bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can Radiologic Tumor Size Following Neoadjuvant Therapy Reliably Guide Tissue Resection in Breast Conserving Surgery in Patients with Invasive Breast Cancer?
Authors: Walcott-Sapp Sarah , Srour Marissa K. , Lee Minna , Luu Michael , Amersi Farin , Giuliano Armando , Chung Alice 
Published: December 2020

Optimum tissue resection volume for patients with invasive breast cancer undergoing breast conserving surgery following neoadjuvant therapy (NAT) is not known. We compared positive margin and in-breast tumor recurrence (IBTR) between 2 groups that were created based on radiologic tumor size (RTS (cm3)) at diagnosis, RTS post-NAT, and volume of tissue resected (VTL): Pre-NAT group, patients with VTL closer to RTS at diagnosis, and post-NAT group, patients with VTL closer to post-NAT RTS. 82 patients with 84 breast cancers treated with NAT between 2007 and 2017 who had pre- and post-NAT imaging were identified from a prospectively maintained database. RTS at diagnosis, RTS post-NAT, and VTL were determined. Clinical and treatment characteristics, IBTR, and disease-free survival (DFS) were compared between pre-NAT (n = 51) and post-NAT (n = 33) groups. Compared to post-NAT patients, pre-NAT patients had smaller RTS at presentation (9.2 vs. 33.5 cm3, P < .001) and post-NAT (1.2 vs. 8.2 cm3, P = .024). At median follow-up of 4 years, there were no differences between groups in pathologic tumor size, positive margin rate, adjuvant therapy, IBTR, or DFS. Resection volumes that matched RTS on post-NAT imaging were not associated with increased positive margins or IBTR. It may be appropriate to use post-NAT imaging to guide lumpectomy volume.
Computerized cognitive behavioural therapy for gender minority adolescents: Analysis of the real-world implementation of SPARX in New Zealand
Authors: Lucassen Mathijs FG , Stasiak Karolina , Fleming Theresa , Frampton Christopher , Perry Yael , Shepherd Matthew , Merry Sally N 
Published: December 2020

Objective: SPARX is a form of computerized cognitive behavioural therapy in serious game format funded via the Ministry of Health to be freely available in New Zealand. At registration users identify themselves as male, female, transgender or intersex. We aimed to establish whether adolescent transgender users of SPARX, compared to adolescent male and female users, were more likely to have high mental health needs at baseline and were more likely to complete SPARX. We also sought to determine changes in transgender adolescents’ depressive symptoms after using SPARX. Methods: Quantitative analysis of 5 years of usage data from the nation-wide delivery of SPARX in New Zealand. Results: There were 9079 adolescents who completed the registration process and used SPARX, 2.3% ( n = 207) identified as transgender. The majority of transgender registrants (69.0%) completing a baseline Patient Health Questionnaire – modified for Adolescents were categorized as having high mental health needs, significantly more so than male and female registrants ( p < 0.001). Over half of all SPARX registrants completed the first module of the program, with subsequently lower proportions of transgender registrants completing Module 4 ( p = 0.005) and Module 7 (i.e. the last module, p = 0.048). Of those registrants completing a baseline and subsequent Patient Health Questionnaire – modified for Adolescents, both male ( n = 247) and female ( n = 630) registrants, on average, had improvements in their scores (2.68 and 3.15, respectively), whereas transgender registrants ( n = 14) did not (−0.43) ( p = 0.048). Conclusion: This is the first study describing the impact of an e-therapy on transgender young people. The analysis of data from this free self-help intervention suggests that transgender adolescents seeking treatment for depression have particularly high mental health needs, and an existing well tested tool may be less effective for them than it is for others. Taken together the results appear to suggest targeted efforts may be required for transgender adolescents.
Impact of Trade Openness and Climate Change on Food Productivity in Nigeria
Authors: Shuaibu Mohammed 
Published: December 2020

Liberal trade regimes could help improve food productivity if environmental concerns such as adverse weather conditions that affect agriculture are addressed. This issue has not received adequate empirical scrutiny as linear models dominate extant literature. In this article, we check whether accounting for trade and climate change asymmetries is important in explaining food productivity in Nigeria. Using a nonlinear autoregressive distributed lag (ARDL) model, the existence of asymmetry was established in the long run but not in the short run. The long-run estimates show that high rainfall variability increases food production, but the reverse is the case in the short run where the decomposed shocks exert a negative impact. An increase in the volume of trade boosts food production in the long run, whereas the contemporaneous estimates reveal that lower trade flows enhance food productivity. The findings have important implications for food policy formulation and implementation. JEL Codes: F18, Q18, Q56
Transitioning from active duty to military retirement: Challenges impacting diabetes self-management
Authors: Fisher Carla L , Ledford Christy JW , Wollney Easton , Crawford Paul F 
Published: December 2020

Objectives: Military retirement happens early in the lifespan presenting a unique transition that challenges chronic illness. The purpose of this study was to explore the factors that military retirees experience as they transition from active duty to military retirement that they perceive as inhibiting their ability to manage type 2 diabetes (T2DM) or pre-diabetes (preDM) and/or which increase their disease risk. Methods: Twenty veterans diagnosed with T2DM or preDM participated in semi-structured, face-to-face interviews in a private setting at their primary care clinic. Transcripts were analysed using constant comparative method. Participants were aged 44 to 63 ( M = 56), with 15 diagnosed with T2DM and 5 as preDM. They had been retired from the military 6 to 22 years ( M = 14 years). Results: Participants linked five inter-related challenging factors to their T2DM/preDM diagnosis (when diagnosed post-retirement) and/or to their inability to manage their disease: (1) diet/eating habits, (2) physical activity, (3) weight fluctuation, (4) health care interactions and (5) systematic barriers. Military retirees’ experiences were embedded within a ‘cultural shift’. They struggled to maintain self-management behaviours once they were no longer on active duty and had more independence as civilians. Discussion: Results provide support for diabetes education during military retirement. Military retirees need help maintaining healthy lifestyle behaviours beyond the structured, health-focused military culture. They could also benefit from patient–provider communication skills training in navigating systematic barriers and attaining the support needed to manage their disease.
Evaluating Different Measures of Low Back Pain Among U.S. Manual Materials Handling Workers: Comparisons of Demographic, Psychosocial, and Job Physical Exposure
Authors: Tang Ruoliang , Kapellusch Jay M. , Hegmann Kurt T. , Thiese Matthew S. , Wang Inga , Merryweather Andrew S. 
Published: December 2020

Objective To examine differences in demographic, psychosocial, and job physical exposure risk factors between multiple low back pain (LBP) outcomes in a prospective cohort of industrial workers. Background LBP remains a leading cause of lost industrial productivity. Different case definitions involving pain (general LBP), medication use (M-LBP), seeking healthcare (H-LBP), and lost time (L-LBP) are often used to study LBP outcomes. However, the relationship between these outcomes remains unclear. Method Demographic, health status, psychosocial, and job physical exposure risk factors were quantified for 635 incident-eligible industrial workers. Incident cases of LBP outcomes and pain symptoms were quantified and compared across the four outcomes. Results Differences in age, gender, medical history, and LBP history were found between the four outcomes. Most incident-eligible workers (67%) suffered an LBP outcome during follow-up. Cases decreased from 420 for LBP (25.4 cases/100 person-years) to 303 for M-LBP (22.0 cases/100 person-years), to 151 for H-LBP (15.6 cases/100 person-years), and finally to 56 for L-LBP (8.7 cases/100 person-years). Conversely, pain intensity and duration increased from LBP to H-LBP. However, pain duration was relatively lower for L-LBP than for H-LBP. Conclusion Patterns of cases, pain intensity, and pain duration suggest the influence of the four outcomes. However, few differences in apparent risk factors were observed between the outcomes. Further research is needed to establish consistent case definitions. Application Knowledge of patterns between different LBP outcomes can improve interpretation of research and guide future research and intervention studies in industry.
Food Worry in the Deaf and Hard-of-Hearing Population During the COVID-19 Pandemic
Authors: Engelman Alina , Paludneviciene Raylene , Wagner Kathryn , Jacobs Katja , Kushalnagar Poorna 
Published: December 2020

Objective The coronavirus disease 2019 (COVID) pandemic has highlighted preexisting health disparities, including food insecurity, in the deaf and hard-of-hearing (DHH) population. We examined factors associated with food worry during the COVID-19 pandemic. Methods We collected survey data on worry about food shortages, worry about contracting COVID-19, and concerns about DHH people staying home and being lonely from April 17 through May 1, 2020, via a bilingual American Sign Language/English online survey platform. The sample consisted of 537 DHH adults living in the United States. We examined the relationship between demographic characteristics and food worry. We used logistic regression and model fitting to predict the likelihood of experiencing food worry. Results The mean (SD) age of survey respondents was 47 (16), and 25% of the sample identified as people of color. Forty-two percent of survey respondents had a high level of food worry. Increased worry about contracting COVID-19 and concerns about DHH people staying home and being lonely among DHH younger adults or those without a college degree predicted food worry. Gender and race/ethnicity did not contribute to the model for food worry. Conclusions Food worry was explained by multiple, intersecting factors, including demographic variables, worry about contracting COVID-19, and concerns about loneliness. Interventions or programs implemented by DHH-serving organizations as well as government programs, social service providers, and food banks should be fully accessible to subgroups of DHH young adults without a college degree who are at risk for food insecurity.
Review Article: Seema Mustafa (Ed.) Shaheen Bagh and the Idea of India and Zia Us Salam and Uzma Ausaf Shaheen Bagh: From a Protest to a Movement
Authors: Manchanda Rita 
Published: December 2020

Seema Mustafa (Ed.) Shaheen Bagh and the Idea of India. New Delhi: Speaking Tiger, 2020, 294 pp., ₹450. ISBN 978-93-89958 (Paperback) Zia Us Salam and Uzma Ausaf Shaheen Bagh: From a Protest to a Movement. London: Bloomsbury Publishing, 2020, 254 pp., ₹599. ISBN978-93-90077-92-2 (Paperback)
Relationship Between Parental Intolerance of Uncertainty and Decisional Conflict in Pediatric Otolaryngologic Surgery
Authors: Cleveland Chelsea , Patel Vijay A. , Steinman Shari A. , Razdan Reena , Carr Michele M. 
Published: December 2020

ObjectiveTo assess the relationship between depression, anxiety, stress, worry, intolerance of uncertainty (IU), and shared decision making (SDM) in parents of pediatric otolaryngology surgical patients with their perceptions of decisional conflict (DC).Study DesignCross‐sectional.SettingAcademic pediatric otolaryngology outpatient clinic.MethodsParticipants were legal guardians of pediatric patients who met criteria for otolaryngologic surgery. Participants completed a demographic survey as well as validated Decisional Conflict Scale (DCS); Shared Decision‐Making Scale (SDMS); Depression, Anxiety and Stress Scale–21 (DASS‐21); Penn State Worry Questionnaire (PSWQ); and short form of the Intolerance of Uncertainty Scale (IUS‐12).ResultsA total of 114 participants were enrolled. Respondents were predominantly female (93.0%) and married (60.5%). Most guardians had not consented previously for otolaryngologic surgery for their child (69.3%). Participants reported low levels of DC and depression as well as moderate levels of anxiety and stress. DC scores were not significantly correlated to DASS‐21, PSWQ, or SDM. IUS‐12 Total and subscale IUS‐12 prospective negatively correlated with Total DC. DC was not related to age, sex, education level, previous otolaryngologic surgery, or type of surgery recommended.ConclusionIn this group, an association was found between IU and DC. Clinicians should be aware that DC is not modified by previous surgical experience. Interventions aimed at addressing parental IU related to surgery may reduce DC. Further research efforts could help us understand how mental health relates to surgical decision making.
Preoperative Radiographic Predictors of Hearing Preservation After Retrosigmoid Resection of Vestibular Schwannomas
Authors: Ren Yin , Tawfik Kareem O. , Mastrodimos Bill J. , Cueva Roberto A. 
Published: December 2020

ObjectiveTo identify preoperative radiographic predictors of hearing preservation (HP) after retrosigmoid resection of vestibular schwannomas (VSs).Study DesignRetrospective case series with chart review.SettingTertiary skull base referral center.MethodsAdult patients with VSs <3 cm and word recognition scores (WRSs) ≥50% who underwent retrosigmoid resection and attempted HP between February 2008 and December 2018 were identified. Pure tone average (PTA), WRS, and magnetic resonance imaging radiographic data, including tumor diameter and dimensional extension relative to the internal auditory canal (IAC), were examined.ResultsA total of 151 patients were included. The average tumor size was 13.8 mm (range, 3‐28). Hearing was preserved in 41.7% (n = 63). HP rates were higher for intracanalicular tumors than tumors with cerebellopontine angle (CPA) components (57.6% vs 29.4%, P =. 03). On multivariate analysis, maximal tumor diameter (odds ratio [OR], 0.892; P <. 001) and preoperative PTA (OR, 0.974; P =. 026) predicted HP, while mediolateral tumor diameter predicted postoperative PTA (OR, 1.21; P =. 005) and WRS (OR, –1.89; P <. 001). For tumors extending into the CPA, younger age (OR, 0.913; P =. 012), better preoperative PTA (OR, 0.935; P =. 049), smaller posterior tumor extension (OR, 0.862; P =. 001), and smaller caudal extension relative to the IAC (OR, 0.844; P =. 001) all predicted HP.ConclusionRates of HP are highest in patients with small intracanalicular VSs and good preoperative hearing. For tumors extending into the CPA, greater posterior and caudal tumor extension relative to the IAC may portend worse hearing outcomes.
Protocol of a Community-Based Intervention on Mental Health in Kashmir
Authors: Bashir Aadil , McDonald Margaret , Egan James , Hawk Mary E. 
Published: December 2020

Introduction: Mental health issues are on an exponential rise in Kashmir due to varied reasons including political instability, eco fragility, the growing lag in the provision of education and employment, and several other reasons. Impediments such as the overwhelming stigma and the cultural sensitivity associated with mental health issues both sustain and perpetuate mental ill health and also prevent any treatment and rehabilitation. This article describes the protocol of a research project, funded by the Indian Council of Medical Research, which aims to address this issue. Aim: To screen the population for mental health issues and to provide community-based intervention for the identified cases also to train community health workers for sustainable mental health support. Methods: We will conduct a household survey using the Hopkins Symptom Checklist (HSCL-25) for the identification of the clients. A multi-stage random sampling shall be used to select the villages and the households from the marginalized communities. A sample of 500 respondents shall be screened using HSCL-25. Those who screen positive for mental health issues will be offered cognitive behavioral therapy (CBT) by a qualified clinical psychologist. The research will be able to address the diagnosis of depression and anxiety-related cases and the subsequent intervention. Additionally, we will utilize the facilitator’s manual for Mental Health Training Program for Community Health Workers to build sustainable mental health services in community settings. Discussion: The study shall present a roadmap focusing on the indispensability of a comprehensive community-based intervention on mental health utilizing a non-pharmacological method. Assessing and analyzing the dynamics of mental health illness first hand, the study shall move ahead to offer a culturally tailored counseling program at the community level. The study also aims to highlight the role of the indigenous human resource (community health workers) and how its participation leads to a more scientific and sustainable intervention for more effective results, with an increased level of awareness and sensitization in a conventional society like Kashmir.
Managing Depression in Diabetes Mellitus: A Multicentric Randomized Controlled Trial Comparing Effectiveness of Fluoxetine and Mindfulness in Primary Care: Protocol for DIAbetes Mellitus ANd Depression (DIAMAND) Study
Authors: Chandra Mina , Raveendranathan Dhanya , Johnson Pradeep R.  , Patra Suravi , Rushi  , Prasad Konasale , Brar Jaspreet S 
Published: December 2020

Background: Suboptimal management of depression in type 2 diabetes mellitus (T2DM) often translates into poor glycemic control, medical complications, and impaired quality of life. Feasibility and effectiveness of collaborative care models of depression in diabetes in low- and middle-income countries (LMICs) remain unexplored. DIAbetes Mellitus ANd Depression (DIAMAND) study, a multicentric single-blind randomized controlled trial (SBRCT) comparing effectiveness of fluoxetine and mindfulness in primary care settings, addresses this gap in scientific literature. Methods: This trial conducted in diverse geographic settings of New Delhi, Bengaluru, and Bhubaneswar will comprise module-based training of primary care providers (PCPs) for screening, diagnosing, and managing depression in diabetes in phase I. Phase II will involve four-arm parallel group RCT on 350 participants with T2DM with comorbid depressive episode randomly allocated to receive fluoxetine, mindfulness therapy, fluoxetine plus mindfulness therapy, or treatment as usual at primary care settings. Interventions would include fluoxetine (up to 60 mg/day) and/or sessions of mindfulness for 16 weeks. Primary outcomes on standardized rating scales include depression scores (Hamilton Depression Rating Scale), treatment adherence (Adherence to Refill and Medication Scale), self-care (Diabetes Self-Management Questionnaire), diabetes-related distress (Diabetes Distress Scale), and glycemic control. Secondary outcomes include quality of life (World Health Organization Quality of Life Brief version [WHO-QOL BREF]) and mindfulness (Five Facets Mindfulness Questionnaire). Discussion: This RCT will investigate the effectiveness of module-based training of PCPs and feasibility of collaborative care model for managing depression in T2DM in primary care settings in LMICs and effectiveness of fluoxetine and/or mindfulness in improving diverse outcomes of T2DM with major depression.
Community-Based Rehabilitation for Persons with Severe Mental Illness in a Rural Community of Karnataka: Methodology of a Randomized Controlled Study
Authors: Sivakumar Thanapal , Thirthalli Jagadisha , Kumar C. Naveen , Basavarajappa Chethan 
Published: December 2020

Background: Task shifting has been recommended as a strategy to reach out to persons with mental illness and bridge the treatment gap. There is a need to explore task-shifting using existing health staff like Accredited Social Health Activists (ASHAs). Aim and Context: ASHAs are involved in ongoing community-based rehabilitation (CBR) program run with a public–private partnership over the last 5 years at Jagaluru Taluk (an administrative block) in Davanagere district (Karnataka, India). This article aims to summarize a randomized controlled trial (RCT) to examine whether CBR delivered by ASHAs is more effective than treatment as usual (TAU) control group in reducing disability associated with severe mental illness (SMI). Method: A group of proactive ASHAs is already working with us for a follow-up of persons with SMI. For the study, we would allocate areas that are currently not being covered proactively by ASHAs randomly in a 1:1 ratio via computer-generated randomization list to receive either ASHAs delivered CBR arm or TAU control group. A sample size of about 100 in each arm is enough to identify an effect size of 0.5 in total IDEAS score between the intervention and control arms with a power of 90% and an alpha of 0.05. We use the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement to describe the methods of the trial. Result: The study has been approved by the institute ethics committee and registered with CTRI (CTRI/2019/08/020585 dated 6th August 2019). The recruitment of subjects is ongoing. The patients will be followed up for 1 year and assessed. The trial is funded by the Indian Council of Medical Research, Government of India. Discussion: The results of the study will be helpful from a public health perspective in delivering cost-effective and replicable CBR for persons with SMI through ASHAs. If the model turns successful, this could be expanded throughout the state/country. This would go a long way in bridging the huge treatment gap.
Development of a Supported Education Program for Students with Severe Mental Disorders in India
Authors: Annapally Sadananda Reddy , Jagannathan Aarti , Kishore Thomas , Daliboyina Muralidhar , Kumar Channaveerachari Naveen 
Published: December 2020

Background: The onset of severe mental disorders (SMDs) is during adolescence or young adulthood, which affects the well-being and the educational aspirations of the students. Models of supported education practiced in the West are not culturally suitable for Indian students or the Indian education system. This study aimed to develop a Supported Education Program (SEP) for students with SMDs to help them with academic reintegration in an Indian context. Methods and Material: To develop the SEP, a realist review was done, followed by an in-depth interview with eight mental health professionals (MHP) and nine lecturers, using a validated interview script. After each interview, interim analysis and modifications were done to improve the rigor of the interview. After all interviews, the SEP was circulated for a second round of iteration for consensual validation by four mental health experts. The outcome of the entire process was the final version of SEP for students with SMDs. Results: The final SEP had two broad themes and 18 subthemes from the qualitative thematic analysis: theme 1 included issues and strategies relevant to the client or caregivers, and theme 2 was pertinent to the education system. Conclusion: The SEP developed and validated for people with SMDs has distinctive components: one for the individual and caregiver and the other for the educational system.