bluuebunny/crossref_metadata_2025 huggingface dataset:
Cervical Cancer Risk Perceptions and Justifications Among Women in Rural El Salvador [22J]
Authors: Rosenbaum Alan , Figueroa Ruben , Maza Mauricio , Alfaro Karla , Chang Judy , Cremer Miriam
Published: May 2017

INTRODUCTION:

To describe cervical cancer risk perceptions and justifications among women in rural El Salvador.

METHODS:

Salvadoran women participating in a cervical cancer educational session were asked in an open-ended manner to describe their self-perceived cancer risk and explain their justification for that belief. Responses were recorded as close to verbatim as possible. Women were later given a cervical cancer screening appointment, for which attendance was recorded. Two investigators performed content analyses coding and categorized participant’s risk perceptions and justifications; agreement was assessed with Cohen’s Kappa correlations. Associations between self-perceived risk, risk perception justifications, and screening attendance were assessed with Pearson’s Chi-square statistics.

RESULTS:

Of 409 participants, 187 (45.7%) women viewed themselves at risk of cervical cancer, 65 (15.9%) not at risk, and 157 (38.4%) unsure. Justification for those beliefs included the perception of having an ability or inability to change their cancer risk and that cancer risk was associated with certain risk factors or indiscriminate. Women viewing themselves at risk of cervical cancer were less likely to attend screening. Women believing they lacked ability to affect their cancer risk and those believing cancer to be indiscriminate more frequently reported being at risk. Additionally, the perception that cancer risk is indiscriminate was associated with decreased attendance.

CONCLUSION:

This study revealed themes that women’s decisions to participate in cervical cancer screening is influenced by beliefs regarding personal risk and sense of control over those risks. Understanding these motivations may allow public health programs to tailor cervical cancer education to improve screening participation in Latin America.
Tobacco-Related Healthcare Among Women of Reproductive Age [29J]
Authors: Pineles Beth L. , Samet Jonathan M.
Published: May 2017

INTRODUCTION:

After a decades-long decline, smoking prevalence has plateaued. It remains one of the most important modifiable risk factors for dozens of health and birth outcomes. Despite evidence that advice to quit and brief counseling improve quit rates, tobacco-related healthcare is suboptimal. We examined correlates of the receipt of tobacco-related healthcare in ambulatory care visits by women of reproductive age.

METHODS:

The National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) collect data annually from nationally-representative samples of ambulatory care visits. We analyzed restricted data on 130,363 visits by women aged 15-44 in the NAMCS and NHAMCS surveys for the years 2001-9.

RESULTS:

Tobacco use was identified in 67% of women and 73% of pregnant women, and this frequency decreased from 2001 to 2009 among pregnant women. Tobacco use/exposure counseling was provided in 19% of visits by tobacco users and 21% of visits by pregnant tobacco users. Obstetrician-gynecologists were more likely to identify tobacco use than were most other specialists. Pregnant women were more likely to have tobacco use identified than were nonpregnant women. Non-white patient race was associated with a lower rate of tobacco use identification. Medical school-affiliated outpatient departments were less likely to identify tobacco use but more likely to provide tobacco use/exposure counseling.

CONCLUSION:

Low and declining rates of identification of tobacco use reinforce the need for improvement. Several associations with suboptimal tobacco-related healthcare were identified which can help tailor programs for improvement.
Knowledge of STIs Among Heterosexual and Sexual Minority Hispanic Women Living in Puerto Rico [30J]
Authors: Garcia-Crescioni Keyla , Cardenas-Suarez Natalia , Muns-Aponte Sofia , Roura Jaime , Romaguera Josefina
Published: May 2017

INTRODUCTION:

Sexually transmitted infections (STIs) are among the most common contagious diseases leading to severe health complications in women. When compared to heterosexual (HET) women, sexual minority women (SMW) have been perceived as a low risk group for STIs. Studies have reported that SMW engage in riskier sexual activities, yet there is insufficient data related to STIs. Here, we examine STIs knowledge in a sample of HET and SMW in PR.

METHODS:

A descriptive cross-sectional, online survey study was employed to collect data from Puerto Rican women (HET=333 and SMW=143). Sociodemographic data, STIs knowledge (using a cultural adaptation of the STD-KQ) and perceived risk of STIs were obtained. Using Mann Whitney Wilcoxon and Chi-square we compare knowledge and perceived risk of STIs.

RESULTS:

Mean age was 34 years (±10), education level of a bachelor’s degree or higher was (HET=75%; SMW=68.6%), and most were in a relationship at the time of the study (HET= 75.7%; SMW= 73.4%). An 80 or better score in the STD-KQ was obtained in 43.8% of HET and 39.6% of SMW (p=0.46). In terms of STIs risk perception, there were no statistically significant differences among groups; both reported to be at no or low risk of acquiring STIs.

CONCLUSION:

Heterosexual and sexual minority women were unaware of general STIs knowledge and perceived themselves as a low risk group. It is imperative to develop culturally appropriate intervention programs to educate and increase both awareness and STIs knowledge in women in PR.
Knowledge and Use of Folic Acid Among Hispanic Women Visiting University of Puerto Rico Prenatal Clinics [31J]
Authors: Rivera-Segarra Stephanie , Ramos-Tollinchi Lizzie , Cardenas-Suarez Natalia
Published: May 2017

INTRODUCTION:

Neural tube defects (NTDs) are mostly caused by a deficiency of folic acid (FA). Although supplementation is recommended for all reproductive-aged women, the incidence of NTD in Puerto Rico has not significantly decreased. In this study, we aim to identify the level of awareness regarding the time to begin FA supplementation and the recommended preconceptional dosage. We also aim to correlate the source of education with the knowledge patients have about the benefits of FA.

METHODS:

This is a descriptive study from August 2015 to November 2015 at the Adults University Hospital High Risk Prenatal Care Clinics. A self-administered questionnaire was assessed and analyzed with Epi Info 7.

RESULTS:

A total of 200 patients were recruited. An 87% of participants were Puerto Rican, most had a high school education and low income status. A 66.5% of participants were taking FA at the time of the study. Of these, 77% understood that the best time to start FA supplementation was before pregnancy. However, 23% of these patients took FA preconceptionally. Most of the patients referred to have received information about FA from a health care professional. Nevertheless, many patients could not identify all of FA benefits.

CONCLUSION:

Although most of our patients are aware of the adequate time for FA supplementation, the majority begin intake once pregnancy is discovered. However, even though the awareness is present, the knowledge received from health care professional is not enough. Most women remain unclear about the benefits of FA supplementation.
Effect of Introduction of a Lactation Counselor on Breastfeeding Uptake and Satisfaction in an Urban Prenatal Clinic [39A]
Authors: Martinez Noelle , Nguyen Antoinette , Hu Fengling , Strohbach Angelina , Hajjar Nadia , Yee Lynn
Published: May 2017

INTRODUCTION:

To assess the association between introduction of a full-time lactation counselor (LC) and breastfeeding outcomes.

METHODS:

This is a prospective observational study of low-income, minority women receiving care in a publicly funded prenatal clinic 6 months before and after introduction of a LC. The LC provided inpatient and outpatient one-on-one antenatal and postpartum lactation education and support. Chart review and survey data were collected to compare women receiving care before versus after LC introduction. The primary outcome was breastfeeding continuation (exclusive or partial) at 6 weeks postpartum; secondary outcomes included breastfeeding comfort, confidence,and training satisfaction. Bivariable and multivariable analyses were utilized as appropriate.

RESULTS:

Of 218 women, 54.6% were post-LC introduction; there were no demographic differences between cohorts. Factors associated with breastfeeding continuation included greater maternal education (aOR 4.10, 95% CI 1.73-9.69) and breastfeeding comfort and confidence (aOR 3.04, 95% CI 1.34-6.91; aOR 4.56, 95% CI 1.81-11.46). Women with LC were more likely to be satisfied with BF training (98.2% vs 84.5%, p=.01), and were more likely to have performed any breastfeeding (89.7% vs 73.6%, p=.007), which remained significant on regression analysis (aOR 3.41, 95% CI 1.35-8.63). However, LC was not associated with continued BF at 6 weeks (aOR 1.28, 95% CI 0.69-2.38).

CONCLUSION:

Continued breastfeeding at 6 weeks postpartum among low-income, minority women was associated with greater maternal education and with breastfeeding comfort and confidence. Lactation counselor introduction was associated with improved breastfeeding training satisfaction and increased rates of any breastfeeding, but was not associated with continued breastfeeding at 6 weeks.
Does 17a-Hydroxyprogesterone Caproate for Preterm Birth Prevention Affect Midtrimester Cervical Length? [37F]
Authors: Wood S. Lindsay , Williams Bria , Tang Ying , Owen John
Published: May 2017

INTRODUCTION:

Weekly intramuscular 17a-hydroxyprogesterone caproate (17P) is endorsed by the American College of Obstetricians and Gynecologists for recurrent preterm birth (PTB) prevention. Cerclage is indicated in patients with prior PTB and a midtrimester cervical length (CL) less than 25 mm. While 17P and CL screening are used concurrently in this population, 17P’s effect on CL is unclear. As such, we aimed to investigate the effect of 17P on midtrimester CL in patients with prior PTB.

METHODS:

Retrospective cohort of all singletons delivered at a single center that underwent CL screening from 2011 to 2016 for prior PTB. Exposure was defined as at least one dose of 17P administered prior to the last measured CL. Primary outcome was shortest observed CL. Secondary outcomes included rate of CL shortening to less than 25 mm and cerclage. ANCOVA was used to assess the relationship between 17P and shortest observed CL, controlling for significant covariates.

RESULTS:

Of 409 women who had CL screening, 211 received and 198 did not receive 17P prior to the last CL. Exposed and unexposed groups differed by initial CL (38.3 vs 36.0 mm, respectively; P < .005) and gestational age of earliest prior PTB (27.1 vs 29.2 weeks, respectively; P < .001). Rates of CL shortening to less than 25 mm (P = .93) and cerclage (P = .471) were similar. After controlling for confounders, shortest observed CL was significantly shorter in those who received 17P prior to the last CL (30.2 vs 32.7 mm; P < .001).

CONCLUSION:

17P does not prevent midtrimester CL shortening in patients with prior PTB.
Application of “Capacity Cascade” as Novel Approach to Emergency Obstetric Care Readiness Assessment in Guatemala [38G]
Authors: Tesfalul Martha , Madriz Solange , Cranmer John , Kestler Edgar , Walker Dilys
Published: May 2017

INTRODUCTION:

Preventing maternal and neonatal morbidity and mortality in health care facilities depends heavily on the provision of emergency obstetric care (EmOC). A dominant framework for assessing EmOC capacity focuses on the presence of tracer items (e.g. antibiotics, MgSO4) for signal functions (e.g. sepsis treatment, management of preeclampsia). Our study aims to assess the feasibility of a novel capacity cascades framework to measure facility EmOC readiness and to compare it with the known signal function framework.

METHODS:

The capacity cascades framework is characterized by three stages of EmOC readiness: 1) identification of emergency, 2) treatment, 3) monitoring and modification of treatment. Retrospective facility inventory data were obtained from 36 Guatemalan basic EmOC facilities. Mapping of the capacity cascades and signal function framework variables was done using STATA12 for: hemorrhage, hypertensive emergency, retained placenta, sepsis. Proportion of facilities meeting criteria for readiness based on each cascade stage and signal function was calculated.

RESULTS:

For hemorrhage EmOC readiness, 75.0% of facilities met signal function criteria versus 97.2% capacity cascade stage 1; 75.0% stage 2; 33.3% stage 3. For hypertensive emergency, 86.1% versus 97.2%; 77.8%; 38.9%. For retained placenta, 75.0% versus 97.2%; 52.8%; 13.9%. For sepsis, 100% versus 100%; 75%; 33.3%.

CONCLUSION:

This study shows that capacity cascade framework is easy to apply and demonstrates a discrepancy from the signal function framework that suggests an overestimate of EmOC readiness by the latter. An early study in Kenya showed similar trends, demonstrating reproducibility. Further work needs to be done investigating association with clinical outcomes to determine clinical relevance.
Postoperative Care After Gender Reassignment Surgery for Trans Women [39Q]
Authors: Luikenaar Rixt
Published: May 2017

INTRODUCTION:

Gender reassignment surgery (GRS) has been performed for many years. There are few surgeons that offer these surgeries and patients often travel far to have this done as part of their transitioning. We have few data regarding postoperative and follow up care. Each surgeon has their own preferred protocol regarding dilatation, use of lubrication and other topical ointments. There is currently no peer committee overseeing these surgeons and their postoperative recommendations.

METHODS:

We performed a literature study and looked at different Gender Reassignment Clinics and their postoperative protocols. These are also provided to my patients after surgery when I do their postoperative care.

RESULTS:

Most clinics have their own recommendations for postoperative care after Gender Reassignment surgery. Often patients come to a gynecologist for postoperative care. There are different recommendations out there and there is limited follow up from the primary surgeons nor communication with the physicians that performed postoperative care.

CONCLUSION:

There needs to be more transparency in postoperative care of patients that undergo GRS. There is little communication with primary surgeons and their patient’s physician that is responsible for postoperative care. Gynecologists will see an increase in patients that need postoperative care after GRS and we need more data on how to do this appropriately and a peer committee that oversees these GRS surgeons, including looking at complications, techniques and outcomes.
Gestational Weight Gain and Perinatal Outcomes by Pre-Pregnancy Obesity Class [1OP]
Authors: Wilkins Emilia , Alabaster Amy , Gunderson Erica
Published: May 2017

INTRODUCTION:

Gestational weight gain (GWG) is a modifiable risk factor that could mitigate poor perinatal outcomes for obese women. This study evaluated the risk of adverse perinatal outcomes among obese women that fall below the Institute of Medicine (IOM) guidelines for GWG.

METHODS:

This retrospective cohort study included 19,810 obese women delivering singleton, live births, greater than 35 weeks in 2009-2012 at Kaiser Permanente Northern California hospitals. Logistic regression was used to estimate the odds ratios (OR, 95% CI) of newborn [size for gestational age, NICU admission, length of hospital stay (LOS)] and maternal (mode of delivery, preeclampsia, gestational hypertension) outcomes associated with GWG below IOM guidelines (less than −2kg, -2kg – 2kg, or 2kg – 5kg) compared to within IOM guidelines (5kg-9kg) for pre-pregnancy obesity classes 1 to 3. Models were adjusted for socio-demographics, parity, gestational age, prenatal care, diabetes, hypertension and smoking.

RESULTS:

Among class 3 obese women, GWG below -2 kg compared to GWG within IOM guidelines was associated with lower odds of: large for gestational age infants OR=0.44 (0.27 – 0.71), preeclampsia/eclampsia OR=0.51 (0.26 – 0.93), cesarean section OR=0.50 (0.35 – 0.71), NICU admission OR 0.70 (0.45 – 1.08) and LOS greater than 3 days OR=0.53 (0.28 – 0.76), but higher odds of small for gestational age OR=2.61 (1.11 – 6.20). Findings were similar for other obesity classes.

CONCLUSION:

Weight loss among severely obese women is associated with improved perinatal outcomes, and higher risk of small for gestational age infants, but without the increased risk of other poor neonatal outcomes.
Does Obesity Affect the Assessment of Third Trimester Amniotic Fluid? [1P]
Authors: Andrikopoulou Maria , Kinzler Wendy , Calixte Rose , Chavez Martin , Fetsak Galyna , Vintzileos Anthony
Published: May 2017

INTRODUCTION:

To determine the inter-observer and intra-observer variability of amniotic fluid index (AFI) and maximum vertical pocket (MVP) measurements in obese pregnant women compared to non-obese pregnant.

METHODS:

This is a prospective study of women presenting for scheduled 3rd trimester clinically indicated ultrasound. AFI and MVP were measured by two sonographers. The first sonographer collected each measurement twice to assess intra-observer variability. The second sonographer was blinded to the measurement of the first sonographer to provide the measurement of inter-observer variability. Both measures of variability were estimated using the intra-class correlation (ICC) with 95% confidence intervals, ICC of 0.4 was considered the minimally accepted level of variability. All analyses were done using SAS 9.4®.

RESULTS:

Of the 126 patients enrolled, there was a mean maternal age of 33.8±5.5 years, mean BMI of 29.1±7.1 kg/m2 and mean gestational age 32.9±0.9 weeks. At that time, 57.8% of the patients were obese, 20.6% of the patients were affected by gestational diabetes, and 19% of the patients had prior cesarean section. The mean BMI for obese patients was 36.9±5.6 kg/m2 and for non-obese 26.5±2.8 kg/m2. ICC and 95% CI are presented for the overall cohort, as well as obese and non-obese women.

CONCLUSION:

Intra-observer variability for both MVP and AFI were acceptable in obese and non-obese women. Inter-observer correlation was poor, particularly when MVP was assessed in both obese and non-obese women. Obesity does not appear to have a significant impact on the variability of amniotic fluid assessment in the third trimester.
Baseline T Classification Predicts Early Tumor Regrowth After Nonoperative Management in Distal Rectal Cancer After Extended Neoadjuvant Chemoradiation and Initial Complete Clinical Response
Authors: Habr-Gama Angelita , São Julião Guilherme Pagin , Gama-Rodrigues Joaquim , Vailati Bruna Borba , Ortega Cinthia , Fernandez Laura Melina , Araújo Sérgio Eduardo Alonso , Perez Rodrigo Oliva
Published: May 2017

BACKGROUND:

Selected patients with rectal cancer and complete clinical response after neoadjuvant chemoradiation have been managed nonoperatively with acceptable outcomes. However, ≈20% of these patients will develop early tumor regrowth. Identification of these patients could select candidates for more intensive follow-up.

OBJECTIVE:

The purpose of this study was to investigate the influence of baseline radiological T classification on recurrences after a complete clinical response managed nonoperatively after chemoradiation.

DESIGN:

This was a retrospective review of a prospective collected database.

SETTINGS:

The study was conducted at a single center.

PATIENTS:

Patients with distal rectal cancer (cT2-4N0-2M0) undergoing extended chemoradiation (54 Gy + 5-fluorouracil–based chemotherapy) were eligible. Patients were reassessed for tumor response at 10 weeks after radiation completion. Patients with complete clinical response (clinical, radiological, and endoscopic) were managed nonoperatively and strictly followed.

MAIN OUTCOMES MEASURES:

Complete clinical response rates, early tumor regrowth rates (<12 mo), local recurrence-free survival, and distant metastases-free survival were measured.

RESULTS:

A total of 91 consecutive patients with rectal cancer underwent extended chemoradiation. Sixty-one patients developed initial complete clinical response (67%). cT2 patients developed similar initial complete clinical response rates compared with cT3/T4 (72% vs 63%; p = 0.403). Early tumor regrowths were more frequent among baseline cT3/4 when compared with cT2 patients (30% vs 3%; p = 0.007). There were no differences in late local recurrences (p = 0.593) or systemic recurrences (p = 0.387). Local recurrence-free survival was significantly better for cT2 patients at 1 year (96% vs 69%; p = 0.009). After Cox regression analysis, baseline T stage was an independent predictor of improved local recurrence-free survival at 1 year (p = 0.03; OR = 0.09 (95% CI, 0.01–0.81)).

LIMITATIONS:

This study was limited by its small sample size, retrospective nature, and short follow-up.

CONCLUSIONS:

cT2 patients who develop complete clinical response after extended chemoradiation managed nonoperatively are less likely to develop early tumor regrowths when compared with cT3/4 patients. cT3/4 patients should undergo more intensive follow-up after a complete clinical response to allow for early detection of early regrowths.
Orbital Perivenous Abscess Complicating the Diagnosis and Management of Orbital Cellulitis
Authors: Verma Rohan , Lee Bradford W. , Alameddine Ramzi M. , Ko Audrey C. , Khanna Paritosh C. , Kikkawa Don O. , Korn Bobby S.
Published: May 2017

An 11-year-old female presented with orbital cellulitis, bacterial sinusitis, enlarged left superior ophthalmic vein, dural venous sinuses, and internal jugular vein. The patient underwent endoscopic sinus surgery and was started on intravenous antibiotics and anticoagulation with limited improvement in orbital signs and symptoms. A magnetic resonance imaging/magnetic resonance venography of the orbits and brain revealed a dilated left superior ophthalmic vein with absence of flow but no clearly discernible orbital abscess. Intravenous corticosteroids resulted in dramatic improvement of pain, hypoglobus, proptosis, and extraocular motility, all of which rapidly recurred on discontinuation. Serial imaging revealed progression of what eventually manifested as a well-defined, rim-enhancing peri-superior ophthalmic vein abscess, which was incised and drained with prompt resolution of orbital cellulitis and complete visual recovery.
Bone Anchored Hearing Implant Surgery: 1 Year Follow-Up Data Shows No Effect of Hydroxyapatite Coating on Soft Tissue Reaction After Loading at 1 Week
Authors: Høgsbro Morten , Agger Andreas , Johansen Lars Vendelbo
Published: May 2017

Objective:

To assess postoperative skin complications around a bone anchored hearing implant (BAHI) abutment coated with hydroxyapatite and loaded after 1 week.

Design:

Single center, prospective cohort study of 25 adults with expected normal skin and bone quality.

Intervention:

Implantation of the Baha BA400 hydroxyapatite coated implant system using a linear incision technique without soft tissue reduction. Abutments with lengths of 8 mm (n = 9), 10 mm (n = 11), and 12 mm (n = 5) were used. The implants were loaded after 7 days (n = 23), 8 days (n = 1), and 12 days (n = 1).

Main Outcome Measures:

: Soft tissue evaluation (Holger's score, skin overgrowth, pain, numbness) at 7 (±2), 14 (±3), and 30 (±7) days and 3 months (±14 days), 6 months (±14 days), and 12 months (±30 days). The results were compared with a historic control group.

Results:

Twenty five patients were included, 23 could be followed up for 1 year. In 93.8% of the visits, patients had a Holger's score less than or equal to 1. One patient needed revision surgery due to skin overgrowth. 18.8% of the patients experienced mild pain during follow-up, primarily during the first month. Sensibility loss was very limited. Compared with similar patients having the smooth titanium abutment (loaded at 2 wk), there was a slightly increased level of short-term soft tissue reaction.

Conclusion:

The study shows a small, non-detrimental, negative effect on short-term soft tissue status after loading of the implant at 7 days. No positive effect from the hydroxyapatite coating could be demonstrated for the long-term soft tissue status.
Patients in prehospital transport to the emergency department: a cohort study of risk factors for 7-day mortality
Authors: Noergaard Bech Camilla L. , Brabrand Mikkel , Mikkelsen Søren , Lassen Annmarie
Published: May 2017

Background

Ambulance transfer is the first contact with the healthcare system for many patients in emergency conditions.

We aimed to identify prognostic risk factors accessible in the prehospital phase that indicate an increased risk of 7-day mortality.

Patients and methods

We included patients aged 18 years or older, transferred by ambulance to the emergency department at Odense University Hospital, from 1 April 2012 to 30 September 2014. We carried out multivariate logistic regressions, adjusted for age and sex, to describe the relationship between vital sign values recorded in the prehospital setting and 7-day mortality.

Results

A total of 32 076 ambulance transfers were recorded. Of these, 20 328 were first-time transfers, including 2692 that received assistance from a physician-staffed mobile emergency care unit (MECU). The 7-day mortality was 5.3% [95% confidence interval (CI): 5.0–5.6]. The risk of death increased with age. The odds ratios (ORs) were 2.0 (95% CI: 1.1–3.5) for ages 30–44 years and 7.3 (95% CI: 4.5–11) for ages 45–69 years compared with the 18–29-year-olds. All abnormal vital sign values were associated with increased 7-day mortality. Glasgow Coma Score of less than 14 had the strongest association (OR: 17, 95% CI: 14.7–19.7). MECU assistance showed an adjusted OR of 5.3 (95% CI: 4.6–6.1).

Conclusion

The overall 7-day mortality was 5.3%, but differed in the two subgroups, with 15.4% in the MECU-assisted ambulance transfers and 3.8% in non-MECU-assisted transfers. Older age and Glasgow Coma Scores below 14 were the strongest of factors associated significantly with 7-day mortality.
Elapsed Time Between the First Symptoms of Breast Cancer and Medical Help-Seeking Behavior and the Affecting Factors
Authors: Gözüm Sebahat , Tuzcu Ayla
Published: May 2017

Background:

Many studies have determined that the time between women’s realization of first symptoms and seeking help from a healthcare professional is more than 1 month. The situation is defined as delay in medical help-seeking behavior (MHSB).

Objective:

The purpose of this study was to determine the time elapsed between the first symptoms of breast cancer and MHSB, as well as the factors contributing to the delay.

Methods:

In this descriptive study, the data were collected from 132 patients who received a diagnosis of breast cancer and are receiving treatment in the Oncology Clinic of Akdeniz University Hospital. The questionnaire used in the study was structured in 3 parts: sociodemographic characteristics, breast cancer history/screening behaviors, and psychological factors affecting MHSB. The elapsed time between patients’ first symptoms and MHSB was classified into “normal” when it was less than 1 month, “delay” when it was between 1 and 3 months, “long-term delay” when it was more than 3 months, and “very serious delay” when it was more than 6 months.

Results:

A total of 59.8% were classified as normal, 16.7% as delayed, 5.3% as a long-term delay, and 18.2% as a very serious delay after first symptoms. The delay in MHSB time was affected 18.55 times by “not caring/minding,” 10.73 times by “fear,” 7.13 times by “having more important problems,” and 4.23 times by “realization of first symptoms” by themselves.

Conclusion:

Psychological factors were the most important determinants in delay. The MHSB time was less if those first realizing the symptoms were healthcare professionals.

Implications for Practice:

Healthcare professionals should direct women to screenings and train them to interpret symptoms correctly.
The 3-Phase Process in the Cancer Experience of Adolescents and Young Adults
Authors: Belpame Nathalie , Kars Marijke C. , Beeckman Dimitri , Decoene Elsie , Quaghebeur Marijke , Van Hecke Ann , Verhaeghe Sofie
Published: May 2017

Background:

When confronted with cancer, adolescents and young adults (AYAs) enter a psychosocial trajectory. Previous research has acknowledged the importance of care adjusted to the specific needs of AYAs. To develop AYA-focused care, in-depth knowledge about the experiences of AYAs with cancer is necessary.

Objective:

The purposes of this study were to discover the psychosocial experiences of and their meanings for AYAs enduring cancer, as well as its treatment and follow-up, and to capture the basic social psychological process that shaped these experiences.

Methods:

This was a qualitative study in which individual semistructured interviews were conducted with 23 participants aged 15 to 25 years.

Results:

A 3-phase process was identified, which demonstrated alterations in the AYAs’ experiences and their underlying meanings: (1) maintaining normal life was essential, (2) normal life was slipping away, and (3) evolving toward a new normal life after treatment. Certain core dynamics were present in these 3 phases. Throughout the cancer trajectory, the AYAs attempted to maintain control, redefine the self, and incorporate their cancer experience to the long-term course of life and had varying expectations of their social networks.

Conclusions:

Understanding the process that AYAs with cancer go through and taking into account their experiences can facilitate better psychosocial care for this emotionally vulnerable population.

Implications for Practice:

Healthcare professionals need to take a patient-centered approach, with a focus on communication, to meet the needs of AYAs throughout the cancer trajectory.
Motivational Factors of Student Nurse Athletes Attributing to Academic Success
Authors: Forst Kimberly A.
Published: May 2017

Student nurse athletes experience difficulties achieving academic success in nursing programs. The purpose of this study was to identify facilitators, barriers, and motivators of student nurse athletes that attribute to their academic success. Athletes ranked time management and prioritization as critical skills to success in the nursing program. This study reinforced the importance of academic support services for student nurse athletes to assist in their academic success.
Integration of Service Learning Into a Doctoral-Level Qualitative Research Methodology Course
Authors: Bryant Keneshia , Matthews Ellyn , DeClerk Leonie
Published: May 2017

This article provides an overview of the integration of a pilot service learning (SL) project in a doctoral-level qualitative research course. Faculty partnered with a nonprofit organization that prepares former foster youth for the challenges of adulthood. The project objectives were to (1) increase students’ knowledge/skills in qualitative methods, research ethics, and cultural/social issues and (2) promote community collaboration. The outcomes demonstrate that the project was feasible, valuable, and aligned with the principles of SL.
Analysis of Interventions Required in 12,021 Children With Acute Intoxications Admitted to PICUs*
Authors: Patel Meral M. , Travers Curtis D. , Stockwell Jana A. , Geller Robert J. , Kamat Pradip P. , Grunwell Jocelyn R.
Published: May 2017

Objectives:

Acute intoxications in children account for 4.6% of annual admissions to the PICU. We aimed to describe the interventions and monitoring required for children admitted to the PICU following intoxications with the ultimate goal of determining patient and intoxication characteristics associated with the need for PICU interventions.

Design:

Retrospective review of prospectively collected data from Virtual Pediatric Systems, LLC.

Setting:

United States PICUs participating in the Virtual Pediatric Systems database from 2011 to 2014.

Patients:

Less than or equal to 18 years old admitted to a PICU with a diagnostic code for poisoning, ingestion, intoxication, or overdose.

Interventions:

None.

Measurements and Main Results:

In total, 12,021 patients were included with a median PICU length of stay of 0.97 days (interquartile range, 0.67–1.60). Seventy-eight percent of the intoxications were intentional. The top five classes of medications ingested were unknown substances (21.6%), antidepressants (11.5%), other chemicals (10.7%), analgesics (7.3%), and antihypertensives (6.2%). Seventy-six (0.61%) patients died. Any of the interventions reported in the Virtual Pediatric Systems database were performed in only 29.1% of the total cases.

Conclusions:

The majority of cases (70.9%) admitted to the PICU following an intoxication did not undergo any significant intervention. Future studies should focus on distinguishing patient and intoxication characteristics associated with need for PICU intervention to optimize patient safety and minimize resource burden.
Brief Report: CYP2B6 516G>T Minor Allele Protective of Late Virologic Failure in Efavirenz-Treated HIV-Infected Patients in Botswana
Authors: Vujkovic Marijana , Bellamy Scarlett L. , Zuppa Athena F. , Gastonguay Marc , Moorthy Ganesh S. , Ratshaa Bakgaki R. , Han Xiaoyan , Steenhoff Andrew P. , Mosepele Mosepele , Strom Brian L. , Aplenc Richard , Bisson Gregory P. , Gross Robert
Published: May 2017

Background:

CYP2B6 polymorphisms that affect efavirenz (EFV) concentrations are common, but the effect of this polymorphism on HIV virologic failure in clinical practice settings has not fully been elucidated. Our objective was to investigate the relationship between the CYP2B6 516G>T genotype and late virologic failure in patients treated with EFV in Gaborone, Botswana.

Setting:

We performed a case–control study that included 1338 HIV-infected black Batswana on EFV-based antiretroviral therapy (ART). Patients were approached for enrollment during regular visits at one of the outpatient HIV clinics between July 2013 and April 2014.

Methods:

Cases experienced late HIV failure, defined as plasma HIV RNA >1000 copies/mL after maintaining viral suppression (<400 copies/mL) for at least 6 months. For each case, a total of 4 control patients were randomly sampled from the same population. Controls had plasma HIV RNA <400 copies/mL on ART for at least 6 months. Logistic regression was used to determine the adjusted odds of late HIV failure by 516G>T genotype.

Results:

After adjustment for the confounding variables age and CD4 count, the CYP2B6 516 T-allele was protective against late HIV virologic breakthrough, adjusted OR 0.70; 95% CI: 0.50 to 0.97.

Conclusion:

The CYP2B6 516 T-allele was protective against late virologic breakthrough in patients with initial (6 month) HIV RNA suppression on EFV-based ART. Future studies are needed to assess long-term viral benefits of identifying and offering EFV containing ART to black African HIV-infected patients with CYP2B6 T-alleles, especially given the wider availability of a single pill EFV in this setting.
Intraluminal Uterine Hypodensity in CT Scans of Postmenopausal Women: Recommendations for Interpretation
Authors: Amitai Michal Marianne , Yassin Mohamad , Kanana Nayrouz , Apter Sara , Rozendorn Noa , Konen Eli , Klang Eyal
Published: May 2017

Objective

This study aims to investigate the association between intraluminal uterine hypodensity and uterine malignancy and establish thresholds that would minimize routine gynecological evaluation.

Methods

Two groups were recruited retrospectively: cancer group, which comprised 32 sequential endometrial cancer patients, and postmenopausal group, which comprised 63 women, with no known gynecologic malignancy.

Two radiologists independently measured hypodensity, transversely in the axial plane and anterioposteriorly in the sagittal plane.

The association between cancer and hypodensity was evaluated. Receiver operating characteristic curves were evaluated diameters predictive of cancer.

Results

Hypodensity was associated with cancer (cancer group, 93.8% vs. postmenopausal group, 38.1%; P < 0.0001). Hypodensity diameters correlated highly with prediction of cancer (transverse area under the curve, 0.899; anteroposterior area under the curve, 0.892). Diameters of 19.5 mm transverse and 6.0 mm anteroposterior yielded a sensitivity of 87% and 83% and specificity of 91% and 83%, respectively.

Conclusions

Intrauterine hypodensity is a common finding in computed tomography scans of postmenopausal women. A transverse diameter of 19.5 mm and an anteroposterior diameter of 6.0 mm are suggested as thresholds for further gynecological sonographic evaluation.
Intraoperative Use of Vasopressors Does Not Increase the Risk of Free Flap Compromise and Failure in Cancer Patients
Authors: Fang Lin , Liu Jun , Yu Cuicui , Hanasono Matthew M. , Zheng Gang , Yu Peirong
Published: May 2017

Objective:

To examine the effects of vasopressors on free flap outcomes.

Background:

Most micro-surgeons avoid the use of vasopressors during free flap surgery due to concerns of vasoconstriction, which could potentially lead to vascular thrombosis and flap failure. Previous studies lack the statistical power to draw meaningful conclusions.

Methods:

All free flaps between 2004 and 2014 from a single institution were reviewed retrospectively. Vasopressors were given intraoperatively as an intravenous bolus when blood pressure dropped >20% from baseline. The timing of intraoperative vasopressor administration was divided into 3 phases: from anesthesia induction to 30 minutes before the start of flap ischemia (P1); end of P1 to 30 minutes after revascularization (P2); end of P2 to end of surgery (P3). Agents included phenylephrine, ephedrine and calcium chloride.

Results:

A total of 5671 free flap cases in 4888 patients undergoing head and neck, breast, trunk, or extremity reconstruction were identified. Vasopressors were used intraoperatively in 85% of cases. The overall incidence of pedicle compromise was 3.6%, with a flap loss rate of 1.7%. A propensity score matching analysis showed that intraoperative use of any agents at any time of surgery was not associated with increased overall pedicle compromise [51/1584 (3.2%) vs 37/792 (4.7%); P = 0.074] or flap failure rates [26/1584 (1.6%) vs 19/792 (2.4%); P = 0.209]. Rather, there was less risk of venous congestion [33/1584 (2.1%) vs 31/792 (3.9%); P = 0.010].

Conclusions:

Intraoperative use of phenylephrine, ephedrine, or calcium chloride as an intravenous bolus does not increase flap compromise and failure rates in cancer patients.
Inferring single-cell behaviour from large-scale epithelial sheet migration patterns
Authors: Lee Rachel M. , Yue Haicen , Rappel Wouter-Jan , Losert Wolfgang
Published: May 2017

Cell migration plays an important role in a wide variety of biological processes and can incorporate both individual cell motion and collective behaviour. The emergent properties of collective migration are receiving increasing attention as collective motion's role in diseases such as metastatic cancer becomes clear. Yet, how individual cell behaviour influences large-scale, multi-cell collective motion remains unclear. In this study, we provide insight into the mechanisms behind collective migration by studying cell migration in a spreading monolayer of epithelial MCF10A cells. We quantify migration using particle image velocimetry and find that cell groups have features of motion that span multiple length scales. Comparing our experimental results to a model of collective cell migration, we find that cell migration within the monolayer can be affected in qualitatively different ways by cell motion at the boundary, yet it is not necessary to introduce leader cells at the boundary or specify other large-scale features to recapitulate this large-scale phenotype in simulations. Instead, in our model, collective motion can be enhanced by increasing the overall activity of the cells or by giving the cells a stronger coupling between their motion and polarity. This suggests that investigating the activity and polarity persistence of individual cells will add insight into the collective migration phenotypes observed during development and disease.
Organization of theDrosophilalarval visual circuit
Authors: Larderet Ivan , Fritsch Pauline M. J. , Gendre Nanaë , Neagu-Maier Larisa , Fetter Rick D. , Schneider-Mizell Casey , Truman James W. , Zlatic Marta , Cardona Albert , Sprecher Simon G.
Published: May 2017

Visual systems transduce, process and transmit light-dependent environmental cues. Computation of visual features depends on the types of photoreceptor neurons (PR) present, the organization of the eye and the wiring of the underlying neural circuit. Here, we describe the circuit architecture of the visual system ofDrosophilalarvae by mapping the synaptic wiring diagram and neurotransmitters. By contacting different targets, the two larval PR-subtypes create parallel circuits potentially underlying the computation of absolute light intensity and temporal light changes already within this first visual processing center. Locally processed visual information then signals via dedicated projection interneurons to higher brain areas including the lateral horn and mushroom body. The stratified structure of the LON suggests common organizational principles with the adult fly and vertebrate visual systems. The complete synaptic wiring diagram of the LON paves the way to understanding how circuits with reduced numerical complexity control wide ranges of behaviors.
Naturally-segregating Variation atUgt86DdContributes to Nicotine Resistance inDrosophila melanogaster
Authors: Highfill Chad A. , Tran Jonathan H. , Nguyen Samantha K. T. , Moldenhauer Taylor R. , Wang Xiaofei , Macdonald Stuart J.
Published: May 2017

Identifying the causative sequence polymorphisms underlying complex trait variation is a key goal of evolutionary and biomedical genetics. By knowing the precise molecular events that confer phenotypic changes we can gain insight into the pathways underlying complex traits and the evolutionary forces acting on variation. Genetic analysis of complex traits in model systems regularly starts by constructing QTL maps, but generally fails to identify causative nucleotide-level polymorphisms. Previously we mapped a series of QTL contributing to resistance to nicotine in aDrosophila melanogastermultiparental mapping resource, and here use a battery of functional tests to resolve QTL to the molecular level. One large-effect QTL resided over a cluster of UDP-glucuronosyltransferases, and quantitative complementation tests using deficiencies eliminating subsets of these detoxification genes revealed allelic variation impacting resistance. RNAseq showed thatUgt86Ddhad significantly higher expression in genotypes that are more resistant to nicotine, and anterior midgut-specific RNAi of this gene reduced resistance. We discovered a naturally-segregating 22-bp frameshift deletion inUgt86Dd, and overexpression of the insertion-containing allele in a range of tissues enhanced resistance. Accounting for the InDel event during mapping largely eliminates the QTL, implying the InDel explains the bulk of the effect associated with the mapped locus. Finally, we edited a relatively resistant genetic background to generate lesions inUgt86Ddthat recapitulate the naturally-occurring putative loss-of-function allele, and succeeded in radically reducing resistance. The putatively causative coding InDel inUgt86Ddcan be a launchpad for future mechanistic exploration of xenobiotic detoxification.

ARTICLE SUMMARY

Resolving the mutations that contribute to among-individual trait variation is a major goal of biomedical and evolutionary genetics. In general however, genetic mapping experiments do not allow immediate resolution of the underlying causative variants. Previous mapping work revealed several loci contributing to nicotine resistance inDrosophila melanogaster. We employed a battery of functional tests to demonstrate that the detoxification geneUgt86Ddhas a major phenotypic effect, and that a segregating frameshift mutation is likely causative. Editing the gene to introduce a premature stop codon led to a significant reduction in resistance, validating its role in xenobiotic detoxification.
Differential proportionality - a normalization-free approach to differential gene expression
Authors: Erb Ionas , Quinn Thomas , Lovell David , Notredame Cedric
Published: May 2017

Gene expression data, such as those generated by next generation sequencing technologies (RNA-seq), are of an inherently relative nature: the total number of sequenced reads has no biological meaning. This issue is most often addressed with various normalization techniques which all face the same problem: once information about the total mRNA content of the origin cells is lost, it cannot be recovered by mere technical means. Additional knowledge, in the form of an unchanged reference, is necessary; however, this reference can usually only be estimated. Here we propose a novel method where sample normalization is unnecessary, but important insights can be obtained nevertheless. Instead of trying to recover absolute abundances, our method is entirely based on ratios, so normalization factors cancel by default. Although the differential expression of individual genes cannot be recovered this way, the ratios themselves can be differentially expressed (even when their constituents are not). Yet, most current analyses are blind to these cases, while our approach reveals them directly. Specifically, we show how the differential expression of gene ratios can be formalized by decomposing log-ratio variance (LRV) and deriving intuitive statistics from it. Although small LRVs have been used to detect proportional genes in gene expression data before, we focus here on the change in proportionality factors between groups of samples (e.g. tissue-specific proportionality). For this, we propose a statistic that is equivalent to the squaredt-statistic of one-way ANOVA, but for gene ratios. In doing so, we show how precision weights can be incorporated to account for the peculiarities of count data, and, moreover, how a moderated statistic can be derived in the same way as the one following from a hierarchical model for individual genes. We also discuss approaches to deal with zero counts, deriving an expression of our statistic that is able to incorporate them. In providing a detailed analysis of the connections between the differential expression of genes and the differential proportionality of pairs, we facilitate a clear interpretation of new concepts. The proposed framework is applied to a data set from GTEx consisting of 98 samples from the cerebellum and cortex, with selected examples shown. A computationally efficient implementation of the approach in R has been released as an addendum to the propr package.1