bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can high-sensitivity C reactive protein (hsCRP) be used as a prognostic marker of functional disability after acute ischaemic stroke? A cross-sectional study at a tertiary care centre in Eastern India
Authors: Vamshikrishnapatel Kotha , Biswas Ratnadeep , Kumar Vijay , Ojha Vishnu Shankar 
Published: November 2024

ObjectivesThis study was conducted with the aim of assessing the correlation between highly sensitive C reactive protein (hsCRP) levels and indicators of disability and functional impairment in individuals presenting with acute ischaemic stroke (AIS).DesignCross-sectional study.SettingDepartment of General Medicine at the All India Institute of Medical Sciences, Patna, Eastern India from August 2022 to August 2023.ParticipantsThe study population comprised a total of 125 patients aged 18 years or more, presenting within 48 hours of symptom onset or time last known well and having confirmed ischaemic stroke through CT or MRI of the brain. Individuals with a history of prior stroke, other neurological disorders, active infections, known coronary artery disease, chronic kidney disease, chronic liver disease and abnormal blood cell counts were excluded.Primary outcome measuresModified Rankin scale (mRS) and Barthel Index (BI) scores on day 2 and day 5 were the primary outcome measures.ResultsThe hsCRP levels on day 2 and day 5 were significantly positively correlated with the National Institutes of Health Stroke Scale scores with Spearman’s rho 0.303 (p=0.001) and 0.386 (p<0.001), respectively. The hsCRP on day 2 exhibited a significant association with mRS scores (p=0.04), indicating disability, but this significance was not sustained on day 5 (p=0.125). A negative correlation was observed between hsCRP and BI scores on both day 2 (Spearman’s rho=−0.265, p=0.003) and day 5 (Spearman’s rho=−0.297, p=0.002). While the hsCRP levels on day 2 did not differ significantly between fatal and non-fatal cases (p=0.110), the hsCRP levels on day 5 were significantly higher in fatal cases (p<0.001).ConclusionsThis study underscores the potential utility of hsCRP as a prognostic indicator in patients with AIS. Elevated hsCRP levels correlated with increased stroke severity and functional disability. Regular assessments of hsCRP in the early phase of AIS could contribute to predicting prognosis and guiding optimal patient management.
‘Maybe we’re not past the traditional gender roles then!’ Exploring less than full-time training among men in Scotland: a qualitative study
Authors: Stone Stephanie , Miller Joy , Johnston Peter 
Published: November 2024

ObjectivesA more sustainable work–life balance is desired by trainees, and increasing access to flexibility in training may improve staff morale and retention. Although a number of less than full-time (LTFT) trainees are increasing, only a minority identify as men. This study aimed to explore the perception and experience of LTFT training among postgraduate medical trainees (PMTs) identifying as men in Scotland.DesignWe carried out a qualitative study using semistructured interviews with 26 male trainees who had current or previous personal experience of training LTFT in Scotland. Interviews were audio recorded, transcribed verbatim, and data was analysed inductively and iteratively using thematic analysis.ResultsOur work identified four main themes: (1)the culture of work in medicine, (2)traditional gender norms and the feminisation of LTFT training, (3)the lived experience of LTFT traineesand (4)‘push and pull’ factors influencing male LTFT trainees. Being an ‘ideal worker’ was felt to gain respect among peers and enhance masculine identity. Participants described the persistence of implicit and explicit gender norms and felt, at best, unusual and, at worst, stigmatised by their decision to train LTFT. Personal and professional benefits to LTFT training were highlighted; however, experience was varied and influenced by personal circumstances and departmental support. Both perceptual and practical barriers for male LTFT applicants were identified.ConclusionsOur study demonstrates the influence of training environment and culture on LTFT applications in Scotland. Multifaceted interventions targeting medical culture, the LTFT application process, workforce planning and communication with trainees are recommended.
Magnitude and associated factors of delayed treatment seeking among patients with malaria in Andabet district, Northwest Ethiopia, 2022: a multicentre institution-based cross-sectional study
Authors: Melese Yibeltal Addis , Merid Mehari Woldemariam , Mekonnen Gebrehiwot Berie 
Published: November 2024

ObjectiveThis study aimed to assess the prevalence of delayed treatment seeking and its associated factors among patients with malaria in the Andabet district, Northwest Ethiopia, 2022.DesignAn institution-based cross-sectional study was conducted from 8 July 2022 to 21 August 2022. Data were collected from malaria patients using structured and pretested questionnaires and entered using Epi data V.4.6 and analysed by using Stata SE V.14. Both bivariable and multivariable logistic regression analyses were used to identify the factors associated with delay seeking treatment among malaria patients. P values less than 0.05 with 95% CI and adjusted OR (AOR) were considered statistically significant.SettingThe study was conducted in the Andabet district, Northwest Ethiopia.ParticipantsA total of 403 malaria patients participated in this study. The sample was allocated proportionally for the six health centres and participants were selected through systematic random sampling techniques.Outcome measuresThe primary outcome is the prevalence of delay in seeking malaria treatment.ResultsA total of 403 malaria patients with a mean age of 27.6±SD 14.26 years were included in this study. The prevalence of delayed malaria treatment seeking was 78.41% (95% CI 74.11%, 82.17%). Do not know the cause of malaria (AOR=2.24, 95% CI (1.07, 4.65)), do not know malaria signs and symptoms (AOR=2.52, 95% CI (1.04, 6.07)), distance greater than 5 km travelled (AOR=5.37, 95% CI (1.22, 23.55)) and fear of treatment cost (AOR=1.88, 95% CI (1.05, 3.36)) were the statistically significant factors associated with delayed treatment seeking among malaria patients.ConclusionsThe prevalence of delayed malaria treatment was high. Lack of knowledge of the cause of malaria, lack of knowledge of malaria signs and symptoms, a distance greater than 5 km travelled and fear of treatment cost were significantly associated with delayed malaria treatment seeking. Therefore, community awareness of early treatment is crucial.
Context, mechanisms and community engagement in implementation strategies: a systematic review protocol of implementation strategies designed using implementation mapping
Authors: Kang Eunyoung , ten Hoor Gill , Craig Derek W , Rodriguez Serena , Stockton Jennifer , Fernandez Maria E 
Published: November 2024

IntroductionImplementation Mapping (IM) has increasingly been used for the design and/or selection and tailoring implementation strategies to promote the effective translation of evidence-based interventions into practice. IM is a tool for guiding the systematic, iterative, step-by-step design process that helps guide the co-creation of theory-based, evidence-informed implementation strategies. This protocol aims to describe the methods of the planned systematic review that will (1) examine the overall landscape of IM in developing implementation strategies, (2) explore the mechanisms of implementation strategies developed using IM and (3) investigate the use of IM and community engagement in the development of implementation strategies. This review will produce synthesised evidence that will describe how IM has been used in selecting, designing and tailoring implementation strategies, with a focus on implementation mechanism and community engagement.Methods and analysisWe will include peer-reviewed original English articles that describe the use of Implementation Mapping or Intervention Mapping to design implementation strategies. We will search Medline Ovid, PsycInfo, Embase, CINAHL and Web of Science using the following terms: ‘Implementation Mapping’ and ‘Intervention Mapping’. At least two reviewers will independently screen the records to examine the eligibility. After several rounds of consistency testing of data extraction among at least two reviewers and confirming the consistent coding among the reviewer team, one coder will proceed with the data extraction. In case of uncertainty, we will reach a consensus through interactive reviewers’ meetings and in consultation with a senior author. We examined the risk of bias in individual studies using the quality assessment tool developed by Hawkeret alin 2002. We will synthesise and present the data by each research aim.Ethics and disseminationEthics approval was not required. Findings will be shared via peer-reviewed journals, and data from the included studies will be made openly accessible.
Using Artificial Intelligence-informed Experience-Based Co-Design (AI-EBCD) to create a virtual reality-based mindfulness application to reduce diabetes distress: protocol for a mixed-methods feasibility study
Authors: Ghosal Shraboni , Stanmore Emma , Sturt Jackie , Bogosian Angeliki , Woodcock David , Zhang Mengying , Milne Nicola , Mubita Womba , Robert Glenn , O'Connor Siobhan 
Published: November 2024

IntroductionPeople with type 2 diabetes can experience diabetes distress which can negatively affect health outcomes. Non-pharmacological interventions such as mindfulness can help address diabetes distress. However, face-to-face programmes can be constrained by cost, poor accessibility and lack of availability. Mobile apps for mindfulness may overcome these issues but evidence of their effectiveness is limited, and some have poor interface design with basic visualisations and feedback.Methods and analysisOur study will explore using virtual reality (VR) as an immersive and interactive technology that could support mindfulness practice to help reduce diabetes distress. We will use a mixed-methods design to pilot a new co-design process called Artificial Intelligence-informed Experience-Based Co-Design. Phase 1 will identify and evaluate existing VR mindfulness apps, followed by interviews with mindfulness experts to gain their perspectives on practising mindfulness in virtual settings. This will be followed by a participatory design phase with a series of five co-design workshops where adults with type 2 diabetes will (1) discuss diabetes distress and learn about mindfulness, (2) evaluate commercially available VR mindfulness apps, (3) employ artistic methods to produce a personalised mindfulness experience, (4) create digital content for a virtual mindfulness experience via generative artificial intelligence tools and (5) prioritise key design features, functionality and content for a tailored VR mindfulness app. The final phase will focus on developing a bespoke VR mindfulness app and evaluating it with adults with type 2 diabetes using interviews, questionnaires and VR app analytics to determine if the new digital mental health intervention can help reduce diabetes distress and improve quality of life.Ethics and disseminationWe received ethical approval from The University of Manchester (2024-18262-32710 and 2024-21170-37093). Written informed consent will be obtained from all participants. Dissemination will include scientific publications and presentations, social media, knowledge translation events and educational resources for teaching students.
Simultaneous approach in tandem occlusion: a safe, effective, and faster way to achieve recanalization
Authors: Kiwan Ruba , Alvarado-Bolanos Alonso , Maree Mosab , Bres-Bullrich Maria , Mascarenhas Annika , Hatipoglu Majernik Gökce , Jukes Alistair , Xuan Lisa , Yang Victor , Mayich Michael , Sharma Manas , Boulton Melfort , Pandey Sachin K 
Published: November 2024

BackgroundEndovascular thrombectomy (EVT) is the standard of care for patients with acute ischemic stroke (AIS) and intracranial vessel occlusion. Tandem occlusions (TO) comprise 20% of all anterior circulation AIS and are related to a poorer prognosis. The optimal EVT treatment strategy remains controversial. Our main objective was to determine if simultaneous endovascular treatment of intracranial and extracranial occlusions in patients with TO results in faster recanalization times, with similar efficacy and safety, compared with the sequential approach.MethodsSingle center, retrospective analysis of patients with TO undergoing EVT using the simultaneous or sequential technical approach. The primary outcome was puncture-to-final recanalization time. Secondary outcomes included modified Rankin scale (mRS) score at 3 months, 30 day mortality, and hemorrhagic transformation.ResultsWe included 111 patients with TO (35 treated with the simultaneous approach and 76 treated with the sequential approach). Successful recanalization was achieved in 91.9% of cases, and the first pass effect was 50.5%, with no differences between groups. The simultaneous technique resulted in shorter puncture-to-final recanalization time (33.0 min (IQR 25.0–55.0) vs 52.0 (30.0–73.0), P=0.018), adjusting for number of passes, first pass effect, thrombolysis, age, and previous stroke (adjusted β −0.21 (95% CI −29.47 to −2.79); P=0.018). No significant differences were found in 30 day functional outcome, mortality, or rate of hemorrhagic transformation when comparing simultaneous and sequential techniques.ConclusionThe simultaneous approach was effective, safe, and faster than the classic sequential approach in patients with TO. This result may obviate the debate over which occlusion should be addressed first during EVT.
One in six patients exhibit changes in reperfusion on 10-minute repeat cerebral angiography during mechanical thrombectomy for stroke
Authors: Midtlien Jackson P , Ashraf Omar , Hui Ferdinand K , Tsappidi Sam , Zhang Yi Jonathan , Forster Aren A , Chang Emily , Wiater Angelina H , Starke Robert M , Abdelsalam Ahmed , Rai Ansaar T , Tarabishy Abdul R , Boo SoHyun , Vu Phong , Ehrig Molly R , Kittel Carol , Brown Patrick A , Wolfe Stacey Q , Fargen Kyle M 
Published: November 2024

BackgroundPost-recanalization target vessel re-occlusion (TVR) following endovascular thrombectomy (EVT) is a known complication of the procedure, and it is associated with worse long-term functional outcomes. The incidence and factors that contribute to TVR are not well understood, particularly within the immediate timeframe following EVT.MethodsA prospective, multicenter study was performed across four comprehensive stroke centers on adult patients undergoing EVT for acute large vessel occlusion. Modified Thrombolysis in Cerebral Infarction (TICI) score was recorded at the end of the standard procedure, and another TICI score was recorded 10 min later to evaluate for TVR.Results167 patients underwent EVT for a large vessel occlusion, 93.4% of which were in the anterior circulation. Twenty-seven patients (16.2%) had a change in their TICI score 10 min after EVT, with 19 of these patients (70%) having a worsening in their score. Of the total sample, 13% had their post-procedure care altered by any intervention, and 8% underwent further endovascular interventions due to the change in reperfusion over the 10 min time period. Functional independence (modified Rankin Scale score 0–2) at 90 days was observed in 31% of the entire cohort and in 21% of patients with a worse TICI score at 10 min.ConclusionsThis is the first study to prospectively assess for TVR in the immediate timeframe following EVT. One in six patients had a change in their TICI score, and one in 11 patients had additional intervention. Accordingly, neurointerventionalists should consider integrating angiographic evaluation at 10 min following EVT.
Biomechanical evaluation of percutaneous compression plate and femoral neck system in Pauwels type III femoral neck fractures
Authors: Xie Xiaoping , Bi Songqi , Song Qingxu , Zhang Qiong , Yan Zhixing , Zhou Xiaoyang , Yu Tiecheng 
Published: November 2024

Abstract
Background
The optimal treatment for Pauwels type III femoral neck fractures remains contentious. We aim to compare the biomechanical properties of three inverted cannulated compression screw (ICCS), femoral neck system (FNS), and percutaneous compression plate (PCCP) to determine which offers superior stability for unstable femoral neck fractures.

Materials and methods
Finite element analysis and artificial bone models were used to establish Pauwels III femoral neck fracture models. They were divided into ICCS, FNS, and PCCP groups based on respective internal fixation assemblies. The models were subjected to vertical axial loads (2100 N) and torsional forces (10 N × mm) along the femoral neck axis in the finite element analysis. The primary outcomes such as the Z axis fragmentary displacements, as well as displacements and the von Mises stress (VMS) distributions of internal fixations, were analyzed. Additionally, the artificial bones were subjected to progressively increasing vertical axial pressures and torsional moments at angles of 2°, 4°, and 6°, respectively. The vertical displacements of femoral heads and the required torque values were recorded.

Results
Finite element analysis revealed that under single-leg stance loading, the maximum Z-axis fragmentary displacements were 5.060 mm for ICCS, 4.028 mm for FNS, and 2.796 mm for PCCP. The maximum displacements of internal fixations were 4.545 mm for ICCS, 3.047 mm for FNS, and 2.559 mm for PCCP. Peak VMS values were 512.21 MPa for ICCS, 242.86 MPa for FNS, and 413.85 MPa for PCCP. Under increasing vertical loads applied to the artificial bones, the average vertical axial stiffness for the ICCS, FNS, and PCCP groups were 244.86 ± 2.84 N/mm, 415.03 ± 27.10 N/mm, and 529.98 ± 23.08 N/mm. For the torsional moment tests, the PCCP group demonstrated significantly higher torque values at 2°, 4°, and 6° compared with FNS and ICCS, with no significant difference between FNS and ICCS (P > 0.05).

Conclusions
Finite element analysis and artificial bone models indicated that PCCP offers the best compressive and rotational stability for fixing Pauwels type III femoral neck fractures, followed by FNS and then ICCS. No significant difference in rotational resistance was observed between FNS and ICCS in synthetic bones.
Level of Evidence Level 5.
Hydraulic strategy defines contrasting responses to an abrupt precipitation during a successive lethal drought
Authors: Lin Xiaoying , Wu Caixiao , Zhang Kaikai , Dong Haoran , Xiao Ling , Li Fan , Huang Yao , Li Qiang 
Published: November 2024

Abstract
Background
As precipitation patterns are predicted to become more erratic, it’s vital to understand how abrupt climate events will affect woody seedlings that develop different hydraulic strategies. We cultivated anisohydric Robinia pseudoacacia L. and isohydric Quercus acutissima Carr. in a greenhouse, and subjected an abrupt precipitation event during a successive drought. Patterns of leaf and root gas exchange, leaf and stem hydraulics, seedlings growth, and non-structural carbohydrate (NSC) patterns were determined.

Results
We found that as an anisohydric species, R. pseudoacacia seedlings adopted a strategy of sacrificing leaves in response to stress, resulting in the lowered photosynthesis and ultimately leading to a decrease in NSC accumulation. In contrast, isohydric Q. acutissima maintained the integrity of leaves by reducing respiratory consumption in response to drought stress, thereby ensured the stability of NSC pool.

Conclusion
R. pseudoacacia exhibited an extravagant strategy with efficient water transport, photosynthetic assimilation, and growth capabilities, but its resistance to embolism was relatively weak, while Q. acutissima adopted a resource-saving strategy with higher hydraulic safety. We also found that Q. acutissima seedlings were prone to allocate carbohydrates to maintain growth, while R. pseudoacacia preferred to sacrifice growth and aboveground NSC limitation only happened when precipitation was subjected after total stomatal closure. We thus believe that hydraulic strategy could define seedlings responses to drought and recovery, and further may adversely affect their re-sprouting capacity after drought stress relief.
Novel retrieving device for coronary stent dislodgement
Authors: Han Zhan-Ying , Zhu Yong-Jian , Lu Wen-Jie , Wang Zhi-Fang , Yang Jian-Feng , Zhang Wen-Cai , Qiu Chun-Guang , Dong Jian-Zeng 
Published: November 2024

Abstract
Background
Stent dislodgement is a rare but particularly challenging complication. However, current treatment strategies are suboptimal.

Objective
This study sought to preliminarily assess the feasibility of a novel self-expanding basket (SEB) catheter to successfully retrieve dislodged stent during percutaneous coronary intervention (PCI).

Method
The novel SEB catheter is designed as a self-expanding basket tip made of superelastic shape nitinol memory alloy, which could automatically expand to tightly wrap and flatten the deformed struts regardless of whether the stent come off the guidewire. Consecutive patients with coronary artery disease who experienced stent dislodgement during PCI were included. The primary outcome was procedure success defined as completely removing the stent without surgical incision of blood vessels, or hemostatic forceps, or injury of access vessels.

Results
From May 2020 to May 2023, a total of 6 patients encountering stent dislodgment were enrolled. Five presented as stent dislodgment with the guidewire in situ and the rest one as total stent and guidewire loss. Successful retrieving of dislodged stent with SEB catheter was achieved in 100% (6 of 6) subjects. After retracting lost stent, 5 of 6 patients received new stent implantation, and one only underwent balloon angioplasty with acceptable imaging results. No safety events were observed.

Conclusions
This preliminary report of the novel stent retrieving device presents favorable efficacy and safety profile. Further multicenter study is required to confirm these findings.

Clinical trial number
Not applicable.
Predicting the time to get back to work using statistical models and machine learning approaches
Authors: Bouliotis George , Underwood M. , Froud R. 
Published: November 2024

Abstract
Background
Whether machine learning approaches are superior to classical statistical models for survival analyses, especially in the case of lack of proportionality, is unknown.

Objectives
To compare model performance and predictive accuracy of classic regressions and machine learning approaches using data from the Inspiring Families programme.

Methods
The Inspiring Families programme aims to support members of families with complex issues to return to work. We explored predictors of time to return to work with proportional hazards (Semi-Parametric Cox in Stata) and (Flexible Parametric Parmar-Royston in Stata) against the Survival penalised regression with Elastic Net penalty (scikit-survival), (conditional) Survival Forest algorithm (pySurvival), and (kernel) Survival Support Vector Machine (pySurvival).

Results
At baseline we obtained data on 61 binary variables from all 3161 participants. No model appeared superior, with a low predictive power (concordance index between 0.51 and 0.61). The median time for finding the first job was about 254 days. The top five contributing variables were ‘family issues and additional barriers’, ‘restriction of hours’, ‘available CV’, ‘self-employment considered’ and ‘education’. The Harrell’s Concordance index was range from 0.60 (Cox model) to 0.71 (Random Survival Forest) suggesting a better fit for the machine learning approaches. However, the comparison for predicting median time on a selected scenario based showed only minor differences.

Conclusion
Implementing a series of survival models with and without proportional hazards background provides a useful insight as well as better interpretation of the coefficients affected by non-linearities. However, that better fit does not translate to substantially higher predictive power and accuracy from using machine learning approaches. Further tuning of the machine learning algorithms may provide improved results.