bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community Integration Challenges of Men and Women After Traumatic Brain Injury: A Reflexive Thematic Analysis of Lived Experiences Through a Gender Lens
Authors: Lian Lulu , Coupland Rachael , Tylinski Sant’Ana Thaisa , Colantonio Angela , Mollayeva Tatyana 
Published: August 2024

Objective:
To investigate community integration (CI) challenges following traumatic brain injury (TBI) through a gender lens.

Setting:
Rehabilitation research-teaching hospital.

Participants:
Adult participants (22 men and 20 women) with a primary diagnosis of mild or moderate-severe TBI, in the acute or chronic stages after injury, were recruited using purposive sampling.

Design:
Qualitative study. Data were collected through semistructured interviews, and thematic analysis was used to identify themes of CI challenges.

Results:
Three overarching themes emerged: (1) lack of a “graduated home plan”: difficulty enacting gendered roles and responsibilities at home, (2) “Something that I cannot handle”: mismatch between occupational demands and abilities, and (3) “Slipping away”: disrupted connections with self and others. Men consistently voiced struggles with and inability to fulfill household tasks, whereas women detailed ways of adapting domestic responsibilities because of postinjury limitations. Productivity challenges resonated with a substantial number of participants, and a gendered pattern was observed: More women reported an inability, whereas more men reported a limited ability to meet occupational demands. Both genders conveyed disruptions in recreational and leisure activities, although women predominantly discussed challenges relating to social activities and men a tendency to avoid social situations because of anticipated stigma and/or shame. Across all themes, a pervasive sense of diminished community contributions and disrupted identities was observed.

Conclusion:
The incongruence between preinjury roles and responsibilities and postinjury abilities resulted in difficulties across multiple CI domains for the study participants and did not go unnoticed by them. It is important for health care professionals to assist patients in addressing gendered challenges at home, work, and in the social circle for a smoother transition back into the community.
Association Between Adverse Childhood Experiences and Sleep Duration in US Children
Authors: Song MinKyoung , McHill Andrew W. , Dieckmann Nathan F. , Musil Carol M. , Hayman Laura L. 
Published: August 2024

Background
Adverse childhood experiences (ACEs) and suboptimal sleep both negatively associate with cardiovascular health. Although an association between ACEs and suboptimal sleep in youth has been reported, there has been no investigation for differential effects among ACE subdomains.

Objective
We examined associations between total and subdomain ACEs and sleep duration, and age as a moderator.

Methods
Using the 2020–2021 National Survey of Children's Health and the American Heart Association Life's Essential 8 scoring algorithm, we created 3 sleep subgroups: (1) optimal, (2) suboptimal (≥1 to <2 hours below or ≥1 hour above optimal), and (3) very suboptimal (≥2 hours below optimal). We assessed association between ACEs (total and subdomains) and sleep duration using multinomial logistic regression, controlling for sex, age, race/ethnicity, caregiver's education, household income, habitual bedtime, and physical activity. We tested the interactions between ACEs and child's age.

Results
In children aged 6 to 17 years (N = 58 964), mean sleep duration score was 77.2 (95% confidence interval, 76.6–77.9). The mean number of ACEs was 0.89 (95% confidence interval, 0.87–0.91). Adjusting for covariates, each additional ACE increased the likelihood of falling into the suboptimal subgroup by 8% and the very suboptimal subgroup by 26%. There was an association between each subdomain of ACE and suboptimal sleep duration, with no significant interaction with age.

Conclusions
Our findings show a dose-response relationship between ACEs and suboptimal sleep duration—a new cardiovascular health indicator in Life's Essential 8. Healthcare providers should screen for ACEs and suboptimal sleep in children to reduce future cardiovascular disease risk.
A Fulbright International Exchange to Expand the Physician Assistant/Associate Curriculum in Geriatrics
Authors: Segal-Gidan Freddi , van den Brink Geert , Brouwers Marijn , Heerdink Gonneke 
Published: August 2024

Abstract
The international growth of the physician assistant/associate (PA) profession provides opportunities for global exchange that PA faculty and clinicians should seek out and cultivate. Physician assistant/associate programs can benefit from the experiences and expertise of faculty educators from different backgrounds and countries. The Fulbright International Scholars Program is a well-established and recognized organization dedicated to supporting international exchange in higher education. This study describes the experience of an American PA who received a Fulbright Specialist Program award that provided the opportunity to collaborate with a Dutch PA program on improvement of their geriatric medicine didactic curriculum.
Lessons Learned From Conducting Virtual Multiple Mini Interviews During the COVID-19 Pandemic
Authors: Coleman Veronica , Tran Bau , Wang Jijia , Sengupta Samarpita , Perez Isela Edna , Howell-Stampley Temple , Jones P. Eugene 
Published: August 2024

Introduction
The COVID-19 pandemic caused disruptions in PA program admissions secondary to the need for social distancing. Therefore, traditional in-person interview processes required modifications. In this article, we determined whether significant differences were identified when comparing applicant demographics, cognitive and noncognitive interview data, as well as feedback from the applicants between in-person multiple mini interview (iMMI) and virtual MMI (vMMI) at UT Southwestern's PA program.

Methods
Virtual MMI was developed and implemented for the admission cycle for the Class of 2023, using telecommunication systems that permit real-time interactions between the interviewer and the interviewee. The following groups of data were collected and compared between iMMI and vMMI: (1) applicant demographics; (2) interviewee OGPA, SGPA, GRE scores (obtained from CASPA); (3) program decisions such as number of interviewees, admission offers, admission declines, students matriculated (program-specific data), and mean MMI scores (from MMI instrument); and (4) feedback surveys to determine satisfaction outcomes. The students in the 2020 and 2021 classes also participated in the feedback survey.

Results
There were no significant differences between the iMMI and vMMI cohorts when comparing applicant demographics and interviewee scores and decisions. In the feedback surveys, 12% of the vMMI cohort reported a lower score on their capacity to “present an accurate portrayal of their ability” during the interview sessions (vMMI Likert score mean of 3.93; MMI mean of 4.36).

Discussion
The outcomes between iMMI and vMMI were not significantly different. The authors determined that the vMMI is a comparable alternative to the iMMI and can be used in lieu of or to supplement in-person interviews.
Advancing Consistency in Education: A Reliability Analysis of the Clinical Reasoning Assessment Tool
Authors: Wolden Ben , Wolden Mitch , Furze Jennifer , McDevitt Amy 
Published: August 2024

Introduction.
Clinical reasoning (CR) is a fundamental component of physical therapist practice in health care. The Clinical Reasoning Assessment Tool (CRAT) was developed to assess CR in Doctor of Physical Therapy (DPT) and residency education. However, the reliability of the CRAT has not been investigated. Our purpose was to investigate the interrater and intrarater reliability of the CRAT.

Review of Literature.
A range of assessment methods are available to assess CR, including didactic-based, simulation learning, and clinic-based assessments. The CRAT is designed to assess CR across learning environments. The CRAT assesses CR across 3 domains: (1) content knowledge, (2) procedural knowledge/psychomotor skills, and (3) conceptual reasoning.

Subjects.
Twenty-two faculty participated.

Methods.
Participants completed an electronic survey at 2 timepoints (T1, T2) that included training on use of the CRAT and 2 case videos of DPT students at different performance levels managing a standardized patient. Participants rated student performance with the CRAT for both case videos (T1) and repeated the sequence at least 30 days later (T2). Intraclass correlation coefficient (ICC) estimates and 95% confidence intervals were used to determine the interrater and intrarater reliability for each domain of the CRAT.

Results.
Video 1 was consistently rated higher for each CRAT domain (T1: 7.32–8.05; T2: 8.05–8.15) compared to video 2 (T1: 2.91–3.68; T2: 3.00–3.68). There were inverse relationships between CRAT ratings and number of years in DPT education, at an institution, and as a licensed physical therapist. At both timepoints, the interrater reliability for each domain was good to excellent (ICCs 0.60–0.79). The intrarater reliability was fair to excellent for all domains for each video (ICCs 0.45–0.75).

Discussion and Conclusion.
The CRAT is a reliable instrument for assessing DPT student CR during a simulated patient encounter. Implementation of the CRAT in DPT education may facilitate improved consistency of CR assessment across the learner continuum.
Ethical considerations in lung re-transplantation
Authors: Lester Lynette A. , Huang Valerie P. , Wightman Sean C. , Rosenberg Graeme M. 
Published: August 2024

Purpose of review
Patients undergoing re-transplantation constitute a growing proportion of annual lung transplants. It is necessary to consider ethical considerations of re-transplantation in parallel with clinical progress.

Recent findings
Most clinical data demonstrate patients undergoing re-transplantation have worse survival outcomes; however, there is limited discussion of the ethical principles surrounding re-transplantation. Ethical guidance in re-transplantation trails clinical advancement.

Summary
The four-box model offers a valuable framework for assessing the ethical considerations in re-transplantation. This includes an analysis of medical indications, patient preferences, quality-of-life and contextual factors to support the ethical use of scarce donor lungs.
Use of Doxycycline and Other Antibiotics as Bacterial Sexually Transmitted Infection Prophylaxis in a US Sample of Primarily Gay and Bisexual Men
Authors: Traeger Michael W. , Krakower Douglas S. , Mayer Kenneth H. , Jenness Samuel M. , Marcus Julia L. 
Published: August 2024

Background
Doxycycline used as postexposure prophylaxis (doxyPEP) within 72 hours of sex reduces the risk of bacterial sexually transmitted infections (STIs) in people assigned male sex at birth. Little is known about current use of antibiotics as STI prophylaxis in US populations likely to benefit from doxyPEP.

Methods
We conducted an online survey in September 2023 of US adults recruited via sexual networking apps used mainly by gay and bisexual men (GBM). Respondents were asked about the use of antibiotics around the time of sex to prevent bacterial STIs.

Results
Of 903 respondents, most (96.2%) identified as GBM; 19.0% were living with HIV and 42.5% were using HIV preexposure prophylaxis (PrEP). Half (49.1%) had heard of using antibiotics to prevent STIs, and 95.6% were interested in use. Overall, 21.0% had used antibiotic STI prophylaxis, and 15.9% had done so in the past year. Among those reporting any use, most (78.1%) had used doxycycline; some used amoxicillin (16.7%), azithromycin (14.5%), or other antibiotics (14.1%). Among those reporting use in the past year, 46.9% used it for some, 28.1% for most, and 25.0% for all sex acts with casual partners during that period. Most (78.3%) of STI prophylaxis users reported their condom use did not change during periods of STI prophylaxis use, 17.2% indicated their condom use declined, and 4.5% indicated their condom use increased. For doxyPEP specifically, 35.7% had heard of it, and 13.0% had used it in the past year, of whom 21.0% had used a dosage other than the 200-mg dose shown to be effective.

Conclusions
In this sample of primarily GBM, interest in bacterial STI prophylaxis was nearly universal. However, some of the use was not informed by current clinical guidance or evidence from research studies. Efforts are needed to increase awareness of effective dosing and monitor real-world use.
Census Tract–Level Social Vulnerability and Gonorrhea Rates in Central Ohio: Results From the STD Surveillance Network, 2020–2021
Authors: Chang Gregory C. , Ramesh Balaji , Liebhard Brittany M. , Borrasca Will E. , Loux Tory , Horan Jessica , Turner Abigail Norris 
Published: August 2024

Background
Gonorrhea remains a significant burden in central Ohio, particularly in socially disadvantaged communities. This study evaluates gonorrhea case rates and changes from 2020 to 2021, focusing on geographic patterns associated with social vulnerability.

Methods
We analyzed gonorrhea case data from the Columbus STD Surveillance Network for 2020 and 2021. Cases were linked to census tracts and categorized into low (0–0.66) or high (0.67–1.0) vulnerability groups based on the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI). We mapped gonorrhea case rates per 100,000 population, stratified by SVI group, and compared changes using Jenks natural breaks to determine cutpoints. High case rates were defined as ≥605 (2020) and ≥532 (2021). A change in case rates was defined as <154 (decrease/no change) or ≥154 (increase). Demographic factors were summarized for both years.

Results
In 2020 and 2021, nearly half of high-SVI tracts had high gonorrhea rates, compared with about 4% to 7% of low-SVI tracts. Median rates in high-SVI tracts were approximately 5 times higher than in low-SVI tracts, with rates of 546 and 598 per 100,000 in 2020 and 2021, compared with 98 and 104 per 100,000, respectively. Gonorrhea rates increased in 23 (9%) of low-SVI tracts and 37 (25%) of high-SVI tracts. Demographic characteristics remained consistent between the 2 years.

Conclusions
Gonorrhea rates increased in central Ohio between 2020 and 2021, with higher burdens in high-SVI census tracts. Understanding the dynamics of social vulnerability at the community level is crucial for targeting limited STD resources effectively.
High School Curriculum and Cognitive Function in the Eighth Decade of Life
Authors: Moorman Sara M. , Khani Saber 
Published: August 2024

Introduction:
Formal educational attainment, or years of schooling, has a well-established positive effect on cognitive health across the life course. We hypothesized that the content and difficulty of the curriculum influence this relationship, such that more challenging curricula in high school lead to higher levels of socioeconomic attainment in adulthood and, in turn, to better cognitive outcomes in older adulthood.

Methods:
We estimated multilevel structural equation models (MSEMs) in data from 2,405 individuals who attended one of 1,312 US high schools in 1960 and participated in the Project Talent Aging Study in 2018.

Results:
A college preparatory curriculum and a greater number of semesters of math and science in high school were positively related to word recall and verbal fluency at an average age of 75. Effects were robust to controlling for adolescent cognitive ability, academic performance, socioeconomic background, and school characteristics.

Discussion:
We discuss the implications of these findings for educational policy.
Enactive behaviour settings: situating agency, normativity and transformation
Authors: Sepúlveda-Pedro Miguel A. , Mojica Laura 
Published: August 2024

Behaviour settings are sociocultural places defined by three main ecological aspects: the affordances of material structures, typical patterns of skilful action and socially situated norms. These aspects explain the observed regularities of human behaviour associated with the material characteristics of places. However, the focus of ecological theories on how individual agents attune their actions to the pre-established order of behaviour settings neglects the agents' active role in sustaining or motivating transformations in this order. We therefore propose an alternative enactive approach to behaviour settings that accounts for the role of agents as active supporters and transformers of behaviour settings. Based on the enactive concepts of agency, normativity and dialectics, we argue that agents, as participants of behaviour settings, simultaneously respond to multiple normative dimensions (e.g. biological, sensorimotor and interactive). To sustain the order of behaviour settings, agents sometimes need to inhibit other normative responses of their bodies, which sometimes is detrimental to one or many aspects of their lives. Nonetheless, agents can collectively trigger the transformation of behaviour settings. This transformation can occur dialectically as tensions between two or more norms to which human bodies respond are resolved, even if new tensions arise and the process of changing behaviour setting continues.
This article is part of the theme issue ‘People, places, things and communities: expanding behaviour settings theory in the twenty-first century’.
Large Language Model Influence on Management Reasoning: A Randomized Controlled Trial
Authors: Goh Ethan , Gallo Robert , Strong Eric , Weng Yingjie , Kerman Hannah , Freed Jason , Cool Joséphine A. , Kanjee Zahir , Lane Kathleen P. , Parsons Andrew S. , Ahuja Neera , Horvitz Eric , Yang Daniel , Milstein Arnold , Olson Andrew P.J , Hom Jason , Chen Jonathan H , Rodman Adam 
Published: August 2024

AbstractImportanceLarge language model (LLM) artificial intelligence (AI) systems have shown promise in diagnostic reasoning, but their utility in management reasoning with no clear right answers is unknown.ObjectiveTo determine whether LLM assistance improves physician performance on open-ended management reasoning tasks compared to conventional resources.DesignProspective, randomized controlled trial conducted from 30 November 2023 to 21 April 2024.SettingMulti-institutional study from Stanford University, Beth Israel Deaconess Medical Center, and the University of Virginia involving physicians from across the United States.Participants92 practicing attending physicians and residents with training in internal medicine, family medicine, or emergency medicine.InterventionFive expert-developed clinical case vignettes were presented with multiple open-ended management questions and scoring rubrics created through a Delphi process. Physicians were randomized to use either GPT-4 via ChatGPT Plus in addition to conventional resources (e.g., UpToDate, Google), or conventional resources alone.Main Outcomes and MeasuresThe primary outcome was difference in total score between groups on expert-developed scoring rubrics. Secondary outcomes included domain-specific scores and time spent per case.ResultsPhysicians using the LLM scored higher compared to those using conventional resources (mean difference 6.5 %, 95% CI 2.7-10.2, p<0.001). Significant improvements were seen in management decisions (6.1%, 95% CI 2.5-9.7, p=0.001), diagnostic decisions (12.1%, 95% CI 3.1-21.0, p=0.009), and case-specific (6.2%, 95% CI 2.4-9.9, p=0.002) domains. GPT-4 users spent more time per case (mean difference 119.3 seconds, 95% CI 17.4-221.2, p=0.02). There was no significant difference between GPT-4-augmented physicians and GPT-4 alone (-0.9%, 95% CI -9.0 to 7.2, p=0.8).Conclusions and RelevanceLLM assistance improved physician management reasoning compared to conventional resources, with particular gains in contextual and patient-specific decision-making. These findings indicate that LLMs can augment management decision-making in complex cases.Trial RegistrationClinicalTrials.govIdentifier:NCT06208423;https://classic.clinicaltrials.gov/ct2/show/NCT06208423Key PointsQuestionDoes large language model (LLM) assistance improve physician performance on complex management reasoning tasks compared to conventional resources?FindingsIn this randomized controlled trial of 92 physicians, participants using GPT-4 achieved higher scores on management reasoning compared to those using conventional resources (e.g., UpToDate).MeaningLLM assistance enhances physician management reasoning performance in complex cases with no clear right answers.
Image retrieval based on closed-loop visual–semantic neural decoding
Authors: Fukuma Ryohei , Yanagisawa Takufumi , Sugano Hidenori , Tamura Kentaro , Oshino Satoru , Tani Naoki , Iimura Yasushi , Khoo Hui Ming , Suzuki Hiroharu , Yang Huixiang , Iwata Takamitsu , Nakajima Madoka , Nishimoto Shinji , Kamitani Yukiyasu , Kishima Haruhiko 
Published: August 2024

AbstractNeural decoding via the latent space of deep neural network models can infer perceived and imagined images from neural activities, even when the image is novel for the subject and decoder. Brain-computer interfaces (BCIs) using the latent space enable a subject to retrieve intended image from a large dataset on the basis of their neural activities but have not yet been realized. Here, we used neural decoding in a closed-loop condition to retrieve images of the instructed categories from 2.3 million images on the basis of the latent vector inferred from electrocorticographic signals of visual cortices. Using a latent space of contrastive language-image pretraining (CLIP) model, two subjects retrieved images with significant accuracy exceeding 80% for two instructions. In contrast, the image retrieval failed using the latent space of another model, AlexNet. In another task to imagine an image while viewing a different image, the imagery made the inferred latent vector significantly closer to the vector of the imagined category in the CLIP latent space but significantly further away in the AlexNet latent space, although the same electrocorticographic signals from nine subjects were decoded. Humans can retrieve the intended information via a closed-loop BCI with an appropriate latent space.
A single-nucleus census of immune and non-immune cell types for the major immune organ systems of chicken
Authors: Sculley Elaina R. , Ricemeyer Edward S. , Carroll Rachel C. , Driver John , Smith Jacqueline , Kaufman Jim , Hearn Cari , Balic Adam , Chen Paula , Lamont Susan , Kramer Skyler , Drechsler Yvonne , Cheng Hans , Warren Wesley C. 
Published: August 2024

AbstractIn the avian host, comprehensively cataloging immune cell types, their transcriptome profiles, and varying molecular responses to pathogen challenges are necessary steps toward a better understanding of the interplay between genetics and disease resilience. We present a first nuclei atlas of immune cell types derived from the three main immune organs of layer chickens, including spleen, bursa, and thymus. In bursa we also present, an accounting of cell type activation with the bacterial toxin lipopolysaccharide (LPS). Our analysis includes 36,370 total nuclei and 16, 12, and 12 transcriptionally distinct clusters for spleen, bursa, and thymus, respectively. We discover nuclei molecular profiles that uniquely distinguish states of the transcriptome within cell type that could serve as new means to characterize avian immune subtypes. We further subcluster refined immune cell type classifications, specifically highlighting the transcriptomic diversity of B and T cell subtypes. In the bursa, inferred intercellular communication and signaling pathway enrichment analyses across immune and non-immune cell types demonstrate the unappreciated complexity of the B cell repertoire in a model mimicking systemic bacterial infection. This census of all cell types in both primary and one major secondary avian immune organ system, although preliminary, provides a first review of how nuclei transcribe numerous genes, known and unknown, a critical prerequisite for the study avian immunogenetics by cell type.