bluuebunny/crossref_metadata_2025_split huggingface dataset:
You cannot be what you cannot see: a retrospective natural longitudinal cohort study exploring the impact of face-to-face rural immersion on student medical training satisfaction and intention to practice rurally
Authors: Nasir Bushra F , Chater Alan Bruce , Kondalsamy-Chennakesavan Srinivas , McGrail Matthew R 
Published: January 2025

ObjectiveCommunity-engaged immersive rural experiences were limited during the COVID-19 pandemic when online learning was instigated across medical institutions globally. This study aimed to explore the impact of online learning on medical students’ satisfaction levels and intentions to practice in a rural area after graduation.Design, setting and participantsWe conducted a natural quasi-experimental longitudinal retrospective cross-sectional study during 2011–2022 for all Australian domestic medical students who undertook a Rural and Remote Medicine (RRM) placement at the University of Queensland. Anonymous administrative course evaluation data were collected for the same two questions in each cohort over 12 years, between 2011 and 2022.Outcome measuresChange in students’ intention to pursue a rural medical career and teaching and placement satisfaction levels was determined. Longitudinal data illustrated trends in students’ intention and overall satisfaction across cohorts before and during COVID-19 disruptions.Results2695 students participated in the surveys with an average response rate of 81%. Intention levels remained steady between 2011 and 2019, during which students experienced a consistent face-to-face orientation and rural placement immersion. During the COVID-19 disruption phase, primarily in 2020 and 2021, students’ intention to pursue a rural medical career significantly decreased when online-only learning placements were implemented, with only 25% of students in the most impacted rotation indicating a strong positive intention, compared with a previous steady 75%. Comparatively, students’ satisfaction with the RRM programme remained steady across all the years at about 85–90%.ConclusionsThere appears to be a detrimental impact of a lack of immersive community-engaged education experiences on medical student’s intention to pursue a rural medical career. This natural experiment demonstrates that while online learning maintains student satisfaction levels, it lacks value and authenticity and does not inspire students to consider future rural careers. The value of face-to-face and immersive community-engaged experiences is fundamentally an important contributor to inspiring students to work in rural areas in the future.
Malnutrition among under-5 children and its determinants in the southwestern coastal region of Bangladesh: A community-based study
Authors: Akter Shahinur , Nishu Nishana Afrin 
Published: January 2025

ObjectiveThe study examines the prevalence of stunting, the most common form of malnutrition and its determinants among children under-5 in the southwestern coastal region of Bangladesh.DesignCross-sectional survey.SettingsTwo coastal villages of the Bagerhat and Khulna districts of Bangladesh.ParticipantsParticipants were selected using the simple random sampling technique with the following criteria: mothers who had at least one under-5 child and resided in the study area for not less than three consecutive years.Outcome measuresTo assess the nutritional status particularly, stunting (height for age) in children under-5, a standardised anthropometric measurement tool, such as a height-measuring vertical scale, was used and categorised into severely stunted, moderately stunted and normal height.ResultsThe study found that 57.5% of children were severely and 29% were moderately stunted. Findings revealed that mothers’ age, prior experience of under-5 mortality, mothers’ working status and age of the children were significant determinants of stunting prevalence among children under-5. Moreover, children of mothers aged 21–30 years (AOR = 2.190; 95% CI: 1.039 to 4.613;p= 0.039) and children of mothers without prior experience of under-5 mortality (AOR = 4.426; 95% CI: 1.461 to 13.405;p= 0.009) were more possibly to be severely and moderately stunted, respectively. Additionally, children of non-working mothers were more likely to be moderately (AOR = 4.037; 95% CI: 1.382 to 11.792;p= 0.011) and severely stunted (AOR = 2.538; 95% CI: 1.033 to 6.238;p= 0.042). Moreover, children aged ≤24 months (AOR = 0.151; 95% CI: 0.034 to 0.661;p= 0.012) and 25–36 months (AOR = 0.195; 95% CI: 0.046 to 0.829;p= 0.027) were less possibly to be moderately stunted.ConclusionThe study recommends training young mothers on effective child-rearing practices, creating income opportunities for women in rural Bangladesh, implementing local awareness programmes about appropriate growth standards for children and expanding facility-based healthcare centres in rural areas for better access to quality healthcare.
Reconstructing Tropical Cyclone Activity from Sedimentary Archives
Authors: Donnelly Jeffrey P. 
Published: January 2025

The brevity of the instrumental record limits our knowledge of tropical cyclone activity on multidecadal to longer timescales and hampers our ability to diagnose climatic controls. Sedimentary archives containing event beds provide essential data on tropical cyclone activity over centuries and millennia. This review highlights the advantages and limitations of this approach and how these reconstructions have illuminated patterns of tropical cyclone activity and potential climate drivers over the last millennium. Key elements to developing high-quality reconstructions include confident attribution of event beds to tropical cyclones, assessing the potential role of other mechanisms, and evaluating the potential influence of geomorphic changes, sea-level variations, and sediment supply on a settings’ susceptibility to event bed deposition. Millennium-long histories of severe tropical cyclone occurrence are now available from many locations in the western North Atlantic and western North Pacific,revealing clear regional shifts in activity likely related to intervals of large-scale ocean-atmosphere reorganization.

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Prior to significant human influence in Earth's climate, natural climate variability dramatically altered patterns of tropical cyclone activity.

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For some regions (e.g., The Bahamas and the Marshall Islands), earlier intervals of tropical cyclone activity exceeded what humans have experienced during the recent period of instrumental measurements (∼1850 CE–present).

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Risk assessments based on the short instrumental record likely underestimate the threat posed by tropical cyclones in many regions.

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Changes in atmospheric and oceanic circulation associated with the Little Ice Age (∼1400–1800 CE) resulted in significant regional changes in tropical cyclone activity.

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Given the past sensitivity of tropical cyclone activity to climate change, we should anticipate regional shifts in tropical cyclone activity in response to ongoing anthropogenic warming of the planet.
Abstract 015: Evaluation of the CEREGLIDE 92 Catheter, a Novel Super‐Bore Aspiration Catheter: SPLENDID Trial Methods
Authors: Froehler M. , Jankowitz B. , Al-Mufti F. , Grandhi R. , Gutierrez S. Ortega , Rai A. 
Published: January 2025

Introduction/Purpose
Mechanical thrombectomy (MT) with a direct aspiration first pass technique (ADAPT) has demonstrated similar reperfusion rates and clinical outcomes as MT using stent retrievers. Super bore catheters have larger inner diameters (ID) that are more closely matched to the vessel ID to provide more suction capability when compared to existing large bore aspiration catheters. The purpose of the SPLENDID study is to evaluate the safety and effectiveness of CEREGLIDE 92 Catheter (largest 8F catheter designed for intracranial access) in the treatment of patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) within the internal carotid, middle cerebral‐M1 segment, basilar, and vertebral arteries up to 24hrs.

Methods
SPLENDID is a prospective, multicenter, single arm, IDE trial that will enroll up to 140 subjects at up to 25 sites. CEREGLIDE 92 will be used for direct aspiration as the first attempted MT device/technique. Follow‐up will occur at 24 hours, 7 days (or discharge), and 90 days post‐procedure. An Imaging Core Lab, blinded independent evaluation of 90‐day modified Rankin Scale (mRS), Clinical Events Committee (CEC) and Data Monitoring Committee (DMC) will be used.

Results
The primary effectiveness endpoint will be first pass reperfusion (eTICI≥2b50 without additional therapy) per the Imaging Core Lab. Secondary effectiveness endpoints will be 90‐day mRS 0‐2, time to reperfusion, first pass reperfusion (eTICI≥2c without additional therapy), final procedural reperfusion (eTICI≥2c), final procedural reperfusion (eTICI 3), and embolization in new territory. Secondary safety endpoints will include 90‐day all‐cause mortality, 24‐hour symptomatic intracranial hemorrhage per CEC, and serious adverse device effects through 30 days per CEC. Health value endpoints will include hospitalization length of stay, healthcare resource utilization, and 90‐day patient‐reported Quality of Life using the PROMIS‐10.

Conclusion
SPLENDID will prospectively evaluate the clinical impact of super large bore aspiration using the CEREGLIDE 92 Catheter for direct aspiration as the first attempted MT technique and is the first IDE (investigational device exemption) study to use first‐pass effect as the primary endpoint.
Abstract 066: Adaptive and physiological cerebrovascular changes at high altitudes: a systematic review and meta‐analysis
Authors: Chirinos J. M. Sequeiros , Zila-Velasque P. , Grados-Espinoza P. , Abanto-Urbano S. , Olarte-Durand M. , Vilca-Salas M. , Moran-Ballon P. , Velasquez-Rimachi V. , Regalado-Rodríguez K. , Quispe-Vicuña C. , Terry F. , Alva-Diaz C. 
Published: January 2025

Introduction
moderate altitude, considered over 1,500 meters (about 4921 ft) above sea level (m.a.s.l), is a particular environment due to the lower oxygen pressure that conditions the development of adaptive mechanisms such as cerebrovascular changes expressed in cerebral blood flow (CBF). Several studies have explored changes in CBF in small populations, however, changes at different altitudes, populations and units of measurement have not been described. These characteristics have been associated with cerebrovascular adaptation

Methods
We systematically searched databases (PubMed‐Medline, Embase, Web of Science, Scopus and Google Scholar) until January 2022 for studies evaluating cerebrovascular changes resulting from exposures at altitudes greater and lower than 1500 m.a.s.l. The Newcastle‐Ottawa scale and RoB‐2 tools was used to assess the risk of bias from observational studies and randomized clinical trials, respectively. A meta‐analysis using a random‐effects model to estimate pooled effects was realized for each outcome and a narrative synthesis when this was not possible. GRADE criteria were used to identify the certainty of evidence for each result.

Results
We included 58 studies (2 randomized clinical trials and 56 non‐randomized clinical trials) with 1959 patients. Most studies were at low risk of bias. We found that in the middle meningeal artery, altitude higher than 1500 m.a.s.l may reduce autoregulatory index (MD −0.42, 95% CI −0.67 to −0.18, I2 84%, 2 studies, low certainty), cerebral oxygen saturation (MD −5.65, 95% CI −8.63 to −2.67, I2 91%), cerebral oxygen saturation (MD −5.65, 95% CI ‐8.63 to ‐2.67, I2 91%) and cerebral oxygen saturation (MD ‐5.65, 95% CI ‐8.63 to ‐2.67, I2 91%): ‐8.63 to ‐2.67, I2: 91%, 3 studies, low certainty), cerebrovascular resistance (MD: ‐25.04, 95% CI: ‐75.61 to 25.54, I2: 100%, 2 studies, low certainty) and Cerebrovascular Conductance (MD: ‐0.01, 95% CI: ‐0.05 to 0.03, I2: 0%, 2 studies, low certainty). Similarly, in the internal carotid and vertebral artery, altitude may increase global cerebral blood flow (MD 200.82, 95% CI 47.17 to 354.46, I2 70%, 2 studies, low certainty).

Conclusion
Exposure to altitudes above 1500 m.a.s.l reduces autoregulation and cerebral oxygen saturation but increases overall cerebral blood flow. These changes could indicate cerebrovascular adaptations to lower oxygen pressures, although the evidence is of low certainty due to variability between studies.
Abstract 086: Design and validation of a scale for the prediction of large vessel occlusion in stroke patients in the Latin American population Escala Predictiva en Ictus de Oclusion EsPIO
Authors: Huamani C. , Rosales-Amaya A. , Moreno-Arias J. , Mercado-Pompa A. A. , López-Mena D. , Gutiérrez-Romero A. , Aburto-Murrieta Y. 
Published: January 2025

Introduction
There are multiple limitations in the approach and management of ischemic stroke in the Latin American people, particularly, in the management of patients requiring thrombectomy. Although there are numerous scales to predict large vessel occlusion (LVO), they have not been validated in this population; therefore, our objective was to design and validate a scale to predict large vessel occlusion in this populace, in order to provide predictive tools for the decision making in the stroke patients.

Methods

A multivariate logistic regression model was constructed from the National Institutes of Health Stroke Scale (NIHSS) items, using the backward stepwise methodology to select the items that best predicted the model, eliminating items with p ≥ 0.05. The significant items comprised the EsPIO (
Escala Precdictiva en Ictus de Oclusión,
i.e. Occlusion Prediction Scale in Stroke). For its creation, we use a validation cohort with the 66% of patients, in whom neuroimaging was performed to assess cervical and cerebral vessels. Sensitivity, specificity, ROC curves, positive predictive value (PPV) and negative predictive value (NPV) were evaluated. The remaining 33% of the cohort was used for a validation cohort. Finally, the results of derivation and the validation cohort in the EsPIO scale were compared.

Results
We included 668 patients; LVO was identified in 15.5%. In the validation cohort, the four significant items were gaze disturbance, arm motor function, language, and extinction or inattention, with which the EsPIO scale was constructed, ranging from 0 to 11 points. With >=3 points, it had a sensitivity (S) of 89% and specificity (E) of 46%, with >=4 points it had S 85% and E 60%, choosing this point, PPV 19%, and NPV 97% when the frequency was 10%. The ROC curve was 0.831 (95%CI 0.771‐0.891). The derivation and validation cohort were compared, with no significant differences.

Conclusion
The results obtained with the creation of the EsPIO scale show very high negative predictive values. This scale may aid in determining which patients may benefit from being translated to thrombectomy‐capable centers.
Abstract 110: Impact of Neuroimaging Markers on Clinical Outcomes in Cerebral Amyloid Angiopathy‐Related Intracerebral Hemorrhage
Authors: Das A. S. , Fouks A. Abramovitz , Gökçal E. , Rotschild O. , Regenhardt R. W. , Selim M. H. , Viswanathan A. , Goldstein J. N. , Rosand J. , Greenberg S. M. , Gurol M. E. 
Published: January 2025

Introduction/Purpose
The recent update (version 2.0) to the Boston criteria for cerebral amyloid angiopathy (CAA) adds two additional neuroimaging markers to increase the sensitivity of CAA detection: multispot white matter hyperintensity (WMH) pattern and severe centrum semiovale enlarged perivascular spaces (CSO EPVS). While the presence of these novel non‐hemorrhagic markers, together with well‐established hemorrhagic markers such as lobar cerebral microbleeds (CMBs) and cortical superficial siderosis (cSS), increases the likelihood of underlying CAA in patients with intracerebral hemorrhage (ICH), it is unclear whether these markers have a prognostic impact on clinical outcomes.

Materials/Methods
Brain MRIs from a prospective database of consecutive non‐traumatic ICH patients admitted to a tertiary care center were reviewed for the presence of CMBs, cSS, multispot WMH pattern, and CSO EPVS. Patients who met the diagnostic criteria for CAA were selected for inclusion in this study. Clinical and neuroimaging predictors of an unfavorable discharge outcome (modified Rankin score ≥ 4) were assessed in univariate and multivariable models.

Results

Between 2003 and 2019, 1,791 patients were admitted with non‐traumatic ICH. Of the 1,297 (72%) patients who received a brain MRI, 645 (36%) were found to have CAA (mean age 74±11 years, 49% female). An unfavorable outcome was observed in 75% of patients. Lobar CMBs occurred in 326 (51%) patients, cSS occurred in 197 (31%), multispot WMH pattern occurred in 123 (19%), and severe CSO EPVS occurred in 156 (24%). In univariate analyses, age, hypertension, diabetes, ischemic stroke history, dementia, admission Glasgow Coma Scale (GCS) scores, intubation, external ventricular drain placement, hematoma evacuation, intraventricular extension, and cSS were associated with an unfavorable discharge outcome (all
p
< 0.05). When entered into a multivariable model subjected to backward elimination, age (aOR 1.05, 95% CI 1.03‐1.08), hypertension (aOR 1.66, 95% CI 1.06‐2.62), dementia (aOR 8.40, 95% CI 1.97‐35.81), GCS score (aOR 0.85, 95% CI 0.75‐0.96), intubation (aOR 2.59, 95% CI 1.09‐6.15), intraventricular extension (aOR 1.75, 95% CI 1.67‐4.84), and cSS (aOR 1.75, 95% CI 1.07‐2.88) remained significantly associated with an unfavorable discharge outcome.

Conclusion
Although non‐hemorrhagic imaging markers are common in CAA patients with ICH, only the presence of cSS is significantly associated with unfavorable clinical outcomes.
Abstract 117: Intravenous Cangrelor Use in Patients with Intracranial Hemorrhage
Authors: Tolba H. , Khan M. , Fakih R. , Gillani S. , Gomez C. R. , Qureshi A. I. 
Published: January 2025

Introduction
Cangrelor is an intravenous (IV), direct‐acting, and reversible P2Y12 inhibitor with rapid onset and offset. Hence, use of Cangrelor in cerebrovascular interventions has recently expanded. We report our experience with IV Cangrelor in patients with intracranial hemorrhage who required antiplatelet medication to avoid stent thrombosis.

Methods
We reviewed the available computed tomographic (CT) images before, during, and after completion of IV Cangrelor infusion to identify any increase in intracranial hemorrhage. We also ascertained any neurological deterioration (defined by increase in NIH stroke scale of ≥4 points) and occurrence of new thromboembolic events.

Results
Four patients we switched from oral P2Y12 inhibitors to IV Cangrelor due to new‐onset intracranial hemorrhage. Two patients had stents placed in cervical Internal Carotid Arteries during thrombectomy, one patient underwent stent placement in vertebral artery during thrombectomy, and one patient underwent stent assisted coiling for internal carotid artery aneurysm. Post‐procedural mean time to initiate IV Cangrelor infusion was 6 days (SD=7.6 days). All patients received a bolus of 5mcg/kg of Cangrelor followed by 1mcg/kg/min maintenance dose for a mean period of 5.8 days (SD=3.3 days). Serial CT scans of head were obtained after initiation of IV Cangrelor in 3 patients (mean number of scans was 3.7), None of the patients experienced either neurological deterioration or worsening of the intracranial hemorrhage during follow up. Three out of four patients underwent repeat vascular imaging, documenting no stent thrombosis or occlusion.

Results
Use of IV Cangrelor infusion appears to be safe in patients with intracranial hemorrhage in whom platelet inhibition is necessary to avoid stent thrombosis.
Abstract 128: Outcomes of Intervention versus Medical Management Alone for Infectious Intracranial Aneurysms ‐ A Nationwide Analysis
Authors: Ehidom C. 
Published: January 2025

Introduction
Infectious intracranial aneurysms (IIA) are one of several cerebrovascular complications associated with infective endocarditis (IE). IIA are initially treated with antibiotics given that treatment of the underlying infection is an important component of therapy. However, given the complex nature of these aneurysms, a multi‐disciplinary approach may be warranted for optimal outcomes, which includes coiling, embolization, clipping, or a combination of these measures. Herein, we aim to better understand outcomes in the use of medical management alone in this group of patients versus additional interventions.

Methods
Using data from the National Inpatient Sample from 2000 to 2020, we conducted an analysis comparing outcomes of intervention with medical management versus medical management alone for hospitalizations with infective endocarditis. A subgroup analysis of ruptured vs unruptured aneurysms was performed with primary endpoints being mortality and favorable outcome defined as discharge disposition to home without services. Treatment modalities were categorized as antibiotics, endovascular, and/or open neurosurgical repair based on ICD‐9 and ICD‐10 codes. Logistic regressions were utilized to assess the association between treatment modality and the outcomes of in‐hospital mortality and discharge disposition, while accounting for age and illness severity [quantified by All Patient Refined Diagnostic Related Groups (APR‐DRG) illness severity subclass]. Effect size was reported as adjusted odds ratio (aOR) with 95% confidence interval (CI).

Results
This analysis identified 2711 hospitalizations for IE, of which 315 (11.6%) were treated with antibiotics alone, versus 2715 (88.4%) which were treated with both antibiotics and intervention. IE patients undergoing intervention experienced significantly decreased mortality rates in comparison to those receiving antibiotics alone (6.3% v 9.9%; p =0.045), however rates of favorable outcomes did not differ (22.5% vs. 25.0%, p=0.343). In sub‐group analysis of ruptured IIA (n=633, 23.4% of total cohort), intervention yielded significantly lower mortality rates (10.6% v 24.8%, p<0.001) and a trend toward increased rates of favorable outcomes (14.3% v 9.1%, p=0.077). In sub‐group analysis of unruptured IIA, intervention resulted in lower absolute mortality rates (2.9% v 6.0%, p=.088) but no difference in favorable outcomes (28.9% v 29.1, p=0.957).

Conclusion
While treatment of IIA often involves a multidisciplinary approach, antibiotics as part of medical management remains integral. Our study showed that intervention in addition to medical management led to decreased mortality rates, especially in patients with ruptured IIA. Further directions for future studies include elucidating predictors of favorable outcomes for undergoing intervention and the most beneficial timing for the procedure during hospitalization.