bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of neighbourhood-level social determinants of health on healthcare utilisation and perinatal outcomes in pregnant women with NAFLD cirrhosis: a population-based study in Ontario, Canada
Authors: Holdsworth Mary B , Djerboua Maya , Flemming Jennifer A 
Published: September 2023

BackgroundCirrhosis is rising in North America, driven partly by the epidemic of non-alcoholic fatty liver disease (NAFLD), most in women of reproductive age. Little is known about factors that impact perinatal outcomes and healthcare utilisation in pregnant women with NAFLD cirrhosis.ObjectivesWe investigated the association between population-level social determinants, health outcomes and healthcare utilisation.MethodsWe retrospectively analysed healthcare utilisation and perinatal outcomes in a cohort of pregnant women with NAFLD cirrhosis from Ontario, Canada from 2000 to 2016 and followed for 90 days postdelivery. We compared utilisation and health outcomes according to income, residential instability, material deprivation, dependency and ethnic diversity. A Cochran-Armitage test for trend was done to assess whether utilisation patterns were linear across quintiles.Results3320 pregnant women with NAFLD cirrhosis formed the study cohort. Decreasing income quintile associated with a higher proportion of women with at least one emergency department (ED) visit. Increasing residential instability, material deprivation and dependency were associated with a higher frequency of ED visitation, with no compelling differences in the rates of perinatal complications or adverse outcomes in pregnant women with NAFLD cirrhosis. Using multiple population-level proxies for social determinants of health, this study demonstrates an association between marginalisation and increased ED visitation.ConclusionsAs the incidence rate of pregnancies among women with NAFLD cirrhosis continues to rise, understanding how this population uses healthcare services will help coordinate care for these patients.
Serum interferon-alpha predicts in-hospital mortality in patients hospitalised with acute severe lupus
Authors: Yerram Keerthi Vardhan , Baisya Ritasman , Kumar Phani , Mylavarapu Rammohan , Rajasekhar Liza 
Published: September 2023

ObjectivesDysregulation of interferon-alpha (IFN-α) is considered central to the immunological abnormalities observed in SLE. Short-term mortality during high disease activity in lupus is up to 30%. Adenovirus vector-introduced IFN-α into a lupus-prone mouse causes the development of glomerulonephritis and death within weeks. We studied serum IFN-α as a biomarker of in-hospital mortality in patients of SLE with high disease activity.MethodsSerum IFN-α (ELISA) was measured in patients hospitalised for acute severe lupus in a tertiary care rheumatology unit in India and the levels were compared between survivors and non-survivors. Serum IFN-α was compared with traditional clinical and serological markers associated with disease activity to assess which better prognosticates survival.ResultsIn a cohort of 90 patients with a mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) of 19.3 (±5.5), the mean serum IFN-α was 88±144 pg/dL. Levels were undetectable in patients with inactive disease. SLEDAI, anti double stranded DNA (dsDNA) antibody titres and serum IFN-α levels were higher and serum complement (C3) lower in non-survivors (p=0.003, p=0.017, p<0.001, p=0.029, respectively). Serum IFN-α level of 140 pg/mL had a sensitivity of 86.7%, specificity of 94.6%, positive predictive value of 76% and negative predictive value of 83.3% (p<0.001) in predicting mortality. The area under the curve for predicting in-hospital mortality was 0.25 for C3, 0.72 for dsDNA, 0.77 for SLEDAI and 0.92 for serum IFN-α.ConclusionsSerum IFN-α was better in predicting in-hospital mortality compared with conventional measures of disease activity such as anti-dsDNA, complements and SLEDAI.
Failure of an inactivated vaccine against porcine reproductive and respiratory syndrome to protect gilts against a heterologous challenge with prrsv
Authors: Scortti M. , Prieto C. , Álvarez E. , Simarro I. , Castro J. M. 
Published: September 2023

This study was designed to evaluate the efficacy of an inactivated vaccine based on a European‐type strain of porcine reproductive and respiratory syndrome virus (prrsv) against the reproductive form of the syndrome in breeding gilts, and any congenital disease in their piglets. Five gilts were vaccinated twice, following the manufacturer's instructions, before they were inseminated. Nine additional gilts remained unvaccinated and served as positive (five gilts) and negative (four gilts) controls. A European wild‐type strain genetically divergent from the vaccine strain was used to challenge the five vaccinated and five unvaccinated positive control gilts at 90 days' gestation. The vaccination of the five seronegative gilts did not produce any clinical signs or adverse reactions. However, the vaccine failed to prevent the clinical signs associated with prrsv infection, viraemia after the challenge and transplacental infection of their piglets. The reproductive performance of the vaccinated gilts was similar to that of the unvaccinated positive controls, and there were no statistically significant differences in most of the parameters tested. However, the preweaning mortality of the piglets born to the vaccinated gilts was significantly lower than that of the piglets born to the positive control gilts.
Providing Realtime Support for Containerized Edge Services
Authors: Zhang Wenzhao , Gao Yi , Dong Wei 
Published: September 2023

Containers have emerged as a popular technology for edge computing platforms. Although there are varieties of container orchestration frameworks, e.g., Kubernetes to provide high-reliable services for cloud infrastructure, providing real-time support at the containerized edge systems (CESs) remains a challenge. In this paper, we propose
EdgeMan
, a holistic edge service management framework for CESs, which consists of (1) a model-assisted event-driven lightweight online scheduling algorithm to provide request-level execution plans; (2) a bottleneck-metric-aware progressive resource allocation mechanism to improve resource efficiency. We then build a testbed that installed three containerized services with different latency sensitivities for concrete evaluation. Additionally, we adopt real-world data traces from Alibaba and Twitter for large-scale emulations. Extensive experiments demonstrate that the deadline miss ratio of time-sensitive services run with
EdgeMan
is reduced by 85.9% on average compared with that of existing methods in both industry and academia.
“Let's Call a Spade a Spade. My Barrier is Being a Black Student”: Challenges for Black Undergraduate Nursing Students in a Western Canadian Province
Authors: Luhanga Florence , Maposa Sithokozile , Puplampu Vivian , Abudu Eunice 
Published: September 2023

Background We need more understanding of experiences that hinder or promote equity, diversity, and inclusion of Black students in undergraduate nursing programs to better inform their retention and success. Purpose To explore documented experiences of Black undergraduate nursing students, review barriers affecting their retention and success, and suggest evidence-based strategies to mitigate barriers that influence their well-being. Methods We used a focused qualitative ethnography for recruiting Black former and current students (N = 18) in a Western Canadian province's undergraduate nursing programs via purposive and snowball sampling. Most participants were female, 34 years or younger, with over 50% currently in a nursing program. Five participants later attended a focus group to further validate the findings from the individual interviews. Descriptive statistics were used to describe participant characteristics; we applied a collaborative constant comparison and thematic analysis approach to their narratives. Results Challenges influencing Black students’ retention and success fell into four main interrelated subthemes: disengaging and hostile learning environments, systemic institutional and program barriers, navigation of personal struggles in disempowering learning environments, and recommendations to improve the delivery of nursing programs. Participants also recommended ways to improve diversity and mitigate these barriers, such as nursing programs offering anti-oppression courses, platforms for safe/healthy dialogue, and more culturally sensitive learning-centered programs and responsive supports. Conclusions The study findings underscore the need for research to better define nursing program conditions that nurture safe, learning-centred environments for Black students. A rethink of non-discriminatory, healthy learning–teaching engagements of Black students and the mitigation of anti-Black racism can best position institutions to promote equity, diversity, and inclusion of Black students.
Combination of Nicorandil and Beta-Adrenergic Receptor Blockers in Patients with Coronary Artery Disease: A Real-World Observational Study
Authors: Cheng Jia , Qiu Lin , Zhang Zixuan , Li Na , Shu Hongyang , Xiao Zhichao , Zhou Ning 
Published: September 2023

Background The effect of combined nicorandil and beta-adrenergic receptor blockers (BBs) compared with that of BBs alone on long-term clinical outcomes in patients with coronary artery disease (CAD) remains undetermined. Methods A multicenter retrospective cohort study was performed. Adult patients who had been hospitalized for CAD and treated for angina with a combination of nicorandil and BBs or BBs alone were included. The effect of different treatments on the cumulative incidence of major adverse cardiovascular event (MACE) and their components within a follow-up duration of 2.5 years were analyzed using Kaplan–Meier survival curves. An inverse probability of treatment weighting (IPTW) method was used to adjust for the possible effect of confounding factors. Results A total of 137,714 patients were screened, of whom 16,912 individuals (mean age: 61.5 years, men: 67.1%) were successfully enrolled. Among the enrolled participants, 4669 received the combined treatment of nicorandil and BBs, while 12,243 received BBs alone. After IPTW, the results demonstrated that the combined treatment was associated with a significantly reduced incidence of MACE (hazard ratio [HR] 0.79, 95% conidence interval [CI] 0.72-0.87) and stroke (HR 0.48, 95% CI 0.42-0.54) but not of MI (HR 1.03, 95% CI 0.92-1.15) or all-cause mortality (HR 0.93, 95% CI 0.64-1.37). Sensitivity analyses revealed similar results. Conclusions A combined antiangina treatment of nicorandil and BBs may be more effective than treatment of BBs alone in reducing the long-term incidence of MACE in patients with CAD.
Comprehensive geriatric assessment in older vascular patients in a tertiary hospital
Authors: Shi Min Chau Christine , Lin Huimin , Li Fuyin , Villan Sigaya Kenneth 
Published: September 2023

Background Comprehensive Geriatric Assessment (CGA) is a validated multidomain assessment of an older person’s myriad issues that has shown positive medical outcomes in surgical settings. However, there is paucity of evidence in older Vascular inpatients. Objectives To determine if a Geriatric Liaison Service using CGA improves medical outcomes in older Vascular inpatients in Singapore. Methods This is a quality improvement prospective cross-sectional study. Vascular patients aged ≥65 years admitted between November 2018 to October 2019 were referred to the Vascular-Geriatric Service (VGS) at the surgeon’s discretion if they had acute medical issues, cognitive concerns, or functional decline. Patients admitted under Vascular Surgery during the preceding year but not referred to VGS were used as control. A pre- and post-analysis was conducted for outcomes of medical complications, while a multivariate analysis was done to look at LOS, 30-day unplanned medical readmissions and 30-day mortality rates. Results Patients had significantly lower rates of pneumonia (2.2% vs 10.8%, p = .021) and delirium (1.1% vs 18.3%, p < .001) post-VGS compared to pre-VGS. VGS decreased the odds of 30-day mortality by 79% as compared to the control group (OR = 0.21, 95% CI: 0.05-0.86, p = .030). The intervention group had increased risk of a longer hospital stay by 48% as compared to control (RR: 1.48 95% CI: 1.11 to 1.97, p = .008). Conclusions VGS was associated with reduction in some medical complications, and 30-day mortality in older frail Vascular inpatients with multimorbidity.
COVID-19 Vaccine Acceptance Among Healthcare Students in Vietnam, Based on Health Belief Model
Authors: Tieu Mai Diep Thi , Thuy Pham Thi 
Published: September 2023

Introduction Healthcare students have a high risk of acquiring COVID-19 while practicing in medical facilities, and their health-related decisions might considerably impact the people around them. In the circumstance of many people refusing vaccination, the delay in accepting the COVID-19 vaccine by this group could be a barrier to providing effective immunity to the entire population against the COVID-19 pandemic. Objective The study aimed to assess the prevalence of vaccination acceptance and the factors influencing COVID-19 vaccine acceptance among Vietnamese healthcare students. Methods A web-based cross-sectional study was conducted among 384 respondents. The chi-square, Fisher's exact, and Mann–Whitney tests were used to assess the association between independent and dependent variables. Binary logistic regression analysis was used to identify the potential determinants of COVID-19 vaccine acceptance. Variables with p values of less than .05 at the 95% confidence interval were considered significant variables. Results Out of 384 participants, 91.7% accepted COVID-19 vaccination. Nurse and midwife (odds ratio [OR] = 6.81, confidence interval [CI] = 2.02–22.94, p < .01), perceived normal health status (OR = 15.22, CI = 2.74–84.66, p < .001), perceived good health status (OR = 149.00, CI = 11.08–2003.42, p < .01), COVID-19 infection among relatives or friends (OR = 4.19, CI = 1.77–9.95, p < .01) were predictors for the COVID-19 vaccine acceptance. Participants were less likely to accept COVID-19 vaccination if they reported greater perceived barriers (OR = 0.80, CI = 0.69–0.93, p < .01). Conclusion The current study offers helpful information on the factors influencing vaccine acceptance based on the Health Belief Model. The findings could benefit policymakers in establishing effective campaigns to improve the acceptance rate of the COVID-19 vaccine among healthcare students and shorten the time required to achieve herd immunity.
Effect of a Commercial NCLEX-RN Preparation Product on First Time Pass Rates
Authors: Lewis Lisa Scandale , Willingham Tonya , Myers John , Hatch Daniel 
Published: September 2023

Introduction Passing the National Council Licensure Exam-Registered Nurse (NCLEX-RN) is the entry into the profession for nurses, and rates of passing the exam on the first attempt are used as an important outcome measure for schools, students, and accrediting agencies. Objective This study was conducted in order to investigate if a commercial NCLEX-RN test preparation product impacted first time pass rates. Methods Data were collected from 688 students from six institutions who were taking the NCLEX-RN for the first time. The intervention group (n = 396) received a 6-month subscription to a commercial product with which to prepare for the NCLEX-RN, and was compared to the control group (n = 292) to test for differences in demographics and test pass rates. Results The intervention group was more likely to be younger than 25 years of age (n = 160, 55.8% vs. n = 76, 34.6%; p < .001) when compared with the control group. No other significant differences in demographics or NCLEX-RN pass rates were observed between the groups. Conclusion and Recommendations This study failed to demonstrate a change in the likelihood of passing NCLEX-RN on the first attempt in a group of students who used a commercial test preparation product. We recommend that instructor-guided use of a test-preparation product, along with other interventions to support test success, be considered in creating an individualized plan for nursing students preparing for NCLEX-RN.
Patients’ Perception Towards Quality of Nursing Care and Associated Factors at Agaro General Hospital, Southwest Ethiopia: A Cross-Sectional Study
Authors: Yesuf Mohammed , Abdu Mehd 
Published: September 2023

Introduction Quality care is currently on the agenda of policy-makers at national and international levels. Patient-centeredness is considered an integral component of healthcare quality dimensions in addition to its effectiveness and safety. This indicates that healthcare should be viewed from a patient's perspective. Methods and Materials An institution-based cross-sectional study was conducted with a total sample size of 422 using systematic random sampling among patients admitted to the Agaro General Hospital. SPSS software version 25.0 was used to enter and analyze the data. The relationship between the dependent variable and covariates was determined using multivariable binary logistic regression analysis. Results A total of 405 patients participated in this study with a response rate of 96.0%. The overall percentage of positive perception was 76.3%. Clients aged 31–40 years were more likely [AOR: 2.191, 95% CI: 1.033–4.645, p-value: .041] and clients aged ≥ 51 years were less likely to perceive positively [AOR: 0.490, 95% CI: 0.271–0.886, p-value: .018]. Patients who had paid for receiving care were more likely to perceive it positively [AOR: 3.046, 95% CI 1.043–8.896, p-value: .042]. The odds of positive perception towards the quality of nursing care were higher among patients who thought the hospital cost was medium [AOR: 3.066, 95% CI: 1.286–7.311, p-value: .012], low [AOR: 13.859, 95% CI: 2.245–85.562, p-value: .005], and uncertain [AOR: 6.116, 95% CI: 1.988–18.809, p-value: .002]. Conclusion and Recommendations Most patients had a positive perception of the quality of nursing care. Being elderly and feeling towards hospital costs have a negative influence whereas having paid for the treatment has a positive influence on the patients’ perception of nursing care. Hence the need increases with age, and healthcare providers should pay great attention while providing care for elderly patients.
Characterizing end-of-life communication in families
Authors: Horning Melanie A. , Bowen Mary Elizabeth 
Published: September 2023

Background: The chronic disease course can be uncertain, contributing to delayed end-of-life discussion within families resulting in missed opportunity to articulate wishes, increased decisional uncertainty, and delayed hospice care. Consistent with the Family Communication Patterns Theory (FCPT), family communication patterns may affect the quality and timing of end-of-life discussion, hospice utilization, and the experience of ‘a good death.’ Objective: To assess how families’ conversation and conformity orientation (spontaneity of conversation and hierarchical rigidity) form four family communication patterns (consensual, pluralistic, protective, and laissez-faire) and may be associated with the number and timing of end-of-life discussions. Design: A cross-sectional study. Methods: Family members of loved ones who died from chronic illnesses while in hospice ( n = 56) completed online surveys including a modified Revised Family Communication Pattern instrument (RFCP) and the Chronic Illness Rating Scale (CIRS). Additional survey questions assessed the number and timing of end-of-life discussions and timing of hospice enrollment. IBM SPSS version 26 was used for descriptive analysis. Results: Most families (42.9%) were pluralistic, reporting communication styles with high conversation and low conformity orientation; (39.29%) were protective, reporting low conversation and high conformity orientation. Pluralistic families had more end-of-life conversations than did protective families. Conclusion: Study findings suggest that there may be a relationship between family communication pattern type and inclination toward end-of-life discussion. This first step supports future research regarding whether the FCPT can be used to predict which families may be at increased risk for ineffective or delayed end-of-life discussion. Additional variables to consider include the timing of hospice enrollment and the quality of the dying experience. Clinicians may ultimately use findings to facilitate earlier identification of and intervention for families who are at risk for poor end-of-life communication and outcomes.
Delayed intracranial hemorrhage after head trauma seems rare and rarely needs intervention—even in antiplatelet or anticoagulation therapy
Authors: Bergenfeldt Henrik , Forberg Jakob Lundager , Lehtinen Riikka , Anefjäll Ebba , Vedin Tomas 
Published: September 2023

Abstract
Background
Traumatic brain injury causes morbidity, mortality, and at least 2,500,000 yearly emergency department visits in the USA. Computerized tomography of the head is the gold standard to detect traumatic intracranial hemorrhage. Some are not diagnosed at the first scan, and they are denoted “delayed intracranial hemorrhages. ” To detect these delayed hemorrhages, current guidelines for head trauma recommend observation and/or rescanning for patients on anticoagulation therapy but not for patients on antiplatelet therapy. The aim of this study was to investigate the prevalence and need for interventions of delayed intracranial hemorrhage after head trauma.

Methods
The study was a retrospective review of medical records of adult patients with isolated head trauma presenting at Helsingborg General Hospital between January 1, 2020, and December 31, 2020. Univariate statistical analyses were performed.

Results
In total, 1627 patients were included and four (0.25%, 95% confidence interval 0.06–0.60%) patients had delayed intracranial hemorrhage. One of these patients was diagnosed within 24 h and three within 2–30 days. The patient was diagnosed within 24 h, and one of the patients diagnosed within 2–30 days was on antiplatelet therapy. None of these four patients was prescribed anticoagulation therapy, and no intensive care, no neurosurgical operations, or deaths were recorded.

Conclusion
Traumatic delayed intracranial hemorrhage is rare and consequences mild and antiplatelet and anticoagulation therapy might confer similar risk. Because serious complications appear rare, observing, and/or rescanning all patients with either of these medications can be debated. Risk stratification of these patients might have the potential to identify the patients at risk while safely reducing observation times and rescanning.