bluuebunny/crossref_metadata_2025_split huggingface dataset:
Digital health applications in Germany: Explorative pilot study on the challenges of approval from the perspective of manufacturers
Authors: Ataiy Omed , Burniki Mia , Sohrabi Keywan , Groß Volker , Scholtes Michael , Schudt Florian 
Published: December 2024

Objective Digital health applications are digital medical products (e.g. apps and web applications) that are prescribed by healthcare service providers and reimbursed by health insurances. Before digital health applications can be prescribed, manufacturers must fulfill the requirements of the approval process. The aim of this study is to identify the challenges faced by digital health applications manufacturers in the German fast-track process. Methods Use of a questionnaire-based online survey with 10 digital health applications manufacturers from March to October 2023. The survey design is based on the German digital health application regulation and the digital health application guideline. Data collection via LimeSurvey and HubSpot and data visualization in bar charts. Results Digital health applications manufacturers see the fast-track process as a challenge, especially in terms of demonstrating positive care effects and compliance with regulatory standards. Challenges include conducting clinical trials, negotiating pricing and improving market acceptance even with innovative approaches. Views on the profitability and relevance of the digital health application model are varied, with concerns over pricing and market strategies predominating. Conclusions The fast-track approval of digital health applications in Germany is a significant barrier to innovation and market entry. Collaboration between stakeholders is essential to optimizing processes while ensuring safety and accessibility for patients. However, even with the limitations, the results provide insights for future research and policy refinements that are necessary to improve the implementation of digital health applications in healthcare.
The Political Economy of Priority Setting and Resource Allocation in European Oral Health Policy
Authors: Sarroukh Z. , Jeurissen P. , Akter S. , Listl S. 
Published: December 2024

Aim: Pressing oral health care challenges pose prioritization dilemmas for governments. This study aimed to identify key determinants of prioritization in oral health policy in Denmark, Germany, the Netherlands, and the United Kingdom, as part of a series of the DELIVER project. Methods: A literature review based on a search of PubMed and Google Scholar articles related to these countries from January 1, 2000, to October 17, 2023, and key informant interviews with policy makers were conducted to identify key trends in oral health policy choices and determinants of priority setting and resource allocation processes. Results: A total of 249 articles were included, and 6 key informants were interviewed. The overarching focus identified was the accessibility of dental care, primarily characterized by incremental and localized programs for vulnerable groups. Supply-side arrangements consisted of adaptations to population needs, including financial incentives for providers and adjusted service delivery models such as task shifting. Several interventions of quality management were found, particularly in Germany. A funnel was produced to illustrate 3 stages driving oral health policy choices. These were political accountability to address population demand, stakeholder influence through negotiations and lobbying, and bureaucratic justification of policy innovations. While findings highlighted political attention on oral health care through public outcry, complex negotiations and limited data formed bottlenecks of prioritization. Conclusion: Prioritization in oral health policy seems to be dominated by fragmented investments in incremental services of delivery rather than synergized reforms such as granular package designs. While some contexts showed political traction for oral health policy, complex negotiations strained by interests of private professionals and challenges of limited evidence result in difficulties in constraining oral health care within public spending targets. This has placed oral health policy in a state of inertia, where insufficient public resources meet the force of content exerted by the private sector. Knowledge Transfer Statement: This study can inform policy makers and researchers to understand the various stakeholder roles in maintaining the status quo of oral health policy and the processes creating the bottlenecks preventing progression in improving oral health care systems. This understanding could lead to novel approaches to oral health policy making and the appropriate data acquisition and analysis to aid oral health policy.
Inequities in Unmet Oral Care Needs after a Swedish Subsidization Reform: An Intersectional Analysis
Authors: Anticona C. , Suominen A.L. , Bastos J.L. , Lif Holgerson P. , Gustafsson P.E. 
Published: December 2024

Introduction: The main strategy to achieve equal provision of oral care in Sweden has been to offer partial subsidies for the adult population. However, their effects on unmet oral care needs (UOCNs) have not been extensively assessed. Objective: This study used an intersectionality framework to examine 1) the overall frequency of UOCNs, 2) single-indicator inequities, and 3) intersectional inequities in total UOCNs and financial-related UOCNs (FUOCNs) in Sweden before and after implementation of a partial subsidization reform in 2008. Methods: Data from 12 national surveys conducted over 2004 to 2018 were divided into 3 periods: prereform (2004 to 2007), early postreform (2008 to 2011), and late postreform (2012 to 2018). The analytic sample consisted of 98,177 respondents aged 24 to 84 y. Changes in the prevalence of UOCNs were estimated by inferential statistics. Single-indicator and intersectional inequities were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy, across 48 strata defined by gender, age, educational level, income, and immigrant status. Results: The prevalence of total UOCNs and FUOCNs decreased significantly early after the reform, followed by a slight rebound. Relative inequities increased by education, income, and immigrant status after the reform and decreased for age. The discriminatory accuracy for both types of UOCNs was moderate and improved marginally but significantly with the inclusion of the intersectional strata. Most intersectional strata showed greater FUOCN inequities after the reform. Conclusions: Contrary to expected, larger inequities in FUOCNs were identified in most intersectional strata after the reform. The moderate discriminatory accuracy suggested that Sweden could benefit from future strategies to foster equity that are universal but proportionately more intense among the intersectional strata with greater inequities (proportionate universalism). Knowledge Transference Statement: This analysis highlighted the benefit of adopting the principle of proportionate universalism as a strategy to reduce unmet oral care needs in Sweden. This would mean implementing universal strategies and specific support measures for the most vulnerable social groups as a future oral care policy change in Sweden.
Effects of elastic therapeutic taping on reducing drooling in children with neurological disorders: a systematic review of randomized controlled trials
Authors: Lam Krystal Tsz Ting , Hung Alex Tsz Wai , Lau Kendy , Lee Eric Kam Pui 
Published: December 2024

Abstract
Background & aims
Effective treatment for anterior drooling in children with neurological disorders can lead to improved social interactions, reduced physical complications such as perioral infections, and enhanced quality of life for both patients and their parents. Elastic therapeutic taping (ETT) has emerged a novel intervention for drooling, but its evidence was limited. This study systematically reviewed the effectiveness of ETT on reducing anterior drooling in children with neurological disorders.

Methods
Multiple electronic databases, such as Ovid MEDLINE, Embase, and Cochrane Library were searched from inception till 30th October 2024. Randomized controlled trials (RCTs) were included if they: (a) used ETT as a treatment for drooling or swallowing difficulties; (b) included participants aged < 18 years old; (c) included participants with anterior drooling and neurological disorders; (d) compared effects of ETT alone or combined with other treatments (e.g. oral motor therapy (OMT)) with no taping, sham taping or other treatments, and (e) published in English. The Cochrane Risk-of-Bias tool was used to assess risk of bias for the included studies.

Results
Seven parallel-arm RCTs, which were conducted in South/southwest Asia, Africa, South America and Middle East, were included. In total, 220 children aged 1 to 11 were included, of which 97 received solely ETT in 4 studies, while 24 received ETT plus OMT in 2 studies. ETT combined with OMT was more effective in reducing drooling in the included 2 RCTs, though the results of ETT alone were inconsistent, likely due to heterogeneity observed in control conditions, application methods, and outcome measures. No side effects were reported in all studies.

Conclusions
This review suggests that ETT combined with OMT is effective in reducing drooling in children with neurological disorders, with no evidence of side effects.

Trial registration
(PROSPERO no.: CRD42023488664)
Functional study of ZmHDZ4 in maize (Zea mays) seedlings under drought stress
Authors: Xie Xiaowen , Ren Zhenzhen , Su Huihui , Abou-Elwafa Salah Fatouh , Shao Jing , Ku Lixia , Jia Lin , Tian Zhiqiang , Wei Li 
Published: December 2024

Abstract
Background
Maize is a major feed and industrial crop and pivotal for ensuring global food security. In light of global warming and climate change, improving maize tolerance to water deficit is crucial. Identification and functional analysis of drought tolerance genes have potential practical importance in understanding the molecular mechanisms of drought stress.

Results
Here, we identified a maize Homeodomain-Leucine Zipper I, ZmHDZ4, in maize seedlings that is associated with drought tolerance. We demonstrated that ZmHDZ4 has transcriptional activation activity, exclusively localized in the nucleus. Several Cis-acting elements associated with abiotic stress have been identified in the core promoter region of ZmHDZ4. Under drought-stressed conditions, transgenic maize plants overexpressing ZmHDZ4 exhibited significantly higher relative water content and peroxidase (POD) and superoxidase dismutase (SOD) activities compared to wide-type plants, while displaying lower malondialdehyde (MAD) content. The expressions of ZmMFS1-88, ZmGPM573, and ZmPHD9 were significantly repressed in the ZmHDZ4-OE plants under drought-stressed conditions, indicating that ZmMFS1-88, ZmGPM573, and ZmPHD9 were the candidate target genes of ZmHDZ4.

Conclusions
ZmHDZ4 is involved in the regulation of drought stress tolerance in maize by participating in osmotic regulation, sugar metabolism pathways, and hormone regulation.
Epidemiology of talus fractures in Finland: a nationwide register study from 1997 to 2020
Authors: Brushtein Evgenii , Partio Nikke , Huttunen Tuomas T. , Repo Jussi P. , Mäenpää Heikki , Mattila Ville M. 
Published: December 2024

Abstract
Background
The aim of this study was to estimate the nationwide incidence of talus fractures (per 100 000 person-years) and to determine the incidence of operative treatment in the Finnish population.

Methods
Based on Finnish Care Register for Health Care data, all patients 18 years and older admitted to hospital with talar fractures between 1997 and 2020 were included.

Results
During the 24-year study period, 5247 patients with primary or secondary diagnoses of talar fracture were identified. The mean incidence during the whole study period was 50.4 per 100 000 person-years. There was a clear increase starting from the year 2009 (61.4 per 100 000 person-years), that continued and the incidence in 2018 raised up to 106.8 person-years. The total incidence of operations performed on talar fractures remained almost the same during the study period (9.1 per 100 000 person-years from 1997 to 2020).

Conclusions
While the incidence of performed operations had remained stable, the incidence of talar fractures in Finland has increased during the last decades. The increase was more prominent in men. The observed change is possibly due to the progress and availability of computer tomography.

Level of Evidence
III
Temporal resolution trumps spectral resolution in UAV-based monitoring of cereal senescence dynamics
Authors: Tschurr Flavian , Roth Lukas , Storni Nicola , Zumsteg Olivia , Walter Achim , Anderegg Jonas 
Published: December 2024

Abstract
Background
Senescence is a complex developmental process that is regulated by a multitude of environmental, genetic, and physiological factors. Optimizing the timing and dynamics of this process has the potential to significantly impact crop adaptation to future climates and for maintaining grain yield and quality, particularly under terminal stress. Accurately capturing the dynamics of senescence and isolating the genetic variance component requires frequent assessment as well as intense field testing. Here, we evaluated and compared the potential of temporally dense drone-based RGB- and multispectral image sequences for this purpose. Regular measurements were made throughout the grain filling phase for more than 600 winter wheat genotypes across three experiments in a high-yielding environment of temperate Europe. At the plot level, multispectral and RGB indices were extracted, and time series were modelled using different parametric and semi-parametric models. The capability of these approaches to track senescence was evaluated based on estimated model parameters, with corresponding parameters derived from repeated visual scorings as a reference. This approach represents the need for remote-sensing based proxies that capture the entire process, from the onset to the conclusion of senescence, as well as the rate of the progression.

Results
Our results indicated the efficacy of both RGB and multispectral reflectance indices in monitoring senescence dynamics and accurately identifying key temporal parameters characterizing this phase, comparable to more sophisticated proximal sensing techniques that offer limited throughput. Correlation coefficients of up to 0.8 were observed between multispectral (NDVIred668-index) and visual scoring, respectively 0.9 between RGB (ExGR-index) and visual scoring. Sub-sampling of measurement events demonstrated that the timing and frequency of measurements were highly influential, arguably even more than the choice of sensor.

Conclusions
Remote-sensing based proxies derived from both RGB and multispectral sensors can capture the senescence process accurately. The sub-sampling emphasized the importance of timely and frequent assessments, but also highlighted the need for robust methods that enable such frequent assessments to be made under variable environmental conditions. The proposed measurement and data processing strategies can improve the measurement and understanding of senescence dynamics, facilitating adaptive crop breeding strategies in the context of climate change.
Impact of gender on the willingness to participate in clinical trials and undergo related procedures in individuals from an Alzheimer’s prevention research cohort
Authors: Canals-Gispert Lidia , Cañas-Martínez Alba , Huesa Gema , Suárez-Calvet Alomà Marc , Milà-Alomà Marta , Arenaza-Urquijo Eider , Cirillo Davide , Dimech Annemarie Schumacher , Iulita Maria Florencia , Martinkova Julie Novakova , Tartaglia Maria Carmela , Quevenco Frances-Catherine , Chadha Antonella Santuccione , Sánchez-Benavides Gonzalo , Minguillón Carolina , Ferretti Maria Teresa , Fauria Karine , Brugulat-Serrat Anna ,   for the ALFA Study, Freixa Jordi , Domingo Gispert Juan , Grau-Rivera Oriol , Gotsens Xavier , Meléndez Xavier , Menchón Tania , Molinuevo José Luis , Sánchez Pau , Vilà Montserrat 
Published: December 2024

Abstract
Background
Although there is growing evidence of the association between gender and early diagnosis of preclinical Alzheimer's disease, little attention has been given to the enrolment ratio of men and women in clinical trials and data reporting.

Methods
This study aims to analyze gender differences in sociodemographic factors associated with the willingness to participate in clinical trials and undergo specific procedures in the context of an Alzheimer's disease prevention research cohort. 2544 cognitively unimpaired participants from the ALFA parent cohort (age 45–75 years) of the Barcelonaβeta Brain Research Center were contacted through a structured phone call to determine their willingness to participate in Alzheimer's disease clinical trials and undergo trial-related procedures (magnetic resonance imaging, lumbar puncture, positron emission tomography, and cognitive assessment). Sociodemographic data on education, occupational attainment, civil and caregiver status were gathered. Stepwise logistic regression models were performed in order to study the interaction between gender and sociodemographic factors in the willingness to participate in clinical trials and to undergo clinical trial-related procedures.

Results
1,606 out of the 2,544 participants were women (63.1%). Women were significantly younger and had lower educational attainment compared with men. In addition, women were more likely to be caregivers, single and unemployed. Women showed a significantly lower willingness than men to participate in a clinical trial (p = 0.003) and to undergo a lumbar puncture (p < 0.001). Single women were less willing to participate in clinical trials than single men (p = 0.041). Regarding clinical trial-related procedures, women with higher years of education were significantly less willing to undergo a lumbar puncture (p = 0.031).

Conclusion
We found gender differences regarding the sociodemographic factors that predict the willingness to participate in clinical trials and to undergo clinical trial-related procedures. Our results highlight the urgent need to design recruitment strategies accounting for gender-related factors, particularly those related to marital status and education.
Eosinophilic esophagitis
Authors: Erdle Stephanie C. , Carr Stuart , Chan Edmond S. , Robertson Kara , Watson Wade 
Published: December 2024

AbstractEosinophilic esophagitis (EoE) is an atopic condition of the esophagus that has become increasingly recognized. Diagnosis of the disorder is dependent on the patient’s clinical manifestations and must be confirmed by histologic findings on esophageal mucosal biopsies. The epidemiology, pathophysiology, diagnosis, treatment, and prognosis of EoE are discussed in this review.
The value of restriction spectrum imaging in predicting lymph node metastases in rectal cancer: a comparative study with diffusion-weighted imaging and diffusion kurtosis imaging
Authors: Yin Huijia , Liu Wenling , Xue Qin , Song Chen , Ren Jipeng , Li Ziqiang , Wang Dongdong , Wang Kaiyu , Han Dongming , Yan Ruifang 
Published: December 2024

Abstract
Background
To investigate the efficacy of three-compartment restriction spectrum imaging (RSI), diffusion kurtosis imaging (DKI), and diffusion-weighted imaging (DWI) in the assessment of lymph node metastases (LNM) in rectal cancer.

Methods
A total of 77 patients with rectal cancer who underwent pelvic MRI were enrolled. RSI-derived parameters (f1, f2, and f3), DKI-derived parameters (Dapp and Kapp), and the DWI-derived parameter (ADC) were calculated and compared using a Mann–Whitney U test or independent samples t-test. Logistic regression (LR) analysis was used to identify independent predictors of LNM status. Area under the receiver operating characteristic curve (AUC) and Delong analysis were performed to assess the diagnostic performance of each parameter.

Results
The LNM-positive group exhibited significantly higher f1 and Kapp levels and significantly lower f3, Dapp, and ADC levels compared to the LNM-negative group (p < 0.05). There was no difference in f2 levels between the two groups (p = 0.783). LR analysis showed that Dapp and Kapp were independent predictors of a positive LNM status. AUC and Delong analysis showed that DKI (Dapp + Kapp) exhibited significantly higher diagnostic efficacy (AUC = 0.908; sensitivity = 87.10%; specificity = 86.96%) than RSI (f1 + f3) and DWI (ADC), with AUCs were 0.842 and 0.771 (Z = 2.113, 3.453; p = 0.035, < 0.001, respectively). The AUC performance between RSI and DWI was also statistically significant (Z = 1.972, p = 0.049).

Conclusion
The RSI model is superior to conventional DWI but inferior to DKI in differentiation between LNM-positive and LNM-negative rectal cancers. Further study is needed before it could serve as a promising biomarker for guiding effective treatment strategies.

Critical relevance statement
The three-compartment restriction spectrum imaging was able to differentiate between LNM-positive and LNM-negative rectal cancers with high accuracy, which has the potential to serve as a promising biomarker that could guide treatment strategies.

Key Points

Three-compartment restriction spectrum imaging could differentiate lymph node metastases in rectal cancer.

Diffusion kurtosis imaging and diffusion-weighted were associated with lymph node metastases in rectal cancer.

The combination of different parameters has the potential to serve as a promising biomarker.

Graphical Abstract
Contracting with sequential care providers
Authors: Grepperud Sverre , Pedersen Pål Andreas 
Published: December 2024

Abstract
Background
The literature on care coordination refers to high service costs, low quality, and consumer dissatisfaction, as the consequences of institutional fragmentation and uncoordinated care.

Objectives
In this work we are concerned with the role financial incentives (reimbursement schemes) might play in promoting coordinated care when providers are organized sequentially along a care pathway and the clients (patients) are transferred from one caregiver to another.

Methods
We apply a game-theoretic framework to analyze the situation where three providers provide services to a patient group and there are interdependencies between the providers in terms of cost-externalities and altruistic patient preferences.

Results
For activity-based contracts, the incentives for cost containment are efficient (internal efficiency), while the incentives for quality provision are inefficient due to preference misalignments and poor coordination that derive from funding costs, imperfect altruism, the presence of externalities and strategic behavior. The optimal cost-based contracts are mixed contracts that vary across providers according to their position in the production chain, and they consist of the following three elements; (i) fixed budgets, (ii) payments contingent upon the treatment costs of production chain followers (integrated penalties), and (iii) payments contingent upon the providers’ own treatment costs (positive or negative cost-sharing). For these contracts, the providers are typically internally inefficient, while the inefficiencies associated with preference misalignments and poor coordination are solved.

Conclusions
Our production chain perspective, when compared to single-provider approaches, enhances the appeal of cost-based contracts relative to pure prospective contracts.