bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary Care Providers’ Communication About Medical Cannabis With Older Adults: A Cross-Sectional Survey
Authors: Elbready Abdallah W. , Warner-Maron Ilene , Glicksman Allen , Peterson Andrew M. 
Published: November 2024

Purpose: Healthcare providers often hesitate to discuss medical cannabis (MC) due to limited understanding, risks and benefits, and misinformation. This reluctance is notable with older adult patients, despite MC’s potential benefits. This study investigates whether primary care providers (PCPs) routinely inquire about MC when treating older adults and the frequency of such inquiries. Methods: A 23-question survey was emailed to 575 physicians, pharmacists, nurse practitioners, and physician assistants who completed a Pennsylvania Department of Health-approved MC course. The survey was conducted in 2022 to 2023, and the participants were drawn from a pool of individuals who completed the course between 2018 and 2022. PCPs need to be practicing in the Tri-state area and caring for older adults. Results were cross-tabulated to examine the relationship between healthcare practitioners’ inquiries about MC and patients’ questions about MC. McNemar and Chi-square tests were used for analysis. Results: Survey results revealed that PCPs were more likely to inquire about alcohol and tobacco use than cannabis with older adults ( P < .0001). Patients were more likely to initiate conversations about MC use ( P = .037). PCPs did not frequently inquire about cannabis use amongst their patients or consider it as a therapeutic option. Conclusion: This study underscores the prevalent reluctance among PCPs to initiate discussions about MC treatment with older adults. Further investigation is needed to identify how to improve communication regarding the risks and benefits of MC.
Impact of Chronic Disease Shocks on Household Consumption in China: The Role of Multi-Level Health Insurance
Authors: Han Linlin , Nan Yongqing , Yang Feng , Zang Xuheng , Xue Xiaoling 
Published: November 2024

Expanding and enhancing the quality of consumption is crucial to satisfy the increasing demand for a higher standard of living. However, the rising risk of chronic diseases impacts not only the level of consumption but also impedes the optimization of consumption patterns. This research utilizes Staggered Difference-in-Differences (DID) and Difference-in-Differences-in-Differences (DDD) models to evaluate the effects of chronic disease shocks on both the levels and structures of household consumption, leveraging data from the China Family Panel Studies (CFPS) across four survey waves from 2012 to 2018. Additionally, the study examines the effects and mechanisms of the multi-level health insurance system in mitigating the impact of chronic disease shocks. The study discerns a significant decrease in household consumption expenditure, obstruction in the enhancement of consumption structures, and a constriction of consumption diversity attributable to chronic disease shocks. Heterogeneous analysis reveals that the impact of chronic shocks varies across factors such as age, capital endowment, urban versus rural residence, and the availability of healthcare resources. Moreover, the analysis highlights the heterogeneous mitigating effects of the multi-level health insurance system, particularly through diminishing out-of-pocket medical expenses and the propensity for precautionary savings. The findings accentuate the imperative for the enhancement and equalization of the multi-level health insurance system to fortify household consumption, offering significant policy insights for the realization of the “Healthy China” vision. JEL Classification: P36, D12.
A Retrospective Case Series of Single-Screw vs Dual-Screw Fixation for Treatment of Medial Malleolus Fractures
Authors: Aamir Junaid , Caldwell Robyn , Long Sarah , Sreenivasan Sachith , Mavrotas Jason , Panesa Ayn , Jeevaresan Shagilan , Lampridis Vasileios , Mason Lyndon 
Published: November 2024

Background: Medial malleolus fractures (MMFs) are common across the world. Currently, there is a lack of consensus on the number of screws used in fixation of MMF. Our aim was to compare the radiographic outcomes of MMF with patients between fractures that have either undergone single-screw (SS) or dual-screw (DS) fixation. Methods: This retrospective study assessed patients who had undergone fixation of their MMF from 2012 to 2022. Analysis of their perioperative radiographs was performed to determine the initial type of injury and then radiographic outcomes of nonunion and malunion. Results: A total of 653 patients suffering bimalleolar fractures were identified across a 10-year period. There were 271 patients (41.50%) in the SS group and 382 in the DS group (58.50%). There was no difference found in the nonunion rate of SS (19.19% [52 of 271]) compared with DS (18.85% [72 of 382]) ( P = .931). A statistically significant difference between malunion rates was found between the SS group (11.07% [30 of 271]) compared with the DS group (3.93% [15 of 382]) ( P < .001). On multiregression analysis, factors that gained significance for development of nonunion was nonfixation of syndesmosis ( P = .039), ankle dislocation on arrival ( P < .001), and nonrestoration of fibular length ( P < .001). Other factors that showed significance for failure to achieve medial anatomical reduction was nonfixation of syndesmosis ( P < .001). Conclusion: Use of an SS rather than DS showed a significant increase in nonanatomical reduction but did not increase nonunion or reoperation rate. Syndesmosis fixation was associated with higher rates of MMF nonunion and malunion; as such, surgeons should have a low index of suspicion of injury and fixation. Level of Evidence: Level III, retrospective case series.
Interpreting deep neural networks for the prediction of translation rates
Authors: Korbel Frederick , Eroshok Ekaterina , Ohler Uwe 
Published: November 2024

Abstract
Background
The 5’ untranslated region of mRNA strongly impacts the rate of translation initiation. A recent convolutional neural network (CNN) model accurately quantifies the relationship between massively parallel synthetic 5’ untranslated regions (5’UTRs) and translation levels. However, the underlying biological features, which drive model predictions, remain elusive. Uncovering sequence determinants predictive of translation output may allow us to develop a more detailed understanding of translation regulation at the 5’UTR.

Results
Applying model interpretation, we extract representations of regulatory logic from CNNs trained on synthetic and human 5’UTR reporter data. We reveal a complex interplay of regulatory sequence elements, such as initiation context and upstream open reading frames (uORFs) to influence model predictions. We show that models trained on synthetic data alone do not sufficiently explain translation regulation via the 5’UTR due to differences in the frequency of regulatory motifs compared to natural 5’UTRs.

Conclusions
Our study demonstrates the significance of model interpretation in understanding model behavior, properties of experimental data and ultimately mRNA translation. By combining synthetic and human 5’UTR reporter data, we develop a model (OptMRL) which better captures the characteristics of human translation regulation. This approach provides a general strategy for building more successful sequence-based models of gene regulation, as it combines global sampling of random sequences with the subspace of naturally occurring sequences. Ultimately, this will enhance our understanding of 5’UTR sequences in disease and our ability to engineer translation output.
Sheffield Adaptive Patterned Electrical Stimulation (SHAPES) Therapy for Post Stroke Arm spasticity: study protocol for a 3-arm, a partially blinded, randomised controlled trial
Authors: Ali Ali , McCarthy Avril D. , Reeves Mark , Healey Jamie , Moody Louise , Adebajo Adewale , Good Tim , Dixon Simon , Baster Kathleen , Tindale Wendy , Nair Krishnan Padmakumari Sivaraman 
Published: November 2024

Abstract
Introduction
Post stroke elbow spasticity (PSES) affects over a third of individuals following stroke and negatively impacts on functional recovery, comfort and quality of life. Drug therapies have limited efficacy and unwanted side effects, botulinum toxin, although effective, is costly, and conventional electrical stimulation therapies are limited long term by habituation. We aim to investigate the efficacy of Sheffield Adaptive Patterned Electrical Stimulation (SHAPES), that delivers temporally and spatially varying pattern of electrical stimulation, against transcutaneous electrical stimulation (TENS) and standard care at reducing PSES.

Methods and design
Overall, 297 people with PSES will be randomised (1:1:1) to one of 3 arms: Standard care (no electrical stimulation), TENS (conventional patterned electrical stimulation) or SHAPES (adaptive patterned electrical stimulation). Both SHAPES and TENS are delivered using a specially designed electrical stimulation sleeve used for 60 min each day for 6-weeks. Outcome measures are completed at baseline, end of treatment (EOT 6 weeks) and then 6-weeks, 12-weeks and 24-weeks after the end of treatment. Efficacy will be determined based on the proportion of participants experiencing meaningful improvement (18%) in the 7-day Numerical Rating Scale (NRS-S) for PSES, compared between both intervention arms and standard care, and between the two intervention groups. Measures of arm motor function (Action Research Arm Test, MRC scale), and quality of life (SQoL-6D, EQ-5D) will also be measured along with a parallel health economic evaluation.

Discussion
The results of the SHAPES trial will inform management of elbow spasticity after stroke. The SHAPES intervention is a low cost, self-administered intervention for the management of spasticity that can be used repeatedly, and if found to be more effective than TENS or control has the potential to be widely implemented in the UK NHS healthcare setting. Furthermore, despite the wide use of TENS in the management of spasticity, this study will provide critically required evidence regarding its efficacy. The trial has been registered with the ISRCTN registry (ISRCTN26060261).
Transient biopsy-proven progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome (PML-IRIS) in an elderly woman without known immunodeficiency: a case report
Authors: Ingebrigtsen Susanne Gaarden , Myrmel Kristin Smistad , Henriksen Stian , Wikran Gry Charlotte , Herder Marit , Tylden Garth D. , Hirsch Hans H. , Rinaldo Christine Hanssen 
Published: November 2024

Abstract
Background
Progressive multifocal leukoencephalopathy (PML) is a severe opportunistic brain disease caused by lytic JC polyomavirus (JCPyV) replication in oligodendrocytes. Although JCPyV infection is common in the general population, PML almost exclusively occurs in patients immunocompromised due to untreated HIV/AIDS, haematological malignancies, primary immunodeficiencies, solid organ transplantation, or immunomodulatory treatment of autoimmune diseases. There is no effective antiviral treatment, and recovery depends on immune reconstitution. Paradoxically, initiation of antiretroviral therapy for HIV/AIDS or interruption of immunomodulating treatment can worsen the clinical manifestations due to immune reconstitution inflammatory syndrome (IRIS). Here, we report an unusual case of spontaneous IRIS in a 76-year-old immunocompetent woman, unmasking PML and leading to unexpected recovery.

Case presentation
The patient was admitted to the hospital due to psychosis, speech impairment, and behavioral changes over the last three months. She had previously been healthy, except for a cerebellar stroke secondary to paroxysmal atrial fibrillation. Magnetic resonance imaging (MRI) revealed multiple contrast-enhancing white matter lesions suspicious of cancer metastases. Due to suspicion of edema, dexamethasone was administered, and the patient was released while waiting for a stereotactic brain biopsy. Eight days later, she suffered tonic seizures and was readmitted. Intravenous levetiracetam gave rapid effect, but the patient was paranoid and non-cooperative, and dexamethasone was unintentionally discontinued. Ten days later, the brain biopsy revealed demyelination, abundant perivascular T cells, macrophages, and scattered JCPyV-infected oligodendrocytes, rendering the diagnosis of PML-IRIS. The cerebrospinal fluid contained low amounts of JCPyV-DNA, and plasma contained high levels of anti-JCPyV immunoglobulin G. Despite extensive immunological testing, no evidence of immunodeficiency was found. The patient gradually recovered clinically and radiologically. More than 19 months after diagnosis, the patient has only a slight impairment in language and behavior.

Conclusions
An apparently immunocompetent elderly person developed clinically symptomatic PML, which spontaneously resolved with symptoms and signs of IRIS. The atypical MRI lesions with contrast enhancement and the lack of known immunological risk factors for PML delayed the diagnosis, eventually proved by biopsy. PML and PML-IRIS should be considered in the differential diagnosis of patients presenting CNS symptoms and focal lesions with contrast enhancement on MRI.
Evaluation of patient satisfaction and maximum biting force of three differently constructed bars on two implants retaining mandibular overdenture - one year follow-up (a randomized controlled clinical trial)
Authors: Badr Amr Mohamed Ismail , Nabawy Mona , Mohammed Gehan Fekry , Radwan Shaimaa Ahmed 
Published: November 2024

Abstract
Background
Different bar construction techniques will affect the bar passive fitness, which may induce stresses or strain on the implant and/or tightening screw and sequentially may affect the biting force and patient satisfaction.

Aim of the study
This clinical investigation assessed patient satisfaction and maximum biting force (MBF) using three differently constructed (conventional casting, milling, and 3D printing CAD/CAM techniques) cobalt-chromium (Co-Cr) bar-retained implants mandibular overdentures over a one-year period of follow-up.

Materials and methods
Thirty edentulous patients seeking for two implants bar-retained mandibular overdentures were randomly assigned into three groups as the following: Group I: 10 patients received a Co-Cr conventional casting bar, Group II: 10 patients received a Co-Cr CAD/CAM milled bar, and Group III: 10 patients received a Co-Cr CAD/CAM 3D-printed bar. All the bar groups were connected to two implants in the canine area bilaterally. Within the first two weeks following implant placement, patients received the definitive prosthesis. Patient satisfaction was evaluated by using the (OHIP-EDENT-19) questionnaire form after 6, and 12 months. Additionally, the maximum biting force was tested at after delivery, 3, 6, and 12 months for each group. The results were collected, tabulated, and statistically analyzed. Trial registration: This study was recorded on ClinicalTrials.gov retrospectively registered (ID: NCT06401187) on 30/04/2024.

Results
After one year follow up, regrading patient satisfaction the three groups showed no statistically significant difference. Although, the functional limitation domain was in favor of the milled bar. Regarding the maximum biting force, no statistically significant difference was found among three groups. However, at 12 mouths follow-up the milled bar showed statistically value.

Conclusion
Within the limitations of this study, the conventional, milled and 3D printed bar overdentures groups can be used as a satisfactory treatment modality for edentulous mandible in terms of patient satisfaction and maximum biting force.
Ethics in the operating room: a systematic review
Authors: Agledahl Kari Milch , Pedersen Reidar 
Published: November 2024

Abstract
Background/Objective
The act of surgery involves harming vulnerable patients with the intent that the results will improve their health and, ultimately, help the patients. Such activities will inevitably entail moral decisions, yet the ethics of surgery has only recently developed as a field of medical ethics. Within this field, it is striking how few accounts there are of actions within the operating room. The aim of this systematic review was to investigate how much of the scientific publications on surgical ethics focus on what take place inside the operating room and to explore the ethical issues included in the publications that focus on medical ethics in the operating room.

Methods
We conducted a systematic search of the Medline and Embase databases using a PICO model and the search terms “surgery”, “ethics” and “operating room”. Papers were included if they focused on doctors, entailed activities inside the operating room and contained some ethical analysis. Thematic synthesis was used for data extraction and analysis.

Findings
Fewer than 2% of the scientific publications on surgical ethics included activities inside the operating room. A total of 108 studies were included in the full-text analysis and reported according to the RESERVE guidelines. Eight content areas covered 2/3 of the included papers: DNR orders in the OR, overlapping surgery, donation of organs, broadcasting live surgery, video recordings in the OR, communication/teamwork, implementing new surgical technology, and denying blood to Jehovah’s Witness.

Discussion/Conclusions
This systematic review indicates that only a small fraction of scientific publications on the ethics of surgery focus on issues inside the operating room, accentuating the need for further research to close this gap. The ethical issues that repeatedly arose in the included papers included the meaning of patient autonomy inside the operating room, the consequences of technological advances in surgery, the balancing of legitimate interests, the dehumanising potential of the OR, and the strong notion of surgeon responsibility.
Association between RANTES/CCL5 levels with Plasmodium infections and malaria severity: a systematic review
Authors: Kwankaew Pattamaporn , Mahittikorn Aongart , Mala Wanida , Kotepui Kwuntida Uthaisar , Anabire Nsoh Godwin , Wilairatana Polrat , Kotepui Manas 
Published: November 2024

Abstract
Background
Malaria continues to be a significant global health concern, and developing effective therapeutic strategies requires an understanding of the immune response to the disease. This systematic review synthesized the current body of research on the role of regulated on activation, normal T cell expressed and secreted (RANTES)—in the pathogenesis and disease severity of malaria.

Methods
A systematic review protocol was registered with PROSPERO under the registration number CRD42024535822. The systematic review was conducted following PRISMA guidelines to identify studies examining RANTES levels in individuals infected with Plasmodium species. Searches were performed across multiple databases, including ProQuest, Journals@Ovid, Embase, Scopus, PubMed, and MEDLINE. Further searches were performed in Google Scholar. Quality assessment was done using the Joanna Briggs Institute (JBI) critical appraisal tools. Alterations in RANTES levels in patients with malaria were synthesized narratively.

Results
A comprehensive search of major databases identified 22 studies meeting inclusion criteria, predominantly focusing on Plasmodium falciparum and Plasmodium vivax infections. RANTES levels were found to vary significantly across different severities of malaria, with several studies reporting lower levels in severe cases compared to non-malarial controls. However, inconsistencies were observed in the alterations of RANTES levels between severe and non-severe malaria cases.

Conclusion
Taken together, the finding of this systematic review underscore the complex regulation of RANTES in malaria pathophysiology. Future research should focus on longitudinal assessments to elucidate the dynamic role of RANTES throughout the course of malaria and recovery, to potentially inform the design of novel therapeutic strategies.
Economic evaluations of eye care services for Indigenous populations in high-income countries: a scoping review
Authors: Nejatian Marcel Maziyar , Sincari Andrei , Alam Khyber , Li Ian , Razavi Hessom 
Published: November 2024

Abstract
Background
Indigenous people in high-income countries have worse eye health outcomes when compared to non-Indigenous people, contributing to ongoing socioeconomic disadvantage. Although services have been designed to address these disparities, it is unclear if they have undergone comprehensive economic evaluation. Our scoping review aimed to identify the number, type, quality, and main findings of such evaluations.

Methods
MEDLINE, Embase, Web of Science, Cochrane Library Database, the National Health Service Economic Evaluation Database, EconLit, and relevant grey literature were systematically searched as per our pre-registered protocol. All economic evaluations of real or model services designed to meet the eye care needs of Indigenous populations in high-income countries were included. Two reviewers independently screened studies, extracted data, and assessed quality using the Quality of Health Economic Studies instrument.

Results
We identified 20 studies evaluating services for Indigenous populations in Australia (n = 9), Canada (n = 7), and the United States of America (n = 4). Common services included diabetic retinopathy (DR) screening through fundus photographs acquired in local primary health care clinics (n = 7) or by mobile teams (n = 6), and general eye care through teleophthalmology (n = 2), outreach ophthalmology (n = 2) or an Indigenous health care clinic optometrist (n = 1). These services were economically favourable in 85% of comparisons with conventional alternatives, mainly through reduced costs of travel, in-person consults, and vision loss. Only four studies assessed the benefits of increased patient uptake. Only five included patient evaluations, but none integrated these into their quantitative analysis. Methodological issues included no stated economic perspective (n = 10), no sensitivity analysis (n = 12), no discounting (n = 9), inappropriate measurement of costs (n = 13) or outcomes (n = 5), and unjustified assumptions (n = 15).

Conclusion
Several Indigenous eye care services are cost-effective, particularly remote DR screening. Other services are promising but require evaluation, with attention to avoid common methodological pitfalls. Well-designed evaluations can guide the allocation of scarce resources to services with demonstrated effectiveness and sustainability.

Trial registration
Our scoping review protocol was pre-registered (Open Science Framework DOI: https://doi.org/10.17605/OSF.IO/YQKWN).