bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Study to Assess the Prevalence  of Headache, its Associated  Factors, Patterns and  Management Strategies Among Nursing Students
Authors: Kumar Maneesh , Bora Pooja , Arya Nisha , Kri Dhruvilu , Choudhary Kiran , Kumari Anjali , Nagi Manisha , Dhandapani Manju 
Published: January 2025

Background Nursing students worldwide face heightened physical and emotional demands from rigorous academic and clinical training, putting them at greater risk for frequent headaches due to the cumulative effects of long duty hours and clinical rotations. Objectives To assess the prevalence of headaches, their associated factors, patterns, and management strategies among nursing students. Methods A descriptive study was conducted in a nursing college/tertiary center in Northern India during the 2023–2024 academic year. The study included 464 nursing students, predominantly female (96.3%) and 17 were male. Ethical clearance was obtained from the Institute Ethics Committee. Tools used for assessment included a sociodemographic profile, headache checklist, Numerical Rating Scale (NRS), Perceived Stress Scale (PSS), and Jenkins Sleep Evaluation Questionnaire (JSEQ) to evaluate headache prevalence, factors, patterns, and management strategies. Results The study found that 76% of nursing students experienced headaches, primarily due to study-related stress (50%) and sleeplessness (25%). Half reported moderate severity, with Tension-type headaches (TTH) being the most common. Management strategies included over-the-counter medications (85.3%), rest and sleep (80%), and head massage (40%), with paracetamol being the most used medication (33%), followed by ibuprofen. Conclusion Three-fourths of nursing students experienced headaches in the past six months, primarily characterized by throbbing or dull pain of mild to moderate severity. High prevalence was noted among those with stress and sleep disturbances, with common management strategies including over-the-counter medications, rest, head massage, and relaxation techniques.
Is Routine Discharge Enough? Needs and Perceptions Regarding Discharge and Readmission of Palliative Care Patients and Caregivers
Authors: Kuntz Aaron A. , Chen Victoria H. , Ambady Leena , Osher Benjamin , DesRoches Catherine 
Published: January 2025

Context The hospital discharge process is fraught for patients with serious illness and their caregivers. Objectives We sought to understand palliative care patient and caregiver concerns regarding the patient-centeredness of the hospital discharge process. Methods We conducted semi-structured interviews with 11 patients receiving palliative care and 4 caregivers. Caregivers were interviewed with patient or alone, for a total of 13 interviews. Interviews were focused on the patient-centeredness of the discharge process, completeness of discharge education, and readmission. Transcripts were analyzed using an inductive approach with open coding. Results We identified four themes: (i) symptoms, (ii) relationship to illness, (iii) variance in patient-provider alignment, and (iv) discharge readiness, including readmission. Physical and non-physical symptoms were common, though non-pain symptoms were more frequently concerns. Illness understanding and empowerment by the discharge process were low, with participants seeking more information. Alignment varied by provider with closer relationships with bedside nurses and outpatient providers, especially oncologists, than inpatient providers. Readmission was not perceived to be avoidable but was associated with symptom burden. Discharge readiness was mixed; common concerns included lack of clarity regarding next steps and post-discharge services. Up to 40% of participants reported incomplete education on given topics. Conclusion Our qualitative study of patients and caregivers receiving palliative care identified unmet needs in the discharge process: non-pain symptom burden, gaps in empowerment and illness understanding, and mixed discharge readiness. Relationship to care informs subsequent engagement with care and medical decision-making. Future interventions should focus on strengthening patient and caregiver empowerment and illness understanding.
Factors Associated With Prolonged Survival in Colorectal Cancer Patients Admitted to Palliative Care: An Exploratory Study
Authors: Ferraz-Gonçalves José António , Lima Áurea , Silva Álvaro José , Calisto Rita 
Published: January 2025

Objective A recently published study concerning variables associated with survival longer than one year in palliative care included several types of cancer. A secondary analysis limited to patients with colorectal cancer was performed to analyze a more homogeneous group of patients. Methods Patients were identified through electronic records from 2012 to December 2018. All patients were over 18 years old and deceased. Cases were defined as patients who survived ≥1 year after being admitted to the palliative care service (PCS), while controls were those who had survived ≤6 months. Results The study includes 33 patients as cases and 119 as controls. 82 (54%) were male, and the median age was 78.5 years (49 to 95). In the univariable analysis, the variables associated with a low probability of living ≥1 year were an ECOG performance status ≥2, liver metastases, and pain. The variables associated with a survival ≥1 year were the neutrophil count ≤5.66 x 109/L and a neutrophil/lymphocyte ratio ≤3.59. In the multivariable analysis, only pain and liver metastases were associated with a low probability, and the neutrophil/lymphocyte ratio ≤3.59 with a high likelihood of living one year or more. Conclusion The data of this study suggests that in colorectal cancer patients admitted to a PCS, the presence of pain, liver metastases, and a high neutrophil/lymphocyte ratio negatively impact the probability of living ≥1 year.
Dual-cell composite acoustic covering layer with broadband absorption characteristics
Authors: Ye Shaopeng , Wu Haobi , Cai Jingyong , Tao Meng 
Published: January 2025

A dual-cell combined acoustic covering layer has been designed and optimized, consisting of a viscoelastic rubber matrix, metal vibrators, cavities, and a steel backing. By parallel coupling the sound absorption characteristics of each cell across different frequency bands, the structural size parameters were optimized using finite element methods and genetic algorithms. The optimized covering layer exhibits an average sound absorption coefficient exceeding 0.98 in the range of 561 Hz to 15000 Hz. When adopting 0.8 as the standard for the sound absorption coefficient, an absorption range of 14439 Hz is achieved, demonstrating its wide frequency band and high sound absorption capabilities. The sound absorption mechanism of the covering layer is further revealed by analyzing the displacement and energy power dissipation distribution cloud diagrams. When the angle of sound wave incidence is 60°, the average sound absorption coefficient of the covering layer is above 0.8; even under a hydrostatic pressure of 5 MPa, the sound absorption coefficient of the covering layer remains stable above 0.8 after 595 Hz, confirming its structural stability and the durability of its sound absorption performance.
Serum Cystatin S (CST4): A Novel Prognostic Marker for Gastric Cancer
Authors: Gu Chao , Chen Shan , Huang Lining , Cao Chenliang , Yuan Renshun , Kou Zhongyang , Chen Weiwei , Shi Haihua , Gu Xiaodong 
Published: January 2025

Background: Serum Cystatin S (CST4), a secretory protein that inhibits cellular matrix degradation, significantly influences the tumor microenvironment and tumor progression. However, the prognostic value of serum CST4 in gastric cancer (GC) remains unclear. This study aims to explore serum CST4’s utility in GC prognostic assessment. Methods: A cohort of 334 patients with GC who underwent radical gastrectomy was assessed. Preoperative serum CST4 levels were measured alongside traditional tumor markers, correlating with clinical data and patient outcomes. The cohort was divided into training and test sets at a ratio of 3:1 for Cox regression analyses, which identified CST4 as an independent risk factor for overall survival (OS) and disease-free survival (DFS). A prognostic model was developed, validated with calibration curves, and its predictive value was evaluated using receiver operating characteristic (ROC) curves. In addition, CST4 expression was correlated with immune cell infiltration using data from The Cancer Genome Atlas (TCGA). Patients were stratified by median CST4 levels, and Kaplan-Meier curves for OS and DFS were plotted. Results: Cystatin S was confirmed as an independent risk factor for OS and DFS. Integrating CST4 with traditional markers and TNM pathological staging significantly enhanced the predictive value for prognosis. Cystatin S’s impact on tumor progression is likely mediated through modulation of the immune microenvironment, including immune suppression and evasion. Conclusion: Cystatin S is an effective biomarker for GC prognostic assessment, assisting in the evaluation of prognosis and the selection of treatment strategies for patients with GC.
Transforming grayscale MRI images to color utilizing generative artificial intelligence to better understand multiple sclerosis
Authors: Okuda Darin T. , Lebrun-Frénay Christine 
Published: January 2025

Multiple sclerosis (MS) falls within the spectrum of central nervous system (CNS) demyelinating diseases that may lead to permanent neurological disability. Fundamental to the diagnosis and clinical surveillance is magnetic resonance imaging (MRI) that allows for the identification of T2-hyperintensities associated with autoimmune injury that demonstrate distinct spatial distribution patterns. Here, we describe the clinical experience of a 31-year-old, right-handed, White man seen in consultation at The University of Texas Southwestern Medical Center in Dallas, Texas, following complaints of headaches that began after head trauma related to military service. Imaging data spanning over 10 years are provided. All MRI data are currently presented in black and white with grayscale values within voxels associated with a single variable, intensity. We transformed these grayscale values into color using generative artificial intelligence (AI). As color allows for the inclusion of three variables: hue, lightness (intensity), and saturation, we hypothesized that additional details may be learned beyond those currently provided with the existing conventional approach of grayscale interpretation. We identified differences in lesion colors that remained consistent from the two MRI timepoints studied. In addition, quantitative R1, R2, and proton density voxel values appeared consistent with the color scheme generated by the AI system. With advancing AI methods and capabilities along with the additional data that color provides in comparison to grayscale, new insights into the biology of disease may be possible. Modifying what we measure in people with chronic conditions and how we present the data may be of greater value than conventional approaches typically used in the study, education, and care of people with MS and other neurological conditions.
Real-world evidence of ocrelizumab in Chilean patients with multiple sclerosis
Authors: del Canto Adolfo , Cárcamo Claudia , Garcia Lorena , Aylwin Ester , Jürgensen-Heinrich Lukas , Guzman-Carcamo Ignacio , de la Barra Juan , Gutierrez-Calquin Leticia , Barrera-Hormazabal Antonia , Cruz Juan Pablo , Bravo Sebastián , Pelayo Carolina , Soler Bernardita , Uribe-San-Martin Reinaldo , Ciampi Ethel 
Published: January 2025

Background: Real-world studies are needed to expand our knowledge concerning populations underrepresented in clinical trials. Objective: This study aimed to evaluate the safety and effectiveness of ocrelizumab in Hispanic/Latino people with multiple sclerosis (pwMS). Methods: Prospective longitudinal observational study including pwMS who received at least one dose of ocrelizumab between June 2018 and October 2023. Results: A total of 305 pwMS (223 relapsing–remitting MS (RRMS), 29 secondary progressive MS (SPMS), and 53 primary progressive MS (PPMS)), 67% female, mean age 38.7, mean disease duration 7 years, and median Expanded Disability Status Scale (EDSS) 2.0 (range 0–7). Median follow-up under ocrelizumab 29.5 (range 6–65) months. Only 1 patient had a relapse, 12-week-confirmed disability worsening was observed in 12.4% of the full cohort. Survival analysis showed higher risk of 12-week-confirmed disability worsening in SPMS compared with RRMS and PPMS ( p = 0.0009). Magnetic resonance imaging (MRI) activity was significantly reduced from baseline across all disease phenotypes. Serious infections were observed in 4.6%, and two patients died during follow-up (one serious COVID-19 and one metastatic cancer). Notably, 22 pregnancies were reported, with 11 newborns and 6 pregnancies still on course. Conclusion: This study supports the effectiveness of ocrelizumab in a real-world cohort of individuals from traditionally underrepresented groups, such as the Latin American population, with a consistent safety profile in patients receiving care at a specialized MS Unit.
Variable Imaging Appearances and Diagnostic Certainty Challenges in Confirming Pancreatic Neuroendocrine Tumours (NET): A Case Report
Authors: Bambhania Kamal J , Shorvon Dr Philip 
Published: January 2025

Introduction: A pancreatic neuroendocrine tumour (NET) originates from the neuroendocrine cells responsible for producing and releasing hormones. They are uncommon findings, mainly seen arising from the head of the pancreas and their appearances may vary among different imaging modalities. Case report: Interesting case of an asymptomatic patient with an incidental finding of a pancreatic lesion and its variable appearances across different modalities and final histology findings. Discussion: Ultrasound (US) is the most requested examination as an imaging modality due to its easy accessibility, affordability, and real time assessment feature. This case shows that ultrasound examination although deemed poor in assessing pancreas due to its location and overlying bowel gas, however, can play a vital role especially among asymptomatic patients. It discusses the range of differentials diagnoses including pancreatic NET, Gastrointestinal stromal tumour (GIST), adenocarcinoma, mucinous cystic neoplasm, and a pseudo papillary neoplasm due to variable imaging appearances of the pancreatic lesion on US and Magnetic Resonance Imaging (MRI). Results were reviewed in the Upper Gastrointestinal Multidisciplinary teams meeting and Endoscopic ultrasound scan (EUS) with tissue sampling was undertaken to confirm the diagnosis. The patient underwent prophylactic surgery, and the histology report concluded that the lesion to be a pancreatic NET. Conclusion: To conclude, we felt that sharing this interesting complex case was important as it highlights the difficulty in diagnostic certainty when dealing with a pancreatic lesion due to its variability in presentation on different modalities and the requirement of multidisciplinary team approach.
Hepatobiliary and pancreatic manifestations in inflammatory bowel disease: an umbrella review of meta-analyses
Authors: Hong Runsheng , Li Zhixue , Li Meng , Dai Yun 
Published: January 2025

Background: Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), can affect the hepatobiliary system and pancreas, substantially impacting the life quality of patients. Objectives: To evaluate the quality of evidence and comprehensively assess the validity of associations of IBD with hepatobiliary and pancreatic diseases. Design: We performed an umbrella review of existing meta-analyses in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) recommendations. Data sources and methods: We systematically searched PubMed, Embase, and Web of Science from inception to April 2024, to identify and appraise meta-analyses examining IBD and risk of hepatobiliary and pancreatic manifestations. Methodologic quality was assessed with A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) and the strength of evidence was graded according to prespecified criteria. Results: A total of 14 meta-analyses of observational studies were included. The strongest-validity evidence suggested the significant associations between IBD and risk of gallstones (odds ratio (OR) = 1.72; 95% confidence interval (CI) = 1.40–2.12) and acute pancreatitis (OR = 3.11; 95% CI = 2.93–3.30). Highly suggestive evidence indicated a significantly increased risk of hepatobiliary cancer in UC (incidence rate ratio (IRR) = 2.05; 95% CI = 1.52–2.76) and CD (IRR = 2.31; 95% CI = 1.25–4.28). In addition, highly suggestive evidence indicated that IBD was associated with portal venous system thrombosis. Suggestive evidence showed a significantly higher prevalence of primary sclerosing cholangitis, non-alcoholic fatty liver disease, autoimmune hepatitis, and autoimmune pancreatitis in IBD patients than in the general population. Conclusion: The associations between IBD and multiple hepatobiliary and pancreatic disorders showed varying levels of evidence and magnitude of risk. Further high-quality primary studies are needed to identify IBD patients who are more at risk and would benefit the most from screening and prevention programs. Trial registration (PROSPERO): CRD42023451461.
Impact of different treatments for chronic pain on cognitive function: A systematic review
Authors: Brennecke Allan Botura , Barreto Eduardo Silva Reis , Lins-Kusterer Liliane , Maria Torres de Araujo Azi Liana , Kraychete Durval 
Published: January 2025

Introduction Experimental evidence supports the hypothesis of reciprocal influence between neural systems involved in cognition and central pain processing circuits. Furthermore, studies have demonstrated bidirectional communication between central pain processing areas and the immune system, leading to changes in behaviour, sensory perception, mood, and cognition. However, the academic community has not yet reached a consensus on whether effective analgesic interventions can mitigate or reverse cognitive deterioration. Methods This systematic review evaluated the effectiveness of various therapeutic interventions in improving cognitive functions (primary outcome) and altering the profile of immunological markers (secondary outcome) in chronic pain patients. The review was limited to randomised controlled trials addressing chronic pain of any aetiology, with searches conducted in PubMed, EMBASE, and Scopus databases. Results The qualitative synthesis of twelve studies conducted between 2003 and 2021, involving 1432 participants in experimental ( n = 950) and control ( n = 482) groups, revealed some interesting patterns. Only half of the studies (6/12) reported cognitive improvement, with attention being the most analysed cognitive domain, followed by memory and executive function. Fibromyalgia was the most studied aetiology of chronic pain. The strategies of intervention/treatment and durations varied widely; however, milnacipran versus placebo emerged as the most frequently employed intervention. Only one study reported immunological markers, limiting the evaluation of this outcome. Conclusion Based on this analysis, it is not possible to affirm that interventions targeting chronic pain improve cognition. This review suggests new research directions and calls for more robust methodological approaches.
Appropriateness of Antiplatelet Therapy and Proton Pump Inhibitor Prescribing in End-Stage Kidney Disease: A Retrospective Quality Investigation Study
Authors: Che Michael , Ahmed Sumaiya , Chan Ryan , Akbari Ayub , Zimmerman Deborah 
Published: January 2025

Background: Patients with end-stage kidney disease (ESKD) have high rates of gastrointestinal bleeding due to several risk factors including platelet dysfunction, comorbid illness, and use of antiplatelet medications. Proton pump inhibitors (PPIs) reduce gastrointestinal bleeding and are recommended for high-risk patients such as those prescribed dual antiplatelet therapy (DAPT). Whether inappropriate duration of DAPT therapy and/or lack of appropriate PPI use contribute to the known elevated risk of gastrointestinal bleeding in hemodialysis patients is not known. Objectives: To determine whether patients with ESKD are appropriately prescribed DAPT and PPI therapy. Design: Retrospective cross-sectional, quality investigation. Setting: Satellite hemodialysis unit of a tertiary care center in Ontario, Canada. Patients: All patients with ESKD treated at a satellite hemodialysis unit of a tertiary care hospital. Measurements: Number of patients prescribed antiplatelets, PPIs, anticoagulants, non-steroidal anti-inflammatory drugs (NSAIDs), and corticosteroids; indications for aforementioned medications. Methods: A chart review was performed to elucidate patients’ medical history and pertinent medications. Patients’ indications for PPI and DAPT were extracted from their electronic medical records. Results: Out of 88 patients with ESKD treated with hemodialysis, 44 were on antiplatelet therapy (4 on DAPT), 1 on NSAID, 12 on corticosteroids, 7 on oral anticoagulants, 2 on histamine H2-receptor antagonists, and 39 on PPIs. Fourteen percent of PPI users had absolute indication for therapy. One patient in whom PPI therapy was indicated was not prescribed one. Out of 4 patients on DAPT, 3 had current indications for DAPT, whereas 1 had a prior indication. Limitations: Single-center study; medication lists obtained from electronic medical records not confirmed by patient interview. Conclusions: At the time of this study, 3% of patients with ESKD treated with hemodialysis had a current indication for DAPT. One patient prescribed DAPT no longer met indication for therapy and was reduced to single antiplatelet therapy. Only one patient with an absolute indication for PPI therapy had not been prescribed one. Overall, it appears that prescribing patterns of DAPT and PPI at our center are unlikely to be a major contributor to the known increased risk of gastrointestinal bleeding in patients treated with hemodialysis. However, this may not be true of all units; ensuring regular medication reviews are undertaken may enhance appropriate prescribing.
The Impact of Shared Auditors and Same Signing Auditors on Merger and Acquisition Decision-making
Authors: Du Lin 
Published: January 2025

This research examines how shared auditors and signing auditors influence the decision-making process in M&A. Using a comprehensive sample of Chinese A-share market M&A transactions from 2004 to 2020, we analyze how sharing the same audit firm or signing auditor influences the likelihood of completing an acquisition. The regression results reveal that firms with common auditors are more likely to achieve successful acquisitions. The effect is particularly pronounced for large acquirers, non-state-owned enterprises, cross-industry M&As, cross-province M&As, and those involving non-Big 4 audit firms. These findings are robust to various model specifications and adjustments. This paper extends the literature by demonstrating the dual-level (firm-level and individual-level) role of auditors as information intermediaries in M&A transactions. The results suggest that organizations and audit teams should consider the potential benefits of shared auditors in enhancing the quality and success of M&A deals. JEL Classification: M42