bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute neurologic toxicity of palliative radiotherapy for brain metastases in patients receiving immune checkpoint blockade
Authors: Arscott W Tristram , Zhu Simeng , Plastaras John P , Maity Amit , Alonso-Basanta Michelle , Jones Joshua 
Published: October 2018

Abstract

Background
The interaction between immune checkpoint blockade (ICB) and radiation (RT) for brain metastases has not been well understood. Given that acute neurotoxicity from this combination is not well characterized, we reviewed patients receiving ICB and RT for brain metastases.

Methods
Patients treated with ICB and cranial RT from 2010 through 2017 were reviewed. ICB and RT must have been administered within 30 days of each other. Treatment parameters, performance status, symptoms prior to treatment, and toxicity were extracted from the electronic medical record. Survival was calculated from the end of RT to last follow-up or death.

Results
Seventy-eight patients were included. Median follow-up was 177 days (range, 12-1603). Median age was 64 years old (range, 29-98) and 47 (63%) were male. The main tumor types were melanoma (n = 47) and nonsmall-cell lung cancer (n = 19). Fifty-seven patients were treated with stereotactic radiosurgery (SRS) and 21 with whole-brain radiotherapy (WBRT). Most patients received single-agent ICB, though 4 patients received nivolumab and ipilimumab. Forty-one (53%) patients reported no neurologic toxicity. Grade 2 or greater neurologic toxicities were reported in 12 (21%) and 8 (38%) patients in the SRS and WBRT groups, respectively. WBRT was associated with a greater risk of any neurotoxicity, though there was no correlation between ICB agent and toxicity. Sequencing of ICB and RT (ie, <30 days vs <7) did not influence rates of toxicity.

Conclusions
ICB during SRS or WBRT does not appear to worsen acute neurotoxicity compared to historical controls of RT alone.
Sex Differences in Subjective and Behavioral Responses to Stressful and Smoking Cues Presented in the Natural Environment of Smokers
Authors: Tomko Rachel L , Saladin Michael E , Baker Nathaniel L , McClure Erin A , Carpenter Matthew J , Ramakrishnan Viswanathan R , Heckman Bryan W , Wray Jennifer M , Foster Katherine T , Tiffany Stephen T , Metts Christopher L , Gray Kevin M 
Published: October 2018

Abstract

Introduction
Some evidence suggests that female smokers may show more context-dependent smoking and that males may show more stereotyped smoking (regardless of stress or cue exposure). The goal of this study was to characterize sex differences in response to stressful and smoking cues ecologically presented in daily life and variability in day-to-day smoking behavior.

Methods
Adult smokers (N = 177) provided ratings of mood and cigarette craving before and after stress and smoking cues were presented four times daily for 14 days via a mobile device. Linear mixed models tested whether (1) female smokers exhibited greater reactivity to stressful cues than male smokers; (2) pre-cue negative affect increased reactivity to smoking cues more in female smokers than male smokers; (3) across both sexes, greater reactivity to stressful and smoking cues correlated with greater quantity of smoking within a day; and (4) female smokers exhibited greater variability in cigarettes per day (CPD) relative to males.

Results
Relative to male smokers, female smokers reported greater negative affect, stress, and craving in response to stressful cues, but not smoking cues, after accounting for time since last cigarette and pre-cue responding. No sex differences in CPD or variability in CPD were detected. Days with higher subjective reactivity to cues were not associated with increased smoking, in either males or females.

Conclusions
Sex differences were observed in response to stress but not smoking cues in the natural environment of regular cigarette smokers. Further research is necessary to evaluate whether stress reactivity in female smokers is associated with reduced latency to smoke following stress exposure in daily life.

Implications
This study provides naturalistic evidence that female smokers may not be more reactive to smoking cues than males, but experience heightened stress and craving following stress exposure. There was no evidence to support the hypothesis that amount smoked per day varied more for females, relative to males, as a result of more context-driven smoking for females.
Rhetoric or Reality? RN to BSN Graduates Returning to the Bedside
Authors: Borgos Jill 
Published: October 2018

Abstract
This article reports on a study designed to illuminate the motivation and future goals of RN to BSN degree completion students, specifically to identify whether RNs returning to an online completion program were doing so with the intention of continuing to practice at the bedside. The findings indicate that students are seeking further education for five reasons: 1) to gain entry into a nurse practitioner program, 2) to complete a master's degree program in general, 3) to find opportunities in management, 4) to assume a position as a nurse educator, or 5) to take on a leadership position in general.
Minnesota Alliance for Nursing Education (MANE): A Unique Multi-institutional Approach to Preparing Nurses for the Future
Authors: Graziano Judith A. , Uppman Faye , Anderson Katherine , Johnson Lynn , Frosch-Erickson Susan , Hill Doris , Eccles Jennifer , Beasley Laura , Kohler Sandra 
Published: October 2018

Abstract

AIM
The purpose of this article is to inform nurse educators of an innovative and transformative approach to advancing nursing education through the creation of the Minnesota Alliance for Nursing Education (MANE).

BACKGROUND
MANE was formed to answer national appeals to transform nursing education and demands by health care organizations for a more highly educated nursing workforce.

METHOD
An action plan was developed with the Minnesota Action Coalition to create a dual admission community college and university eight-semester baccalaureate curriculum that students could complete seamlessly in four years.

RESULTS
Admissions to the program have been robust, matriculation rates to upper division course work have exceeded initial goals, and diversity of students is increasing.

CONCLUSION
Measures to date show that MANE is a viable and successful program that is surpassing its initial goals.
Supporting Doctoral Students and Faculty: The Development of an Annual Doctoral Symposium
Authors: Wheeler Rebecca M. 
Published: October 2018

Abstract

AIM
The aim of the study was to develop a sustainable annual symposium to support doctoral students in nursing across the state of Georgia.

BACKGROUND
A goal of the nursing profession, highlighted in the Institute of Medicine Future of Nursing report of 2011, is to increase the number of nurses with doctorates. They are needed to fill faculty positions as professors retire and to step into leadership positions as health care systems become more complex.

METHOD
The Georgia Nursing Leadership Coalition developed a Doctoral Symposium in 2014 that has been repeated annually.

RESULTS
The Doctoral Symposium gives doctoral students and faculty the opportunity to network, discuss current issues, advance their skills, and (for students) share their work. Approximately 100 people attend each year; costs and attendance fees have been kept low. Lessons learned are provided.

CONCLUSION
The Doctoral Symposium is a sustainable, valuable activity for supporting doctoral students and faculty.
Maryland Action Coalition: Academic Progression Takes Several Pathways
Authors: Wiseman Rebecca , Trocky Nina M. , Travis Patricia T. , Kirschling Jane Marie 
Published: October 2018

Abstract

AIM
The purpose of this article is to provide an overview of the Maryland Action Coalition academic progression activities.

BACKGROUND
Maryland is predicted to be one of four states that will experience a shortage of 10,000 or more registered nurses in 2025. The Maryland Action Coalition has committed to the Institute of Medicine’s Future of Nursing recommendation that 80 percent of nurses be educated at the baccalaureate (or higher) level.

METHOD
Various approaches to seamless academic progression are described. The Maryland articulation model was revised to reflect new academic models.

RESULTS
More BS and BSN degrees have been awarded, and more employers have advertised a preference for RNs who have completed a baccalaureate degree.

CONCLUSION
Maryland is developing a solid foundation to ensure that the state has a well-educated nursing workforce to meet the complex health needs of all residents.
Innovation in Academic Progression: Progress of the New Mexico Nursing Education Consortium Model
Authors: Landen Jenny , Evans-Prior Diane , Dakin Becky , Liesveld Judy 
Published: October 2018

Abstract

AIM
The Institute of Medicine (IOM) challenged nursing education programs to increase the proportion of nurses with a baccalaureate degree in nursing to 80 percent by 2020.

BACKGROUND
All 18 state-funded prelicensure nursing programs in New Mexico joined forces to create the New Mexico Nursing Education Consortium (NMNEC).

METHOD
NMNEC is a model of collaboration with a statewide common curriculum that provides seamless transferability for students between schools while offering the BSN on community college campuses.

RESULTS
Over three years, university partnerships with community colleges increased prelicensure BSN seats by 77 percent.

CONCLUSION
This article describes the NMNEC model, challenges and opportunities associated with implementation, current program outcomes, and factors that have contributed to NMNEC’s success. Also discussed are future steps for sustainability and growth as NMNEC continues in its commitment to meeting the IOM challenge.
From Start-up to Sustainability: A Decade of Collaboration to Shape the Future of Nursing
Authors: Gubrud Paula , Spencer Angela G. , Wagner Linda 
Published: October 2018

Abstract

AIM
This article describes progress the Oregon Consortium for Nursing Education has made toward addressing the academic progression goals provided by the 2011 Institute of Medicine’s Future of Nursing: Leading Change, Advancing Health report.

BACKGROUND
The history of the consortium's development is described, emphasizing the creation of an efficient and sustainable organization infrastructure that supports a shared curriculum provided through a community college/university partnership.

METHOD
Data and analysis describing progress and challenges related to supporting a shared curriculum and increasing access and affordability for nursing education across the state are presented.

RESULTS
We identified four crucial attributes of maintaining collaborative community that have been cultivated to assure the consortium continues to make progress toward reaching the Institute of Medicine's Future of Nursing goals.

CONCLUSION
Oregon Consortium for Nursing Education provides important lessons learned for other statewide consortiums to consider when developing plans for sustainability.
Assessing Individuals’ Exposure to Environmental Conditions Using Residence-based Measures, Activity Location–based Measures, and Activity Path–based Measures
Authors: Morrison Christopher N. , Byrnes Hilary F. , Miller Brenda A. , Kaner Emily , Wiehe Sarah E. , Ponicki William R. , Wiebe Douglas J. 
Published: October 2018

Background:
Many approaches are available to researchers who wish to measure individuals’ exposure to environmental conditions. Different approaches may yield different estimates of associations with health outcomes. Taking adolescents’ exposure to alcohol outlets as an example, we aimed to (1) compare exposure measures and (2) assess whether exposure measures were differentially associated with alcohol consumption.

Methods:
We tracked 231 adolescents 14–16 years of age from the San Francisco Bay Area for 4 weeks in 2015/2016 using global positioning systems (GPS). Participants were texted ecologic momentary assessment surveys six times per week, including assessment of alcohol consumption. We used GPS data to calculate exposure to alcohol outlets using three approach types: residence-based (e.g., within the home census tract), activity location–based (e.g., within buffer distances of frequently attended places), and activity path–based (e.g., average outlets per hour within buffer distances of GPS route lines). Spearman correlations compared exposure measures, and separate Tobit models assessed associations with the proportion of ecologic momentary assessment responses positive for alcohol consumption.

Results:
Measures were mostly strongly correlated within approach types (ρ ≥ 0.7), but weakly (ρ < 0.3) to moderately (0.3 ≤ ρ < 0.7) correlated between approach types. Associations with alcohol consumption were mostly inconsistent within and between approach types. Some of the residence-based measures (e.g., census tract: β = 8.3, 95% CI = 2.8, 13.8), none of the activity location–based approaches, and most of the activity path–based approaches (e.g., outlet–hours per hour, 100 m buffer: β = 8.3, 95% CI = 3.3, 13.3) were associated with alcohol consumption.

Conclusions:
Methodologic decisions regarding measurement of exposure to environmental conditions may affect study results.
Continuation of postmenopausal hormone replacement therapy: comparison of cyclic versus continuous combined schedules
Authors: Ettinger Bruce , Li De-Kun , Klein Raymond 
Published: October 2018

Abstract
Discontinuation of hormone replacement therapy (HRT) is much more common than what is reported in randomized, double-blind clinical trials. Our purpose in this retrospective study, using a prescription database, was to compare the continuation rate among women who took cyclic combination therapy adding progesterone to estrogen (CYC-PERT) or continuous combined estrogen progestin therapy (CC-PERT). The study subjects were 1,532 women, ≥45 years old, who initially filled index prescriptions for 0.625 mg conjugated estrogens. They were divided into two groups (CYC-PERT = 644, CC-PERT = 888) on the basis of coprescribed medroxyprogesterone. We found that for all women initiating therapy, 35-40% did not return for a refill and 76-81% stopped therapy within 3 years. Those prescribed CC-PERT initially were more likely to stop than those prescribed CYC-PERT (rate ratio [RR] = 1.20; 95% confidence interval [CI] = 1.06-1.35). Adjustments for age, year of starting medication, cost of medication, and prescriber specialty did not affect the difference in discontinuation between the two regimens (RR 1.18, 95% CI = 1.04-1.34). We conclude that the likelihood of women continuing HRT beyond 3 years of initiation is low. Furthermore, compared with CYC-PERT users, those receiving CC-PERT have a slightly higher probability of discontinuation. Efforts should be made to understand why three quarters of women beginning HRT will stop it long before it can provide major long-term benefit.
Breast cancer risk among women under 55 years of age by joint effects of usage of oral contraceptives and hormone replacement therapy
Authors: Brinton Louise A. , Brogan Donna R. , Coates Ralph J. , Swanson Christine A. , Potischman Nancy , Stanford Janet L. 
Published: October 2018

Abstract

Objective:
To assess effects on breast cancer risk of exposure to both oral contraceptives and menopausal hormones, an increasingly common exposure.

Design:
A case-control study of breast cancer among women under the age of 55 years in Atlanta, GA involving 1,031 cases and 919 population controls was conducted.

Results:
Ever use of oral contraceptives was associated with a relative risk of 1.1 (95% 0.9-1.4), whereas the relative risk for hormone replacement therapy was 0.9 (95% CI 0.7-1.2). Seventeen percent of the cases versus 19% of the population controls reported exposure to both agents, resulting in a relative risk of 1.0 (95% CI 0.7-1.4) relative to those unexposed to either preparation. Although there was little variation in risk associated with joint effects by either age or race, there were statistically nonsignificant elevations in risk for this exposure among women who had experienced a natural menopause (relative risk = 2.0, 95% CI 0.7-5.6), were relatively thin (relative risk = 1.5, 0.8-3.0), or who had a first degree relative with breast cancer (relative risk = 2.0, 0.6-7.0). When joint effects of longer term use of both agents were considered, subjects who reported use of oral contraceptives for 10 or more years and hormone replacement for 3 or more years had a relative risk of 3.2 (95% CI 1.4-7.4) compared with nonusers of either preparation.

Conclusions:
Although our results must be cautiously interpreted given small numbers within subgroups, they raise concern and emphasize the need for further evaluation on breast cancer risk of the increasingly common exposure to both oral contraceptives and hormone replacement therapy.
The Utian Quality of Life (UQOL) Scale: development and validation of an instrument to quantify quality of life through and beyond menopause
Authors: Utian Wulf H. , Janata Jeffrey W. , Kingsberg Sheryl A. , Schluchter Mark , Hamilton James C. 
Published: October 2018

Abstract

Objective:
Quality of life (QOL) is an outcome variable requiring measurement in clinical care or pivotal regulatory trial research. Current menopause QOL measures are mostly life phase or disease symptom inventories or scores. Believing that QOL should refer more to “sense of well-being,” we have developed the Utian QOL scale (UQOL) that is strongly based on perception of sense of well-being as distinct from menopausal symptoms.

Design:
A pool of items sampling various aspects of well-being was developed. Peri- and postmenopausal women (n = 327) responded to the items, and their responses were subjected to a factor analysis. Four factors emerged, each representing a QOL domain. The resulting 23-item instrument was validated in a geographically and socioeconomically diverse sample of peri- and postmenopausal women using the Short Form-36, an established, frequently used QOL inventory. QOL domains were subjected to confirmatory factor analyses, formal item analysis was completed, and the measure was assessed for reliability and validity, including a second sample of women (n = 270).

Results:
Women (n = 597; mean age, 52.9 years) from 12 communities across the United States completed the measure. The UQOL seems to reflect four components of QOL: occupational QOL, health QOL, emotional QOL, and sexual QOL. The questionnaire and scoring system are presented.

Conclusion:
We are reporting on the process of validating an instrument for quantifying sense of well-being in a perimenopausal population. Substantial reliability and validity estimates for the scale and its subscales support the UQOL as a valuable new tool for use in clinical research and practice.
Predictors of decreased libido in women during the late reproductive years
Authors: Gracia Clarisa R. , Sammel Mary D. , Freeman Ellen W. , Liu Li , Hollander Lori , Nelson Deborah B. 
Published: October 2018

Abstract

Objective:
To identify risk factors for decreased libido among women in the late reproductive years.

Design:
Prospective cohort. Women aged 35 to 47 years identified through random digit dialing were prospectively followed for 4 years with serial hormone assays and standardized questionnaires. Mean hormone values, hormone trends over 4 years, and fluctuation in hormone levels were compared among women with and without a decrease in libido at the last assessment period. Total testosterone, dihydroepiandrosterone sulfate, estradiol, follicle-stimulating hormone, luteinizing hormone, body mass index, psychosocial, and socioeconomic variables were evaluated using multivariable logistic regression.

Results:
Of 326 women, 87 (27%) reported a decreased libido, whereas 239 (73%) did not. Participant-specific means for all hormone levels over the study period were similar among both groups. However, total testosterone fluctuation over the study was significantly different between groups. Women whose testosterone levels fluctuated from 3.8 to 21.5 ng/dL around a mean value of 9 ng/dL were four times more likely to report decreased libido compared with women with little fluctuation in testosterone [odds ratio (OR) 4.0; 95% CI, 1.6-10.0]. Depression (OR 3.4; 95%CI, 1.9-6.1), vaginal dryness (OR 3.5; 95%CI, 1.8-6.6), and children living at home (OR 1.4; 95%CI, 1.1-1.7) were also independently associated with decreased libido.

Conclusions:
Decreased libido in the late reproductive years is associated with a pronounced fluctuation in total testosterone over time. Other independent risk factors for decreased libido include vaginal dryness, depression, and living with children. Sexual dysfunction is a complex disorder, related to physiological and psychosocial factors, requiring further investigation.
Correlates of sexual function among multi-ethnic middle-aged women: results from the Study of Women's Health Across the Nation (SWAN)
Authors: Avis Nancy E. , Zhao Xinhua , Johannes Catherine B. , Ory Marcia , Brockwell Sarah , Greendale Gail A. 
Published: October 2018

Abstract

Objective:
To examine sexual function in a cohort of Baby Boomer women of diverse racial/ethnic backgrounds; to compare differences between pre-and early perimenopausal women; and to identify sociodemographic, health-related, and psychosocial (including psychological, behavioral, and relationship) factors related to sexual function.

Design:
Six domains of sexual function were studied in 3,167 women in the baseline cohort of the Study of Women's Health Across the Nation (SWAN). Participants were 42 to 52 years old, pre-or early perimenopausal, and not using hormones. The study sample included non-Hispanic white, African American, Hispanic, Chinese, and Japanese women.

Results:
Early perimenopausal women reported greater pain with intercourse than premenopausal women (P = 0.01), but the two groups did not differ in frequency of sexual intercourse, desire, arousal, or physical or emotional satisfaction. Variables having the greatest association across all outcomes were relationship factors, the perceived importance of sex, attitudes toward aging, and vaginal dryness. Despite controlling for a wide range of variables, we still found ethnic differences for arousal (P < 0.0001), pain (P = 0.03), desire (P < 0.0001), and frequency of sexual intercourse (P = 0.0003). African American women reported higher frequency of sexual intercourse than white women; Hispanic women reported lower physical pleasure and arousal. Chinese women reported more pain and less desire and arousal than the white women, as did the Japanese women, although the only significant difference was for arousal.

Conclusions:
Relationship variables, attitudes toward sex and aging, vaginal dryness, and cultural background have a greater impact on most aspects of sexual function than the transition to early perimenopause.