bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retina and optic nerve diffusion restriction in acute central retinal artery occlusion: A case-control study
Authors: Harahsheh Ehab , Zhang Nan , Elshaighi Omer , Parikh Parth , Gomez Daniel , Weinberg Emilie , Hoxworth Joseph M , Rath Tanya J , Dumitrascu Oana M 
Published: November 2024

Objective To determine the frequency and accuracy of diffusion restriction (DR) of the retina and/or optic nerve (ON) detection on standard brain magnetic resonance diffusion-weighted imaging (DWI-MRI) in patients presenting with acute non-arteritic central retinal artery occlusion (CRAO). Methods This is a retrospective case-control study that includes all consecutive patients presenting to our tertiary academic center from 2013-2021 with acute non-arteritic CRAO (cases) or acute ischemic stroke syndrome (controls, age and gender-matched) that had brain MRI performed within 14 days from symptom onset. Two neurology residents (junior and senior), a vascular neurologist, and two neuroradiologists, blinded to the site of CRAO, independently reviewed the brain MRIs to assess for the presence of retina and ON DR. The consensus agreement between the two neuroradiologists was used to perform sensitivity and specificity analyses and calculate inter-rater reliability (prevalence-adjusted bias-adjusted kappa coefficient). Results A total of 128 patients with acute non-arteritic CRAO (mean (SD) age 69 (14) years; 50% female; median time from CRAO to DW-MRI 2 days (IQR 1-5)) and 128 age and gender-matched controls with acute cerebral ischemia were included. After the neuroradiologist consensus, DR was correctly identified in the retina or ON in 51/128 (39.8%) CRAO cases, retina alone 27.3%, ON alone 24.2%, and both retina and ON 11.7%, with almost perfect neuroradiologists’ inter-rater reliability for retina (K = 0.91) and ON (K = 0.83). Among controls, the retina DR was identified in 1/128 (0.8%) and ON DR in 5/128 (3.9%). The sensitivity, specificity, positive predictive value, and negative predictive value were 28.1%, 99.2%, 97.3%, and 58.0% for retina DR, and 27.3%, 96.1%, 87.5%, and 56.9% for ON DR. Conclusions Though experienced neuroradiologists identified retina and ON DR with excellent inter-rater reliability, these are infrequent findings in real world CRAO practice, with excellent specificity but limited sensitivity. Prospective studies with larger cohort of patients, optimization of standardized orbit DWI-MRI protocols are needed to facilitate a more accurate and reliable identification of retina and ON DR in acute CRAO.
Impact of equine interactions on human acute pain perception: Two cross sectional studies
Authors: Doherty-Sneddon Gwyneth , Caiazza Roberta , Pawlowska Emilia , Vuong Quoc 
Published: November 2024

Background Research has demonstrated the effectiveness of Animal-Assisted Therapy, usually involving dogs, as a way to reduce pain in inpatient and outpatient populations. Here two studies investigate the effectiveness of interacting with horses for reducing human acute pain perception. Methods In Study 1, a blood-pressure cuff was used to administer acute ischaemic pain to 70 adult participants, who were allocated to one of three groups: Equine Assisted Psychotherapy (EAP), Horse Interaction without EAP (HI), and a Control (no horses present). All participants engaged in an activity (finding a horse treat) in a large, enclosed arena. The dependent variable was the subjective pain rating (scale 0-10) of the participant in response to moderate pain induced pre- and post-activity. In Study 2, 53 adult participants were recruited and allocated to either an Equine Assisted Learning (EAL) Group or a Control Group. The same paradigm was used. Following the activity sessions, qualitative data was elicited from the participants regarding their insights and feelings. It was hypothesized that any interaction with horses would significantly reduce an individual’s perception of pain. Results In both studies, planned paired-samples t-tests showed significant reductions in pain ratings from pre-activity to post-activity in the EAL, EAP and HI groups (large and medium effect sizes) but not the Control groups. Thematic analysis of the qualitative responses showed an overwhelmingly positive array of responses from those who interacted with the horses, for example, feeling relaxed and happy during the activity. Conclusion Interactions with horses can reduce acute pain perception. Distraction, physiological changes, and positive emotions are discussed as possible underlying mechanisms. It remains to be seen how this could be more widely applied, for example, in relation to chronic pain.
Evaluating the Benefits of Transition to Home Palliative Care: Pharmacological Prescriptions, Social, and Psychological Support Post-Referral
Authors: Ribeiro Hugo , Rocha-Neves João , Dourado Marília , Andrade José Paulo 
Published: November 2024

Introduction/Objectives: Community palliative care support teams specialize in providing at-home care under referral criteria distinct from hospital teams, focusing on functional status, limited benefit from continued hospital specialty care, and increased clinical complexity. This study aimed to assess the quality of referrals and the transition of care to a specialized community palliative care team, emphasizing adherence to established referral criteria. Methods: An observational, longitudinal, retrospective cohort study evaluated clinical health records of patients who received palliative care from a community team in 2023. We evaluated prior multidisciplinary follow-up, basic social support, medication changes made during the team’s first consultation, and recurrences to hospital emergency care. The data was collected from the patients’ clinical files. Results: The patient cohort had a mean age of 80.7 years (±11.92), ranging from 31 to 103 years. Males comprised 56.3% of the participants, with a median follow-up time of 32 days. Primary diagnoses included cancer (50%), end-stage organ failure (26%), and neurodegenerative disease (24%). Among the deceased, 85.6% died at home. Patients showed marked changes in psychological support and social rights, as we observed an improvement from 6.8% to 100% ( P = .0011) and from 47.1% to 100% ( P = .01) in these supports, respectively. We also observed significant changes in pharmacotherapeutic plans, regardless of the referring team. The study observed significant difficulty in recognizing referral criteria for specialized palliative care and defining clinical complexity. Referrals were often delayed, particularly for those previously under hospital care ( P = .001). Increased prescription of pro re nata medications significantly correlated with home deaths ( P = .021). Conclusions: Most complex patients can be effectively monitored and die at home, reserving hospital deaths for exceptional cases requiring interventions not possible at home or due to significant caregiver burden. There was no difference in the biopsychosocial approach of patients previously followed by other teams, including hospital palliative care teams, which suggests very different approaches.
The Hidden Pandemic: School Counselors’ Insights on Post-Pandemic Socialization
Authors: Lee Jisu , Haberski Jenny , Hovey Scott , Mirielli Lindsey , Williams Michael Steven , Wachter Morris Carrie , Slaten Christopher D. 
Published: November 2024

Background The role of school counselors has undergone a considerable evolution in response to societal, economic, and cultural shifts, with the aftermath of the COVID-19 pandemic standing as a particularly significant period of change. With students reentering formal school environments after prolonged isolation, disruptions in learning, and potential trauma, the importance of social skill development has become paramount. Objectives This study aimed to explore school counselors’ perceptions and experiences related to students’ social skills after the pandemic. To understand the multifaceted role of school counselors in supporting this development, we drew on Bronfenbrenner’s ecological systems theory, emphasizing the interconnected layers of influence on a child’s development. Research Questions 1. How do school counselors’ experiences in post-pandemic classrooms relate to students’ social development? 2. How do school counselors perceive students’ social needs in post-pandemic classrooms? Methods The study employed a qualitative constructivist grounded theory approach to gather in-depth data. We conducted focus groups with 48 school counselors across the United States, organized into nine groups based on grade levels (elementary, middle, high) and school settings (rural, suburban, urban). Results Two major themes emerged: (a) interpersonal/communication skills and (b) online communication, with school counselors highlighting the need for targeted interventions in both areas. Conclusion The findings underscore the common social challenges faced by school counselors nationwide with K–12 students in post-pandemic classrooms. They emphasize the need for adapting classroom lessons to address students’ evolving social needs. Future research should further explore this topic, particularly in online contexts, and incorporate culturally responsive approaches.
Financial cost of end-of-life cancer care in palliative care units (PCUs) and non-PCUs in Iran: insights from low- and middle-income countries
Authors: Darrudi Ali , Poupak Amir Hossein , Darroudi Rajabali , Sargazi Nasrin , Zendehdel Kazem , Sallnow Libby , Ghanbari Motlagh Ali , Tahmasebi Mamak , Nahvijou Azin 
Published: November 2024

Background: End-of-life care for patients with advanced cancer can impose a significant financial burden. However, data on the economic impact of end-of-life care in low- and middle-income countries are limited. Objective: This study aims to compare the costs associated with palliative care units (PCUs) and non-PCU settings for cancer patients in Iran. Design: We designed a retrospective study at the largest hospital in the country. Methods: We conducted a comprehensive evaluation of hospitalization costs and care service delivery for 150 patients in the final 5 days of life, who were admitted to the largest hospital complex in Iran. All costs were adjusted based on the 2018 USD exchange rate. Results: Among the 150 patients included in the study, 56 (37%) were admitted to the PCU. The average total treatment cost during the final 5 days of life was three times higher in general wards compared to PCUs. In non-PCU settings, the total cost of care during this period amounted to $2873, while in PCU settings, it was $909.63. Conclusion: The establishment of PCUs within tertiary hospitals and the provision of palliative consultation services to patients with advanced cancer can yield significant benefits, even when resources are limited.
Examining the Role of Medical School Faculty in Developing Students’ Cultural Humility Skills: Insights From a Single-Center Multimethod Study
Authors: Binda Dhanesh D. , Harris Angelique C. , Tan Taralyn , Fischer Krisztina , Molina Rose L. , Mehta Darshan 
Published: November 2024

Background While the Liaison Committee on Medical Education emphasizes the teaching of cultural competence in medical education, the concept of cultural humility, focusing on self-reflection and lifelong learning, has been proposed as a more effective approach. Although there have been numerous discussions on both topics, understanding how faculty in clinical settings help students develop cultural humility skills remains limited. Objective Our multimethod study utilized a survey and semi-structured interviews to identify strategies that faculty at one institution use to help students develop cultural humility skills. Methods We administered a 10-question survey to assess faculty demographics, teaching characteristics, and familiarity with cultural humility. Participants most familiar with cultural humility were invited for semi-structured interviews. Survey data were analyzed with descriptive statistics, and interview data were thematically analyzed to identify key teaching strategies. Results In our study of 49 medical faculty members, the majority of participants were female (61%) and predominantly White (67%), covering a wide range of specialties and years of teaching. Of the participants, 74% expressed being at least somewhat familiar with cultural humility, and 10 consented to interviews. Strategies for cultural humility education included one-on-one instruction, feedback, and reflections. Thematic analysis underscored fostering learner curiosity about cultures, early patient exposure, and incorporating diverse learning perspectives as essential in developing students’ cultural humility skills. Conclusion Cultural humility is an important attribute for healthcare professionals that can enhance patient-centered care. Through focused interviews with faculty in our study and subsequent thematic analysis, our results suggest the need for longitudinal and multimodal educational strategies to cultivate cultural humility among medical students. By understanding current teaching methods, educators can design and assess more effective curricula to prepare future doctors for a culturally diverse patient population.
Pliocene to modern sediment routing in the Aare valley: implications for sediment recycling
Authors: Stutenbecker Laura , Hinderer Matthias , Berndt Jasper , Glotzbach Christoph , Schlunegger Fritz , Schwenk Michael 
Published: November 2024

AbstractRivers transport sediment from source to sink, forming an essential part of sediment routing systems. Sediment generation is often assumed to be focused on the upstream reaches of mountainous rivers, characterized by high topographic gradients and high denudation rates. However, sediment recycling from uplifted and incised basin fills with relatively low topography, for example in foreland basins, may contribute significant amounts of material to the sediment cascade. Identifying and quantifying sediment recycling from such lowlands, however, is complicated by the lack of proxies sensitive to sediment recycling. Nevertheless, it is a crucial task in sedimentary system analysis, because any interpretation of allogenic or autogenic factors that control sediment dynamics in sedimentary systems strongly depends on where and how sediment is generated. We here present a sedimentary provenance study on the Aare river, a tributary to the Rhine river, which is sourced in the Swiss Alps and drains the Alpine foreland basin fill in its middle and lower reaches. Using garnet geochemistry as a proxy, the sediment sources in the Aare catchment can be precisely determined. We show that the modern Aare river carries garnet types incompatible with the crystalline rocks outcropping in the present-day catchment area, but compatible with Miocene sandstones of the foreland basin fill. By comparing modern-day fluvial sediment to Pleistocene and Pliocene paleo-Aare deposits we show that recycling from the foreland basin has been a dominant sediment generation process since the onset of the Pleistocene glaciation and the incision of river valleys. Instead, garnet compositions in a Pliocene terrace are more compatible with sediment sources in the Alpine crystalline core, pointing towards first-cycle sediment. Our study further emphasizes that (1) sediment recycling can be identified using appropriate provenance proxies, (2) provenance data are crucial to understanding the sediment dynamics and drainage evolution in Alpine river valleys, and (3) recycling from lowland basin fills may be a significant source of sediment that should be considered to prevent erroneous provenance interpretations.
Risk factors for proximal radial abnormalities in children with untreated chronic Monteggia fractures: a review of 142 cases
Authors: Wang WenTao , Mei QianQian , Liu Hang , Guo YueMing , Mei HaiBo , Canavese Federico , Andreacchio Antonio , Lyu HanQing , Chen ShunYou , He ShengHua 
Published: November 2024

Abstract
Background
The risk factors for proximal radial abnormalities (PRA) in paediatric patients with untreated chronic Monteggia fractures (CMFs) are unclear. This multicentre study aimed to evaluate the risk factors for PRA in children with untreated CMFs.

Materials and methods
The clinical data of 142 patients (mean age at the time of injury: 5.73 years) with untreated unilateral CMFs were retrospectively reviewed. The radial neck-shaft angle (RNSAP) and radial head size (RHL) were measured on anteroposterior (AP) and lateral (L) radiographs, respectively. The RHL size was the ratio of the widest width of the proximal radial metaphysis to the narrowest radial neck width. The En-RNSAP and En-RHL were the ratios of the enlargement (En) of the RNSAP angle and RHL size of the injured elbow to those of the uninjured elbow, respectively. Paired-sample t-tests, single-factor analyses and multiple linear regression analyses were performed to evaluate the correlation between the differences in these parameters between the injured and uninjured elbows and the assessed risk factors. These risk factors included institution, sex, laterality, age at injury, time from injury to diagnosis, direction of RH dislocation, distance of RH dislocation (DD-RH), presence of radial or median nerve injury, heterotopic ossification and immobilization of the elbow after injury.

Results
In children with untreated CMFs (mean time from injury to diagnosis: 14.6 months), Student’s t-test revealed a significant difference in the RHL size (P < 0.001) but not in the RNSAP angle (P = 0.075) between the injured and uninjured elbows. Pearson correlation analysis revealed a potential correlation between En-RHL and age at the time of injury (P = 0.069), time from injury to diagnosis (P < 0.001) and DD-RH (P < 0.001), excluding other risk factors (P > 0.05). Multiple linear regression analysis revealed that age at the time of injury (P = 0.047), time from injury to diagnosis (P = 0.007) and DD-RH (P = 0.001) were risk factors for an increased En-RHL in patients with untreated CMFs; the variability in En-RHL among the other three risk factors was 21.4%.

Conclusions
In paediatric patients with unilateral untreated CMFs, PRA of the injured elbow consisted mainly of RH enlargement or radial neck narrowing rather than valgus deformities of the proximal radius. Older age at injury, increased time from injury to diagnosis and DD-RH were risk factors for more severe PRA.

Level of evidence
III.
Validation of two predictive models for survival in anaplastic thyroid cancer (ATC)
Authors: Käsmann Lukas , Nieto Alexander , Rennollet Robert , Gurtner Ralph , Oliinyk Dmytro , Augustin Teresa , Koehler Viktoria Florentine , Neu Maria , Belka Claus , Spitzweg Christine , Rauch Josefine 
Published: November 2024

Abstract
Background
The prognosis of patients with anaplastic thyroid cancer (ATC) remains dismal. A small portion of patients experience longterm survival and need to be identified before treatment allocation. Survival scores may guide clinicians making more informed decisions about treatment options and improve the understanding of patients’ prognosis. The aim of this study was to validate two prognostic scores using an independent dataset to analyze which prognostic index is superior in discriminating survival.

Methods
Thirty-four patients with histologically confirmed ATC diagnosed between January 2009 and December 2019 were consecutively treated at our department and evaluated. Next generation sequencing was performed in 7 (21%) patients, but no druggable mutation was found. 50% of all patients received surgery and 56% were treated with chemoradiotherapy. The median radiation dose in equivalent dose in 2 Gy fractions (EQD2) was 50 Gy (SD:21 Gy). The study compared the discrimination of the Sugitani Prognostic Index (SPI) and the Marchand-Crety Prognostic Score (MCPS) using concordance statistics, area under the receiver-operating characteristics curve (AUC), net reclassification index, and integrated discrimination improvement for 6-month survival.

Results
The median survival of the entire cohort was 5 months (range: 1-133). The AUC for 6-month survival was 0.85 (95% confidence interval [CI]:0.72–0.97) for SPI and 0.69 (95% CI: 0.56–0.83) for MCPS (p < 0.0001). Using the net reclassification index (NRI), 73% of patients were correctly reclassified using SPI instead of MCPS for 6-month survival (p = 0.0237).

Conclusion
The SPI was more accurate than the MCPS to determine patients’ life expectancies and should be recommended for clinical guidance and treatment allocation. In the last decade, comprehensive genetic profiling of actionable mutations in ATC has become vital to guide targeted therapy.
Public perception of the physician associate profession in the UK: a systematic review
Authors: Swainston Rhys , Zhao Yingxi , Harriss Eli , Leckcivilize Attakrit , English Mike , Nagraj Shobhana 
Published: November 2024

Abstract
Background
The physician associate (PA) role within the NHS is currently under scrutiny due to recent legislative changes and concerns about their scope of practice within primary and secondary healthcare. There is currently limited knowledge of public understanding of PAs and their levels of satisfaction with PAs. This review synthesises the evidence relating to patients’ and potential patients’ understanding of and satisfaction with the PA profession in the UK.

Methods
We systematically searched Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, EBSCOhost CINAHL, Education Resources Information Centre (ERIC), ProQuest Dissertations and Theses Global, and Scopus databases for empirical studies of patient understanding of PAs or satisfaction with PAs. We included quantitative, qualitative, and mixed-methods studies looking at PAs in primary and/or secondary care. Quality appraisal was conducted using the CASP Critical Appraisal checklists. A reflexive thematic analysis was used to synthesise data and the GRADE-CERqual method was used to assess the certainty of the themes.

Results
A total of 18 papers involving 15 studies were included in the review. Findings revealed that patients had limited understanding of the PA role with many mistaking PAs for doctors and other healthcare professionals. Patients were confused by the lack of PA prescribing rights. There was receptivity to learn more about the PA role. The evidence suggests that patients had a largely positive view of PAs after an encounter, despite their lack of knowledge about the role. Many patients expressed a willingness to be seen by PAs in future and viewed them as a useful part of the wider healthcare system.

Conclusion
In the UK, there is limited information about, and understanding of, the PA role. Nevertheless, patients were largely satisfied with the quality of care they receive from PAs during consultations. Our findings suggest a need for comprehensive public information regarding the roles and scope of practice of PA’s, and to provide the public and patients with clear expectations of their relative strengths and limitations. Further research might determine if these findings are specific to PAs, or reflect wider issues affecting public perception of other cadres of healthcare professionals.