bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigating Quality of Life, Academic Resilience, and Influential Factors in Nursing Education: A Mixed-Methods Study among Nursing Students
Authors: Abou Hashish Ebtsam Aly , Bajbeir Erada , Almabadi Salwa Amer , Alzebali Nowr Dakhel , Alhubishi Shahad Fawzi 
Published: December 2024

Introduction Investigating the correlation between quality of life (QoL) and academic resilience (AR) and understanding their influencing factors is crucial for adequately preparing nursing students to navigate the challenges in their future professional careers. Objectives This research aims to investigate the relationship between QoL and AR among nursing students. Additionally, to explore factors influencing these variables from the students’ perspectives. Methods A mixed-methods design, incorporating both quantitative and qualitative data, was conducted at a Saudi nursing college. The quantitative data were collected through a cross-sectional design, with a convenience sample of 190 students completing the Brunnsviken Brief Quality of Life Scale (BBQ) and the Academic Resilience Scale (ARS-30). Simultaneously, qualitative data were collected using open-ended questions to gain insights into the factors influencing their QoL and AR, as well as the role of nursing education. The analysis involved inferential statistics and content analysis. Results The study revealed that Saudi nursing students reported a moderate level of both QoL and AR. A significant positive correlation indicates that AR explains around 34.0% of the variation in QoL (p < 0.005). The qualitative data identified various supportive and barrier factors impacting the QoL and AR of nursing students, and students reflected on the significant role of nursing educators and academic advising. Conclusion The findings hold implications for interventions such as establishing supportive educational environments, enhancing academic advising, implementing resilience-building and wellness programs, peer support initiatives, and encouraging social engagement—all essential strategies to bolster nursing students’ overall well-being, QoL, and AR.
Identifying and Prioritizing Ethical Challenges in Clinical Services of Patients With Confirmed COVID-19 in Iran's Hospitals
Authors: Keshavarz Mohsen , Mirmoghtadaie Zohrehsadat , Ahmadian Maliheh , Rasouli Davood 
Published: December 2024

Aim Since COVID-19 has set the state of health of the country in an emergency, it is natural that in such circumstances, violation of some principles of professional ethics is inevitable. This study aimed to identify and prioritize ethical challenges in the clinical services of patients with confirmed coronavirus disease in Iran's hospitals. Design This study was a mixed method with an exploratory sequential design. Methods This study was done in 2 qualitative and quantitative phases. In the qualitative phase, a systematized review was conducted and in the quantitative phase, a questionnaire of 35 questions based on the results of Phase 1 was formulated and completed. Results The challenges related to the provider of clinical services (physicians and nurses), the recipients of clinical services (patients), and the organizational challenges had the most significant importance, respectively ( P < .05, χ2 = 6.23).
The mediating role of behavioural and socio-structural factors on the association between household wealth and childhood malaria in Ghana
Authors: Habermann Theresa , Wafula Solomon T. , May Jürgen , Lorenz Eva , Puradiredja Dewi Ismajani 
Published: December 2024

Abstract
Background
Children under five continue to bear a disproportionate burden of malaria morbidity and mortality in endemic countries. While the link between socioeconomic position (SEP) and malaria is well established, the causal pathways remain poorly understood, hindering the design and implementation of more targeted structural interventions. This study examines the association between SEP and malaria among children in Ghana and explores the potential mediating role of behavioural and socio-structural factors.

Methods
Data from the Ghana Demographic and Health Survey (DHS) 2022 were analysed. As part of the survey, children were tested for malaria using a rapid diagnostic test (RDT), and SEP was measured using a household asset-based wealth index. Mediation analysis (MA) using a regression-based approach was performed to assess mediated effects between SEP and malaria in children under five in Ghana through housing quality, educational attainment (EA), long-lasting insecticidal net (LLIN) use, indoor residual spraying (IRS), and healthcare-seeking behaviour (HSB). Reported are the total natural indirect effects (TNIEs) and the proportion mediated (PM).

Results
Of the 3,884 children included in the survey, 19.4% (757) had malaria. Belonging to a household with high SEP was associated with a 43% lower risk of malaria (Prevalence Ratio, PR = 0.57; 95% Confidence Interval, CI 0.46–0.71). Regarding indirect (mediated) effects, maternal EA of secondary school or higher (OR = 0.68; 95% CI 0.60–0.77; PM = 17.5%), improved housing (OR = 0.80; 95% CI 0.68–0.91, PM = 9.2%), LLIN use (OR = 0.95; 95% CI 0.90–0.99, PM = 2.1%) partially mediated the association between SEP and malaria. The combined effect of all three mediators was higher than those in a single mediator or two sequential mediators (with EA as the initial mediator) (OR = 0.58; 95% CI 0.51–0.68, PM = 25.7%). No evidence of mediation was observed for HSB and IRS.

Conclusion
We found evidence of mediation by EA, housing, LLIN use and IRS, suggesting that current biomedical and behavioural malaria control efforts could be complemented with structural interventions, such as improved housing and education. Future studies that test the effect of different or joint effects of multiple mediators based on prospective designs are recommended to strengthen the evidence.
Factor validation of the International Trauma Questionnaire in a sample of trauma-exposed Colombian adults in the MI-VIDA study
Authors: Robinson Martin , Hanna Donncha , Bloch Natasha , Armour Chérie 
Published: December 2024

Background
The ICD-11 introduced a new diagnosis of complex post-traumatic stress disorder (CPTSD) defined by disturbances in self-organisation in addition to traditional post-traumatic stress disorder symptoms. The International Trauma Questionnaire (ITQ) is the established measure of this construct and has been validated for use in a variety of populations and languages; however, evidence for the measure's use in Latin America is limited.

Aims
This study sought to validate the factor structure of the Latin American Spanish version of the ITQ in a trauma-exposed sample in Colombia.

Method
Confirmatory factor analysis was used to assess a range of factor models validated previously, including first- and second-order factor models.

Results
Assessment of fit indices demonstrated that a correlated six-factor model comprised of re-experiencing, avoidance, sense of threat, affect dysregulation, negative self-concept and disturbed relationships provided the best fit for these data. Factor loadings for this model were found to be high and statistically significant.

Conclusion
Results concur with prior research validating the use of alternative language versions of the ITQ internationally, and with the theoretical underpinnings of the CPTSD diagnostic category. The ITQ is therefore a valid measure of CPTSD in this Latin American sample. Further validation research is needed in clinical populations in this region.
Prevalence and treatment of perinatal anxiety: diagnostic interview study
Authors: Ayers Susan , Sinesi Andrea , Meade Rose , Cheyne Helen , Maxwell Margaret , Best Catherine , McNicol Stacey , Williams Louise R. , Hutton Una , Howard Grace , Shakespeare Judy , Alderdice Fiona , Jomeen Julie ,   the MAP Study Team
Published: December 2024

Background
Anxiety affects around one in five women during pregnancy and after birth. However, there is no systematic information on the proportion of women with perinatal anxiety disorders who want or receive treatment.

Aims
To examine (a) the prevalence of anxiety disorders during pregnancy and after birth in a population-based sample, and (b) the proportion of women with anxiety disorders who want treatment and receive treatment.

Method
This study conducted 403 diagnostic interviews in early pregnancy (n = 102), mid-pregnancy (n = 99), late pregnancy (n = 102) or postpartum (n = 100). Participants also completed self-report measures of previous/current mental health problems and desire for treatment at every time point.

Results
The prevalence of anxiety disorders over all time points combined was 19.9% (95% CI 16.1–24.1), with greatest prevalence in early pregnancy (25.5%, 95% CI 17.4–35.1). The most prevalent disorders were obsessive–compulsive disorder (8.2%, 95% CI 5.7–11.3) and generalised anxiety disorder (5.7%, 95% CI 3.7–8.4). The majority of women with anxiety disorders did not want professional help or treatment (79.8%). Most women with anxiety disorders who did want treatment (20.2%) were receiving treatment. The majority of participants with anxiety disorders had a history of mental health problems (64.6%).

Conclusions
Prevalence rates overall are consistent with previous research, lending validity to the findings. However, findings challenge the assumption that everyone with a psychological disorder wants treatment. These findings highlight the importance of relationship-based care, where individual needs and contextual barriers to treatment can be explored.
SWOG S1815: A Phase III Randomized Trial of Gemcitabine, Cisplatin, and Nab-Paclitaxel Versus Gemcitabine and Cisplatin in Newly Diagnosed, Advanced Biliary Tract Cancers
Authors: Shroff Rachna T. , King Gentry , Colby Sarah , Scott Aaron J. , Borad Mitesh J. , Goff Laura , Matin Khalid , Mahipal Amit , Kalyan Aparna , Javle Milind M. , El Dika Imane , Tan Benjamin , Cheema Puneet , Patel Anuj , Iyer Renuka , Kelley R. Katie , Thumar Jaykumar , El-Khoueiry Anthony , Guthrie Katherine A. , Chiorean E. Gabriela , Hochster Howard , Philip Philip A. 
Published: December 2024

PURPOSE
SWOG S1815 was a randomized, open label phase III trial, evaluating gemcitabine, nab-paclitaxel, and cisplatin (GAP) versus gemcitabine and cisplatin (GC) in patients with newly diagnosed advanced biliary tract cancers (BTCs).

METHODS

Patients with newly diagnosed locally advanced unresectable or metastatic BTC, including intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC) and gallbladder carcinoma (GBC), were randomly assigned 2:1 to either GAP (gemcitabine 800 mg/m
2
, cisplatin 25 mg/m
2
, and nab-paclitaxel 100 mg/m
2
intravenously once per day on days 1 and 8 of a 21-day cycle) or GC (gemcitabine 1,000 mg/m
2
and cisplatin 25 mg/m
2
intravenously once per day on days 1 and 8 of a 21-day cycle).

RESULTS

Among 452 randomly assigned participants, 441 were eligible and analyzable, 67% with ICC, 16% with GBC, and 17% with ECC. There was no significant difference in overall survival (OS) between GAP versus GC. Median OS with GAP was 14.0 months (95% CI, 12.4 to 16.1) and 13.6 months with GC (95% CI, 9.7 to 16.6); hazard ratio (HR), 0.91 (95% CI, 0.72 to 1.14);
P
= .41. Median progression-free survival (PFS) was similar between groups with median PFS for GAP being 7.5 months (95% CI, 6.4 to 8.5) versus 6.3 months for GC (95% CI, 4.4 to 8.2); HR, 0.89 (95% CI, 0.71 to 1.12);
P
= .32. In exploratory subset analyses, the OS and PFS benefits of GAP versus GC treatment were greater in locally advanced disease compared with metastatic disease, although not statistically significant (interaction
P
= .14 for OS and
P
= .17 for PFS). Moreover, GAP versus GC showed greater improvement in PFS among participants with GBC than those with ICC or ECC (interaction
P
= .01), but not OS (interaction
P
= .28).

CONCLUSION
The addition of a taxane in the GAP regimen to the standard gemcitabine-cisplatin regimen did not improve OS in newly diagnosed BTC. More toxicity was encountered with GAP versus GC.
Biological Heterogeneity in Susceptibility to Glucocorticoid-Induced Bone Loss: Short- and Long-Term Hip BMD Trajectories
Authors: Hansen Benjamin Bakke , Hass Rubin Katrine , Vind Nielsen Catharina , Frost Nielsen Morten , Hermann Anne Pernille , Abrahamsen Bo 
Published: December 2024

Abstract

Context
Glucocorticoids (GCs) are widely used for their anti-inflammatory and immunosuppressive properties. Their effect on bone health is predominantly negative by decreasing bone formation and increasing risk of fractures.

Objective
This work aimed to quantify the short- and long-term changes in total hip bone mineral density (THBMD) after initiating systemic GC treatment in previously GC treatment-naive adults without bone protective agents.

Methods
An observational study was conducted using THBMD data from dual-energy x-ray absorptiometry (DXA). Individuals were stratified by sex and tertiles of GC exposure. Individuals not GC-exposed served as a reference group. Routine-care DXA scans were obtained from the main public hospitals servicing the Island of Funen in Denmark. A total of 15 099 adults underwent routine DXA at Odense University Hospital between 2006 and 2021. Data were enriched with Danish national registers. Intervention included systemic GCs (observational data). The short-term outcome included annualized THBMD changes between first 2 DXA scans. The long-term outcome included greater than 5% annualized THBMD loss over a 10-year follow-up.

Results
Strong associations between GC exposure and THBMD loss was found for both outcomes, with larger losses in the middle and upper tertiles of GC exposure. The risk of experiencing greater than 5% annualized THBMD loss was elevated, especially in the first 2 years of initiating GC treatment. There is significant heterogeneity in THBMD responses, with approximately 1 in 5 patients experiencing no nominal bone loss despite receiving upper tertile levels of GC exposure.

Conclusion
The findings confirm the association between initial GC exposure and significant bone loss. The heterogeneity in individual responses emphasizes the need for early monitoring and personalized approaches in managing bone health for patients undergoing GC treatment.
Experiences of clinicians working in the inpatient and community mental health care pathway for young people in the UK
Authors: Shah Ashika , Holland Josephine , Briley Paul M , Majumder Pallab 
Published: December 2024

Background/Aims Increases in the complexity, severity and risk level of patients referred to child and adolescent mental health services has put considerable pressure on bed availability in adolescent psychiatric hospitals, resulting in lengthy admission processes. This study aimed to explore clinicians' experiences of the admission process and transition between community and inpatient care for adolescents, with a view to informing improvement, allowing appropriate, timely admission and discharge and achieving better outcomes. Methods Two questionnaires were developed by the authors to collect data on their experiences of the admissions and discharge process to and from psychiatric inpatient wards. One questionnaire was designed for community clinicians (14 items) and one for inpatient teams (nine items), all working under child and adolescent mental health services. The questionnaires were distributed, completed and returned by eligible staff across six NHS trusts. A combination of multiple-choice and open-ended questions were used. Descriptive statistics were used to analyse quantitative data from the multiple-choice questions, while thematic analysis was used to analyse qualitative data from the open-ended questions and generate themes. Results Quantitative analysis showed that over half (54.0%) of community clinicians who had been involved in requesting an admission for a young person had received no, minimal or sporadic updates about the progress of the referral. Delays to the bed finding process meant that over a third (35.5%) of these clinicians had felt forced to call for a Mental Health Act assessment for a young person. Five themes were generated from the qualitative data: communication; issues with the admissions process (particularly with Form 1); benefits and drawbacks of technology; bed finding processes; and the importance of Form 1 for inpatient teams. Conclusions There is scope for improvement in the admissions process. Measures may include modifications to Form 1, holding regular meetings between community and inpatient teams, creating clearer bed finding and management processes and developing strategies for better risk management in the community while a young person waits for an inpatient bed.
Medicines management activity of advanced practice dietitians and therapeutic radiographers
Authors: Carey Nicola , Edwards Judith , Babashahi Saeideh , Stenner Karen 
Published: December 2024

Background: Recent changes have allowed advanced level UK dietitians and therapeutic radiographers to prescribe medicines. To date, there has been no comprehensive review of this evidence. Aim: To undertake a rapid review of the role advanced practice dietitians and therapeutic radiographers have in relation to medicines management. Method: Searches of MEDLINE, CINAHL and economic databases were conducted for literature published from 1968–November 2023. Registered with Figshare, a narrative synthesis following PRISMA guidelines was undertaken. Findings: Twenty articles revealed a dearth of literature evaluating advanced practice or prescribing in either profession. A lack of clarity regarding advanced practice roles led to ambiguity and hindered implementation. Conclusion: There is a lack of evidence evaluating dietitian and therapeutic radiographer advance practice or prescribing. Urgent evaluation of dietitian and therapeutic radiography advanced practice, including prescribing, is required if their contribution to alleviating workforce shortages is to be better understood.
The acute management of Pilon fractures (ENFORCE) study: a national evaluation of practice
Authors: Hill DS , Davis JR ,   ENFORCE Collaborative
Published: December 2024

Introduction Pilon fractures are potentially limb-threating injuries. Staged soft tissue damage control is described, but actual practices are unknown. We report a national trainee collaborative evaluating how tibial Pilon fractures are acutely managed. Methods ENFORCE was a multicentre retrospective observational study of the acute management of tibial Pilon fractures over a three-year period. Mechanism of injury, imaging, fracture classification, time to cast application, soft tissue damage control strategy and definitive management details were determined. Results A total of 656 patients (670 fractures) across 27 centres were reported. AO fracture classifications were: partial articular (n=294) and complete articular (n=376). Initial diagnostic imaging mobilities were plain radiographs (n=602) and a trauma computed tomography (CT) scan (n=54). A total of 526 fractures had a cast applied in the emergency department (91 before radiological diagnosis), with the times taken to obtain postcast imaging being: mean 2.7 hours, median 2.3 hours and range 28 minutes–14 hours. 35% (102/294) of partial articular and 57% (216/376) of complete articular fractures had a spanning external fixator applied, all of which underwent a planning CT scan. Definitive management consisted of open reduction internal fixation (n=495), fine wire frame (n=86), spanning external fixator (n=25), intramedullary nail (n=25) or other (n=18). Conclusion The management of tibial Pilon fractures is variable, with just over half of complete articular fractures managed with the gold standard ‘span, scan, plan’ staged soft tissue resuscitation. A national standard of care would increase the profile and standardise management of these potentially limb-threatening injuries, together with setting them apart from more straightforward ankle fractures.
Design and analysis of highly birefringent porous core photonic crystal fibers for terahertz applications
Authors: Bastida Gabriel C. , Castellani Carlos E. S. , Coelho Elizandra P. R. , Segatto Marcelo E. V. 
Published: December 2024

Here, we propose and numerically analyze the performance of two different designs of porous core photonic crystal fibers (PC-PCFs) projected for terahertz (THz) wave transmission, exploring the design malleability property of PCFs with the purpose of comprehending how structural changes in fiber core affect its propagation parameters, namely, the birefringence, losses, nonlinearity, V-parameter, and dispersion over the propagation bandwidth. The propagation characteristics were investigated by using the finite difference eigenmode solver from Ansys Lumerical software. Our results shown a high dependence of the fiber birefringence and dispersion with respect to the core porosity, suggesting the simplicity in reshaping its curves just by adjusting the core hole radius. Total transmission losses also could be decreased to admissible values close to 0.40 dB/cm, at 1.02 THz, by changing core porosity. Furthermore, both fibers have easily manufactured designs based only in circular air holes, providing polarization-maintaining applications with one of the lowest reported dispersion and acceptable losses.
Presence of Trypanosoma cruzi (TcI) in different tissues of Didelphis virginiana from the metropolitan area of Merida, southeastern Mexico: Epidemiological relevance and implications for non-vector transmission routes
Authors: Martínez-Vega Pedro Pablo , Rivera-Pérez Marian , Pellegrin Gabrielle , Amblard-Rambert Antoine , Calderón-Quintal Jorge Andrés , Barnabé Christian , Teh-Poot Christian , Ruiz-Piña Hugo , Ortega-Pacheco Antonio , Waleckx Etienne 
Published: December 2024

Background
Trypanosoma cruzi is mainly transmitted to mammals by vectors, but other transmission routes exist. For example, opossums can harbor the infectious form of the parasite in their anal glands, underscoring their potential role in non-vectorial transmission. T. cruzi has been detected in the anal gland secretions of various opossum species, and their infectivity has been confirmed in Didelphis marsupialis and D. albiventris. Vertical transmission has also been proposed in D. virginiana. However, if this occurs in opossums, it remains unclear whether it happens during pregnancy or lactation. In Mexico, Didelphis virginiana and D. marsupialis are the main opossum species. Our objective was to investigate the possible contribution of urban opossums to non-vectorial transmission of T. cruzi in the metropolitan area of Merida, Yucatan, in southeastern Mexico.

Methodology/principal findings
Blood, anal gland secretions, and milk were collected from opossums captured in Merida, Mexico, all identified as D. virginiana using taxonomic keys and Cytb sequencing. By PCR, T. cruzi was detected in 16/102 opossums (15.69%) in at least one type of sample. The prevalence was 14.71% (15/102) in blood and 0.98% (1/102) in anal gland secretions. 1/22 milk samples (4.55%) tested positive. Blood of 37 offspring from T. cruzi-positive mothers was collected and tested negative. qPCR revealed that females with offspring tended to have lower parasite load in blood compared to females without offspring and males. Genotyping of the parasite through multiplex PCR revealed only the DTU TcI.

Conclusions/significance
This study agrees with previous works where D. virginiana was the most abundant opossum species in urban areas in southeastern Mexico and confirms that it is associated with TcI. Detection of T. cruzi in a sample of anal gland secretions underscores the potential risk represented by D. virginiana in non-vectorial transmission in urban areas of southeastern Mexico. Detection in the milk of a lactating female, along with the observed tendency towards a lower parasite load in females with offspring, highlight the importance of further investigating vertical transmission in D. virginiana.