bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of Care and Outcomes of Definitive External Beam Radiotherapy and Radioembolization for Localized Hepatocellular Carcinoma
Authors: Bitterman Danielle S. , Sanford Nina N. , Niemierko Andrzej , Mahal Brandon A. , Qadan Motaz , Ganguli Suvranu , Blaszkowsky Lawrence S. , Zhu Andrew X. , Hong Theodore S. , Devlin Phillip M. , Goyal Lipika , Wo Jennifer Y. 
Published: June 2019

Objectives:
Most localized hepatocellular carcinoma (HCC) patients are not surgically operable or transplantation candidates, increasing the role for nonsurgical therapies. Ablative external beam radiotherapy (XRT) and transarterial radioembolization (TARE) are emerging radiotherapeutic treatments for localized HCC. We sought to evaluate their utilization and efficacy in a large nationwide cohort.

Materials and Methods:
We conducted an observational study of 2685 patients from the National Cancer Database (NCDB) diagnosed with American Joint Committee on Cancer 7th edition clinical stage I to III HCC between 2004 and 2015, treated with definitive-intent XRT delivered in 1 to 15 fractions or TARE. The association between treatment modality (XRT vs. TARE) and overall survival (OS) was defined using propensity score–weighted Kaplan-Meier estimators and propensity score–weighted multivariable Cox regressions.

Results:
Among 2685 patients, 2007 (74.7%) received TARE and 678 (25.3%) received XRT, with increasing usage for both from 2004 to 2015 (P
trend<0.001), but with overall greater uptake and absolute usage of TARE. Patients who received TARE were more likely to have elevated alpha fetoprotein and more advanced stage (P<0.05 for all). Median OS was 14.5 months for the entire cohort. XRT was associated with an OS advantage compared with TARE on propensity score–unadjusted analysis (adjusted hazard ratio [AHR], 0.89; 95% confidence interval, 0.79-1.00; P=0.049), but not on propensity score–adjusted analysis (AHR, 0.99; 95% confidence interval, 0.86-1.13; P=0.829).

Conclusions:
Our study demonstrates that while both XRT and TARE usage have increased with time, there was greater uptake and absolute use of TARE. We found no difference in survival between XRT and TARE after propensity score adjustment.
Focus group reactions to an arts-based educational exhibit on menopausal hot flashes
Authors: Carpenter Janet S. , Schmidt Karen K. , Jarvis Lynsey M. , Lapum Jennifer L. , Kesling Mark D. 
Published: June 2019

Abstract

Objective:
To assess public reactions to an arts-based educational exhibit designed to immerse and engage people in scientific facts to increase their conceptual understanding of hot flashes. Our ultimate goals were to stimulate learning and conversations about menopausal hot flashes to change interactions between menopausal women and providers, and menopausal women and other people (family, friends, etc). Focus groups reacted to the concept art (graphics, miniaturized model); and a questionnaire for quickly assessing reactions.

Methods:
Using a qualitative descriptive methodology, six focus groups of diverse people (n = 50) aged 13 to 64 years described their reactions to the art and questionnaire. Recruitment methods were word of mouth, advertisements on university websites, and a university-based participant registry. Data were analyzed using qualitative content analysis and inductively derived codes.

Results:
Reactions to the concept art were generally favorable. Participants remarked on appealing and less appealing aspects and age appropriateness. Appealing aspects were resonance with women's experiences, clear information, use of symbolism, and overall design. Less appealing aspects lacked resonance, contained confusing information, or unappealing design elements. Participants felt the exhibit should be open to all ages. The final questionnaire reflected participants’ descriptions of the art's ability to stimulate learning, dispel myths, spur dialog, and increase empathy.

Conclusions:
The concept art is an appropriate tool for improving knowledge and communication about hot flashes. Displaying the concept art and/or future full-scale exhibit in healthcare settings or public venues may facilitate learning and communication among three groups—menopausal women, healthcare providers, and others.
Public survey reactions to an arts-based educational menopausal hot flash exhibit
Authors: Carpenter Janet S. , Rand Kevin L. , Schmidt Karen K. , Lapum Jennifer L. , Kesling Mark D. 
Published: June 2019

Abstract

Objective:
The aim of this study was to obtain public survey reactions to concept art for an exhibit about menopausal hot flashes designed to stimulate learning, dispel myths, spur dialogue, and increase empathy.

Methods:
Immediately before viewing the art, participants provided demographic information and answered one open-ended question. Immediately after viewing the art, participants answered the same open-ended question, one additional open-ended question, and completed quantitative survey questions.

Results:
Overall, public reactions to the concept art were positive. Qualitative and quantitative data indicated that the public thought the exhibit was appealing, stimulated learning, dispelled myths, spurred desire to have conversations about hot flashes, and increased empathy for women with menopausal hot flashes.

Conclusions:
The exhibit concept art was appealing and was reported to have a positive impact on the public. Study findings provide support for building the exhibit full-scale as a traveling educational resource that might change public discourse around menopausal hot flashes.
Objective measures of physical performance associated with depression and/or anxiety in midlife Singaporean women
Authors: Ganasarajah Shamini , Sundström Poromaa Inger , Thu Win Pa Pa , Kramer Michael S. , Logan Susan , Cauley Jane A. , Yong Eu-Leong 
Published: June 2019

Abstract

Objectives:
The aim of this study was to identify correlates of depression and anxiety in midlife Asian women, with a special focus on the potential role of objectively measured physical performance.

Methods:
Sociodemographic characteristics, reproductive health, menopause status, medical history, lifestyle choices, physical activity, and physical performance of healthy women aged 45 to 69 attending routine gynecologic care were collected. Depressive symptoms were assessed utilizing the Center for Epidemiologic Studies for Depression Scale (CES-D) and anxiety symptoms by the General Anxiety Disorder Scale (GAD-7). Upper body physical performance was assessed by handgrip strength, and lower body physical performance was assessed by the Short Physical Performance Battery. Chi-square tests and multivariable models were used to assess the crude and adjusted associations, respectively, between the studied risk factors and depression and/or anxiety. The main outcome measures were elevated depressive symptoms ≥16 on the CES-D, and/or elevated anxiety symptoms >10 on the GAD-7 score.

Results:
Of 1,159 women (mean age 56.3 ± 6.2), 181 (15.9%) were identified as having depressive and/or anxiety symptoms. Weak upper body (handgrip strength) and poor lower body strength (longer duration to complete the repeated chair stand test) were associated with elevated depressive and/or anxiety symptoms (adjusted odds ratio [aOR], 1.68; 95% CI, 1.18-2.40) and (aOR, 1.33; 95% CI, 1.09-1.63), respectively.

Conclusions:
Weak upper and lower body physical performances were associated with depressive and anxiety symptoms in midlife Singaporean women. Future trials are required to determine whether strengthening exercises that improve physical performance could help reduce depressive and anxiety symptoms in midlife women.

Video Summary:
Supplemental Digital Content 1, http://links.lww.com/MENO/A419.
An arts-based educational exhibit on menopausal hot flashes
Authors: Carpenter Janet S. , Kesling Mark , Schmidt Karen K. 
Published: June 2019

Abstract

Objective:
The aim of this study was to describe the development process, science, and symbolism of an arts-based educational exhibit designed to address myths, misinformation, negative imagery, and use of unproven treatments related to menopausal hot flashes.

Methods:
The development process included iterative and informal feedback from a variety of individuals, a partnership with an experienced exhibit designer, and collaborations between artists and scientists.

Results:
The resulting exhibit creates an environment where the public is immersed in accurate information about hot flashes. Although based on an iterative process, the resulting exhibit content reflects an estimated 500+ scientific studies, including those referenced in The North American Menopause Society position statements on hormone and nonhormone management of hot flashes. The seven main exhibit pieces convey scientific information and symbolize various aspects of women's experiences.

Conclusions:
This innovative exhibit has high potential to be a disruptive innovation to address the preponderance of myths, misinformation, and negative imagery surrounding menopausal hot flashes and potentially decrease the use of unproven therapies.
The 6-Minute Walk Test
Authors: Kamiya Kuniyasu , Adachi Takuji , Kono Yuji , Shibata Kenichi , Kitamura Hideki , Izawa Hideo , Yamada Sumio 
Published: June 2019

Purpose:
To examine the use of 10-m usual walking speed as an explanatory variable of the 6-min walk test distance (6MWD) in cardiac patients and community-dwelling older adults.

Methods:
This was a cross-sectional secondary analysis correlational study. Participants of the present study were 119 patients hospitalized for cardiac disease and 109 community-dwelling older adults. Data including 6MWD, 10-m usual walking speed, age, sex, grip strength, height, weight, and cognitive function were obtained from the medical records of patients in 2 acute care hospitals and a cohort of community-dwelling Japanese older adults. Multiple linear regression models for the 6MWD were examined in each group.

Results:
The mean ± standard deviation for 6MWDs were 276 ± 106 m in hospitalized patients and 466 ± 81 m in community-dwelling older adults. In both groups, 10-m usual walking speed was the strongest factor correlated with 6MWD. On univariate analysis, the correlation between walking tests was stronger in the hospitalized group (β = .855) than in the community-dwelling elderly (β = .627). When age and sex were added into the models, the determination coefficients improved (adjusted R
2 = 0.745 and 0.463 in the hospitalized patients and the community-dwelling elderly, respectively).

Conclusions:
The present findings indicated that the 6MWD was more strongly associated with 10-m usual walking speed in patients hospitalized for cardiac disease than in community-dwelling older adults. The predictive validity of 10-m walking speed for future adverse outcomes among cardiac patients is an issue for future research.
IMPACT OF RETINAL ISCHEMIA ON FUNCTIONAL AND ANATOMICAL OUTCOMES AFTER ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN PATIENTS WITH RETINAL VEIN OCCLUSION
Authors: Khayat Meiaad , Wright David M. , Yeong Jianlee , Xu Daniel , Donley Christopher , Lakshmipathy Gokul R. , Low Mei Ken , White Natasha , Williams Michael , Lois Noemi 
Published: June 2019

Purpose:
To compare the impact of the classification of retinal vein occlusion (RVO) into ischemic or nonischemic forms on outcomes after anti–vascular endothelial growth factor therapy.

Methods:
Retrospective review of consecutive patients with RVO evaluated at the Belfast Health and Social Care Trust between July 1, 2014, and December 31, 2015. Outcomes, including gain of ≥10 and ≥15 letters at 12 months, mean change in best-corrected visual acuity from baseline to 12 months, resolution of macular edema at 12 months, and development of neovascular complications and epiretinal membrane after anti–vascular endothelial growth factor therapy, were compared between ischemic and nonischemic eyes using regression models.

Results:
One hundred and seventeen eyes (115 patients), 58 with central RVO and 59 with branch RVO, were included. A greater proportion of eyes with ischemic branch RVO gained ≥10 and ≥15 letters at 12 months than those with nonischemic branch RVO (P = 0.005 and P = 0.016, respectively). No statistically significant differences in visual outcomes were observed between ischemic and nonischemic central RVO. Retinal vein occlusion classification was not associated with anatomical outcomes after treatment.

Conclusion:
Findings support the use of anti–vascular endothelial growth factors in ischemic and nonischemic forms of RVO.
Competency in obesity management: An educational intervention study with nurse practitioner students
Authors: Fruh Sharon M. , Golden Angela , Graves Rebecca J. , Minchew Leigh A. , Platt Terrie H. , Hall Heather R. , Williams Susan G. , Mehari Krista , Sims Brook M. , Hauff Caitlyn , Cheese Callie 
Published: June 2019

ABSTRACT

Background:
The National Center for Health Statistics reported that obesity is at epidemic levels in the United States, with an estimated 70.7% of adults affected by overweight and obesity. The disease state of obesity affects all generations and is pervasive among all socioeconomic groups.

Purpose:
This study was designed to examine the impact of implementing educational modules to determine if the intervention improved knowledge and comfort levels for Nurse Practitioner students when managing patients with obesity.

Methods:
Nurse Practitioner students completed a survey regarding knowledge and comfort level in managing patients with obesity. Students then completed modules designed to train health care providers on the management of obesity. A postmodule assessment was administered to determine if the obesity management modules improved competency and perceived skills when treating patients with overweight and obesity.

Results:
Participants' mean score on the knowledge test represented a significant improvement following training. Their comfort level in managing patients with obesity increased.

Implications for practice:
Implementing these modules in graduate education may be a helpful avenue to improve competency in obesity management. Acknowledging that obesity is a disease and requires a multifaceted approach when helping patients improve their health. This change in perception may lead to better goal-setting with the patient, empathetic understanding, and broader patient involvement in the treatment.
Treating hypertension in older adults: Beyond the guidelines
Authors: Benenson Irina , Waldron Frederick A. , Bradshaw Molly J. 
Published: June 2019

ABSTRACT
Hypertension in older adults is extremely common. It constitutes the major modifiable risk factor of cardiovascular disease, premature disability, and death. Despite proven benefits of blood pressure (BP) reduction in older individuals, there is a considerable disagreement between major guidelines surrounding the optimal levels of BP treatment and control to be achieved. Given the high prevalence of older adults with hypertension, nurse practitioners should critically examine the overall benefit of treatment, use of antihypertensive therapies, and BP targets to provide high-quality care to this patient population. The purpose of this article is to outline the evidence surrounding the management of BP in older adults and to offer strategies to reconcile conflicting guideline recommendations.
Treating chronic pain and opioid misuse disorder among underserved populations in Colorado
Authors: Medina Rosario , Sorrell Tanya , Techau Aimee , Weiss Jason 
Published: June 2019

ABSTRACT
The increased use of prescription opioids has resulted in widespread misuse. As a result, more than 40,000 Americans lost their lives to opiate overdose in 2016 alone. These data have led to a national movement focused on appropriate opioid prescribing practices. The Centers for Disease Control and Prevention (CDC) developed its Guidelines for Prescribing Opioids for Chronic Pain (2017), a template for pain management and substance assessment in primary care. These CDC guidelines aim to prevent misuse/deaths and early identification of substance use disorders. Although the guidelines are appropriate for initiation of opioid therapy, they are not sufficient to manage patients who have already developed misuse disorders. Other modalities such as medication-assisted treatment (MAT) have been described as beneficial for patients with high risk for or who have an opioid misuse disorder. This article builds on the CDC's 2017 advisory document by applying it in praxis: first, non-opioid medication therapy options and nonmedication therapy options are explored; next, a case study is presented of an integrated primary care–managed patient who presented with both chronic pain and established opioid use disorder. Although the CDC guidelines were not followed in the patient's initial prescription opioid treatment regimen, those guidelines were used as a starting point for follow-up treatment, helping both to assess the patient's risk for opioid misuse disorder and to determine that MAT was an appropriate method of treatment.
Hybrid insulin peptides are neo-epitopes for CD4 T cells in autoimmune diabetes
Authors: Baker Rocky L. , Jamison Braxton L. , Haskins Kathryn 
Published: June 2019

Purpose of review
The current review covers recent advances in our knowledge of the newest autoantigen neo-epitopes in type 1 diabetes (T1D): hybrid insulin peptides or HIPs. These ligands for autoreactive T cells are formed by peptide fusion, a novel posttranslational modification process that we first reported in 2016.

Recent findings
Two major HIPs in the nonobese diabetic mouse model, ligands for diabetogenic CD4 T-cell clones, have been incorporated into tetramers and used to track HIP-reactive T cells during progression of disease. HIPs have also been used in strategies for induction of antigen-specific tolerance and show promise for delaying or reversing disease in the nonobese diabetic mouse. Importantly, CD4 T cells reactive to various HIPs have been detected in the islets and peripheral blood mononuclear cell of T1D patients and newly developed human T-cell clones are being employed to gather more data on the phenotype and function of HIP-reactive T cells in patients.

Summary
These new hybrid insulin peptide epitopes may provide the basis for establishing autoreactive T cells as biomarkers of disease and as potential tolerogens for treatment of T1D.
Complication After PDO Threads Lift
Authors: Ahn Seung Ki , Choi Hwan Jun 
Published: June 2019

Abstract
Thread-lifting is as a minimally invasive procedure with limited scarring, rapid recovery, and fewer complications compared with the standard incisional surgery for facial rejuvenation. Using absorbable thread-like polydioxanone is a relatively simple procedure that is also performed by nonmedical professionals in Korea. Although several acute or delayed complications after using nonabsorbable thread types were also reported, it is uncommon to find cellulitis caused by a delayed complication after thread-lifting. A 41-year-old woman presented to our clinic with inflamed multiple palpable masses. She underwent 3 courses of acupoint embedding therapy at a Korean oriental medical clinic. She was treated with combination antibiotic therapy; however, the inflammation did not subside. Consequently, excisional biopsy was performed under local anesthesia. During the procedure, threads were detected and removed. Dimpling, thread exposure, alopecia, under-correction, asymmetry, and parotid gland injury also can occur as early complications of the procedure. Fortunately, these reactions are predominantly mild to moderate in intensity, and can be corrected by a relatively simple procedure. Chronic inflammatory reactions in the thread-lifting area, as identified in the authors’ case, are an infrequent complication. It is recommended to consult with experts in the field for the implementation of this procedure. In addition, experts also need to notify the above side effects and solutions in advance to ensure safe and satisfactory procedures for their patients.
An Extremely Rare Cause of Headache; Osteoma of the Middle Concha Bullosa
Authors: Gulsen Secaattin 
Published: June 2019

Abstract
Osteomas are benign, slow-growing tumors originating from bone tissue. Osteomas of the paranasal region, which are usually asymptomatic, are detected incidentally on tomographies taken for other medical needs. Paranasal sinus osteomas frequently localized in the frontal and ethmoid sinuses are among the infrequent reasons for headaches. In this case report, the authors submit the first case of an osteoma that was localized inside the middle concha bullosa and causing headache. It was successfully excised via an endoscopic endonasal approach without any complications.
Strategy of Mandibular Central Arch Reconstruction After Firearm Injury
Authors: Fernandes Breno dos Reis , Mendes Bruno Coelho , Mulinari-Santos Gabriel , Okamoto Roberta , Homsi Nicolas , Rocha-Jr Hernando Valentim da , Magacho Luiz Fernando , Pereira Rodrigo dos Santos 
Published: June 2019

Abstract
Gunshot wounds can cause extensive destruction of soft tissue and bone, and the maxillofacial region is often affected. The reconstructive treatment is complex due to the difficulty to reestablish the central arch mandibular contour and volume. Moreover, the goal is to avoid postoperative infections and obtain bone graft neovascularization. Therefore, this report shows a clinical case of a patient presenting mandibular deformity with a mandibular central arch discontinuity caused by a firearm injury. The strategy to the reconstructive treatment as performed with a condensed and stabilized particulate autogenous bone graft was essential and effectiveness. After 1 year, it was obtained a satisfactory result to the patient.
The Natural History of Treated and Untreated Zygomatic Arch Fractures
Authors: Homer Alexander , Homer Benjamin , Sullivan Stephen R. , Taylor Helena O. 
Published: June 2019

Abstract
The authors present the case of a 32-year-old patient treated for a left, isolated zygomatic fracture following assault. The injury was reduced without fixation via the Keene approach. The same patient presented to the emergency room 16 months later with a right-sided fracture similar to the previous contralateral injury. This fracture was left untreated. Repeated assaults over a 4-year period provide us with a natural history of both injuries, allowing for comparison between the 2 approaches. The authors found that reduction of the arch without fixation led to an outcome without palpable or visible deformity and no impaired mastication. Additionally, considering etiology of injury, such as alcohol or drug use, treatment may provide an important point of intervention to prevent recurrence.