bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘They say’: medical students’ perceptions of General Practice, experiences informing these perceptions, and their impact on career intention—a qualitative study among medical students in England
Authors: Banner Kimberley , Alberti Hugh , Khan Shehleen Arbab , Jones Melvyn Mark , Pope Lindsey Margaret 
Published: November 2023

ObjectivesThe number of UK graduates choosing General Practice training remains significantly lower than the current numbers required to meet the demands of the service. This work aims to explore medical students’ perceptions of General Practice, experiences which lead to the development of these perceptions, and the ultimate impact of these on career intention.DesignThis mixed-methods, qualitative study used focus groups, semistructured interviews, longitudinal audio diary data and debrief interviews to explore and capture the experiences and perceptions of students in their first and penultimate years of university.SettingThree English medical schools.ParticipantsTwenty students were recruited to focus groups from first and fourth/fifth year of study. All students in these years of study were invited to attend. Six students were recruited into the longitudinal diary study to further explore their experiences.ResultsThis work identified that external factors, internal driving force and the ‘they say’ phenomenon were all influential on the development of perceptions and ultimately career intention. External factors may be split into human or non-human influences, for example, aspirational/inspirational seniors, family, peers (human), placements and ‘the push’ of GP promotion (non-human). Driving force refers to internal factors, to which the student compares their experiences in an ongoing process of reflection, to understand if they feel General Practice is a career they wish to pursue. The ‘they say’ phenomenon refers to a passive and pervasive perception, without a known source, whereby usually negative perceptions circulate around the undergraduate community.ConclusionFuture strategies to recruit graduates to General Practice need to consider factors at an undergraduate level. Positive placement experiences should be maximised, while avoiding overtly ‘pushing’ GP onto students.
Prevalence and factors associated with cognitive frailty in heart failure: a systematic review and meta-analysis protocol
Authors: Bolaji Olayiwola Akeem , Shoar Saeed , Ouedraogo Faizal , Demelash Simachew , Adabale Olanrewaju 
Published: November 2023

IntroductionHeart failure (HF) is a global health issue affecting millions of people worldwide. Cognitive frailty, a syndrome characterised by physical frailty and cognitive impairment without dementia, is increasingly recognised in this population. Cognitive frailty is associated with worse outcomes, including increased hospitalisation, disability and mortality. This systematic review and meta-analysis aimed to investigate the incidence, prevalence and predictors of cognitive frailty in HF patients.MethodsA systematic search will be conducted in MEDLINE/PubMed, EMBASE/Ovid, Web of Science and Google Scholar from inception to the latest search date. Eligible studies will report original data on adult patients (age ≥18 years) with HF, focusing on the incidence, prevalence and predictors of cognitive frailty. Two investigators will independently extract data and assess study quality using the Newcastle-Ottawa Scale and mixed-methods appraisal tool. Meta-analyses and meta-regression will be performed to estimate the pooled prevalence of cognitive frailty in HF patients and to identify predictors associated with increased risk, respectively. Subgroup analyses will be conducted to explore potential sources of heterogeneity.Ethics and disseminationThis systematic review does not require ethical approval and informed consent, as it does not use identifiable patient data. The results of this study will be submitted for publication in a peer-reviewed medical journal. This comprehensive meta-analysis of the literature on cognitive frailty among HF patients will inform tailored interventions and management strategies, ultimately improving patients’ quality of life and outcomes.
Relationship between Framingham Cardiovascular Risk Score and cognitive performance among ageing rural Indian participants: a cross-sectional analysis
Authors: Mensegere Abhishek Lingegowda , Sundarakumar Jonas S , Diwakar Latha , Issac Thomas Gregor 
Published: November 2023

ObjectiveThe burden of cardiovascular risk factors is increasing in India, which, in turn, can adversely impact cognition. Our objective was to examine the effect of cardiovascular risk factors measured by Framingham Risk Score (FRS) on cognitive performance among a cohort of healthy, ageing individuals (n=3609) aged ≥45 years from rural India.DesignA cross-sectional analysis.SettingA rural community setting in southern India.ParticipantsHealthy, ageing, dementia-free participants, aged 45 years and above, belonging to the villages of Srinivaspura (a rural community located around 100 km from Bangalore, India), were recruited.Primary outcome measuresUsing a locally adapted, validated, computerised cognitive test battery, we assessed cognitive performance across multiple cognitive domains: attention, memory, language, executive functioning and visuospatial ability.ResultsThe median (IQR) age of the sample was 57 (50.65) and 50.5% were women. Multiple linear regression analysis showed that participants with higher FRS performed poorly in attention (visual attention (β=−0.018, p=0.041)), executive functioning (categorical fluency (β=−0.064, p<0.001)), visuospatial ability (form matching (β=−0.064, p<0.001) and visuospatial span (β=−0.020, p<0.001)), language (reading and sentence comprehension (β=−0.010, p=0.013), word comprehension (β=−0.021, p<0.001) and semantic association (β=−0.025, p<0.001)), and memory (episodic memory IR (β=−0.056, p<0.001), episodic memory DR (β=−0.076, p<0.001) and name-face association (β=−0.047, p<0.001)).ConclusionIncreased cardiovascular risk as evidenced by FRS was associated with poorer cognitive performance in all cognitive domains among dementia-free middle-aged and older rural Indians. It is imperative to design and implement appropriate interventions (pharmacological and lifestyle-based) for cardiovascular risk reduction and thereby, prevent or mitigate accelerated cognitive impairment in ageing individuals.
Comparing proficiency of obstetrics and gynaecology trainees with general surgery trainees using simulated laparoscopic tasks in Health Education England, North-West: a prospective observational study
Authors: Khan Zaibun N , Shrestha Donna , Shugaba Abdulwarith , Lambert Joel E , Clark Justin , Haslett Elizabeth , Afors Karolina , Bampouras Theodoros M , Gaffney Christopher J , Subar Daren A 
Published: November 2023

BackgroundTraining programmes for obstetrics and gynaecology (O&G) and general surgery (GS) vary significantly, but both require proficiency in laparoscopic skills. We sought to determine performance in each specialty.DesignProspective, observational study.SettingHealth Education England North-West, UK.Participants47 surgical trainees (24 O&G and 23 GS) were subdivided into four groups: 11 junior O&G, 13 senior O&G, 11 junior GS and 12 senior GS trainees.ObjectivesTrainees were tested on four simulated laparoscopic tasks: laparoscopic camera navigation (LCN), hand–eye coordination (HEC), bimanual coordination (BMC) and suturing with intracorporeal knot tying (suturing).ResultsO&G trainees completed LCN (p<0.001), HEC (p<0.001) and BMC (p<0.001) significantly slower than GS trainees. Furthermore, O&G found fewer number of targets in LCN (p=0.001) and dropped a greater number of pins than the GS trainees in BMC (p=0.04). In all three tasks, there were significant differences between O&G and GS trainees but no difference between the junior and senior groups within each specialty. Performance in suturing also varied by specialty; senior O&G trainees scored significantly lower than senior GS trainees (O&G 11.4±4.4 vs GS 16.8±2.1, p=0.03). Whilst suturing scores improved with seniority among O&G trainees, there was no difference between the junior and senior GS trainees (senior O&G 11.4±4.4 vs junior O&G 3.6±2.1, p=0.004).DiscussionGS trainees performed better than O&G trainees in core laparoscopic skills, and the structure of O&G training may require modification.Trial registration numberClinicalTrials.gov Registry (NCT05116332).
Design and rationale of the ATTRACTIVE trial: a randomised trial of intrAThrombus Thrombolysis versus aspiRAtion thrombeCTomy during prImary percutaneous coronary interVEntion in ST-segment elevation myocardial infarction patients with high thrombus burden
Authors: Zhang Zhen , Sheng Zhaoxue , Che Wuqiang , An Shuoyan , Sun Di , Zhai Zhengqin , Zhao Xuecheng , Yang Yaliu , Meng Zhen , Ye Zixiang , Xie Enmin , Li Peizhao , Yu Changan , Gao Yanxiang , Xiao Zhu , Wu Yanfen , Dong Fen , Ren Jingyi , Zheng Jingang 
Published: November 2023

IntroductionST-segment elevation myocardial infarction (STEMI) with high thrombus burden is associated with a poor prognosis. Manual aspiration thrombectomy reduces coronary vessel distal embolisation, improves microvascular perfusion and reduces cardiovascular deaths, but it promotes more strokes and transient ischaemic attacks in the subgroup with high thrombus burden. Intrathrombus thrombolysis (ie, the local delivery of thrombolytics into the coronary thrombus) is a recently proposed treatment approach that theoretically reduces thrombus volume and the risk of microvascular dysfunction. However, the safety and efficacy of intrathrombus thrombolysis lack sufficient clinical evidence.Methods and analysisThe intrAThrombus Thrombolysis versus aspiRAtion thrombeCTomy during prImary percutaneous coronary interVEntion trial is a multicentre, prospective, open-label, randomised controlled trial with the blinded assessment of outcomes. A total of 2500 STEMI patients with high thrombus burden who undergo primary percutaneous coronary intervention will be randomised 1:1 to intrathrombus thrombolysis with a pierced balloon or upfront routine manual aspiration thrombectomy. The primary outcome will be the composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, heart failure readmission, stent thrombosis and target-vessel revascularisation up to 180 days.Ethics and disseminationThe trial was approved by Ethics Committees of China-Japan Friendship Hospital (2022-KY-013) and all other participating study centres. The results of this trial will be published in peer-reviewed journals.Trial registration numberNCT05554588.
Combined effect of cortical superficial siderosis and cerebral microbleed on short-term and long-term outcomes after intracerebral haemorrhage
Authors: Jin Yujia , Huang Yu-hui , Chen Yu-ping , Zhang Yao-dan , Li Jiawen , Yang Kai-cheng , Ye Xianghua , Jin Lu-hang , Wu Jian , Yuan Chang-zheng , Gao Feng , Tong Lu-sha 
Published: November 2023

Background and purposeCortical superficial siderosis (cSS) and cerebral microbleed (CMB) have distinct effects on intracerebral haemorrhage (ICH). We aim to investigate the combined effect of cSS and CMB on outcomes after ICH.MethodsBased on a single-centre stroke registry database, patients with spontaneous ICH who had CT scan within 48 hours after ictus and MRI subsequently were identified. Eligible patients were divided into four groups (cSS-CMB−, cSS-CMB+, cSS+CMB−, cSS+CMB+) according to cSS and CMB on susceptibility-weighted image of MRI. Primary outcomes were haematoma volume on admission and unfavourable outcome defined as modified Rankin Scale scores ≥3 at 3 months. Secondary outcomes were all-cause death, recurrence of stroke and ICH during follow-up (median follow-up 2.0 years, IQR 1.0–3.0 years).ResultsA total of 673 patients were identified from 1044 patients with spontaneous ICH. 131 (19.5%) had cSS and 468 (69.5%) had CMB. Patients with cSS+CMB+ had the highest rate of poor outcome at 3 months, as well as all-cause death, recurrent stroke and ICH during follow-up. In cSS− patients, CMB was associated with smaller haematoma (β −0.13; 95% CI −0.22 to −0.03; p=0.009), but it still increased risks of recurrent ICH (OR 4.6; 95% CI 1.3 to 15.6; p=0.015) and stroke (OR 2.0; 95% CI 1.0 to 4.0; p=0.049). These effects of CMB became unremarkable in the context of cSS+.ConclusionsPatients with different combinations of cSS and CMB have distinct patterns of short-term and long-term outcomes. Although CMB is related to restrained haematoma, it does not improve long-term outcomes.Trial registration numberNCT04803292.
Cerebral small vessel disease modifies outcomes after minimally invasive surgery for intracerebral haemorrhage
Authors: Li Yunke , Cho Sung-Min , Avadhani Radhika , Ali Hassan , Hao Yi , Murthy Santosh B , Goldstein Joshua N , Xia Fan , Hu Xin , Ullman Natalie L , Awad Issam , Hanley Daniel , Ziai Wendy C 
Published: November 2023

BackgroundMinimally invasive surgery (MIS) for spontaneous supratentorial intracerebral haemorrhage (ICH) is controversial but may be beneficial if end-of-treatment (EOT) haematoma volume is reduced to ≤15 mL. We explored whether MRI findings of cerebral small vessel disease (CSVD) modify the effect of MIS on long-term outcomes.MethodsPrespecified blinded subgroup analysis of 288 subjects with qualified imaging sequences from the phase 3 Minimally Invasive Surgery Plus Alteplase for Intracerebral Haemorrhage Evacuation (MISTIE) trial. We tested for heterogeneity in the effects of MIS and MIS+EOT volume ≤15 mL on the trial’s primary outcome of good versus poor function at 1 year by the presence of single CSVD features and CSVD scores using multivariable models.ResultsOf 499 patients enrolled in MISTIE III, 288 patients had MRI, 149 (51.7%) randomised to MIS and 139 (48.3%) to standard medical care (SMC). Median (IQR) ICH volume was 42 (30–53) mL. In the full MRI cohort, there was no statistically significant heterogeneity in the effects of MIS versus SMC on 1-year outcomes by any specific CSVD feature or by CSVD scores (all Pinteraction>0.05). In 94 MIS patients with EOT ICH volume ≤15 mL, significant reduction in odds of poor outcome was found with cerebral amyloid angiopathy score <2 (OR, 0.14 (0.05–0.42); Pinteraction=0.006), absence of lacunes (OR, 0.37 (0.18–0.80); Pinteraction=0.02) and absence of severe white matter hyperintensities (WMHs) (OR, 0.22 (0.08–0.58); Pinteraction=0.03).ConclusionsFollowing successful haematoma reduction by MIS, we found significantly lower odds of poor functional outcome with lower total burden of CSVD in addition to absence of lacunes and severe WMHs. CSVD features may have utility for prognostication and patient selection in clinical trials of MIS.
Species–environment relationships, clusters, and thermal ranges of fish species inhabiting boreal rivers
Authors: Sutela Tapio , Vehanen Teppo , Jounela Pekka , Aroviita Jukka , Lehtonen Topi K. 
Published: November 2023

Understanding how key environmental factors affect fish communities is necessary for sound environmental management. Accordingly, we studied fish species–environment relationships in Finnish boreal rivers. A self-organizing map (SOM) analysis showed strong relationships between the occurrence of 18 fish species and 10 environmental variables (variance explained: 43.4%). In our logistic regression models run for each fish species, the predictive power varied from poor (AUC = 0.67–0.68) to excellent (AUC = 0.96), indicating that the responses were species-specific. The overall best predictors of the species occurrence were the local variables water depth and water temperature, and the regional variables stream size, altitude and annual mean temperature. Our results on fish assemblage types (clusters), identified by SOM, and co-occurrence of fish species, discovered by a hierarchical cluster analysis, reveal insights into the structure of the river fish assemblages. Moreover, our results suggest that the stream size contributes to thermal ranges in which each species is able to occur, which has relevance to predicting the impacts of climate change on riverine fish.
Health-Related and Psychosocial Factors Associated with Prostate Cancer Stage at Diagnosis among Males Participating in Alberta’s Tomorrow Project
Authors: Aktary Michelle L. , Shewchuk Brittany , Wang Qinggang , Hyndman Eric , Shack Lorraine , Robson Paula J. , Kopciuk Karen A. 
Published: November 2023

Prostate cancer (PCa) stage at diagnosis is an important predictor of cancer prognosis. In Canada, over one-quarter of males are diagnosed with advanced-stage PCa. Studies have identified several factors associated with PCa stage at diagnosis; however, evidence from Canada is limited. This study aimed to examine associations between sociodemographic characteristics, health history, health practices, and psychosocial factors and PCa stage at diagnosis among males participating in Alberta’s Tomorrow Project (ATP), a prospective cohort in Alberta, Canada. The study included males aged 35–69 years who developed PCa until January 2018. Factors associated with PCa stage at diagnosis were examined using partial proportional odds (PPO) ordinal regression models. A total of 410 males were diagnosed with PCa over the study period. A higher number of lifetime prostate-specific antigen tests were associated with earlier-stage PCa (OR 0.91,

p

= 0.02, 95% CI 0.83–0.99), while higher abdominal circumference (OR 1.02,

p

= 0.05, 95% CI 1.00–1.03), lower social support (OR 2.34,

p

< 0.01, 95% CI 1.31–4.17), and having children (OR 2.67,

p

< 0.01, 95% CI 1.38–5.16) were associated with later-stage disease. This study identified factors previously found in the literature as well as novel factors associated with PCa stage at diagnosis, which can help inform targets for cancer prevention programs to improve PCa prognosis.
Trajectories of Blood Lipids Profile in Midlife Women: Does Menopause Matter?
Authors: Wu Bingjie , Fan Bingbing , Qu Yanlin , Li Chunxia , Chen Jiahao , Liu Ying , Wang Jiali , Zhang Tao , Chen Yuguo 
Published: November 2023

Background
It remains controversial whether changes of lipids over menopause transition (MT) are more age‐related or more menopause‐related. We aimed to classify women into different trajectory groups based on pattern and level of total cholesterol, low‐density lipoprotein cholesterol, apolipoprotein B (ApoB), high‐density lipoprotein cholesterol (HDL‐C), triglyceride, and apolipoprotein A‐I over the MT, as well as examine the effect of MT‐related factors on lipid trajectory groups and levels.

Methods and Results
The cohort included 2582 subjects from the Study of Women's Health Across the Nation. Different trajectory patterns of lipids during the MT were determined using the latent class growth mixture model. The predictors of distinct blood lipids trajectory groups were determined by multiple linear regression models and multinomial logistic regression models. Women were categorized into either inverse U‐shape or progressing trajectory group in each blood lipids measurement. The inverse U‐shape total cholesterol, low‐density lipoprotein cholesterol, apolipoprotein B, high‐density lipoprotein cholesterol, log(TG), and apolipoprotein A‐I trajectories showed an increasing trend before menopause but a decreasing trend after menopause. The U‐shape total cholesterol, low‐density lipoprotein cholesterol, and apolipoprotein B trajectories started to rise 5 years before menopause. Age at menopause, follicle‐stimulating hormone, vasomotor symptoms, and estradiol predicted the shape and level of the women's lipids over the MT.

Conclusions
Distinct lipid trajectories were identified during the MT, and the existence of at least 1 trajectory in each lipid parameters suggested a contribution of menopause. Our study highlights the need for earlier and continuous surveillance of lipids during the MT.
Theory of Mind and Evidentiality Acquisition in Heritage Bilingual Aymara-Spanish Children in the North of Chile
Authors: Markovits Rojas Jennifer 
Published: November 2023

Abstract
The present work examines the connection between language and conceptual development, investigating whether false-belief reasoning (FBR) and source-monitoring ability (SMA), abilities within the theory of mind (ToM) framework, trigger the comprehension of semantic and pragmatic knowledge (evidential scalar implicatures) encoded in the evidentiality structure (Papafragou et al., 2007). Furthermore, the present work examines whether age modulates the comprehension of ToM abilities, and whether age influences comprehension of grammar knowledge encoded in the target structure. Twenty-one bilingual Aymara-Spanish heritage children performed one FBR task and one SMA task. In addition, the same group and 15 bilingual Aymara-Spanish adults performed one semantic and one pragmatic Aymara evidentiality task. The results showed that age was relevant in developing ToM abilities and comprehending the target structure’s evidential semantic features. Furthermore, the results demonstrated that semantic features had a positive relationship with the acquisition of ToM abilities, as opposed to pragmatic knowledge. These outcomes suggest that the computation of Aymara evidential scalar implicatures is lexically driven as opposed to contextually driven.
The Soul: A Psychological Enquiry
Authors: Peters Frederic 
Published: November 2023

Abstract
Soul beliefs are universal among religious folk but vary tremendously from culture to culture, In fact, in tribal societies without formal religious dogmas, soul beliefs can vary from individual to individual. A review of notions regarding the soul (or souls) amongst tribal and post-tribal societies does evidence, nonetheless, a recurring pattern of focus on the soul envisaged as the vital life energy of the body and/or as encapsulating one of more mental faculties. Not surprisingly, theories as to the psychological basis for soul belief vary as well, but a strong case can be advanced that at its core, soul belief is about the essence of the self, which involves the psychological process of ipseity.
Sympathetic Magic: A Psychological Enquiry
Authors: Peters Frederic 
Published: November 2023

Abstract
Sympathetic magic features strongly in virtually all religious traditions and in folk customs generally. Scholars agree that It is based on the association of ideas perceived as external, mind-independent causal realities, as connections mediating causal influence. Moreover, religious folk believe that this mediation involves forms of supernatural agency. From a psychological perspective, the key question revolves around the principles by which the cognitive system deems some of its content to reference the external world and other content to constitute internal mental forms of activity like thoughts, feelings and attitudes. The paper proposes that the critical factor has to do with the balance between two distinctly different kinds of cognitive content: representations of things (mentation arising in the form of something other than itself), as distinct from registrations referencing the intrinsic phenomenal properties of the mental state itself. The balance between these two determines whether content is perceived as external worldly event or a form of internal mental content.