Therefore, further investigations are necessary.

DOI: https://doi.org/10.3345/cep.2022.01382

Infection

Clinical, biochemical, and genetic study of TACE/TNF-α/ACE signaling pathway in pediatric COVID-19 infection (2,570 times)

Ahmed El-Abd Ahmed, Sawsan M.A. Abuhamdah, Mohammed H. Hassan, Nagwan I. Rashwan, Eman A. Abd-Elmawgood, Haggagy Mansour, Hoda S. Sherkawy, Shymaa G. Rizk

Clin Exp Pediatr. 2024;67(12):704-717. Published online November 27, 2024

Question: Is the tumor necrosis factor (TNF) signaling pathway (TNF-α-converting enzyme [TACE]/TNF-α/angiotensin converting enzyme [ACE]) involved in pediatric coronavirus disease 2019 (COVID-19) infection?
Finding: Significantly increased circulating TACE/TNF-α and decreased ACE2 levels were noted. TNF-α-308G/A plays a significant role in susceptibility to COVID-19 infection among children. The ACE (I/D) (rs4646994) and ACE2 (rs2285666) single nucleotide polymorphisms lack significant associations with pediatric COVID-19 infection.
Meaning: The TNF signaling pathway participates in pediatric COVID-19 infection.

DOI: https://doi.org/10.3345/cep.2024.00941

Rheumatology

Recurrent immunoglobulin A vasculitis in children and adolescents: prevalence and associated risk factors (2,563 times)

Nootsara Atchariyaphuk, Maynart Sukharomana, Thanaporn Chaiyapak, Sirirat Charuvanij

Clin Exp Pediatr. 2026;69(1):46-55. Published online October 22, 2025

Question: What can predict immunoglobulin A vasculitis (IgAV) recurrence, and when does it occur? How do childhood- and adolescent-onset IgAV compare?
Finding: The IgAV recurrence rate was 35.6%. It usually occurred within 12 months and was associated with corticosteroids treatment.
Meaning: Childhood-onset IgAV more commonly featured gastrointestinal and musculoskeletal manifestations and required hospitalization. Adolescent-onset IgAV more commonly featured renal involvement. Vigilant monitoring for recurrence is necessary, particularly with corticosteroids treatment.

DOI: https://doi.org/10.3345/cep.2025.01158

Review Article

Infection

Incidence, causative organisms, and risk factors of bloodstream infections in pediatric liver transplant patients: a systematic review (2,559 times)

Mohamad Shieb, Rand Hasanain, Zara Arshad, Faisal A. Nawaz, Rahul Kashyap, Eric J. Stern

Clin Exp Pediatr. 2024;67(9):427-434. Published online April 5, 2024

Web of Science 1 Crossref 1

The overall incidence of bloodstream infections was 23.5%. Gram-negative organisms occur at a much higher rate in pediatric liver transplant recipients then that the general pediatric population. However, when comparing pediatric and adult liver transplant recipients Gram-positive organisms occur with a much higher rate in the pediatric population highlighting the importance of early and broad spectrum antimicrobial coverage when bloodstream infections are suspected.

DOI: https://doi.org/10.3345/cep.2023.01466

Original Article

Infection

Clinical outcomes and healthcare utilization of hospitalized children with influenza versus COVID-19 (2,538 times)

David Chun-Ern Ng, Chuin-Hen Liew, Kah Kee Tan, Joanne Pereira, Muhammad Ihsan Roslan, Xiang Lin Cheng, Hui Yi Lim, Farah Nuruliayana A. Nazri, Asuwani Maran, Wan Fei Wong, Yasothai Chandran, Syaniza Shaharudin, Pon Ling Lau, Naveen Nair Gangadaran, Marlindawati Mohd Ali

Clin Exp Pediatr. 2025;68(12):1007-1014. Published online October 2, 2025

Question: How do clinical presentations, healthcare resource utilization, and outcomes differ between children hospitalized with influenza versus coronavirus disease 2019 (COVID-19)?
Finding: Patients with influenza were older, were more symptomatic, and required greater healthcare resources, including intravenous fluids, empirical antibiotics, respiratory support, and pediatric intensive care unit admission.
Meaning: Influenza involves greater severity and a higher healthcare burden than COVID-19, highlighting the need for preventive strategies such as vaccination and hospital resource planning during seasonal outbreaks.

DOI: https://doi.org/10.3345/cep.2025.00759

Oncology

Prognostic role of mid-regional pro-adrenomedullin in predicting infection in pediatric cancer with febrile neutropenia (2,527 times)

Seham M. Ragab, Sara Mahmoud El-Deeb, Ahmed Saeed, Asmaa A. Mahmoud

Clin Exp Pediatr. 2025;68(6):445-453. Published online January 13, 2025

Web of Science 1 Crossref 1

· Infection remains a leading cause of death in febrile neutropenia (FN).
· Mid-regional pro-adrenomedullin (MR-ProADM) levels are higher among patients with FN and a bacterial infection.
· A longer FN duration and hospital stay length as well as elevated C-reactive protein, procalcitonin, and MR-ProADM levels are significant risk factors for mortality.

DOI: https://doi.org/10.3345/cep.2024.01620

Gastroenterology

Adenosine deaminase and interleukin-1 receptor antagonist genetic polymorphisms among obese children with versus without metabolic dysfunction-associated fatty liver disease (2,519 times)

Hala M. Sakhr, Mohammed H. Hassan, Azza Mohamed Taha, Ali Helmi Bakri

Clin Exp Pediatr. 2025;68(10):808-818. Published online May 29, 2025

Question: Is there an association between adenosine deaminase (ADA) G22A and interleukin-1 receptor antagonist (IL-1RN) genetic polymorphisms and pediatric metabolic dysfunction-associated fatty liver disease (MAFLD)?
Finding: The GG genotype and G allele of ADA G22A were significantly associated with obesity but not pediatric MAFLD, while the *1/*2 genotype of the IL-1RN gene was significantly associated with obesity and pediatric MAFLD.
Meaning: The IL-1RN gene may contribute to pediatric MAFLD.

DOI: https://doi.org/10.3345/cep.2025.00731

Gut microbiota and metabolomic alterations in newborns of mothers with gestational diabetes mellitus (2,477 times)

Wan-Hsin Su, Yi-Wei Wang, Chien-Chang Chen, Ming-Wei Lai, Hsun-Chin Chao, Ming-Chou Chiang, Ren-Huei Fu, Pai-Jui Yeh

Clin Exp Pediatr. 2026;69(1):26-35. Published online October 22, 2025

Question: Does maternal gestational diabetes mellitus (GDM) affect newborn gut microbiota and metabolomic profiles?
Finding: Neonates born to mothers with diet-controlled GDM exhibited reduced gut microbiota α-diversity, altered β-diversity, and metabolic shifts, including changes in fumarate and succinate levels, with peroxisome proliferator-activated receptor and adipocytokine signaling pathway activation.
Meaning: Maternal GDM affects early microbial colonization and metabolism in newborns and may have long-term health implications.

DOI: https://doi.org/10.3345/cep.2025.01074

Developmental and Behavioral Medicine

Effectiveness of online responsive teaching in young children with developmental disabilities: a pilot study (2,467 times)

Jung Sook Yeom, Jeongmee Kim

Clin Exp Pediatr. 2024;67(6):303-311. Published online May 21, 2024

Web of Science 2 Crossref 2

Question: Does online responsive teaching (RT) impact children's and parents’ emotions and behaviors, and do parents find it satisfactory?
Finding: Online RT significantly improved children's pivotal and problem behaviors, decreased parenting stress, and enhanced parental interactive styles with high satisfaction.
Meaning: This pilot study's findings suggest that online RT can enhance child outcomes, offering accessible interventions amid challenges such as limited access and pandemics.

DOI: https://doi.org/10.3345/cep.2023.01662

Editorial

Neonatology (Perinatology)

Exploring the role of laryngeal masks in neonatal resuscitation (2,421 times)

Euiseok Jung

Clin Exp Pediatr. 2024;67(5):247-248. Published online December 28, 2023

· Laryngeal masks (LMs) offer stable airway access and skill retention advantages, making them promising alternatives to positive-pressure ventilation in neonatal care.
· The ease of teaching LM insertion techniques to less experienced providers addresses the need for swift intervention and skill retention.
· Careful consideration of the benefits and challenges of LMs is essential in determining their effective integration into enhanced neonatal resuscitation protocols.

DOI: https://doi.org/10.3345/cep.2023.01200

Original Article

Cardiology

Comparative analysis of adolescent hypertension definitions for predicting early adulthood carotid artery intima-media thickness: Tehran lipid and glucose study (2,411 times)

Maryam Barzin, Shirin Yaghoobpoor, Maryam Mahdavi, Behnaz Abiri, Majid Valizadeh, Fereidoun Azizi, Pooneh Dehghan, Farhad Hosseinpanah

Clin Exp Pediatr. 2024;67(12):694-703. Published online September 12, 2024

Web of Science 2 Crossref 1

Question: What is the prevalence of HTN among adolescents enrolled in the TLGS according to 3 different accepted definitions (4th report, ESH, and AAP-CPG). Also, what is the ability of each of these definitions in predicting early adulthood CIMT, as a surrogate for cardiovascular disease events?
Finding: The highest and lowest prevalence of stage 1 HTN was observed with the AAP-CPG (17.7%) and ESH (8.8%), respectively. Similarly, the highest and lowest prevalence of stage 2 HTN was noted with the AAP-CPG (1.5%) and ESH (0.8%), respectively. The highest to lowest predictive abilities belonged to the 4th report, ESH, and AAP-CPG, respectively.
Meaning: Among the various definitions of pediatric HTN, the 4th report offered the best ability to predict a high CIMT during early adulthood, followed by the ESH and AAP-CPG.

DOI: https://doi.org/10.3345/cep.2024.00248

Allergy

Maternal sleep disorders during pregnancy and subsequent risk of allergic diseases in Japanese children: the TMM BirThree Cohort Study (2,409 times)

Ami Uematsu, Masatsugu Orui, Mami Ishikuro, Keiko Murakami, Aoi Noda, Genki Shinoda, Taku Obara, Shinichi Kuriyama

Clin Exp Pediatr. 2026;69(1):36-45. Published online October 22, 2025

Web of Science 1 Crossref 1

Question: Associations have been made between maternal sleep disorders during pregnancy and allergic diseases including bronchial asthma, atopic dermatitis, food allergy, and allergic conjunctivitis/rhinitis/hay fever in their children.
Finding: In the crude model, sleep disorders during pregnancy were associated with all examined allergic diseases in children. After adjustment, significant associations remained for atopic dermatitis and allergic conjunctivitis/rhinitis/hay fever.
Meaning: The study highlights associations between maternal sleep and child allergic diseases.

DOI: https://doi.org/10.3345/cep.2025.01165

Gastroenterology

Progression from acute to chronic pancreatitis in children: a systematic review and meta-analysis (2,405 times)

Endre Botond Gagyi, Mahmoud Obeidat, Edina Tari, Szilárd Váncsa, Dániel Sándor Veres, Peter Banovcin, Péter Jenő Hegyi, Péter Hegyi, Bálint Erőss

Clin Exp Pediatr. 2026;69(2):117-129. Published online December 4, 2025

Approximately 1 in 5 children with acute pancreatitis develops recurrent attacks, and over one-third of such cases progress to chronic pancreatitis. Progression is closely linked to genetic mutations, particularly PRSS1, and anatomical abnormalities, whereas demographic and routine clinical factors lack predictive value. These results support early genetic and anatomical assessments, enabling targeted follow-ups and timely interventions in highrisk pediatric patients.

DOI: https://doi.org/10.3345/cep.2025.01879

Infection

Role of miRNA-146a and miRNA-125b in Helicobacter pylori (2,392 times)

Nashwa Farouk Mohamed, Ola G.A. Behairy, Manal S. EL-Defrawy, Mona Mahmoud Elsayed, Naglaa F. Alhusseini

Clin Exp Pediatr. 2025;68(10):781-789. Published online April 1, 2025

Web of Science 1 Crossref 3

Question: Why is the early detection of Helicobacter pylori-associated gastritis in children important?
Finding: The early detection of H. pylori-related gastritis is crucial for its effective management, especially in pediatric patients with dyspepsia.
Meaning: The use of miRNA signatures could detect early gastritis, enabling timely H. pylori eradication treatment to mitigate growth delays and cancer risk.

DOI: https://doi.org/10.3345/cep.2025.00192

Review Article

Other

Peripheral nerve sheath tumors in the head and neck in patients with APC gene deletion mutations: a case report and scoping review of the literature (2,305 times)

Koral M. Blunt, Monirah Albathi, Miriam Conces, Tendy Chiang

Clin Exp Pediatr. 2025;68(6):428-433. Published online January 13, 2025

In this report, we describe our experience with a patient with an APC-related genetic syndrome who presented with a rare palatal lesion with characteristics of a schwannoma. We discuss the role of immunohistochemical staining in discerning the differential diagnosis.

DOI: https://doi.org/10.3345/cep.2024.01375

Original Article

Genetics and Metabolism

Long-term follow-up of neurocognitive function in patients with citrin deficiency and cholestasis (2,216 times)

Meng-Ju Melody Tsai, Jung-Chi Chang, Heng-Yu Lu, Susan Shur-Fen Gau, Yin-Hsiu Chien, Wuh-Liang Hwu, Yen-Hsuan Ni, Huey-Ling Chen, Ni-Chung Lee

Clin Exp Pediatr. 2025;68(3):257-265. Published online November 28, 2024

Web of Science 1 Crossref 1

Question: Do transient metabolic disturbances in early childhood due to citrin deficiency have lasting effects on neurocognitive function?
Finding: Children with citrin deficiency have a higher prevalence of ADHD compared to the general population, with elevated ammonia levels in infancy associated with increased hyperactivity-impulsivity risk.
Meaning: Metabolic disturbances in early childhood due to citrin deficiency may contribute to long-term neurocognitive impacts, particularly ADHD, while IQ and life outcomes generally remain normal.

DOI: https://doi.org/10.3345/cep.2024.01102

Clinical Note

Gastroenterology

Congenital antral web: rare cause of gastric outlet obstruction successfully managed with endoscopic balloon dilatation (2,175 times)

Upasana Ghosh, Ujjal Poddar, Srinivas Srinidhi Vadlapudi, Moinak Sen Sarma, Anshu Srivastava

Clin Exp Pediatr. 2025;68(3):266-268. Published online January 13, 2025

DOI: https://doi.org/10.3345/cep.2024.01242

Review Article

Nutrition

Exploring nutritional screening tools for hospitalized children: a narrative review (2,161 times)

Pankaj Soni, Amit Agrawal, Gaurav Jadon

Clin Exp Pediatr. 2025;68(12):963-970. Published online October 22, 2025

Malnutrition is frequently identified in hospitalized children, and the use of nutritional screening tools is crucial for assessing their nutritional status during their hospital admission and stay. Common tools include the Pediatric Yorkhill Malnutrition Score, Screening Tool for Assessment of Malnutrition in Pediatrics, and Screening Tool for Risk of Nutritional Status and Growth. However, these tools have varying sensitivities and specificities, and none is recommended for all hospitalized children.

DOI: https://doi.org/10.3345/cep.2025.00633

Original Article

Pulmonology

Ciclesonide shows a lung-protective effect in neonatal hyperoxia-exposed rats (2,119 times)

Victoria Mielgo, Miguel A. Gomez-Solaetxe, Lara Olazar, Begoña Loureiro, Carmen Rey-Santano

Clin Exp Pediatr. 2025;68(12):1023-1030. Published online October 2, 2025

Question: Bronchopulmonary dysplasia (BPD) is the most prevalent chronic lung disease of prematurity. Numerous nonpharmacological/pharmacological interventions have been investigated without clear consensus. Can ciclesonide, a new synthetic glucocorticoid, effectively treat BPD?
Finding: Ciclesonide mitigated hyperoxia-induced lung injury and right ventricular hypertrophy in newborn rats.
Meaning: These findings suggest that postnatal ciclesonide may be an alternative to existing corticosteroids for the treatment of BPD.

DOI: https://doi.org/10.3345/cep.2025.01137

Editorial

Allergy

Trends in food allergen immunotherapy in Korea after changed national regulations (2,115 times)

Tae Won Song

Clin Exp Pediatr. 2024;67(4):201-202. Published online November 21, 2023

National regulations, academic guidelines, and clinical trends in food allergen immunotherapies (FA-AIT) differ among countries and have changed rapidly. Current officially approved FA-AIT are oral immunotherapy (OIT) using heated milk/egg in Korea and peanut OIT using standardized products in the United States and Europe. FA-AIT should be administered by specialist physicians with experience administering oral food challenge tests and managing severe allergic reactions inside and outside research settings.

DOI: https://doi.org/10.3345/cep.2023.01123

Perspective

General Pediatrics

Parenting principles to combat attention-deficit/hyperactivity disorder and form resilient young minds (2,089 times)

Jandy Le, Sandhya J. Kadam

Clin Exp Pediatr. 2025;68(10):838-841. Published online September 22, 2025

The prevalence of attention-deficit/hyperactivity disorder, conduct disorder, and other related behavioral problems is increasing among children, likely due to less interaction with their parents and the real world and more time spent on screens, on social media, and in the virtual world. This article highlights several simple, basic parenting principles to facilitate the growth of healthy, resilient minds and combat the symptoms of opposition, hyperactivity, and distractibility.

DOI: https://doi.org/10.3345/cep.2025.01004

Editorial

General Pediatrics

Global breastfeeding efforts: a long way to go (2,084 times)

Hye-Jung Shin

Clin Exp Pediatr. 2025;68(4):300-302. Published online November 13, 2024

Web of Science 2 Crossref 2

· Despite much effort, breastfeeding practices remain unsatisfactory worldwide.
· Effective breastfeeding-promoting interventions are needed that are appropriate for age, culture, and social environment.
· Interventions can promote breastfeeding, especially in younger populations such as adolescent mothers.

DOI: https://doi.org/10.3345/cep.2024.01361

Original Article

General Pediatrics

Associations of routine breakfast and napping habits with early adiposity rebound by age 3 years: a population-based cohort study in Japan (2,033 times)

Toshifumi Yodoshi

Clin Exp Pediatr. 2026;69(2):163-170. Published online October 22, 2025

In a population‑based cohort of 74,466 children, 25% experienced early adiposity rebound (AR) by age 3. Daily breakfast and routine napping at 1.5 years were independently associated with lower odds of AR, while obesity at 1.5 years was a strong predictor. These modifiable routines could help delay AR and enable early identification during routine child health checks.

DOI: https://doi.org/10.3345/cep.2025.01998

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