bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healthcare professionals’ perceived barriers in providing palliative care in primary care and nursing homes: a survey study
Authors: Kochems Katrin , de Graaf Everlien , Hesselmann Ginette M. , Ausems Marieke J. E. , Teunissen Saskia C. C. M. 
Published: December 2023

Background: Palliative care in primary care and nursing home settings is becoming increasingly important. A multidimensional palliative care approach, provided by a multiprofessional team, is essential to meeting patients’ and relatives’ values, wishes, and needs. Factors that hamper the provision of palliative care in this context have not yet been fully explored. Objectives: To identify the barriers to providing palliative care for patients at home or in nursing homes as perceived by healthcare professionals. Design: Cross-sectional survey study. Methods: A convenience sample of nurses, doctors, chaplains, and rehabilitation therapists working in primary care and at nursing homes in the Netherlands is used. The primary outcome is barriers, defined as statements with ⩾20% negative response. The survey contained 56 statements on palliative reasoning, communication, and multiprofessional collaboration. Data were analyzed using descriptive statistics. Results: In total, 249 healthcare professionals completed the survey (66% completion rate). The main barriers identified in the provision of palliative care were the use of measurement tools (43%), consultation of an expert (31%), estimation of life expectancy (29%), and documentation in the electronic health record (21% and 37%). In primary care, mainly organizational barriers were identified, whereas in nursing homes, most barriers were related to care content. Chaplains and rehabilitation therapists perceived the most barriers. Conclusion: In primary care and nursing homes, there are barriers to the provision of palliative care. The provision of palliative care depends on the identification of patients with palliative care needs and is influenced by individual healthcare professionals, possibilities for consultation, and the electronic health record. An unambiguous and systematic approach within the multiprofessional team is needed, which should be patient-driven and tailored to the setting.
Practitioners’ experiences with 2021 amendments to Canada’s medical assistance in dying law: a qualitative analysis
Authors: Close Eliana , Downie Jocelyn , White Ben P. 
Published: December 2023

Background: In 2016, Canada joined the growing number of jurisdictions to legalize medical assistance in dying (MAiD), when the Supreme Court of Canada’s decision in Carter v Canada took effect and the Canadian Parliament passed Bill C-14. Five years later, Bill C-7 introduced several significant amendments. These included removing the ‘reasonably foreseeable natural death’ requirement (an aspect that was widely debated) and introducing the final consent waiver. Since Bill C-7 is so new, very little research has investigated its operation in practice. Objectives: This study investigates the experiences of MAiD assessors and providers regarding the Bill C-7 amendments. It explores implications for understanding and improving regulatory reform and implementation. Design: Qualitative thematic analysis of semi-structured interviews. Methods: In all, 32 MAiD assessors and providers (25 physicians and 7 nurse practitioners) from British Columbia ( n = 10), Ontario ( n = 15) and Nova Scotia ( n = 7) were interviewed. Results: The analysis resulted in five themes: (1) removing barriers to MAiD access; (2) navigating regulatory and systems recalibration; (3) recognizing workload burdens; (4) determining individual ethical boundaries of practice and (5) grappling with ethical tensions arising from broader health system challenges. Conclusion: This is one of the first studies to investigate physicians’ and nurse practitioners’ experiences of the impact of Bill C-7 after the legislation was passed. Bill C-7 addressed key problems under Bill C-14, including the two witnesses requirement and the 10-day waiting period. However, it also introduced new complexities as practitioners decided how to approach cases involving a non-reasonably foreseeable natural death (and contemplated the advent of MAiD for persons with a mental disorder as a sole underlying condition). This study highlights the importance of involving practitioners in advance of legislative changes. It also emphasizes how the regulation of MAiD involves a range of organizations, which requires strong leadership and coordination from the government.
How I treat myeloproliferative neoplasms in pregnancy
Authors: Robinson Susan , Ragheb Monica , Harrison Claire 
Published: December 2023

Abstract
Although myeloproliferative neoplasms (MPNs) are traditionally considered diseases of adults in their sixth or seventh decade, these conditions do occur in young patients; for example, for essential thrombocythemia, in particular, there is a second peak in women of reproductive age. Therefore, pregnancy is an uncommon but not rare occurrence and clinical challenge in some scenarios. Here, we discuss in detail our local approach to the management of pregnancy in patients with MPN while taking a case-based approach. We include relevant updates in the field and point to a future research strategy that should be internationally focused to obtain as much information in as short a time as possible.
A 14-year-old male patient with diagnosis of Prader–Willi syndrome in Ethiopia: a case report
Authors: Belay Kibret Enyew , Ayalew Beza Leulseged , Amogne Melaku Taye , Alemneh Theodros Aberra , Geletew Tedla Kebede 
Published: December 2023

Abstract
Background
Prader–Willi syndrome is a complex multisystem disorder due to the absent expression of paternally active genes in the Prader–Willi syndrome-critical region on chromosome 15 (15q11.2-q13). The main clinical features are hyperphagia (which frequently results in early-onset obesity), hypogonadism, developmental delays, typical behaviors (such as obsessive–compulsive tendencies, tantrums, perseveration, insistence on sameness, and rigidity), and distinctive facial features. In infants, the most prominent findings are hypotonia and feeding difficulties.

Case presentation
This paper highlights a case of a 14 year old male patient of an Ethiopian ethnicity with diagnosis of Prader–Willi syndrome, which is first report in Ethiopia. He presented with progressive excessive weight gain, insatiable appetite, clinical and laboratory features of hypogonadism, ophthalmological refractory error, and facial features of Prader–Willi syndrome, which was further confirmed by genetic analysis. He is currently on lifestyle intervention, testosterone replacement, and treatment for vitamin D deficiency.

Conclusion
Prader–Willi syndrome should be considered in a child who presents with progressive weight gain and other typical clinical features such as cognitive impairment, excessive insatiable eating, or hypothalamic hypogonadism. Early lifestyle intervention may help to reduce excessive weight gain. To our knowledge, this is the first case reported in Ethiopia.
Plausible reasons for the resurgence of Mpox (formerly Monkeypox): an overview
Authors: Zebardast Arghavan , Latifi Tayebeh , Shafiei-Jandaghi Nazanin-Zahra , Gholami Barzoki Mehdi , Shatizadeh Malekshahi Somayeh 
Published: December 2023

AbstractPoxviruses are large and diversified viruses that cause an emerging zoonotic disease known as monkeypox (mpox). In the past, mpox predominated primarily in the rural rainforests of Central and West Africa. Recently, the exportation of mpoxv from Africa to other continents has been progressively reported. However, the lack of travel history to Africa in most of the currently reported cases in 2022 promotes the sign of changing epidemiology of this disease. Concerns over the geographic distribution and continued resurgence of mpox is growing. In this review, we addressed the geographic distribution, transmission, reasons for the resurgence of mpox, and vaccination. Although the precise cause of the resurgence in mpox cases is mostly unknown, several suggested factors are believed to be waning immunity, accumulation of unvaccinated people, ecological conditions, risk behaviors of men who have sex with men, and genetic evolution.
Host genetic variants associated with susceptibility and severity of pneumococcal pneumonia in adult patients
Authors: Boix-Palop Lucía , Arranz María J. , Sangil Anna , Dietl Beatriz , Xercavins Mariona , Pérez Josefa , Calbo Esther 
Published: December 2023

Abstract
Background
Pneumococcal community-acquired pneumonia (P-CAP) is a major cause of morbidity and hospitalization. Several host genetics factors influencing risk of pneumococcal disease have been identified, with less information about its association with P-CAP. The aim of the study was to assess the influence of single nucleotide polymorphisms (SNP) within key genes involved in the innate immune response on the susceptibility to P-CAP and to study whether these polymorphic variants were associated with the severity and outcome of the episodes in a cohort of adult Caucasian patients.

Methods
Seventeen SNPs from 7 genes (IL-R1, IL-4, IL-10, IL-12B, NFKBIA, NFKBIE, NFKBIZ) were analyzed. For susceptibility, a case-control study including a cohort of 57 adult with P-CAP, and 280 ethnically matched controls was performed. Genetic influence on clinical severity and outcome was evaluated in a prospective observational study including all consecutive adult P-CAP patients from November 2015 to May 2017.

Results
The NFKBIA polymorphism rs696 and a haplotype combination were associated with susceptibility to P-CAP (OR = 0.62, p = 0.005 and OR = 0.63, p = 0.008, respectively). The SNP IL4 rs2227284 was associated with severe P-CAP (OR = 2.17, p = 0.04). IL-R1 (rs3917267) and IL-10 (rs3024509) variants were related with respiratory failure (OR = 3.31, p = 0.001 and OR = 0.18, p = 0.003, respectively) as well as several haplotype combinations in NFKBIA, NFKBIZ, IL-R1 and IL-10 (p = 0,02, p = 0,01, p = 0,001, p = 0,03, respectively). CURB-65 values were associated with the IL-10 rs3024509 variant (beta = − 0.4, p = 0.04), and with haplotype combinations of NFKBIZ and IL-10 (p = 0.05, p = 0.04, respectively). Genetic variants in IL-10 (rs3024509) and in IL-12B (rs730691) were associated with PSI values (beta = − 0.54, p = 0.01, and beta = − 0.28, p = 0.04, respectively), as were allelic combinations in IL-R1 (p = 0.02) and IL-10 (p = 0.01). Finally, several polymorphisms in the IL-R1 gene (rs13020778, rs2160227, & rs3917267) were associated with the time elapsed until clinical stability (beta = − 0.83, p = 0.03; beta = − 1, p = 0.02 and beta = 1.07, p = 0.008, respectively).

Conclusions
A genetic variant in NFKBIA was associated with susceptibility to P-CAP in adult Caucasian patients and genetic variants from key cytokines of the innate immune response (Il-4, IL-10, IL-R1 and IL-12B) and NF-κB inhibitors were associated with different phenotypes of severe P-CAP. If validated, these SNPs may help to identify people at risk of P-CAP or severe P-CAP on which preventive measures could be applied.
Synthesizing the risk of morbidities and lifestyle factors on insomnia symptoms among middle-aged and older adult persons in India
Authors: Saha Subhadeep , Das Priya , Das Tanu , Das Partha , Roy Tamal Basu 
Published: December 2023

Abstract
Purpose
Most of the time increasing age and improper lifestyle enhance the burgeoning health challenge for middle-aged and older adult persons. In this way, the present study seeks to know the association of morbidity, lifestyle parameters, and background characteristics with insomnia symptoms among middle-aged and older adults in India.

Methods
The study utilizes a sample of 46,462 older individuals aged 45 years and above from LASI wave-1. Multivariate binary logistic models were applied to acquire the results.

Result
Insomnia symptom was closely linked with hypertension [AOR: 1.33; 1.27–1.39], heart diseases [AOR: 1.37; 1.23–1.53], the neurological problem [AOR: 1.67; 1.46–1.91], as compared to older adults who did not suffer from any morbidity. The likelihood of insomnia symptoms was also higher among older individuals who reported following an accustomed lifestyle i.e., no reading habit [AOR: 1.35; 1.26–1.45], never going to the park for relaxing leisure hours [AOR: 1.38; 1.01–1.73]. Moreover, insomnia increases with age, and among elder women.

Conclusion
The encouragement of remedies for morbidity and improper lifestyle practices could be considered as part of a plan to decrease insomnia symptoms. As well as the detection of early stages of insomnia by health professionals and intervention of public health services is necessary.
Peripheral Neutrophil to Lymphocyte Ratio (NLR), a cogent clinical adjunct for Ki-67 in breast cancer
Authors: Arora Radhika , Alam Feroz , Zaka-ur-Rab Atia , Maheshwari Veena , Alam Kiran , Hasan Mahboob 
Published: December 2023

Abstract
Background
Clinical utility of Ki-67 immunohistochemistry (IHC) in breast cancer (BC) is mainly limited to decide for the use of chemotherapy and estimate prognosis in patients with either Ki-67 index < 5% or > 30%; however, lacunae still exists pertaining to its analytical validity. Neutrophilia is common in cancer with accompanying lymphocytopenia. Neutrophil to lymphocyte ratio (NLR) captures the intricate balance between pro-tumor neutrophilia and anti-tumor lymphocyte immunity. This study aimed to correlate cellular proliferation in breast cancer with NLR.

Methods
An observational study was carried out including 73 cases of BC; pre-treatment NLR and Ki-67 grading were performed. NLR < 3 was considered low, while ≥ 3 was high. The Ki-67 expression was graded as low ≤ 5%, intermediate 6–29%, or high ≥ 30%. Various clinico-pathological variables were studied, and the association of categorical variables was analyzed using Pearson’s chi-square test, and a p-value of < 0.05 was taken as significant.

Results
Ki-67 correlated significantly with modified Scarff-Bloom-Richardson (SBR) grade (p < 0.01), and tumor-node-metastasis (TNM) stage (p < 0.001). Correlation of NLR was not significant with SBR grade (p > 0.05) and molecular subtype (p > 0.05); however, NLR was found to be significantly correlated with TNM stage (p < 0.001) and Ki-67 (p < 0.001).

Conclusion
NLR is fast emerging as a personalized theranostic marker in breast cancer. Instead of determining a generalized cut-off value, individual baseline NLR and its dynamics with disease progression will help manage patients better, obviating some of the drawbacks associated with Ki-67.
Surgical treatment of a mine blast wound of the T11 vertebra with anatomical disruption of the spinal cord: a rare clinical case and a brief review of the current literature
Authors: Manukovskiy V. A. , Movsisyan A. B. , Timonin S. Yu. 
Published: December 2023

The experience of treating a patient with a mine blast wound of the T11 vertebra with an anatomical disruption of the spinal cord, bilateral hemo- and pneumothorax is presented. As a result of the injury, the patient suffered massive destruction of soft tissues with the formation of a full-thickness defect up to the vertebral bodies. The tactics of staged surgical treatment of the patient are described: elimination of fracture dislocation, fixation of the spine and plastic surgery of the soft tissues of the wound defect using the VAC system.A review of current publications devoted to the epidemiology and tactics of treatment of combat injuries of the spine and spinal cord is presented.
The problem of double thoracic idiopathic scoliosis: a non-systematic literature review
Authors: Dolotin D. N. , Lukinov V. L. , Mikhaylovskiy M. V. 
Published: December 2023

Objective. To analyze the current situation in the community of spine surgeons regarding the determination of the zone of posterior spinal fusion for double thoracic idiopathic scoliosis.Material and Methods. The content of 16 publications containing the results of surgical correction of double thoracic scoliotic deformities was analyzed. The number of studied clinical cohorts was 25, of which in 13 groups only the right-sided main thoracic (MT) curve (MT group) was blocked, and in 12 – both MT and left-sided proximal upper thoracic (PT) curve (MT + PT group). Four parameters were analyzed in both groups: preoperative Cobb angle, preoperative curve mobility, deformity correction, and postoperative deformity progression.Results. Significant differences were found in the MT and MT + PT groups only in two cases: for the initial Cobb angle of the PT curve and the magnitude of its correction (Cobb angle before surgery minus Cobb angle immediately after the intervention). When choosing the extent of the instrumental fusion zone, the authors of the publications included in the review were guided, first of all, by the initial magnitude of the Cobb angle of the proximal thoracic curve. In the MT + PT group, it averaged 37–40° and was 11–13° more than in the MT group. At the same time, PT curve mobility in both groups is not statistically different. The achieved correction was statistically significantly greater in the МT + РT group, despite a more severe proximal curvature as compared to the MT group. Postoperative dynamics of kyphosis (both T2–T5 and T5–T12) is insignificant. The length of the instrumental spinal fusion zone has virtually no effect on the parameters of the sagittal contour of the thoracic spine. A fairly high frequency of the adding-on phenomenon development (20.6 %) indicates the presence of a connection between this complication and the dynamics of PT curve, but the available data are not enough to formulate a final conclusion. Literature data regarding patients’ self-assessment of quality of life after surgical treatment of Lenke types 1 and 2 scoliosis are scarce, although the majority of those operated on assess the result of treatment as positive.Conclusion. The problem of determining the extent of the instrumental fusion zone for double thoracic scoliosis remains unresolved. Most surgeons focus not so much on the mobility of the proximal curve, but on its magnitude. There is no consensus in predicting the development of the adding-on phenomenon; there is little information about changes in the quality of life of patients after surgery. New research is needed.
Effect of non-thermal plasma treatment and resin cements on the bond strength of zirconia ceramics with different yttria concentrations
Authors: Ozturk Deniz , Sen Nazmiye , Isler Sabire 
Published: December 2023

Abstract

Objectives
To investigate the effect of different surface treatments and resin cements on the shear bond strength of zirconia ceramics with different yttria concentrations.

Methods
Zirconia blocks characterized by different yttria concentrations [Vita YZ HT (HT), Vita YZ ST (ST) and Vita YZ XT (XT)] were used to prepare disc-shaped specimens (n=252). Specimens prepared to investigate shear bond strength (SBS), water contact angle and surface roughness (Ra) were divided into four subgroups; control (C), sandblasting (S), sandblasting + nonthermal plasma treatment (SNTP) and nonthermal plasma treatment (NTP). For SBS testing, specimens were further divided into two groups (n=108) according to the luting cement used [Panavia F2.0 (P) and Rely X U200 (R)]. The water contact angles were determined by sessile drop technique and Ra was analyzed with optical profilometer. SBS tests were performed in a universal testing machine at a crosshead speed of 0.5 mm/min. The data sets were statistically analyzed with two and three-way ANOVAs followed by post-hoc comparisons (α=0.05).

Results
The water contact angle and Ra data were significantly affected by surface treatments. The mean Ra values of ST and XT were significantly lower than HT for the surface treatment groups of C and NTP. The SBS values were significantly different among the groups subjected to different surface treatments. The mean SBS values of surface treatment groups (S, SNTP and NTP) when cemented with R were significantly higher than the groups of C (p<0.05).

Conclusions
For the tested zirconia ceramics with different yttria concentrations, non-thermal plasma activation helps to improve SBS and is a promising tool in practical use.
Synthesis, characterization, and biological target prediction of novel 1,3-dithiolo[4,5-b]quinoxaline and thiazolo[4,5-b]quinoxaline derivatives
Authors: El-Gaby Mohamed S. A. , Ammar Yousry A. , Ismail Mostafa A. , Ragab Ahmed , Abusaif Moustafa S. 
Published: December 2023

Abstract
Quinoxalines are a family of nitrogen-based heterocyclic compounds that have garnered much interest because of their wide range of applications. 2,3-Dichloroquinoxaline is an aromatic molecule that frequently serves as a synthetic intermediate in materials science, pharmaceuticals, and organic chemistry. 1,3-Dithiolo[4,5-b]quinoxaline derivatives 8a–c and thiazolo[4,5-b]quinoxaline derivatives 11a,b were synthesized by the reaction of 2,3-dichloro-6-sulfonyl quinoxaline derivative 5 with 1,3-binucleophiles. Moreover, 1,3-dithiolo[4,5-b]quinoxalin2-ylidene derivatives 8a–c were obtained by treating 2,3-dichloro-6-sulfonyl quinoxaline derivative 5 with potassium salts of hydrazonodithioates 7a–c at room temperature. Additionally, 2,3-dichloroquinoxaline derivative 5 was reacted with thioureas 9a,b in 1,4-dioxane to yield 6-(pyrrolidin-1-yl sulfonyl)thiazolo[4,5-b]quinoxalin-2(3H)-imines 11a,b rather than thiazolo[5,4-b]quinoxaline 10. Elemental analysis, infrared spectroscopy, 1H NMR, 13C NMR, and mass spectroscopy were used to confirm the structures of the newly synthesized compounds. Finally, we used artificial intelligence to perform biological evaluation via predicting the possible molecular targets and antimicrobial activity of the designed derivative. The results showed good bacterial activity, weak fungal potency, and potential biological targets.
Clarifying the Analysis of Deadweight Loss from Taxation
Authors: Fegley Tate , Hansen Kristoffer Mousten , Israel Karl-Friedrich 
Published: December 2023

Abstract
The standard microeconomic analysis of taxation suggests that excise taxes on goods with a price-inelastic demand are more efficient in that they lead to a lower deadweight loss than taxes on goods with price-elastic demand. This argument ignores secondary effects on the rest of the economy. By narrowly focusing on the primary effects on the market where the tax is raised, the overall deadweight loss is underestimated when demand is price-inelastic. Moreover, it is overestimated when demand is price-elastic. This puts into question the validity of the standard textbook argument. In this paper we address this issue by considering how taxes affect consumer behavior in other markets. From this we can clearly see how the impact of an excise tax is not limited to one market in isolation, but is spread over all markets and affects the demand for cash balances. We suggest a simple way to incorporate this important insight into a standard textbook exposition.