bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a novel instrument for assessing intentional non-adherence to official medical recommendations (iNAR-12): a sequential mixed-methods study in Serbia
Authors: Purić D , Petrović M B , Živanović M , Lukić P , Zupan Z , Branković M , Ninković M , Lazarević L B , Stanković S , Žeželj I 
Published: June 2023

ObjectivesWe aimed to (1) develop a novel instrument, suitable for the general population, capturing intentional non-adherence (iNAR), consisting of non-adherence to prescribed therapy, self-medication and avoidance of seeking medical treatment; (2) differentiate it from other forms of non-adherence, for example, smoking; and (3) relate iNAR to patient-related factors, such as sociodemographics, health status and endorsement of irrational beliefs (conspiratorial thinking and superstitions) and to healthcare-related beliefs and experiences ((mis)trust and negative experiences with the healthcare system, normalisation of patient passivity).DesignТо generate iNAR items, we employed a focus group with medical doctors, supplemented it with a literature search and invited a public health expert to refine it further. We examined the internal structure and predictors of iNAR in an observational study.SettingData were collected online using snowball sampling and social networks.ParticipantsAfter excluding those who failed one or more out of three attention checks, the final sample size was n=583 adult Serbian citizens, 74.4% female, mean age 39.01 years (SD=12.10).Primary and secondary outcome measuresThe primary, planned outcome is the iNAR Questionnaire, while smoking was used for comparison purposes.ResultsFactor analysis yielded a one-factor solution, and the final 12-item iNAR Questionnaire had satisfactory internal reliability (alpha=0.72). Health condition and healthcare-related variables accounted for 14% of the variance of iNAR behaviours, whereas sociodemographics and irrational beliefs did not additionally contribute.ConclusionsWe constructed a brief yet comprehensive measure of iNAR behaviours and related them to health and sociodemographic variables and irrational beliefs. The findings suggest that public health interventions should attempt to improve patients' experiences with the system and build trust with their healthcare practitioners rather than aim at specific demographic groups or at correcting patients’ unfounded beliefs.Study registrationThe design and confirmatory analyses plan were preregistered (https://osf.io/pnugm).
Preferences of patients with diabetes mellitus for primary healthcare institutions: a discrete choice experiment in China
Authors: Lv Yuyu , Qin Jingzhu , Feng Xia , Li ShunPing , Tang Chengxiang , Wang Haipeng 
Published: June 2023

ObjectivesTo quantify the preference of patients with diabetes mellitus (DM) for primary healthcare (PHC) institutions in China to redirect the patient flow and improve health outcomes.DesignCross-sectional study. Discrete choice experiment (DCE) surveys asked patients with DM to choose between hypothetical institutions that differed in the medical service capacity, out-of-pocket (OOP) medical costs per month, travel time, the attitude of medical staff and the availability of diabetes drugs.SettingShandong province, China.ParticipantsThe participants were 887 patients with DM from 36 urban communities and 36 rural villages in Shandong province. One participant did not provide any DCE answers and a further 57 patients failed the internal consistency test. 829 fully completed surveys were included in the final data analysis.Main outcomes and measuresA mixed logit model was used to calculate the willingness to pay and predict choice probabilities for PHC institution attributes. Preference heterogeneity was also investigated.ResultsAll five attributes were associated with the preferences of patients with DM. The OOP medical costs and the medical service capacity were the most influential attributes. Improvements simultaneously in the attitude of medical staff, drug availability and travel time increased the likelihood of a patient’s PHC institution choice. Preferences differed by region, annual household income and duration of diabetes.ConclusionsOur patient preference data may help policymakers improve health services and increase acceptance of choosing PHC institutions. The OOP medical costs and medical service capacity should be regarded as a priority in decision-making.
Longitudinal trajectories of sedation level and clinical outcomes in patients who are mechanically ventilated based on a group-based trajectory model: a prospective, multicentre, longitudinal and observational study in Korea
Authors: Hyun Dong-gon , Ahn Jee Hwan , Gil Ha-Yeong , Nam Chung Mo , Yun Choa , Lim Chae-Man 
Published: June 2023

ObjectivesChanges in sedation levels over a long time in patients who are mechanically ventilated are unknown. Therefore, we investigated the long-term sedation levels of these patients by classifying them into different longitudinal patterns.DesignThis was a multicentre, prospective, longitudinal, and observational study.SettingTwenty intensive care units (ICUs) spanning several medical institutions in Korea.ParticipantsPatients who received mechanical ventilation and sedatives in ICU within 48 hours of admission between April 2020 and July 2021.Primary and secondary outcome measuresThe primary objective of this study was to identify the pattern of sedation practice. Additionally, we analysed the associations of trajectory groups with clinical outcomes as the secondary outcome.ResultsSedation depth was monitored using Richmond Agitation-Sedation Scale (RASS). A group-based trajectory model was used to classify 631 patients into four trajectories based on sedation depth: persistent suboptimal (13.2%, RASS ≤ −3 throughout the first 30 days), delayed lightening (13.9%, RASS ≥ −2 after the first 15 days), early lightening (38.4%, RASS ≥ −2 after the first 7 days) and persistent optimal (34.6%, RASS ≥ −2 during the first 30 days). ‘Persistent suboptimal’ trajectory was associated with delayed extubation (HR: 0.23, 95% CI: 0.16 to 0.32, p<0.001), longer ICU stay (HR: 0.36, 95% CI: 0.26 to 0.51, p<0.001) and hospital mortality (HR: 13.62, 95% CI: 5.99 to 30.95, p<0.001) compared with ‘persistent optimal’. The ‘delayed lightening’ and ‘early lightening’ trajectories showed lower extubation probability (HR: 0.30, 95% CI: 0.23 to 0.41, p<0.001; HR: 0.72, 95% CI: 0.59 to 0.87, p<0.001, respectively) and ICU discharge (HR: 0.44, 95% CI: 0.33 to 0.59, p<0.001 and HR: 0.80, 95% CI: 0.65 to 0.97, p=0.024) compared with ‘persistently optimal’.ConclusionsAmong the four trajectories, ‘persistent suboptimal’ trajectory was associated with higher mortality.
Association of obstructive sleep apnoea with long-term cardiovascular events in patients with acute coronary syndrome with or without hypertension: insight from the OSA-ACS project
Authors: Wang Ge , Miao Huangtai , Hao Wen , Zhao Guanqi , Yan Yan , Gong Wei , Fan Jingyao , Ai Hui , Que Bin , Wang Xiao , Nie Shaoping 
Published: June 2023

BackgroundA close relationship exists between obstructive sleep apnoea (OSA) and hypertension. However, the impact of hypertension on the prognostic significance of OSA in patients with acute coronary syndrome (ACS) remains unclear.MethodsThis is a post hoc analysis of the OSA-ACS project, which consecutively included patients with ACS and receiving overnight sleep study from June 2015 to January 2020. OSA was defined as AHI ≥15 events/hour. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), including a composite of cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularisation or hospitalisation for unstable angina or heart failure.ResultsA total of 1927 patients with ACS were finally enrolled in this study. The mean patient age was 56.4±10.5 years. Among them, 1247 (64.7%) patients had hypertension, and 1014 (52.6%) patients had OSA. During 2.9 (1.5, 3.6) years of follow-up, OSA was associated with an increased risk of MACCE among patients with hypertension (HR=1.35, 95% CI 1.04 to 1.75, p=0.02), but not in patients without hypertension (HR=1.15, 95% CI 0.79 to 1.68, p=0.47). The interaction between OSA and hypertension for MACCE was not statistically significant (interaction p=0.29). For patients with pre-existing hypertension, OSA was associated with an increased risk of MACCE only among those with grade 3 hypertension (HR 1.54, 95% CI 1.12 to 2.13, p=0.008), but not those with grade 1 or 2 hypertension.ConclusionsOSA was associated with an increased risk of MACCE following ACS in patients with hypertension, especially in patients with pre-existing severe hypertension. These findings highlight the importance of identifying OSA in ACS patients with hypertension.Trial registration numberNCT03362385.
Go-to-Controller is Better: Efficient and Optimal LPM Caching with Splicing
Authors: Gozlan Itamar , Avin Chen , Einziger Gil , Scalosub Gabriel 
Published: June 2023

Data center networks must support huge forwarding policies as they handle the traffic of the various tenants. Since such policies cannot be stored within the limited memory available at commodity switches, SDN controllers can manage the memory available at the switch as a cache, updating and changing the forwarding rules in the cache according to the policy and workloads dynamics. Most policies, such as Longest-prefix-match (LPM) policies, include dependencies between the forwarding rules, which introduce consistency constraints on the structure of the cached content, affecting the performance in terms of throughput and delay. Previous work suggested the concept of splicing to address such deficiencies, where modified Go-to-Controller rules can be inserted into the cache to improve performance while maintaining consistency.
We present the first optimal algorithm for determining the cache content with splicing, as well as several efficient heuristics with some performance guarantees. We evaluate our solutions using traces derived from real systems and traffic, and show that splicing can reduce the cache miss ratio by as much as 30%, without increasing the cache size. We further propose a new metric which can provide a quick estimate as to the potential benefits of splicing compared to classical LPM-caching. The full version of our work appeared in [2].
Mean-field Analysis for Load Balancing on Spatial Graphs
Authors: Rutten Daan , Mukherjee Debankur 
Published: June 2023

A pivotal methodological tool behind the analysis of large-scale load balancing systems is mean-field analysis. The high-level idea is to represent the system state by aggregate quantities and characterize their rate of change as the system size grows large. An assumption for the above scheme to work is that the aggregate quantity is Markovian such that its rate of change can be expressed as a function of its current state. If the aggregate quantity is not Markovian, not only does this technique break down, the mean-field approximation may even turn out to be highly inaccurate.
In load balancing systems, if servers are exchangeable, then the aggregate quantity is indeed Markovian. However, the growing heterogeneity in the types of tasks processed by modern data centers has recently motivated the research community to consider systems beyond the exchangeability assumption. The main reason stems from data locality, i.e., the fact that servers need to store resources to process tasks of a particular type locally and have only limited storage space. An emerging line of work thus considers a bipartite graph between task types and servers [2, 3, 5 -7]. In this compatibility graph, an edge between a server and a task type represents the server's ability to process these tasks. In practice, storage capacity or geographical constraints force a server to process only a small subset of all task types, leading to sparse network topologies. This motivates the study of load balancing in systems with suitably sparse bipartite compatibility graphs.
Optimal Scheduling in the Multiserver-job Model under Heavy Traffic
Authors: Grosof Isaac , Scully Ziv , Harchol-Balter Mor , Scheller-Wolf Alan 
Published: June 2023

Multiserver-job systems, where jobs require concurrent service at many servers, occur widely in practice. Essentially all of the theoretical work on multiserver-job systems focuses on maximizing utilization, with almost nothing known about mean response time. Our goal in this paper is to minimize mean response time in a multiserver-job setting. Minimizing mean response time requires prioritizing small jobs while simultaneously maximizing utilization. Our question is how to achieve these joint objectives.
We devise the ServerFilling-SRPT scheduling policy, which is the first policy to minimize mean response time in the multiserver-job model in the heavy traffic limit. In addition to proving this heavy-traffic result, we present empirical evidence that ServerFilling-SRPT outperforms all existing scheduling policies for all loads, with orders of magnitude improvements at high load.
Because ServerFilling-SRPT requires knowing job sizes, we also define the ServerFilling-Gittins policy, which is optimal when sizes are unknown or partially known.
For more detail, see the full paper https://doi.org/10.1145/3570612
SLITS: Sparsity-Lightened Intelligent Thread Scheduling
Authors: Jin Wangkai , Peng Xiangjun 
Published: June 2023

To make the most of hardware resources in multi-core architectures, effective thread scheduling is crucial. To achieve this, various scheduling objectives have been developed, such as reducing hardware resource contention [1, 11], allocating resources evenly for co-running threads [ 5, 6], and following priority-based policies [7]. Current thread scheduling designs can be categorized into two types. The first type involves fixed-rule scheduling1, which does not depend on workload characteristics and cannot meet the needs of different scheduling objectives. The second type takes the scheduling objectives into account by collecting run-time information on threads together with their correlations (e.g., Cache Miss Count [10, 13], Thread IPC [20], dynamic priority requirements like Earliest Deadline First [2 , 8, 17]), and making scheduling decisions based on thread-to-thread interactions.
A unified approach to these two types of scheduler designs can be achieved by focusing on Thread-Interaction statistics. To this end, we introduce the Thread-Interaction Matrix (TIM), which stores statistics on thread-to-thread interaction. These statistics can be any type of run-time statistics concerning the thread-to-thread pairs (e.g., Cache Miss Count [10 , 13], Thread IPC [20], dynamic priority requirements like Earliest Deadline First [2 , 8, 17])2. For fixed-rule scheduling, the TIM contains static values as the statistics do not affect the scheduling decisions. Based on the TIM, scheduling policies can be customized by specifying the rules of thread rescheduling, such as reschedule conditions and strategy. Combining the Thread-Interaction Matrix and scheduling policy provides a formalization of existing thread scheduler designs. Therefore, it is essential to design a general scheduler that can be tailored to different scheduling objectives by co-designing the Thread-Interaction Matrix and the scheduling policy in a synergistic manner.
Clinical Activity and Exploratory Resistance Mechanism of Milademetan, an MDM2 Inhibitor, in Intimal Sarcoma with MDM2 Amplification: An Open-Label Phase Ib/II Study
Authors: Koyama Takafumi , Shimizu Toshio , Kojima Yuki , Sudo Kazuki , Okuma Hitomi Sumiyoshi , Shimoi Tatsunori , Ichikawa Hitoshi , Kohsaka Shinji , Sadachi Ryo , Hirakawa Akihiro , Yoshida Akihiko , Ando Reiko Makihara , Ueno Toshihide , Yanagaki Mitsuru , Matsui Naoko , Nakamura Kenichi , Yamamoto Noboru , Yonemori Kan 
Published: June 2023

Abstract

Intimal sarcoma is an extremely rare, life-threatening malignant neoplasm. Murine double minute 2 (MDM2) amplification is observed in &gt;70% of intimal sarcomas. Milademetan, an MDM2 inhibitor, may provide clinical benefit in this patient population. We conducted a phase Ib/II study in patients with MDM2-amplified, wild-type TP53 intimal sarcoma as a substudy of a large nationwide registry for rare cancers in Japan. Milademetan (260 mg) was administered orally once daily for 3 days every 14 days, twice in a 28-day cycle. Of 11 patients enrolled, 10 were included in the efficacy analysis. Two patients (20%) showed durable responses for &gt;15 months. Antitumor activity correlated with TWIST1 amplification (P = 0.028) and negatively with CDKN2A loss (P = 0.071). Acquired TP53 mutations were detected in sequential liquid biopsies as a novel exploratory resistance mechanism to milademetan. These results suggest that milademetan could be a potential therapeutic strategy for intimal sarcoma.

Significance:
Strategies to optimize outcomes could include the use of new biomarkers (TWIST1 amplification and CDKN2A loss) to select patients with MDM2-amplified intimal sarcoma who might benefit from milademetan and combination with other targeted treatments. Sequential liquid biopsy of TP53 can be used to evaluate disease status during treatment with milademetan.
See related commentary by Italiano, p. 1765.
This article is highlighted in the In This Issue feature, p. 1749
“It’s Bigger Than Just a Book Challenge”: A Collective Case Study of Educators’ Experiences With Censorship
Authors: Sachdeva Danielle E. , Kimmel Sue C. , Chérres J. Sebastián 
Published: June 2023

Background: Challenges to books are surging across the United States, and books that portray diverse human experiences are particularly targeted. Censorship has deleterious consequences, such as undermining children’s intellectual freedom and influencing educators’ book selections. In a climate of censorship, when educators face the realistic possibility of a challenge, diverse voices may be silenced, and real-world issues avoided. Despite the impact that book challenges have, the experiences of educators who have faced them are understudied. Purpose: This study investigates the self-reported experiences of seven educators who have been involved in book challenges within K–12 public schools within the United States. Its goal is to yield new insights about how educators perceive the experience of censorship and what resources they leverage as they defend children’s right to read. It is significant because the lessons learned from these educators may be instructive for novice and veteran teachers and school librarians who are facing censorship—an increasingly likely possibility in contemporary times. It also highlights the range of forms that censorship takes within today’s schools. Research Design: This research employs a collective case study design. Seven teachers and school librarians from K–12 public schools across the United States were interviewed about their experiences with book challenges and other forms of censorship. Interview transcripts were qualitatively analyzed using Pierre Bourdieu’s types of cultural capital as a framework. Within-case and cross-case analyses are presented. Conclusions: Participants drew from various forms of cultural capital in their efforts to defend children’s intellectual freedom, including their professional ethics, school policies, and institutional knowledge. The study emphasizes the importance of building cultural capital among pre- and in-service educators within university preparation and professional development programs. It also calls on professional groups within education and librarianship to take an organized stand against censorship.
Supporting the Safe Use of the Dorsogluteal Intramuscular Injection Site: An Evidence-Based Quality Improvement Project
Authors: Kilroy Grainne , Lorbiecki Meghan , Ndakuya-Fitzgerald Florine , Hagle Mary 
Published: June 2023

INTRODUCTION: Administering intramuscular (IM) injections is common in the adult mental health patient care setting, using the deltoid, vastus lateralis, ventrogluteal, or dorsogluteal site. Mental health nurses frequently use the dorsogluteal site to administer short and long-acting IM injections as specified in the drug package insert or because of patient agitation. However, the site is often not recommended due to the potential risk of nerve injury. AIMS: Aims of this evidence-based quality improvement project were to (1) determine the best evidence for supporting the safe use of the dorsogluteal site for short and long-acting IM injections and (2) implement this evidence through nurse education. METHOD: This project had two phases: Determining best evidence through an integrative literature review and implementing the recommendations to use the dorsogluteal site when directed by the drug package insert, clinical need, nursing judgment, or patient preference. Implementation followed the Plan-Do-Study-Act quality improvement process and involved written resources and simulation. RESULTS: Evidence supported the use of the dorsogluteal site in four instances and the importance of education. Nurses were highly satisfied with the education and opportunity to practice their skills with feedback during return demonstration. After studying nurses’ follow-up survey results, a refresher simulation and medical center guideline were completed. There were no reports of IM injection patient injuries after 2 years and approximately 768 dorsogluteal and ventrogluteal IM injections in the academic medical center. CONCLUSION: Pursuing recent and possibly overlooked evidence provided guidance in supporting the safe use of the dorsogluteal site for IM injections.
Performance portable ice-sheet modeling with MALI
Authors: Watkins Jerry , Carlson Max , Shan Kyle , Tezaur Irina , Perego Mauro , Bertagna Luca , Kao Carolyn , Hoffman Matthew J , Price Stephen F 
Published: June 2023

High-resolution simulations of polar ice sheets play a crucial role in the ongoing effort to develop more accurate and reliable Earth system models for probabilistic sea-level projections. These simulations often require a massive amount of memory and computation from large supercomputing clusters to provide sufficient accuracy and resolution; therefore, it has become essential to ensure performance on these platforms. Many of today’s supercomputers contain a diverse set of computing architectures and require specific programming interfaces in order to obtain optimal efficiency. In an effort to avoid architecture-specific programming and maintain productivity across platforms, the ice-sheet modeling code known as MPAS-Albany Land Ice (MALI) uses high-level abstractions to integrate Trilinos libraries and the Kokkos programming model for performance portable code across a variety of different architectures. In this article, we analyze the performance portable features of MALI via a performance analysis on current CPU-based and GPU-based supercomputers. The analysis highlights not only the performance portable improvements made in finite element assembly and multigrid preconditioning within MALI with speedups between 1.26 and 1.82x across CPU and GPU architectures but also identifies the need to further improve performance in software coupling and preconditioning on GPUs. We perform a weak scalability study and show that simulations on GPU-based machines perform 1.24–1.92x faster when utilizing the GPUs. The best performance is found in finite element assembly, which achieved a speedup of up to 8.65x and a weak scaling efficiency of 82.6% with GPUs. We additionally describe an automated performance testing framework developed for this code base using a changepoint detection method. The framework is used to make actionable decisions about performance within MALI. We provide several concrete examples of scenarios in which the framework has identified performance regressions, improvements, and algorithm differences over the course of 2 years of development.