Fructosamine-3-kinase is a deglycating enzyme that reverses the glycation reaction by phosphorylating the first stable Maillard intermediate, fructosamine to fructosamine-3-phosphate, thereby causing decomposition of that glycation adduct. In this paper I propose that a close homolog of that kinase, fructosamine-3-phosphate-related protein, phosphorylates 3-ketosamine, a Maillard intermediate downstream from fructosamine, to 3-ketosamine-4-phosphate. This phosphorylation causes decomposition of the 3-ketosamine intermediate, providing thereby another mechanism for reversing the Maillard reaction.
Background In Peru, 41% of adults do not reach a minimum level of financial literacy, and informal employment exceeds 86% in Cajamarca and Amazonas. Little is known about whether market traders’ financial knowledge shows in how they handle their taxes, or about the conditions that change this relationship. This study estimated it in two markets in northern Peru, with accounting digitalisation, business formalisation and digital financial transformation as moderators. Methods Quantitative, observational, cross-sectional study with a non-probability sample of 218 traders from the markets of Chota (n = 109) and Bagua Grande (n = 109) in 2026. A 36-item Likert questionnaire, validated by expert judgement, was used, with Cronbach’s alpha between 0.927 and 0.977. Twenty-one linear regressions with interaction terms and centred predictors were estimated, with HC3 standard errors and bootstrap intervals from 5000 resamples for each interaction. Results Low financial literacy was found in 28.0% of traders and low tax management in 33.5%. Financial literacy had a positive partial effect on tax management (b between 0.446 and 0.519, p < 0.001), and only business formalisation moderated this effect (b = 0.053, 95% CI 0.008 to 0.096). The three dimensions of financial literacy were associated with tax management without moderation, and formalisation strengthened the effect on digital tax compliance (b = 0.071, 95% CI 0.011 to 0.130), which held without influential cases. Conclusions Financial literacy goes hand in hand with better tax management, above all in formalised businesses. Common method bias and the closeness between constructs mean these coefficients should be confirmed with data from other sources, such as tax administration records.
Background Cholestasis in infancy carries a heterogeneous aetiology. Extrahepatic biliary atresia and intrahepatic disorders share a clinical picture of persistent jaundice, yet outcomes in extrahepatic disease deteriorate rapidly with each week of diagnostic delay. Contemporary Indian data on their separation using an integrated diagnostic approach are limited. Methods We conducted a single-centre retrospective cohort study of infants (birth to one year) with prolonged cholestatic jaundice at a tertiary hospital in South India between January 2017 and December 2023. Each infant was classified as extrahepatic or intrahepatic on the basis of scintigraphy, ultrasonography, liver biopsy and intra-operative cholangiography. Continuous variables were compared with the Mann Whitney U test (effect size r reported), and receiver operating characteristic analysis was performed for candidate biochemical predictors. Results Of 101 infants, 61 (60.4 per cent) had extrahepatic cholestasis and 40 (39.6 per cent) had intrahepatic cholestasis. Median direct bilirubin was 8.94 versus 5.70 milligrams per decilitre (p equals 0.001, r equals 0.35), gamma glutamyl transferase 526 versus 128 units per litre (p less than 0.001, r equals 0.41), and total protein 6.10 versus 5.05 grams per decilitre (p less than 0.001, r equals 0.47). Total protein yielded the highest area under the receiver operating characteristic curve (0.79, 95 per cent confidence interval 0.67 to 0.90; Youden cut off 5.8, sensitivity 75.5 per cent, specificity 76.0 per cent). Mortality was 34.7 per cent versus 14.3 per cent (risk difference 20.4 per cent, 95 per cent confidence interval 1.8 to 39.0). Conclusions Extrahepatic biliary atresia dominated referrals and diagnosis was often delayed. Total protein, direct bilirubin and gamma glutamyl transferase discriminated the two groups with clinically useful accuracy. A tiered diagnostic pathway anchored on these biochemistry markers is warranted for early identification of extrahepatic biliary atresia in Indian tertiary settings.
Background When a medicine is missing, facilities substitute, conserve or seek other supplies, changing what reaches the bedside and the patient. This evidence is divided between pharmacy, nursing and outcome studies and between income settings. This review synthesized studies relating responses to medication-safety consequences and patient outcomes. Methods Following PRISMA 2020, Scopus, PubMed/MEDLINE and OpenAlex were searched on 7 October 2026, and citations of included studies were searched. Eligible studies were English-language journal articles from 2020 with empirical data on at least two of response, consequence and outcome. Two authors independently screened 1,476 records and assessed 170 full texts, plus 23 from citation searching. Appraisal used MMAT 2018, synthesis followed SWiM with effect-direction coding, and confidence was rated with GRADE-CERQual. Results We included 142 studies (143 reports) from 69 countries; 110 (77.5%) were from high-income countries and 123 (86.6%) from hospitals. Therapeutic substitution was the most frequent response (85 studies; high confidence). In measured hospital comparisons, mortality, length of stay and readmission mostly showed no clear difference (moderate confidence), whereas worse disease control was reported mainly when long-term treatment was interrupted or switched (moderate confidence). The share of respondents associating shortages with medication errors ranged from 1.1% to 77.7%, and four studies measured errors (moderate confidence). In low- and middle-income settings, staff and patients reported referral to buy medicines elsewhere (moderate confidence). Procurement, inventory and governance responses were least often connected to any consequence or outcome (high confidence). No study reported occupational exposure or outcomes of nutrition commodity stock-outs. Conclusions Evidence is densest for clinical decisions in high-income hospitals and thinnest for supply and governance responses and for primary care in low- and middle-income countries. Substitutes without a close therapeutic equivalent and interrupted long-term treatment warrant monitoring, and studies with concurrent controls and measured errors and outcomes are needed.
Act Long-term contracts with monetary obligations are exposed to changes in economic circumstances, yet the Jordanian Civil Law contains no specific provision on the clause by which the parties agree in advance that such obligations will be adjusted automatically. This article examines the attribution clause (also called the indexation clause) as a mechanism for preserving the contractual balance, and asks under what conditions the clause is valid and effective under Jordanian law, in comparison with French and Egyptian law. The study is qualitative: it uses doctrinal and comparative legal analysis of legislation, judicial decisions and scholarly writing. The attribution clause acts as a tool to modify the terms of a contract by accepting pre-specified terms and conditions. This methodology ensures that the contractual relationship is protected while addressing potentially complex scenarios that may arise during contract execution due to evolving circumstances. To maintain the binding force of the contract, Parties expedite dispute resolution and protect the integrity of their contracts by choosing recourse and prior agreeing to remedies, which encourages continuity in enforcement. These clauses are intended to automatically amend the terms of the contract without requiring the parties to participate in the amendment process. These items adjust the amount of funds subject to the obligation according to changes observed by external indicators associated with the obligation. This is done by comparing the price of a particular currency with the price of a different commodity. In the case of payment in gold or foreign currency, it represents an assault on the binding legal force of the national currency by competing with it as a means of payment and considering it as one of them. Terms of payment in gold and foreign currency are excluded from the attribution requirement, which replaces legal means of payment with new means of payment. It does not constitute a basis for determining the extent of fulfillment of the obligation, and we conclude that the attribution clause is a distinct legal system that deals with amending contractual terms and the contractual imbalance they cause. Amendment is permitted in the event of circumstances occurring that would upset the balance throughout the contract implementation period, and we recommend adopting the attribution clause as an automatic adjustment tool and propose a legislative provision to regulate it. The clause is suited to contracts whose monetary obligations are performed over time (such as leases, loans, construction and supply contracts); it is not a remedy for breach and it is not claimed to apply to every civil contract.
