bluuebunny/crossref_metadata_2025 huggingface dataset:
DNA methylation assay based on pyrosequencing for determination of smoking status
Authors: Alghanim Hussain , Wu Wensong , McCord Bruce
Published: June 2018

The goal of this study was to utilize pyrosequencing to identify CpG sites indicative of tobacco smoking using DNA sequences surrounding ten frequently reported smoking‐related CpGs. Initially, six genetic loci were investigated including AHRR, 2q37, 6p21.33, GFI1, F2RL3, and MYO1G in order to detect novel CpG sites associated with tobacco smoking. The methylation data revealed a set of 23 consecutive CpG sites in blood (Chr5:373,115‐Chr5:373,653) that were significantly hypomethylated in current smokers. In addition, 10 of these 23 CpGs were also significantly hypomethylated in the saliva of current smokers. The most significant CpG sites were located at Chr5:373,490 in blood and Chr5:373,476 in saliva with a decrease in methylation in current smokers of 42.3% and 21.3% respectively. In the model‐building steps of this study, a quick 4‐CpG assay was developed. The assay consisted of the top ranked CpG sites in blood and saliva. The assay was applied in a leave‐one‐out approach to test its ability to infer an individual's self‐identified history of smoking habits. A multinomial logistic regression model (MLR) containing all 4 CpG sites gave the most accurate results in blood and saliva. In blood, the model correctly predicted 90.0% of current smokers, 66.7% of former smokers, and 84.9% of never smokers. In addition, the MLR model correctly predicted 86.9% of current smokers, 54.5% of former smokers, and 77.8% of never smokers in saliva. These results demonstrate that this pyrosequencing‐based assay can provide an effective tool for identifying individuals who smoke tobacco, particularly when using epigenetic markers in blood.
Systematic Analysis of Evidence and Sound Expert Assessment: Two Enablers of Evidence‐Based Decision‐Making in Health
Authors: Kieny Marie Paule , Moorthy Vasee
Published: June 2018

This commentary discusses attributes, membership, and modus operandi of advisory committees in the health sector, taking examples of a few committees operating internationally. It concludes on the importance of transparency and legitimacy for the credibility of their outcomes.
Impact of frequency of internet use on development of brain structures and verbal intelligence: Longitudinal analyses
Authors: Takeuchi Hikaru , Taki Yasuyuki , Asano Kohei , Asano Michiko , Sassa Yuko , Yokota Susumu , Kotozaki Yuka , Nouchi Rui , Kawashima Ryuta
Published: June 2018

Excessive internet use is shown to be cross sectionally associated with lower cognitive functioning and reduced volume of several brain areas. However, the effects of daily internet use on the development of verbal intelligence and brain structures have not been investigated. Here, we cross sectionally examined the effects of the frequency of internet use on regional gray/white matter volume (rGMV/rWMV) and verbal intelligence as well as their longitudinal changes after 3.0 ± 0.3 (standard deviation) years in a large sample of children recruited from the general population (mean age, 11.2 ± 3.1 years; range, 5.7–18.4 years). Although there were no significant associations in cross sectional analyses, a higher frequency of internet use was found to be associated with decrease of verbal intelligence and smaller increase in rGMV and rWMV of widespread brain areas after a few years in longitudinal analyses. These areas involve areas related to language processing, attention and executive functions, emotion, and reward. In conclusion, frequent internet use is directly or indirectly associated with decrease of verbal intelligence and development to smaller gray matter volume at later stages.
A random forest and simulation approach for scheduling operation rooms: Elective surgery cancelation in a Chinese hospital urology department
Authors: Luo Li , Liu Chuang , Feng Li , Zhao Shuzhen , Gong Renrong
Published: June 2018

Many hospitals encounter surgery cancelations for various reasons. We present a methodology applying data mining and simulation to optimize operating room (OR) scheduling in a urology department in West China Hospital. To the best of our knowledge, this is 1 of the first efforts to seek an optimal schedule solution based on cancelation risk of elective surgeries as well as OR allocation between elective and nonelective surgeries. First, chi‐square test and random forest prediction modeling were used to predict potential elective surgeries with high cancelation risk, and the factors, including surgeon, number of days since admission of patient, first surgery or not, etc., that influence elective surgery cancelation were identified. Second, a simulation technology was designed to compare 7 different scheduling strategies. The results demonstrated that for elective surgery, cancelation rate low surgery first outperformed the others and increased the productivity of the ORs from 72% to 83%, while for nonelective surgery performed in a separate OR, there was no improvement because the supply was greater than necessary at present. However, in total, the selected strategies led to 7% higher productivity.
How might organisational institutionalism support the challenges of the modern hospice?
Authors: Hodges Emma , Read Sue
Published: June 2018

The external environment within which UK charitable hospice care operates is changing. More people are dying with conditions other than cancer; however, this disease still dominates modern hospice care. Organisational institutionalism offers a theoretical lens through which to consider the challenges facing the hospice movement. Concepts such as legitimacy, decoupling, deinstitutionalisation, and reinstitutionalisation can help hospice leaders understand the challenges of change and some of the strategies that can be employed at local and national levels. This paper outlines a number of environmental and influencing factors driving and impacting change. A model of institutional change is introduced, explored, and considered from the context of hospice. When it comes to understanding change, legitimacy is a major concept introduced to challenge and pose questions for hospices to address. This paper proposes a model demonstrating a perspective regarding the current structure of services within hospice organisations. The model argues that only hospice care for people with cancer is truly institutionalised and that other areas of care lack comparable legitimacy. It provides 3 directions for hospice in addressing the challenges faced: (i) decoupling, (ii) deinstitutionalisation then reinstitutionalisation, and (iii) a new social movement. The paper concludes with recommendations for future consideration.
Groundwater and surface water connectivity within the recharge area of Guarani aquifer system during El Niño 2014–2016
Authors: Batista Ludmila Vianna , Gastmans Didier , Sánchez‐Murillo Ricardo , Farinha Bárbara Saeta , dos Santos Sarah Maria Rodrigues , Kiang Chang Hung
Published: June 2018

Recharge areas of the Guarani Aquifer System (GAS) are particularly sensitive and vulnerable to climate variability; therefore, the understanding of infiltration mechanisms for aquifer recharge and surface run‐off generation represent a relevant issue for water resources management in the southeastern portion of the Brazilian territory, particularly in the Jacaré‐Pepira River watershed. The main purpose of this study is to understand the interactions between precipitation, surface water, and groundwater using stable isotopes during the strong 2014–2016 El Niño Southern Oscillation event. The large variation in the isotopic composition of precipitation (from −9.26‰ to +0.02‰ for δ18O and from −63.3‰ to +17.6‰ for δ2H), mainly associated with regional climatic features, was not reflected in the isotopic composition of surface water (from −7.84‰ to −5.83‰ for δ18O and from −49.7‰ to +33.6‰ for δ2H), mainly due to the monthly sampling frequency, and groundwater (from −7.04‰ to −7.76‰ for δ18O and from −49.5‰ to −44.7‰ for δ2H), which exhibited less variation throughout the year. However, variations in deuterium excess (d‐excess) in groundwater and surface water suggest the occurrence of strong secondary evaporation during the infiltration process, corresponding with groundwater level recovery. Similar isotopic composition in groundwater and surface water, as well as the same temporal variations in d‐excess and line‐conditioned excess denote the strong connectivity between these two reservoirs during baseflow recession periods. Isotopic mass balance modelling and hydrograph separation estimate that the groundwater contribution varied between 70% and 80%, however, during peak flows, the isotopic mass balance tends to overestimate the groundwater contribution when compared with the other hydrograph separation methods. Our findings indicate that the application of isotopic mass balance methods for ungauged rivers draining large groundwater reservoirs, such as the GAS outcrop, could provide a powerful tool for hydrological studies in the future, helping in the identification of flow contributions to river discharge draining these areas.
A method for uncertainty constraint of catchment discharge and phosphorus load estimates
Authors: Hollaway Michael J. , Beven Keith J. , Benskin Clare Mc W. H. , Collins Adrian L. , Evans Robert , Falloon Peter D. , Forber Kirsty J. , Hiscock Kevin M. , Kahana Ron , Macleod Christopher J. A. , Ockenden Mary C. , Villamizar Martha L. , Wearing Catherine , Withers Paul J. A. , Zhou Jian G. , Barber Nicholas J. , Haygarth Philip M.
Published: June 2018

River discharge and nutrient measurements are subject to aleatory and epistemic uncertainties. In this study, we present a novel method for estimating these uncertainties in colocated discharge and phosphorus (P) measurements. The “voting point”‐based method constrains the derived stage‐discharge rating curve both on the fit to available gaugings and to the catchment water balance. This helps reduce the uncertainty beyond the range of available gaugings and during out of bank situations. In the example presented here, for the top 5% of flows, uncertainties are shown to be 139% using a traditional power law fit, compared with 40% when using our updated “voting point” method. Furthermore, the method is extended to in situ and lab analysed nutrient concentration data pairings, with lower uncertainties (81%) shown for high concentrations (top 5%) than when a traditional regression is applied (102%). Overall, for both discharge and nutrient data, the method presented goes some way to accounting for epistemic uncertainties associated with nonstationary physical characteristics of the monitoring site.
Strontium isotope identification of water mixing and recharge sources in a river system (Oder River, central Europe): A quantitative approach
Authors: Zieliński Mateusz , Dopieralska Jolanta , Belka Zdzislaw , Walczak Aleksandra , Siepak Marcin , Jakubowicz Michał
Published: June 2018

This study uses Sr isotope composition (87Sr/86Sr) and Sr content of waters of the Oder, one of the largest rivers in central Europe, to fingerprint natural and anthropogenic contributions to its Sr budget and to evaluate water mixing processes in its hydrological system. It also demonstrates a simple method of quantifying natural and anthropogenic Sr inputs in the watershed. The method has potential for environmental and archaeological research because past Sr geochemistry of river water can easily be reconstructed. For the first time, a catchment‐scale impact of anthropogenic sources on the Sr budget of a middle‐size river is shown in a quantitative way. The water of the Oder is characterized by a relatively uniform Sr isotope composition, from 0.7100 to 0.7108, contrasting with strong variations in Sr concentration, from 0.25 to 1.27 mg/L. There is a general seasonal trend in variability, with waters becoming more radiogenic and dilute with respect to the Sr in the spring time. This Sr systematics differs significantly from the Sr budgets of the majority of the Oder tributaries that exhibit more radiogenic composition and systematically lower Sr concentrations. A mixing scenario in the Oder involves Sr contribution from four principal water sources: (a) shallow ground waters with Sr derived from near‐surface weathering of silicates, (b) moderately radiogenic mine waters from the Upper Silesian Coal Basin, (c) unradiogenic mine waters from the Permian sequence of the copper district, and (d) unradiogenic ground waters from shallow‐seated Palaeogene, Neogene, and Mesozoic aquifers. The Sr budget of the Oder is primarily controlled by inputs of dissolved Sr from anthropogenic sources, which overprint the natural background, controlled by geology. Thus, about 47.5% of Sr originates from agriculture, industrial, and municipal additions, 31.5% from mine water inputs, and only 21% from natural sources, that is, rock weathering and atmospheric precipitation. Reconstruction of the past Sr chemistry of the Oder reveals that its present‐day Sr isotope composition is temporary and significantly different from that of the preindustrial times.
Individualized Pharmacokinetic Dosing of Vancomycin Reduces Time to Therapeutic Trough Concentrations in Critically Ill Patients
Authors: Truong James , Smith Shawn R. , Veillette John J. , Forland Steven C.
Published: June 2018

Dosing vancomycin in critically ill patients often results in subtherapeutic and supratherapeutic trough concentrations. In this retrospective study, we compared the time to goal trough attainment and incidence of acute kidney injury in intensive care unit (ICU) patients whose vancomycin was dosed by a pharmacy pharmacokinetic (PK) dosing and monitoring service to the standard of care. Three‐hundred fifty adult ICU patients at a Level 1 trauma, teaching hospital who received vancomycin for >24 hours from February 1, 2016, to November 30, 2016, were screened. Patients were included in the PK group if consecutive serum concentrations were used to calculate individualized PK and determine a dosing regimen. Patients who were dosed using troughs only were then matched 1‐to‐1 to the PK group by date of vancomycin initiation and included in the traditional group. Fifty patients were included in each group. Baseline characteristics were similar, except the PK group had more patients under the care of the neuromedical ICU service (42% vs 18%; P = .02) and fewer patients with a corrected creatinine clearance <30 mL/min/1.73 m2 (22% vs 46%; P = .02). Attainment of goal trough concentrations for the PK and traditional groups were 84.4% and 29.4% by 48 hours (P = .0001), 88.4% and 60.7% by 72 hours (P = .009), and 92.9% and 77.8% by 96 hours (P = .1), respectively. Incidence of acute kidney injury between the PK and traditional groups was not statistically significant (8.3% vs 14%; P = .5). Utilization of individualized pharmacokinetic dosing of vancomycin in critically ill patients resulted in faster goal trough attainment without an increase in nephrotoxicity.
Sex‐based differences in antiretroviral therapy initiation, switching and treatment interruptions: global overview from the International Epidemiologic Databases to Evaluate AIDS (IeDEA)
Authors: Giles Michelle L , Achhra Amit C , Abraham Alison G , Haas Andreas D , Gill Michael John , Lee Man Po , Luque Marco , McGowan Catherine , Cornell Morna , Braitstein Paula , de Rekeneire Nathalie , Becquet Renaud , Wools‐Kaloustian Kara , Law Matthew
Published: June 2018

Introduction

In 2015, the World Health Organization recommended that all HIV‐infected individuals consider ART initiation as soon as possible after diagnosis. Sex differences in choice of initial ART regimen, indications for switching, time to switching and choice of second‐line regimens have not been well described. The aims of this study were to describe first‐line ART and CD4 count at ART initiation by sex, calendar year and region, and to analyse time to change or interruption in first‐line ART, according to sex in each region.

Methods

Participating cohorts included: Southern, East and West Africa (IeDEA‐Africa), North America (NA‐ACCORD), Caribbean, Central/South America (CCASAnet) and Asia‐Pacific including Australia (IeDEA Asia‐Pacific). The primary outcomes analysed for each region and according to sex were choice of initial ART, time to switching and time to discontinuation of the first‐line regimen.

Results and Discussion

The combined cohort data set comprised of 715,252 participants across seven regions from low‐ to high‐income settings. The median CD4 count at treatment initiation was lower in men compared with women in nearly all regions and time periods. Women from North America and Southern Africa were more likely to switch ART compared to men (p < 0.001) with approximately 90% of women reporting a major change after 10 years in North America. Overall, after 8 years on ART, >50% of HIV‐ positive men and women from Southern Africa, East Africa, South and Central America remained on their original regimen. Men were more likely to have a treatment interruption compared with women in low‐ and middle‐income countries from the Asia/Pacific region (p < 0.001) as were men from Southern Africa (p < 0.001). Greater than 75% of men and women did not report a treatment interruption after 10 years on ART from all regions except North America and Southern Africa.

Conclusions

There are regional variations in the ART regimen commenced at baseline and rates of major change and treatment interruption according to sex. Some of this is likely to reflect changes in local and international antiretroviral guideline recommendations but other sex‐specific factors such as pregnancy may contribute to these differences.
Cross‐sectional association of physical activity and periodontal antibodies
Authors: Anderson A. Paige , Park Yong‐Moon , Shrestha Deepika , Zhang Jiajia , Liu Jihong , Merchant Anwar T.
Published: June 2018

Background

The objective of this study was to evaluate the cross‐sectional association between physical activity and serum IgG antibodies against selected periodontal microorganisms.

Methods

The study population consisted of 5,611 randomly selected US adults who participated in the National Health and Nutrition Examination Survey (NHANES) III (1988 to 1994), who were 40 years and older with complete IgG antibody data against 19 oral microorganisms. We used cluster analysis to classify the 19 antibody titers into 4 mutually exclusive groups called “Orange‐Red,” “Red‐Green,” “Yellow‐ Orange,” and “Orange‐Blue,” and calculated cluster scores by summing antibody titer z‐scores for each of the four groups. Physical activity was evaluated based on reported frequency and intensity of physical activity conducted in the last month. Participants were grouped into three categories: adequately physically active, inadequately physically active, and inactive. The outcomes were IgG cluster scores with physical activity as the predictor. Multivariable models adjusted for age, sex, race, smoking status, waist circumference, education, poverty‐income‐ratio, alcohol, and diabetes.

Results

In adjusted models, physical activity was positively associated with the antibodies in the Orange‐Blue cluster (E. nodatum, A. naeslundii), a cluster that is associated with healthy periodontal states. The mean differences in cluster scores were 15.2 (95% CI −1.0, 31.4) for Model 3, and 7.0 (95% CI −8.3, 22.3) for Model 4 comparing the sufficiently active group to the inactive group.

Conclusions

Antibody titers against periodontal microorganisms reflecting good oral health trended higher among physically active individuals, but the results were not statistically significant at the 0.05 level.
Raman vibrational spectral characteristics and quantitative analysis of H2 up to 400°C and 40 MPa
Authors: Li Lianfu , Zhang Xin , Luan Zhendong , Du Zengfeng , Xi Shichuan , Wang Bing , Cao Lei , Lian Chao , Yan Jun
Published: June 2018

In situ Raman detection is an ideal method to determine the concentration of dissolved H2 in deep‐sea high temperature hydrothermal fluids, but studies on in situ Raman qualitative and quantitative analyses of H2 that are suitable for detection in high temperature hydrothermal fluids are lacking. In this study, the Raman characteristics of gaseous and dissolved H2 were researched at 0–400°C and 0–40 MPa in detail, which cover most deep‐sea hydrothermal environments. The strong density and temperature dependences of the wavenumber and bandwidth of gaseous hydrogen vibrational Raman bands were observed. The interactions between the water molecules and hydrogen molecules were affected by temperature and pressure, and the opposite effect on the vibrational band of dissolved hydrogen was observed before and after reaching the critical condition of water. A high temperature and pressure quantitative analysis model suitable for in situ Raman detection of dissolved H2 was also developed with the linear equation
, where A (H2)/A (H2O) is the peak area ratio of H2 and H2O, and C (H2) is the concentration of dissolved H2 in mol/kg. The experimental temperature and pressure conditions did not influence the linear trend between the peak area ratio of A (H2)/A (H2O) and the concentrations of H2, which indicated that the calibration model can be applied to high temperature and pressure environments.
The impact of a malignant diagnosis on the pattern and outcome of readmission after liver and pancreatic surgery: An analysis of the nationwide readmissions database
Authors: Bagante Fabio , Beal Eliza W. , Merath Katiuscha , Paredes Anghela , Chakedis Jeffery , Olsen Griffin , Akgül Ozgür , Idrees Jay , Chen Quinu , Pawlik Timothy M.
Published: June 2018

Background and Objectives

Reducing readmissions is an important quality improvement metric. We sought to investigate patterns of 90‐day readmission after hepato‐pancreatic (HP) procedures.

Methods

The Nationwide Readmissions Database (NRD) was used to identify patients undergoing HP procedures between 2010 and 2014. Patients were stratified according to benign versus malignant HP diagnoses and as index (same hospital as operation) versus non‐index (different hospital) readmissions.

Results

Among the 41 059 patients who underwent HP procedures, 26 563 (65%) underwent a liver resection while 14 496 (35%) pancreatic resection. Among all patients, 11 902 (29%) had a benign diagnosis versus 29 157 (71%) who had a cancer diagnosis. Overall 90‐day readmission was 22% (n = 8 998) with a slight increase in readmissions among patients with a malignant (n = 6 655;23%) versus benign (n = 2 343;20%) diagnosis (P < 0.001). Readmission to an index hospital was more common (n = 7 316 81%) versus a non‐index hospital (n = 1 682 19%). Non‐index hospital readmissions were more frequent among patients with malignant HP diagnoses (OR, 1.41;P  = 0.001).

Conclusions

Up to one in four patients were readmitted after HP surgery. Late readmission was more common among patients with a cancer‐diagnosis. While most readmissions occurred at the index hospital, 19% of all readmissions occurred at a non‐index hospital and were more frequent among patients with malignant diagnoses.
Nanofiber‐Based Multi‐Tubular Conduits with a Honeycomb Structure for Potential Application in Peripheral Nerve Repair
Authors: Xue Jiajia , Li Haoxuan , Xia Younan
Published: June 2018

Peripheral nerve injury is a large‐scale problem and it is a great challenge to repair the long lesion in a thick nerve. The design of a multi‐tubular conduit with a honeycomb structure by mimicking the anatomy of a peripheral nerve for the potential repair of large defects in thick nerves has been reported. A bilayer mat of electrospun nanofibers is rolled up to form a single tube, with the inner and outer layers comprised aligned and random nanofibers, respectively. Seven such tubes are then assembled into a hexagonal array and encased within the lumen of a larger tube to form the multi‐tubular conduit. By introducing an adhesive to the regions between the tubes, the conduit is robust enough for handling during surgery. The seeded bone marrow stem cells (BMSCs) are able to proliferate in all the tubes with even circumferential and longitudinal distributions. Under chemical induction, the BMSCs are transdifferentiated into Schwann‐like cells in all the tubes. While the cellular version holds great promise for peripheral nerve repair, the multi‐tubular conduit can also be used to investigate the fundamental aspects involved in the development of peripheral nervous system and migration of cells.
Existence and multiplicity of solutions for ‐Laplacian equations in
Authors: Xie Weihong , Chen Haibo
Published: June 2018

In this paper, we study a class of sublinear or superlinear ‐Laplacian equations in . Some new criteria to guarantee that the existence of multiple solutions for the considered problem is established by using the Morse theory and minimax methods.
Interpolation of compact bilinear operators among quasi‐Banach spaces and applications
Authors: Cobos Fernando , Fernández‐Cabrera Luz M. , Martínez Antón
Published: June 2018

We study the interpolation properties of compact bilinear operators by the general real method among quasi‐Banach couples. As an application we show that commutators of Calderón–Zygmund bilinear operators are compact provided that , and .
A hybrid method to study the mechanical information induced by needle rotating
Authors: Yao Wei , Yu Yi , Ding Guanghong
Published: June 2018

Acupuncture has been used in China for more than 2000 years; its curative effect is acknowledged wildly in the world, but the underlying mechanisms are not revealed. The study focuses on mechanical effect of manual acupuncture. In this paper, a mathematical model based on viscoelastic theory and quasilinear viscoelastic theory of soft tissue is constructed; a hybrid method was used to study the tissue displacement and energy dissipation induced by needle rotation. It shows that (1) needle rotation will induce the extracellular matrix deformation and generate a mechanical stress field in the interstitium, (2) the deformation depends on rotation frequency and is mainly restrained in the vicinity of the needle, and (3) energy dissipation is affected by rotation frequency and very sensitive at low frequency. These results are consistent with experimental observations, and may help to explain some acupuncture theories and phenomena. Furthermore, this work not only contributes to reveal the mechanical effect of acupuncture (needle rotation) by modern scientific methods but also provides a hybrid method to study the strain and stress deriving from mechanical stimuli of connective tissue.
Toward in vivo dosimetry in external beam radiotherapy using x‐ray acoustic computed tomography: A soft‐tissue phantom study validation
Authors: Lei Hao , Zhang Wei , Oraiqat Ibrahim , Liu Zhipeng , Ni Jun , Wang Xueding , El Naqa Issam
Published: June 2018

Purpose

To study, using phantoms made from biological tissues, the feasibility and practical challenges of monitoring the position of the radiation beam and the deposited dose by x‐ray acoustic computed tomography (XACT) during external beam radiotherapy delivery.

Material and methods

A prototype XACT system with a single immersion ultrasound transducer, which was positioned around the target sample driven by a motor‐controlled rotation stage, was used to acquire the x‐ray acoustic (XA) signals produced by a medical linear accelerator (Linac) to form an XACT image of the irradiated phantom. To investigate the feasibility of XACT in tracking the position of radiation dose, a large piece of veal liver with embedded fat tissue was imaged and beam misalignments were measured. Next, we explored the sensitivity of XACT in monitoring and quantifying the delivered dose, in which a block of porcine gel was embedded with equally spaced lard cylinders and imaged. The doses on the lard cylinders modulated by physical wedges were quantified from the XACT image and were verified by comparison to measurements from radiochromic films as the gold standard. Then, to simulate how XACT can perform in a targeted tissue in the human body, a porcine gel phantom with lard cylinders covered by different materials (bone, muscle, and air gap, respectively) was also imaged.

Results

The reconstructed XACT images of the phantoms show congruence with the boundaries of the beam field and the interfaces between the different tissue materials. The beam displacement from the target was tracked properly by the reconstructed XACT images. An intensity difference as small as 2.9% in delivered dose region can be measured from XACT images P = 0.02. The intensities of XACT images were highly correlated to the film measurements with an R2 better than 0.986. The expected variances of dose delivered to different target regions as a result of the difference in attenuation were successfully captured by the XACT images.

Conclusions

This study validated the feasibility of XACT in accurately obtaining relative dose maps of tissue‐mimicking phantoms. XACT offers a practical method for verifying the beam position against the target and quantifying the relative dose delivered to the target during external beam radiotherapy.
Weight and Shape Concern Impacts Weight Gain Prevention in the SNAP Trial: Implications for Tailoring Intervention Delivery
Authors: Olson KayLoni L. , Neiberg Rebecca H. , Tate Deborah F. , Garcia Katelyn R. , Gorin Amy A. , Lewis Cora E. , Unick Jessica , Wing Rena R.
Published: June 2018

Objective

The Study of Novel Approaches to Weight Gain Prevention (SNAP) trial demonstrated that two self‐regulatory interventions prevented weight gain in young adults. Weight and shape concern (WSC) at baseline was evaluated as a moderator of weight outcomes at 24 months.

Methods

Young adults (n = 599) were randomized to self‐regulation with small changes (to create 200 kcal/day deficit), self‐regulation with large changes (to facilitate preemptive weight loss of 5‐10 lb), or self‐guided control. WSC was assessed by using one item from the Eating Disorders Assessment. ANOVA was used to examine whether the association between baseline level of WSC and percent weight change over 24 months differed across treatment conditions.

Results

Approximately 22% of participants reported high WSC (37% moderate; 41% low). WSC and treatment condition interacted to influence weight change at 24 months (P = 0.03). Individuals with high WSC gained weight in the large changes group (WSC least squares means ± SE, high: + 0.73% ± 1.19%; moderate: −2.74% ± 0.84%; low: −2.41% ± 0.79%). The small changes condition was particularly effective for those with high WSC (high WSC: −2.49% ± 1.16%; moderate: −0.60% ± 0.88%; low: −0.71% ± 0.80%). WSC did not impact weight change among control participants.

Conclusions

Individuals with high WSC may benefit from a small‐changes approach to weight gain prevention. These findings indicate WSC may be used to match individuals to weight gain prevention treatment conditions.
CD4+ and CD8+ T‐Cell‐Specific DNA Cytosine Methylation Differences Associated With Obesity
Authors: Hohos Natalie M. , Smith Alicia K. , Kilaru Varun , Park Hea Jin , Hausman Dorothy B. , Bailey Lynn B. , Lewis Richard D. , Phillips Bradley G. , Meagher Richard B.
Published: June 2018

Objective

Lifestyle factors associated with obesity may alter epigenome‐regulated gene expression. Most studies examining epigenetic changes in obesity have analyzed DNA 5´‐methylcytosine (5mC) in whole blood, representing a weighted average of several distantly related and regulated leukocyte classes. To examine leukocyte‐specific differences associated with obesity, a pilot study examining 5mC in three distinct leukocyte types isolated from peripheral blood of women with normal weight and obesity was conducted.

Methods

CD4+ T cells, CD8+ T cells, and CD16+ neutrophils were reiteratively isolated from blood, and 5mC levels were measured across >450,000 CG sites.

Results

Nineteen CG sites were differentially methylated between women with obesity and with normal weight in CD4+ cells, 16 CG sites in CD8+ cells, and 0 CG sites in CD16+ neutrophils (q < 0.05). There were no common differentially methylated sites between the T‐cell types. The amount of visceral adipose tissue was strongly associated with the methylation level of 79 CG sites in CD4+ cells, including 4 CG sites in CLSTN1's promoter, which, this study shows, may regulate its expression.

Conclusions

The methylomes of various leukocytes respond differently to obesity and levels of visceral adipose tissue. Highly significant differentially methylated sites in CD4+ and CD8+ cells in women with obesity that have apparent biological relevance to obesity were identified.
Echocardiographic predictors of neonatal illness severity in fetuses with critical left heart obstruction with intact or restrictive atrial septum
Authors: Gellis Laura , Drogosz Monika , Lu Minmin , Sleeper Lynn A. , Cheng Henry , Allan Catherine , Marshall Audrey C. , Tworetzky Wayne , Friedman Kevin G.
Published: June 2018

Background

Neonates with critical left heart obstruction and intact atrial septum (IAS) or restrictive atrial septum (RAS) are at risk for hypoxia within hours of birth and remain a group at high risk for mortality.

Methods

Prenatally diagnosed fetuses with critical left heart obstruction and IAS or RAS with follow‐up from January 1, 2005, to February 14, 2017, were included. Primary outcome was a composite measure of severe neonatal illness (pH < 7.15, venous pH < 7.10, bicarbonate < 16 mmol/L, lactic acid > 5 mmol/L, or median oxygen saturation < 60% within 2 hours of birth).

Results

Of 68 live born fetuses, 52 (76.5%) had hypoplastic left heart syndrome, 14 (20.5%) had critical aortic stenosis, and two (3%) had complex anatomy with mitral stenosis/atresia. There were 27 (39.7%) fetuses with IAS and 41 (60.3%) with RAS. Severe neonatal illness was present in 36 (52.9%). The strongest discriminators for severe neonatal illness were a pulmonary vein A:R VTI ≤ 2.7 (P < 0.001, AUC 0.93) and larger pulmonary vein diameter (P = 0.025, AUC 0.77). A:R VTI ≤ 2.7 predicted death or transplant (log‐rankP = 0.03).

Conclusions

In neonates with hypoplastic left heart syndrome and IAS or RAS, A:R VTI ≤ 2.7 is predictive of severe neonatal instability. This threshold can help guide resource planning, delivery management, and improve fetal intervention criteria.
Impacts of variants of uncertain significance on parental perceptions of children after prenatal chromosome microarray testing
Authors: Desai Preeya , Haber Hannah , Bulafka Jessica , Russell Amita , Clifton Rebecca , Zachary Julia , Lee Seonjoo , Feng Tianshu , Wapner Ronald , Monk Catherine , Chung Wendy K.
Published: June 2018

Objective

There are concerns regarding the potential harms in receipt of prenatal chromosome microarray (CMA) results, particularly variants of uncertain significance (VUS). We examined the influence that the return of genomic results had on parental well‐being and perceptions of children's development.

Methods

Parents (n = 138) of 83 children who underwent prenatal chromosomal microarray testing completed questionnaires assessing perception of children's development, parent‐child attachment, parental mood, parenting competence, martial satisfaction, satisfaction with the decision to undergo testing, and attitudes about genetics at age 12 and/or 36 months. Responses were compared between parents who received normal/likely benign results and VUS results.

Results

Compared to normal/likely benign results, parents who received VUS results rated their child as less competent on the BITSEA scale at 12 (β = −1.65, P = .04) though not 36 months (P = .43). There were no differences in parent mood, marital satisfaction, or parenting competence. At 36 months, parents in the VUS group reported less satisfaction with their decision to undergo genetic testing (β = 1.51, P = .02).

Conclusion

Chromosome microarray VUS results have limited impact on parental well‐being and perception of children's development. However, the initial diminished perception of child competency and later dissatisfaction with genomic testing indicate the need to assist parents in coping with ambiguous results.
Rare autosomal trisomies: Important and not so rare
Authors: Scott Fergus , Bonifacio Michael , Sandow Rhiannon , Ellis Katie , Smet Maria‐Elisabeth , McLennan Andrew
Published: June 2018

Objective

Noninvasive prenatal testing (NIPT) can assess chromosomes other than 13, 18, 21, X and Y. These rare autosomal trisomies (RATs) can adversely affect pregnancy outcome.

Methods

A prospective study of NIPT using the Illumina sequencing platform assessing all chromosomes were reported for further management.

Results

There were 28 RATs identified in 23 388 samples (one in 835), the most common being trisomy 7 (n = 6), followed by trisomy 16 (n = 4) and trisomy 22 (n = 3). Abnormal outcomes occurred in 16 cases: miscarriage (n = 6), true fetal mosaicism (n = 5), and fetal structural anomaly on ultrasound (n = 5). Growth restriction was seen in eight cases and correlated with very low‐pregnancy‐associated plasma protein‐A levels. Two of the 17 live born babies had a structural anomaly, and one had a phenotype similar to mosaic trisomy 16 despite a normal microarray result.

Conclusion

Rare autosomal trisomies are not rare and often associated with poor obstetric outcomes. They should be discussed with the clinician to guide management. Pregnancy outcomes varied by chromosome being generally favourable for some (eg, trisomy 7) and poor for others (eg, trisomy 22). In the presence of a RAT, pregnancy‐associated plasma protein‐A is predictive of placental dysfunction and fetal growth restriction.
PROMIS and legacy measures compared in a supportive care intervention for breast cancer patients and caregivers: Experience from a randomized trial
Authors: Sikorskii Alla , Victorson David , O'Connor Patrick , Hankin Vered , Safikhani Abolfazl , Crane Tracy , Badger Terry , Wyatt Gwen
Published: June 2018

Objective

Accurate and efficient measurement of patient‐reported outcomes is key in cancer symptom management trials. The newer Patient Reported Outcomes Measurement Information System (PROMIS) and previously developed measures of similar conceptual content (legacy) are available to measure symptoms and functioning. This report compares the performance of two sets of measures, PROMIS and legacy, in a recently completed trial of a supportive care intervention that enrolled breast cancer patients and their friend or family caregivers.

Methods

Patient‐caregiver dyads (N = 256) were randomized to either reflexology delivered by caregivers or usual care control. Post‐intervention, PROMIS and legacy measures of symptoms and functioning were analyzed in relation to trial arm, while adjusting for baseline values. Responsiveness of the two sets of measures was assessed using effect sizes and P‐values for the effect of trial arm on patients' and caregivers' symptom and functioning outcomes.

Results

Similar conclusions about intervention effects were found using PROMIS and legacy measures for pain, fatigue, sleep, anxiety, physical, and social functioning. Different conclusions were obtained for patient and caregiver depression: legacy measures indicated the efficacy of reflexology, while PROMIS depression measure did not.

Conclusion

Evidence of similar responsiveness supports the use of either set of measures for symptoms and functioning in clinical and general populations. Differences between PROMIS and legacy measures of depression need to be considered when choosing instruments for use in trials of supportive care interventions and in clinical practice.
Suicide rates among patients with cancers of the digestive system
Authors: Anderson Chelsea , Park Eliza M. , Rosenstein Donald L. , Nichols Hazel B.
Published: June 2018

Objective

Previous studies have suggested that suicide rates are elevated among cancer patients relative to the general population. In this analysis, we comprehensively evaluated characteristics associated with higher suicide rates among patients with cancers of the digestive system.

Methods

Using the United States Surveillance, Epidemiology, and End Results database, we identified all patients diagnosed with digestive system cancers during 2000 to 2014. Patients were classified as having died of suicide if their cause of death in Surveillance, Epidemiology, and End Results was listed as “suicide and self‐inflicted injury.” Suicide rates were compared to age‐, sex‐, and race‐adjusted rates in the general population.

Results

A total of 881 suicides were identified among 856 293 patients diagnosed with digestive system cancers. The suicide rate in this population was 32.8 per 100 000 person‐years and was nearly twice that in the general population (standardized mortality ratio [SMR] = 1.91; 95% CI, 1.79‐2.04). Suicide rates were significantly elevated for all cancer sites but were highest for esophageal (SMR = 5.03), pancreatic (SMR = 5.28), stomach (SMR = 2.84), and liver (SMR = 2.14) cancers. Standardized mortality ratios for suicide were highest within the first 5 years of diagnosis and increased with age at diagnosis for all sites except colon and stomach.

Conclusions

Patients with cancers of the digestive system have a higher incidence of suicide than the general population. Suicide rates among esophageal and pancreatic cancer patients are more than 5 times general population rates. The involvement of psychiatrists and other mental health professionals may be a critical component of cancer care for these high‐risk patient subgroups.
Social support and breast cancer screening in rural Appalachia
Authors: Smalls Brittany L. , Aroh Adaeze , McQuerry Kristen , Adegboyega Adebola , Schoenberg Nancy , Hatcher Jennifer
Published: June 2018

Purpose

Women in the Appalachian region have a high mortality rate attributable to cancer in spite of lower incidence of cancer compared with the general US population. Empirical evidence suggests that social support influences cancer outcomes, including adherence to screening guidelines and treatment recommendations. The purpose of this study is to examine the impact of social support on breast cancer screening patterns in a sample of rural Appalachian women.

Methods

This paper reports the results of analyses of baseline cross‐sectional data on breast cancer screening collected during a community‐based group‐randomized trial. We used the 2010 National Health Institute Survey questionnaires and the Medical Outcomes Study Social Support Survey to assess screening behavior and perceived social support, respectively. Data were analyzed using ANCOVA and ANOVA to assess the mean social support on breast cancer screening patterns (frequently, irregularly, and rarely/never) and relevant sociodemographic variables.

Findings

Of the eligible participant records analyzed (N = 289), 50% were married, 36% were employed, 20% attended college, 40% had no mammogram in 6 years, and 20% never had mammograms. Overall social support score was high at 73.1 (SD = 18.2). Association between breast cancer screening patterns and social support scores was not statistically significant at α < 0.05 (P value = 0.09).

Conclusions

Although social support as it measured in this study does not show significant associations with screening patterns, it is important to understand how social network structures may influence screening patterns. Familial and social roles/responsibilities that result in reported social support may also be the barrier to cancer screening and other prevention health behaviors.
Enhancing clinical practice in the management of distress: The Therapeutic Practices for Distress Management (TPDM) project
Authors: McLeod Deborah , Esplen Mary Jane , Wong Jiahui , Hack Thomas F. , Fillion Lise , Howell Doris , Fitch Margaret , Dufresne Julie
Published: June 2018

Objective

The Therapeutic Practices for Distress Management (TPDM) project was carried out to support clinicians in integrating recommendations from four clinical practice guidelines (CPGs) in routine care at five Pan Canadian cancer care sites.

Methods

Using a concurrent, mixed‐method study design and knowledge translation (KT) activities, this project included two phases: phase I—a baseline/preparation phase and phase II—an intervention phase plus evaluation. The intervention phase (the focus of this report) included a one‐year education and supervision program (24 hours in virtual class; 12‐hour group supervision). Primary outcomes were knowledge and self‐efficacy in practicing CPGs as measured by a Knowledge and Self‐Efficacy Survey (KSES). A secondary outcome was observer‐rated performances with standardized patients (objective structured clinical exams). Participants included 80 (90%) nurses, and 9 (10%) social workers (N = 89).

Results

The TPDM program was effective in accomplishing change in knowledge, self‐efficacy, and performance. All measures demonstrated significant change pre and post module, with evidence of increasing knowledge (P < .01) and confidence (P < .01) over time. Further, there was evidence of a shift in barriers and enablers to practicing in alignment with the CPGs.

Conclusions

A tailored education program using case‐based learning and supervision over time improves knowledge and practice among front line clinicians. The findings have implications for quality improvement in cancer care.
Quality of life after pelvic exenteration for gynecologic cancer: Findings from a qualitative study
Authors: Nelson Ashley M. , Albizu‐Jacob Alexandra , Fenech Alyssa L. , Chon Hye Sook , Wenham Robert M. , Donovan Kristine A.
Published: June 2018

Objective

Pelvic exenteration (PE) in carefully selected gynecologic cancer patients has a 5‐year survival rate as high as 60%. Thus, there is a growing number of PE survivors dealing with the effects of this radical surgery. The current study sought to explore women's physical, psychological, and social quality of life (QOL) after PE.

Methods

Fourteen women who had undergone PE for recurrent gynecologic cancer at least 1 year previously completed semistructured qualitative interviews designed to elicit expectations and experiences of QOL following PE. Thematic analysis was used to code transcripts for both a priori and emergent themes.

Results

Themes included PE versus palliative care, preparedness, persistent symptoms, the not so normal new normal, new rules of social engagement, support, emotional diversity, and bouncing back through adaptive coping. Key differences with previous studies include the explicit acknowledgement of the need for palliative care, the chronic nature of multiple, seemingly unaddressed physical symptoms in survivorship, and the predominance of positive psychological symptoms. While a minority expressed emotional distress and regret for undergoing PE, most articulated a sense of resilience gained through a variety of adaptive coping strategies.

Conclusions

Findings underscore the persistent physical, psychological, and social effects of PE on QOL and the need for comprehensive, multidisciplinary patient care before and long after surgery. Findings should promote development of a best practice clinical pathway for the care and education of women who undergo PE with curative intent for gynecologic cancer.