bluuebunny/crossref_metadata_2025 huggingface dataset:
60Fe in core-collapse supernovae and prospects for X-ray and gamma-ray detection in supernova remnants
Authors: Jones Samuel W , Möller Heiko , Fryer Chris L , Fontes Christopher J , Trappitsch Reto , Even Wesley P , Couture Aaron , Mumpower Matthew R , Safi-Harb Samar
Published: February 2019

We investigate 60Fe in massive stars and core-collapse supernovae focussing on uncertainties that influence its production in 15, 20, and 25 M$\odot$ stars at solar metallicity. We find that the 60Fe yield is a monotonic increasing function of the uncertain 59Fe(n, γ)60Fe cross-section and that a factor of 10 reduction in the reaction rate results in a factor of 8–10 reduction in the 60Fe yield, while a factor of 10 increase in the rate increases the yield by a factor of 4–7. We find that none of the 189 simulations we have performed are consistent with a core-collapse supernova triggering the formation of the Solar system, and that only models using 59Fe(n, γ)60Fe cross-section that is less than or equal to that from NON-SMOKER can reproduce the observed 60Fe/26Al line flux ratio in the diffuse interstellar medium. We examine the prospects of detecting old core-collapse supernova remnants (SNRs) in the Milky Way from their gamma-ray emission from the decay of 60Fe, finding that the next generation of gamma-ray missions could be able to discover up to ∼100 such old SNRs as well as measure the 60Fe yields of a handful of known Galactic SNRs. We also predict the X-ray spectrum that is produced by atomic transitions in 60Co following its ionization by internal conversion and give theoretical X-ray line fluxes as a function of remnant age as well as the Doppler and fine-structure line broadening effects. The X-ray emission presents an interesting prospect for addressing the missing SNR problem with future X-ray missions.
Factors Associated with Insulin Resistance in Women with Migraine: A Cross-Sectional Study
Authors: Gur-Ozmen Selen , Karahan-Ozcan Ruhan
Published: February 2019

Objective

Studies have shown a relationship between insulin resistance (IR) and migraine that is more evident in some migraineurs. Long-term use of various drugs and increased risk of diverse side effects is an unavoidable reality in this population of patients. Thus, in this study, we aimed to investigate factors associated with IR in migraine and the impact of chronic usage of various drugs, which might play a part in development of IR.

Design

Cross-sectional study.

Setting

Gebze Fatih General Hospital, Kocaeli, Turkey.

Subjects

Migraine patients (N = 150) were investigated.

Methods

Weight, height, waist circumference, and blood pressure were measured. Fasting glucose, fasting insulin, glycated hemoglobin, and lipid profile were also measured. IR was selected as a dependent variable. The independent variables included age, cigarette smoking, alcohol consumption, family history of migraine, diabetes mellitus and hypertension, characteristics of pain, migraine triggers and subgroups, medication used during attack treatment, medication used as prophylactic treatment, and oral contraceptive treatment. Descriptive analysis and multivariate logistic regression were performed.

Results

Central obesity (odds ratio [OR] = 7.131, 95% confidence interval [CI] = 2.451–20.741, P < 0.0001), metoclopramide treatment during an attack (OR = 3.645, 95% CI = 0.996–13.346, P = 0.041), family history of DM (OR = 3.109, 95% CI = 1.189–8.132, P = 0.035), nonsteroidal anti-inflammatory drug (NSAID) usage during an attack (OR = 2.578, 95% CI = 1.053–6.311, P = 0.043), and negative family history of hypertension (OR = 0.226, 95% CI = 0.085–0.602, P = 0.002) were significant factors for exhibiting IR in migraine.

Conclusions

Our study demonstrates an association between metoclopramide and NSAID treatments and IR in migraine.
Incorporating the latest pediatric nutrition support guidelines into clinical practice
Authors: Irving Sharon Y. , Guenter Peggi , Mehta Nilesh M.
Published: February 2019

Optimal nutrition support in critically ill children is associated with improved outcomes and decreased mortality. Nutrition provision often competes with other care priorities in critically ill patients. The 2017 Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient supplement clinician knowledge and inform best practices for nutrition therapy in this vulnerable patient population.
Successful grant applications
Authors: Clark Rebecca Culver , Carter Kimberly Ferren
Published: February 2019

All nurses have the potential to influence the healthcare industry and the nursing profession through research, but preparing a grant application can be intimidating. This article addresses the process of writing and developing successful grant proposals.
Combating compassion fatigue
Authors: Perregrini Michelle
Published: February 2019

Nurses are especially susceptible to compassion fatigue. This article offers strategies to help nurses recognize the signs of compassion fatigue, take steps to combat it, and support their coworkers.
Glucose and Lactate Concentrations in Cerebrospinal Fluid After Traumatic Brain Injury
Authors: Lozano Angels , Franchi Federico , Seastres Ramon J. , Oddo Mauro , Lheureux Olivier , Badenes Rafael , Scolletta Sabino , Vincent Jean-Louis , Creteur Jacques , Taccone Fabio S.
Published: February 2019

Background:

Studies in which brain metabolism has been monitored using microdialysis have indicated decreases in cerebral glucose concentration and increases in lactate concentration in patients with traumatic brain injury (TBI). However, few data are available on glucose and lactate concentrations in the cerebrospinal fluid (CSF) of TBI patients. This study investigates the relationship between CSF glucose and lactate concentrations and outcomes after TBI.

Methods:

Consecutive adult (>18 y) TBI patients were admitted to our 35-bed medicosurgical between 2011 and 2014 and were included in the study if they met the following inclusion criteria: presence of an external ventricular drain (EVD) for intracranial pressure monitoring, daily analysis of CSF glucose and lactate concentrations for 4 consecutive days, and concomitant measurements of blood glucose/lactate concentrations. Neurological outcome was assessed at 3 months using the extended Glasgow Outcome Scale (GOS), and unfavorable outcome defined as a GOS 1 to 4.

Results:

Of 151 TBI patients who had an EVD, 56 met the inclusion criteria. Most EVDs were placed on the day of intensive care unit admission, and maintained for 10 (interquartile range: 6 to 14) days. On day 1, there was a weak but significant correlation between blood and CSF glucose concentrations (R
2=0.07, P=0.04), and a greater correlation between blood and CSF lactate (R
2=0.32, P<0.001). In multivariable analysis, day 1 CSF glucose/lactate ratio was independently associated with mortality (odds ratio: 0.22, 95% confidence interval: 0.08-0.61; P=0.003), and day 1 CSF lactate concentration with unfavorable outcome (odds ratio: 4.86; 95% confidence interval: 1.86-12.67; P=0.001).

Conclusions:

Low CSF glucose/lactate ratio is observed in nonsurvivors after severe TBI and may have prognostic value.
Incidence of complete spinal instrumentation removal following surgery for spinal deformity: a 22-year single institution study
Authors: Abola Matthew V. , Hardesty Christina K. , Knapik Derrick M. , Poe-Kochert Connie , Son-Hing Jochen P. , Thompson George H.
Published: February 2019

The aim of this study was to define the incidence of complete implant removal following surgical correction of spinal deformity in pediatric patients over a 22-year period and identify possible risk factors. A retrospective review of our Pediatric Orthopedic Spine Database between 1992 and 2016 was performed. We included patients undergoing complete implant removal following scoliosis correction surgery with a minimum of 2-year follow-up. Medical charts were reviewed to determine initial patient diagnosis and the indication for implant removal. Statistical analysis was carried out to determine the associations between sex and factors such as primary diagnosis and indication for removal. A review of 1117 procedures in 1114 patients identified complete instrument removal in 52 (4.7%) patients (34 females and 18 males). Mean time to removal following surgery was 2.3 years (range: 0–5.9 years). Removal occurred in 24 of 548 (4.4%) patients with adolescent idiopathic scoliosis, four of 117 (3.4%) patients with juvenile idiopathic scoliosis, 11 of 287 (3.8%) patients with neuromuscular scoliosis, and three of 79 (3.8%) patients with syndromic scoliosis. Infection was the most common indication for complete implant removal [24 (46%) patients], followed by persistent pain [8 (15%) patients], and metal intolerance [8 (15%) patients]. There were two cases of early infection (<1 year following surgery) and 22 late infections (≥1 year following surgery). The overall 22-year incidence of complete implant removal following spinal correction surgery for scoliosis was 4.7%. Infection continues to be the most common indication, followed by pain and metal intolerance.
The Impact of Cervical Spinal Muscle Degeneration on Cervical Sagittal Balance and Spinal Degenerative Disorders
Authors: Tamai Koji , Grisdela Phillip , Romanu Joshua , Paholpak Permsak , Nakamura Hiroaki , Wang Jeffrey C. , Buser Zorica
Published: February 2019

Study Design:

This is a retrospective analysis of kinematic magnetic resonance images (kMRI).

Objective:

To assess the association of cervical paraspinal muscle with cervical sagittal balance and degenerative spinal disorders.

Summary of Background Data:

Although the effects of spinal disorders and cervical imbalance on patient’s symptoms have been well described, the relationship of the cervical muscle quality and volume to cervical imbalance or spinal disorders is not well established.

Materials and Methods:

In total, 100 kMRI taken in a neutral weight-bearing position were analyzed. The adjusted cross-sectional area ratio (aCSA ratio: the value of muscle CSA divided by the vertebral CSA) and fat infiltration ratio of the transversospinalis muscles at C4 and C7 vertebral levels were measured using axial slice of kMRI. The correlation with cervical balance parameters [Oc–C2 angle, C2–C7 angle, C7–T1 angle, C7 slope, T1 slope, cranial tilt, cervical tilt, thoracic inlet angle (TIA), and neck tilt] and cervical degenerative disorders (disk degeneration, Modic change, and spondylolisthesis) were evaluated.

Results:

The aCSA ratio at C4 correlated with C2–C7 angle (r=0.267), C7 slope (r=0.207), T1 slope (r=0.221), disk degeneration at C3–4, C4–5, C5–6 (r=−0.234, −0.313, −0.262) and spondylolisthesis at C3 (anterior: r=−0.206, posterior: r=−0.249). The aCSA ratio at C7 correlated with disk degeneration at C3–4, C4–5, C5–6, C6–7 (r=−0.209, −0.294, −0.239, −0.209). The fat infiltration ratio at C4 correlated with TIA (r=0.306) and neck tilt (r=0.353), likewise the ratio at C7 correlated with TIA (r=0.270) and neck tilt (r=0.405). All correlations above were statistically significant with P<0.05.

Conclusions:

The paraspinal muscle volume showed significant relationship with the cervical balance parameters and disk degeneration. While, paraspinal muscle quality related to the thoracic inlet parameters. Our findings can be an important step to develop the knowledge of the association between cervical muscle and cervical degenerative disorders, as well as the sagittal balance of the cervical spine.

Level of Evidence:

Level III.
Comparison Between Stable Sagittal Vertebra and First Lordotic Vertebra Instrumentation for Prevention of Distal Junctional Kyphosis in Scheuermann Disease
Authors: Gong Yining , Yuan Lei , He Miao , Yu Miao , Zeng Yan , Liu Xiaoguang , Chen Zhongqiang
Published: February 2019

Study Design:

This study was a systematic review and meta-analysis.

Objectives:

To compare stable sagittal vertebra (SSV) and first lordotic vertebra (FLV) instrumentation for prevention of distal junctional kyphosis (DJK) in Scheuermann disease.

Summary of Background Data:

The SSV has been increasingly chosen as the lowest instrumented vertebra to prevent DJK, and some studies have provided supportive results. However, other studies demonstrate that lowest instrumented vertebra located in the FLV has similar DJK incidence with the benefit of saving levels.

Materials and Methods:

Electronic searches of PubMed, Embase, the Cochrane Database, and Web of Science were performed. Radiographic parameters, incidence of DJK, and revision surgery rates were compared between SSV and FLV groups. The odds ratio (OR) was used to identify differences between the groups and P<0.05 was considered statistically significant.

Results:

Four studies with a total of 173 patients were included. There were no differences between the SSV and FLV groups in most radiographic parameters. The incidence of DJK among 173 patients was 20.8% (36/173). The SSV group demonstrated a significantly lower DJK rate than the FLV group (OR, 0.11; 95% confidence interval, 0.04–0.30; P<0.0001; I
2=39%). In this study, 5.9% (5/85) of the SSV group and 43.6% (24/55) of the FLV group developed DJK; 27.8% (10/36) who developed DJK underwent revision surgery, including 25.0% (6/24) in the FLV group and 40.0% (2/5) in the SSV group. The revision surgery rate was lower in the FLV group than in the SSV group, with no statistical difference (OR, 3.27; 95% confidence interval, 0.26–41.73; P=0.36; I
2=0%).

Conclusions:

The overall DJK rate in Scheuermann disease was 20.8%, and 27.8% of DJK patients needed revision surgery. A distal fusion level including the SSV demonstrated a significantly lower DJK rate.
Closing the Gap: Experienced Simulation Educators' Role and Impact on Everyday Health care
Authors: Tamás Éva , Södersved Källestedt Marie-Louise , Hult Håkan , Karlgren Klas , Allvin Renée
Published: February 2019

Introduction:

Trained simulation educators (SEs) usually work both at simulation centers and in everyday health care, and thus, they possess dual expertise. Experienced SEs are known to grow confident with their expanding experience, but evidence is scarce about how this affects their development as clinical professionals. The aim of this study was to explore how experienced SEs describe their role within the context of everyday health care.

Methods:

An explorative descriptive study including 14 semistructured interviews and 27 questionnaires was conducted with 41 experienced SEs. An inductive thematic analysis was used to identify and analyze patterns describing SEs' perceptions of the influence of their educational work on everyday health care.

Results:

The SEs' descriptions of their encounters during everyday clinical work, which were affected by the fact that they had experience of facilitating simulation training, were gathered into three main themes with three of their own subthemes: education (educational needs, routines/guidelines, and being a resource), nontechnical skills (communication, feedback, and leadership/coworkership), and clinical proficiency (situational insight, role model, and confidence in clinical practice). The insights gained and actions taken as clinical professionals are all intended to be implemented with the ultimate aim of safe patient care.

Discussion:

All the aspects of the SEs' work are perceived to be successfully translated into clinical practice and can be summarized by the main themes of education, nontechnical skills, and clinical proficiency as delineated by this study. These themes are demonstrated at the individual, team, and organizational levels through increased competence and confidence.
Cutaneous lupus associated with pembrolizumab therapy for advanced melanoma: a report of three cases
Authors: Blakeway Elizabeth A. , Elshimy Noha , Muinonen-Martin Andrew , Marples Maria , Mathew Bipin , Mitra Angana
Published: February 2019

Checkpoint blockade immunotherapy has revolutionized the treatment of advanced melanoma, with impressive survival benefits attained through upregulation of the anticancer immune response. Blockade of regulatory checkpoint molecules can, however, also result in aberrant immune activation leading to undesirable inflammation and autoimmunity. Although many genetic determinants have been described in patients with primary autoimmune diseases, it is uncertain whether patients developing autoimmune skin disease as an adverse effect of anti-PD-1 therapy share the same genetic risks. Furthermore, it is also unclear whether treatment with these agents can result in the unveiling of underlying ‘silent’ autoimmunity resulting in chronic inflammatory disease. We report three cases of cutaneous lupus associated with pembrolizumab therapy for advanced melanoma. One patient had a previous diagnosis of histologically proven discoid lupus erythematosus, well-controlled without treatment for over 2 years, which flared on first exposure to pembrolizumab. The remaining two patients had no previous history of autoimmune disease; both developed cutaneous eruptions, histologically and immunohistologically, in keeping with subacute cutaneous lupus following treatment with pembrolizumab. Our report bolsters what is currently an exceedingly small body of evidence documenting the development of cutaneous lupus in the setting of pembrolizumab therapy. Our third case specifically documents an otherwise unreported severe reflare of previously diagnosed, quiescent discoid lupus erythematosus in the setting of pembrolizumab, vividly highlighting the potential for autoimmune and specifically, lupus reactivation in the setting of anti-PD-1 therapy.
Phase IB Study of Induction Chemotherapy With XELOX, Followed by Radiation Therapy, Carboplatin, and Everolimus in Patients With Locally Advanced Esophageal Cancer
Authors: Saba Nabil F. , Force Seth , Staley Charley , Fernandez Felix , Willingham Field , Pickens Allan , Cardona Kenneth , Chen Zhengjia , Goff Laura , Cardin Dana , Lambright Eric , Nesbitt Jon , Krasinskas Alyssa , Higgins Kristin , Harvey R. Donald , Owonikoko Taofeek , Ramalingam Suresh S. , Shin Dong M. , Beitler Jonathan J. , El-Rayes Bassel F. , Salaria Safia , El-Rifai Wael , Landry Jerome , Chakravarthy A.B.
Published: February 2019

Purpose:

Preclinical studies have shown synergy between everolimus, an mTOR inhibitor, radiation, and platinum agents. We conducted a phase IB trial to determine the recommended phase II dose of everolimus with carboplatin and radiation.

Materials and Methods:

Patients with stage II/III esophageal cancer were enrolled. Following 2 cycles of Capecitabine/Oxaliplatin (XELOX), patients with no disease progression, received 50.4 Gy in 28 fractions and concurrent weekly carboplatin (area under the curve=2), with escalating doses of everolimus. A standard 3+3 dose escalation design was used.

Results:

Nineteen patients were enrolled. Two patients were screen failures and 4 were removed due to poor tolerance to XELOX (n=2) or disease progression (n=2). All treated patients had adenocarcinoma. Median age was 58 (44 to 71 y) and 85% were male patients. One patient at dose level 1 was replaced due to ongoing anxiety. One of 6 patients had a dose-limiting toxicity of bowel ischemia that was fatal. At dose level 2, two of 6 patients had a dose-limiting toxicity (fever with neutropenia and nausea). The recommended phase II dose of everolimus was 2.5 mg QOD. Grade ≥3 toxicities included lymphopenia (11%), nausea (10%), low white blood cell (8.0%) vomiting (5.5%), decreased neutrophils (4.0%). All patients achieved an R0 resection with a pathologic response rate of 40% and a pathologic complete response (ypCR) rate of 23%. The 2-year progression-free survival and overall survival were 50% and 49.6%, respectively.

Conclusions:

The recommended phase II dose of everolimus with concurrent weekly carboplatin and radiation is 2.5 mg QOD.
Effects of Social and Contextual Factors Including Marital Status and Children on the Use of Palliative Chemotherapy in Metastatic Colorectal Cancer
Authors: Ahmed Shahid , Baig Tayyba , Iqbal Nayyer , Le Duc , Chalchal Haji , Zaidi Adnan , Pahwa Punam
Published: February 2019

Background:

There is evidence that social and contextual factors such as living alone are associated with outcomes in cancer patients. However, little is known about their influence on the use of palliative chemotherapy in metastatic colorectal cancer (mCRC). In this study, we examined social and contextual factors, including marital status, having children, and distance to a cancer center, for their association with the use of chemotherapy in patients with mCRC.

Methods:

A cohort of patients with mCRC diagnosed from 2006 to 2010 in Saskatchewan was evaluated. Logistic regression analyses were performed to assess the relationship between the variables and use of chemotherapy.

Results:

Of 569 patients, 326 (57%) received chemotherapy significant differences were noted between the chemotherapy versus no chemotherapy groups with respect to age (62 vs. 76 y), poor performance status (18% vs. 58%), comorbid illness (24% vs. 63%), low albumin (61% vs. 89%), anemia (61% vs. 87%), elevated alkaline phosphatase (53% vs. 84%), elevated creatinine (6% vs. 11%), hyponatremia (20% vs. 14%), primary tumor resection (61% vs. 47%), metastasectomy (21% vs. 9%), mean distance to cancer center (98.7±113.6 vs. 127.8±124.6 km), married/partnered (67% vs. 33%), and having children (64% vs. 36%). On multivariate logistic regression analysis, low performance status (odds ratio [OR], 5.1; 95% confidence interval [CI]: 3.1-8.1), not having children (OR, 3.3; 95% CI: 1.78-6.2), hyponatremia (OR, 2.9; 95% CI: 1.6-5.1), elevated alkaline phosphatase (OR, 2.9; 95% CI: 1.8-4.8), and low albumin (OR, 2.2; 95% CI: 1.2-3.8) were correlated with low rates of chemotherapy use.

Conclusions:

Our results showed that the use of chemotherapy in patients with mCRC significantly varies between those with and without children.
Sex Differences in Treatment Strategies Among Patients With Ulcerative Colitis: A Retrospective Cohort Analysis of Privately Insured Patients
Authors: Sceats Lindsay A. , Morris Arden M. , Bundorf M. Kate , Park K.T. , Kin Cindy
Published: February 2019

BACKGROUND:

Sex-based treatment disparities occur in many diseases. Women undergo fewer procedural interventions, and their care is less consistent with guideline-based therapy. There is limited research exploring sex-based differences in ulcerative colitis treatment. We hypothesized that women are less likely to be treated with strategies consistent with long-term disease remission, including surgery and maintenance medications.

OBJECTIVE:

The aim of this study was to determine if patient sex is associated with choice of treatment strategy for ulcerative colitis.

DESIGN:

This is a retrospective cohort analysis.

SETTING:

Data were gathered from a large commercial insurance claims database from 2007 to 2015.

PATIENTS:

We identified a cohort of 38,851 patients newly diagnosed with ulcerative colitis, aged 12 to 64 years with at least 1 year of follow-up.

MAIN OUTCOME MEASURES:

The primary outcomes measured were the differences between male and female patients in 1) rates and types of index ulcerative colitis operations, 2) rates and types of ulcerative colitis medication prescriptions, and 3) rates of opioid prescriptions.

RESULTS:

Men were more likely to undergo surgical treatment for ulcerative colitis (2.94% vs 1.97%, p < 0.001, OR 1.51, p < 0.001). The type of index operation performed did not vary by sex. Men were more likely to undergo treatment with maintenance medications, including biologic (12.4% vs 10.2%, p < 0.001, OR 1.22, p < 0.001), immunomodulatory (16.3% vs 14.9%, p < 0.001, OR 1.08, p = 0.006), and 5-aminosalicylate medications (67.0% vs 63.2%, p < 0.001, OR 1.18, p < 0.001). Women were more likely to undergo treatment with rescue therapies and symptomatic control with corticosteroids (55.5% vs 54.0%, p = 0.002, OR 1.07, p = 0.002) and opioids (50.2% vs 45.9%, p < 0.001, OR 1.17, p < 0.001).

LIMITATIONS:

Claims data lack clinical characteristics acting as confounders.

CONCLUSIONS:

Men with ulcerative colitis were more likely to undergo treatment consistent with long-term remission or cure, including maintenance medications and definitive surgery. Women were more likely to undergo treatment consistent with short-term symptom management. Further studies to explore underlying mechanisms of sex-related differences in ulcerative colitis treatment strategies and disease trajectories are warranted. See Video Abstract at http://links.lww.com/DCR/A943.
A Retrospective Cohort Study of Cutaneous Squamous Cell Carcinoma With Lymph Node Metastasis: Risk Factors and Clinical Course
Authors: Feinstein Shera , Higgins Shauna , Ahadiat Omeed , Wysong Ashley
Published: February 2019

BACKGROUND

The single most important prognostic indicator for mortality in patients with cutaneous squamous cell carcinoma (SCC) is the development of nodal metastasis (NM).

OBJECTIVE

To characterize the risk factors for and clinical course of cutaneous SCC with NM.

METHODS

Ten-year retrospective cohort study (2006–2017) at an academic tertiary care center reviewing 53 cutaneous SCC tumors with NM.

RESULTS

Most patients were men (84.6%, 44/52), and almost all primary tumors were on the head and neck (96.2%, 51/53). Most primary tumors were characterized by known “high-risk features” including perineural invasion (56.6%, 30/53), diameter ≥2 cm (54.7%, 29/53), invasion beyond subcutaneous fat (43.4%, 23/53), and poor differentiation (32.1%, 17/53). In addition, many tumors were recurrent (52.8%, 28/53), and many patients were immunosuppressed (30.8%, 16/52). Disease-free survival after treatment of nodal disease was 7.5% (4/53) at 5 years.

CONCLUSION

To the best of the authors' knowledge, this study is the largest retrospective cohort of cutaneous SCC with NM to date. The results verify the significance of “high-risk features” used by current staging systems while highlighting additional features that may have prognostic value. This study may be used to refine current staging systems, improve early detection, and optimize management for these aggressive tumors.
Potential Country-level Health and Cost Impacts of Legalizing Domestic Sale of Vaporized Nicotine Products
Authors: Petrović-van der Deen Frederieke S. , Wilson Nick , Crothers Anna , Cleghorn Christine L. , Gartner Coral , Blakely Tony
Published: February 2019

Background:

The net impact on population health and health system costs of vaporized nicotine products is uncertain. We modeled, with uncertainty, the health and cost impacts of liberalizing the vaporized nicotine market for a high-income country, New Zealand (NZ).

Methods:

We used a multistate life-table model of 16 tobacco-related diseases to simulate lifetime quality-adjusted life-years (QALYs) and health system costs at a 0% discount rate. We incorporated transitions from never, former, and current smoker states to, and from, regularly using vaporized nicotine and literature estimates for relative risk of disease incidence for vaping compared with smoking.

Results:

Compared with continuation of baseline trends in smoking uptake and cessation rates and negligible vaporized nicotine use, we projected liberalizing the market for these products to gain 236,000 QALYs (95% uncertainty interval [UI] = 27,000 to 457,000) and save NZ$3.4 billion (2011 NZ$) (95% UI = NZ$370 million to NZ$7.1 billion) or US$2.5 billion (2017 NZ$). However, estimates of net health gains for 0- to 14-year olds and 65+ year olds had 95% UIs including the null. Uncertainty around QALYs gained was mainly driven by uncertainty around the impact of vaporized nicotine products on population-wide cessation rates and the relative health risk of vaping compared with smoking.

Conclusions:

This modeling suggested that a fairly permissive regulatory environment around vaporized nicotine products achieves net health gain and cost savings, albeit with wide uncertainty. Our results suggest that optimal strategies will also be influenced by targeted smoking cessation advice, regulations around chemical constituents of these products, and marketing and age limits to prevent youth uptake of vaping.
Attitude toward livestock farming does not influence the earlier observed association between proximity to goat farms and self-reported pneumonia
Authors: Borlée Floor , Yzermans C. Joris , Oostwegel Floor S. M. , Schellevis François , Heederik Dick , Smit Lidwien A. M.
Published: February 2019

Background:

Attitudes toward environmental risks may be a source of bias in environmental health studies because concerns about environmental hazards may influence self-reported outcomes.

Objective:

The main aim was to assess whether earlier observed associations between proximity to goat farms and self-reported pneumonia were biased by participants’ attitude toward farming.

Methods:

We developed an attitude-score for 2,457 participants of the Dutch Livestock Farming and Neighbouring Residents’ Health Study (veehouderij en gezondheid omwonenden) by factor analysis of 13 questionnaire items related to attitude toward livestock farming. Linear regression analysis was used to assess associations between attitude and potential determinants. The effect of attitude on the association between goat farm proximity and pneumonia was analyzed by evaluating (1) misclassification of the outcome, (2) effect modification by attitude, and (3) exclusion of participants reporting health problems due to farms in their environment.

Results:

In general, the study population had a positive attitude toward farming, especially if participants were more familiar with farming. Older participants, females, ex-smokers, and higher-educated individuals had a more negative attitude. Both self-reported respiratory symptoms and exposure to livestock farms were associated with a more negative attitude. Misclassification of self-reported pneumonia was nondifferential with regard to participants’ attitude. Furthermore, no indication was found that the association between proximity to goat farms and pneumonia was modified by attitude. Excluding subjects who attributed their health symptoms to livestock farms did also not change the association.

Conclusions:

The association between goat farm proximity and pneumonia was not substantially biased by study participants’ attitude toward livestock farming.
PRAGMATISM OF RANDOMIZED CLINICAL TRIALS ON RANIBIZUMAB FOR THE TREATMENT OF DIABETIC MACULAR EDEMA
Authors: Stewart Stephen , Yeong Jian Lee , Virgili Gianni , Azuara-Blanco Augusto , Lois Noemi
Published: February 2019

Purpose:

To evaluate the pragmatism and generalizability of randomized clinical trials (RCTs) on ranibizumab for diabetic macular edema and determine whether clinical outcomes would differ based on whether or not patients fulfill the eligibility criteria of these RCTs.

Methods:

Pragmatism and generalizability of three RCTs on ranibizumab for diabetic macular edema (DRCRnet Protocols I and T, and RESTORE) were rated using the PRECIS-2 tool. A cohort of consecutive patients with diabetic macular edema was assessed to determine whether clinical outcomes differed based on whether or not patients met the RCT eligibility criteria. Univariable and multivariable regression analyses, adjusted for baseline best-corrected visual acuity, central retinal thickness and number of injections received, were used.

Results:

All RCTs were rated as being more pragmatic than explanatory, with DRCRnet trials being the most pragmatic. Of the 216 eyes (176 patients) included in the cohort, 63% would have met eligibility criteria for Protocol T, 61% for Protocol I, and 56% for RESTORE. When adjusted for best-corrected visual acuity, central retinal thickness, and number of ranibizumab injections received, there were no statistically significant differences in best-corrected visual acuity or central retinal thickness found between “eligible” and “ineligible” patients.

Conclusion:

Randomized clinical trials evaluating ranibizumab for diabetic macular edema were more pragmatic than explanatory. “Ineligible” patients still benefited from ranibizumab therapy.
Comparison of Medicare Claims-based Proxy Measures of Poor Function and Associations With Treatment Receipt and Mortality in Older Colon Cancer Patients
Authors: Mayer Sophie E. , Tan Hung-Jui , Peacock Hinton Sharon , Sanoff Hanna K. , Stürmer Til , Hester Laura L. , Faurot Keturah R. , Jonsson Funk Michele , Lund Jennifer L.
Published: February 2019

Background:

Multiple claims-based proxy measures of poor function have been developed to address confounding in observational studies of drug effects in older adults. We evaluated agreement between these measures and their associations with treatment receipt and mortality in a cohort of older colon cancer patients.

Methods:

Medicare beneficiaries age 66+ diagnosed with stage II–III colon cancer were identified in the Surveillance, Epidemiology, and End Results-Medicare database (2004–2011). Poor function was operationalized by: (1) summing the total poor function indicators for each model; and (2) estimating predicted probabilities of poor function at diagnosis. Agreement was evaluated using Fleiss’ κ and Spearman’s correlation. Associations between proxy measures and: (1) laparoscopic versus open surgery; (2) chemotherapy versus none; (3) 5-fluorouracil (5FU)+oxaliplatin (FOLFOX) versus 5FU monotherapy; and (4) 1-year mortality were estimated using log-binomial regression, controlling for age, sex, stage, and comorbidity. Survival estimates were stratified by functional group, age, and comorbidity.

Results:

Among 29,687 eligible colon cancer patients, 67% were 75+ years and 45% had stage III disease. Concordance across the poor function indicator counts was moderate (κ: 0.64) and correlation of predicted probability measures varied (ρ: 0.21–0.74). Worse function was associated with lower chemotherapy and FOLFOX receipt, and higher 1-year mortality. Within age and comorbidity strata, poor function remained associated with mortality.

Conclusions:

While agreement varied across the claims-based proxy measures, each demonstrated anticipated associations with treatment receipt and mortality independent of comorbidity. Claims-based comparative effectiveness studies in older populations should consider applying one of these models to improve confounding control.
Incidence and Mortality Rates of Second Pancreatic Cancer Among Survivors of Digestive Cancers
Authors: Ahn Hyeong Sik , Kang Tae Uk , Swan Heather , Kang Min Ji , Kim Nayoung , Kim Hyun Jung , Park Seon Mee
Published: February 2019

Objectives

We analyzed the incidence and mortality rates of second pancreatic ductal adenocarcinoma (PDAC) among survivors of digestive cancers in South Korea.

Methods

We evaluated data from the Korea National Health Insurance to identify individuals with digestive cancers in 2005 to 2015. The standardized incidence ratios (SIRs) of second PDACs and survival rates were evaluated.

Results

Among 772,534 patients with first digestive cancers, 1696 (0.22%) developed second PDACs. The incidence of second PDACs increased until 10 years since the first cancer diagnosis. Patients with biliary tract cancers (BTCs) showed a higher incidence of second PDACs than did those with gastrointestinal cancers or hepatocellular carcinoma. In ages 20 to 49 years, SIRs (95% confidence interval) were higher in survivors of hepatocellular carcinoma (3.08; 1.04–3.08), gastric cancer (3.40; 1.90–3.40), colorectal cancer (5.00; 2.75–5.00), gallbladder cancer (58.52; 11.81–58.52), intrahepatic cholangiocarcinoma (86.99; 1.73–86.99), extrahepatic cholangiocarcinoma (89.41; 27.42–89.41), and ampulla of Vater cancer (156.78; 48.08–156.78). In ages 50 to 64 years, colorectal cancer (1.42; 1.04–1.42), gastric cancer (1.66; 1.29–1.66), and BTCs revealed higher SIRs. In ages more than 65 years, SIR was increased only in BTCs. Second PDACs revealed a more favorable prognosis than first PDACs.

Conclusions

Careful surveillance for second PDACs after curative treatment of BTCs and colorectal cancers should be considered.
Desmoplasia in Lymph Node Metastasis of Pancreatic Adenocarcinoma Reveals Activation of Cancer-Associated Fibroblasts Pattern and T-helper 2 Immune Cell Infiltration
Authors: Nizri Eran , Bar-David Shoshi , Aizic Asaf , Sternbach Neta , Lahat Guy , Wolf Ido , Klausner Joseph
Published: February 2019

Objectives

Pancreatic ductal adenocarcinoma (PDAC) is characterized by a peritumoral proliferation of fibroblasts and extracellular matrix production known as desmoplasia. We aimed to study desmoplasia in PDAC lymph node (LN) metastases.

Methods

We evaluated LNs from 66 patients with PDAC and LN metastases. We used immunohistochemistry and real-time polymerase chain reaction to phenotype the desmoplastic response.

Results

Desmoplasia was identified in 57% of patients with LN metastases (Des+). Cancer-associated fibroblasts (CAFs) in Des+ expressed α-smooth muscle actin and collagen 11A1. The latter expression was present only in CAFs but not in LN stroma or in LN metastases without desmoplasia (Des−). Desmoplasia was associated with upregulation of transforming growth factor β messenger RNA. Whereas numbers of CD8+ in tumor vicinity were not different between Des+ and Des− patients (78 [standard deviation {SD}, 57] vs 92 [SD, 52], P = 0.48, respectively), the numbers of GATA-3+ cells, a marker of T-helper 2 immune response was significantly increased (3.7 [SD, 6.3] for Des+ vs 1.3 [SD, 2.7] for Des−, P < 0.05).

Conclusions

Lymph node desmoplasia is associated with CAF pattern activation and Th2 infiltration. Therapeutic modulation of desmoplasia may be relevant in the metastatic phase and influence antitumor immune response.
A Meta-analysis of Traffic-related Air Pollution and Risk of Childhood Leukemia
Authors: Gong Zeng-Hong , Li Jian , Wang Xiao-Yong , Yu Yan , Ren Min-Min , Zhou Jian
Published: February 2019

Background:

Many studies have analyzed the association between traffic-related air pollution and risk of childhood leukemia, but the results are inconsistent. Therefore, we performed this meta-analysis to investigate the association between traffic-related air pollution and risk of childhood leukemia.

Methods:

PubMed, Cochrane, and Embase databases were searched by the index words to identify eligible case-control studies, and relevant literature sources were also searched. The latest research was performed in September 2017. Odds ratio (OR) along with 95% confidence interval (95% CI) were used to analyzed the main outcomes.

Results:

Twenty-one case-control studies were included in the meta-analysis. The results indicated that in the studies of overall traffic density (OR: 1.01, 95% CI: 0.98-1.04), high traffic density (OR: 1.04, 95% CI: 0.91-1.17), moderate exposure to NO2 (OR: 1.02, 95% CI: 0.93-1.10), and benzene (OR: 1.04, 95% CI: 0.71-1.37), the risks of childhood leukemia incidence were higher in the case group than the control group, but no significant difference was found. In other analysis, no significant difference was observed in the risk of childhood leukemia in the 2 groups.

Conclusions:

Current evidence suggests that childhood leukemia is associated with traffic density, and moderate exposure to NO2 and benzene. However, more high-quality studies are required to confirm the conclusions.
Using a Delphi Survey to Develop Clinical Nursing Research Priorities Among Nursing Management
Authors: Sun Carolyn , Prufeta Patricia
Published: February 2019

OBJECTIVE

The aim of this study was to identify clinical nursing research priorities among nurse managers (NMs).

BACKGROUND

Determining research priorities is the 1st step toward building a solid evidence base for clinical practice. NMs are well poised to identify research priorities, and yet, a literature review revealed a dearth of research priorities as determined by clinical NMs.

METHODS

Using a Delphi survey, 38 NMs were queried at a large, urban hospital regarding critical priorities for nursing research.

RESULTS

Critical priorities for clinical nursing research included nursing workforce/nursing workflow and communication (categorized as critical by 68% and 53% of NMs, respectively). Other important priorities focused on falls/patient safety/hospital-acquired infections, patient/family satisfaction, emergency preparedness, patient outcomes, and collaboration/interdisciplinary research.

CONCLUSIONS

Because NMs are positioned to direct clinical research agendas, the results provide a critical guide for policy development surrounding nursing research. Directing research toward these identified topics will help build a solid evidence base for nurses and ultimately improve patient outcomes.
The Implementation of an Introductory Surgical Pathology Didactic Series to Transition First Year Residents and Facilitate Upper Level Resident Teaching
Authors: Mehr Chelsea R. , Montone Kathleen T. , Schwartz Lauren E.
Published: February 2019

The increasing complexity of the practice of pathology and health care in general requires that pathology residents acquire a vast number of skills during their training. This has been reflected by the broad range of skills addressed in the Accreditation Council for Graduate Medical Education (ACGME) milestones. In order to address some of these milestones, our residency program instituted an introductory didactic series in surgical pathology that focused on 2 objectives. First, the didactics provided basic grossing and histology training to first year residents transitioning from medical school. Second, the sessions allowed upper level residents to refine their teaching and communication skills at the microscope and therefore served as an important career development tool. Surveys of both first year residents and the upper level residents that led these sessions confirm the utility of these didactics and the use of upper level residents to teach junior trainees. In addition, these sessions led to a dramatic increase in RISE scores among first year trainees. An introductory series with upper level residents leading slide sessions could easily be replicated at other institutions and provide similar benefits.
Small and Isolated Immunohistochemistry-positive Cells in Melanoma Sentinel Lymph Nodes Are Associated With Disease-specific and Recurrence-free Survival Comparable to that of Sentinel Lymph Nodes Negative for Melanoma
Authors: LeBlanc Robert E. , Barton Dorothea T. , Li Zhongze , Angeles Christina V. , Ernstoff Marc S. , Bagley Eryn , Wimmer Daniel , Wong Sandra L. , Barth Richard J. , Shirai Keisuke , Yan Shaofeng
Published: February 2019

Although immunohistochemistry (IHC) has improved our ability to detect melanoma metastases in sentinel lymph nodes (SLN), the American Joint Committee on Cancer (AJCC) does not provide a lower threshold for determining if a SLN is positive for metastasis. Existing literature suggests that even a small aggregate or an enlarged, abnormal cell detectable by IHC can be associated with an adverse outcome. In our experience, however, some SLNs contain small solitary cells the size of neighboring lymphocytes demonstrable only by IHC. We sought to determine their clinical significance. A total of 821 patients underwent a SLN biopsy at our institution over a 12-year period. In all, 639 (77.8%) were SLN-negative, 125 (15.2%) were SLN-positive, and 57 (6.9%) had rare IHC-positive cells of undetermined clinical significance with no disease progression over a mean 59-month follow-up. Kaplan-Meier method with pair-wise comparisons revealed no significant difference in disease-specific survival and recurrence-free survival between SLN-negative and rare IHC-positive groups. There were significant differences in survival and recurrence between patients in the rare IHC-positive group and those with melanoma metastases, including those with solitary melanoma cells and those with tumor burdens ≤0.2 mm. While the lower diagnostic threshold for metastatic melanoma on IHC-stained sections needs to be studied further, our data suggest that rare IHC-positive cells lacking cytomorphologic features of overt malignancy are equivocal for melanoma and could impart a similar prognosis as patients with no evidence of SLN involvement.
Distributing Local Resources for Public Health Preparedness Grants: A Data-Driven Approach
Authors: Zamboni Lucila M. , Martin Erika G.
Published: February 2019

Objectives:

To simulate allocations of Public Health Emergency Preparedness funds to counties using alternative metrics of need, minimum allocation amounts, and the proportion earmarked for discretionary considerations.

Design:

We developed a county-level community resilience index of 57 New York State counties using publicly available indicators, which we incorporated into an interactive spreadsheet of 8 hypothetical allocation formulas with different combinations of population size, the index and its 5 domains, and population density. Simulations were compared with the 2013-2014 fiscal year grant allocation.

Results:

New York allocated $6.27 million to counties outside New York City, with a median allocation of $78 038, ranging from $50 825 to $556 789. These allocations would vary under different strategies, with the largest changes among sparsely populated counties that currently receive a minimum allocation of $50 825. Allocations were sensitive to changes in minimum allocation, amount earmarked for discretionary allocation, and need indicator.

Conclusions:

Population-based approaches are commonly used but ignore important dimensions of need. It is feasible to include robust local community resilience measures in formulas, and interactive spreadsheet models can help stakeholders evaluate the consequences of alternative funding strategies.
Incentivizing Healthy Snacks During Out-of-School Time Through Grocery Store Partnerships
Authors: Anzman-Frasca Stephanie , Folta Sara C. , Angstrom Heather M. , Brown Clarissa M. , Beets Michael W. , Finley Anna Marie , Nelson Miriam E. , Economos Christina D.
Published: February 2019

Context:

Volunteer-led out-of-school-time (OST) programs, such as 4-H, scouting, and youth sports, reach a large population of children and are positioned to offer opportunities for healthy eating. However, cost is a barrier to providing healthy snacks such as fruits and vegetables (FVs) during OST.

Objective:

Offering discounts through grocery store partnerships has shown promise in addressing this barrier in structured, staff-led after-school programs. We tested this model in volunteer-led OST programs and evaluated it using mixed methods.

Design/Setting:

The Snack It Up (SIU) intervention was designed to promote FV snacks to volunteer-led OST programs through weekly $5 grocery store discounts. Participation was limited to 1 leader per program.

Participants:

Thirty-five of 36 recruited OST program leaders completed the study; 16 were enrolled in SIU and 19 in a comparison group.

Main Outcome Measures:

We assessed the following: (1) discount redemption among SIU leaders; (2) snacks served by SIU and comparison group leaders via photographs from 3 to 4 OST program sessions during SIU implementation; and (3) SIU leader perspectives using key informant interviews before and after implementation.

Results:

SIU leaders saved an average of $48.75 on FV snacks throughout the intervention ($2.90 per week, more than one-fifth of typical self-reported spending on snacks). SIU leaders also served a greater frequency (100% of sessions vs 75%, P < .001) and variety of FVs (an average of 3.5 types per session vs 1.3, P < .001) and fewer salty/sweet snacks (0.0 vs 1.3 types per session, P < .001) than those in the comparison group and expressed positive impressions of SIU.

Conclusions:

Partnerships between OST programs and grocery stores are a promising avenue for promoting healthier snacks during OST.