bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dry Eye Symptoms May Have Association With Psychological Stress in Medical Students
Authors: Hyon Joon Young , Yang Hee Kyung , Han Sang Beom 
Published: December 2018

Purpose:
To evaluate the prevalence and risk factors of symptomatic dry eye disease (DED) among medical students.

Methods:
This cross-sectional study included 209 students at a medical school in Korea. Dry eye symptoms were assessed using a 9-item questionnaire, and DED was defined as having one or more dry eye symptoms often or all the time. The ocular surface disease index (OSDI) and visual analog scale (VAS) questionnaires were also administered to quantify the dry eye symptoms. A survey including demographic data, potential risk factors for DED, personal habits, and psychological stress was also performed.

Results:
Of the 209 students, 188 (93 men and 95 women) completed the survey. The average age was 28.0±2.5 (mean±SD; range, 23–37) years. Prevalence of DED was 27.1% (51/188). Participants with DED had significantly higher VAS and OSDI than those without DED (P<0.001 for both). Univariate analysis revealed that female sex (P=0.001), contact lens (CL) wear (P=0.034), prolonged computer use (P=0.001), and higher psychological stress score (P<0.001) had significant association with DED. Multivariate analysis also showed the significant association between DED and female sex (P=0.026), CL wear (P=0.042), prolonged computer use (P=0.004), and higher stress score (P=0.014).

Conclusions:
Symptomatic DED was prevalent among medical students. Increased psychological stress was associated with higher risk of DED. Its risk also increased among women, CL wearers, and prolonged computer users.
Somatosensory profiles in acute herpes zoster and predictors of postherpetic neuralgia
Authors: Kramer Sybille , Baeumler Petra , Geber Christian , Fleckenstein Johannes , Simang Michael , Haas Laura , Schober Gabriel , Pfab Florian , Treede Rolf-Detlef , Irnich Dominik 
Published: December 2018

Abstract
This prospective cohort study aimed to characterize the sensory profile during acute herpes zoster (AHZ) and to explore sensory signs as well as physical and psychosocial health as predictors for postherpetic neuralgia (PHN). Results of quantitative sensory testing of 74 patients with AHZ at the affected site and at the distant contralateral control site were compared to a healthy control group. Pain characteristics (Neuropathic Pain and Symptom Inventory and SES), physical functioning, and psychosocial health aspects (Pain Disability Index, SF-36, and STAI) were assessed by questionnaires. Patients with PHN (n = 13) at 6-month follow-up were compared to those without PHN (n = 45). Sensory signs at the affected site were thermal and vibratory hypesthesia, dynamic mechanical allodynia (DMA), pressure hyperalgesia, and high wind-up (18%-29%), as well as paradoxical heat sensations and pinprick hypalgesia (13.5%). The unaffected control site exhibited thermal and vibratory hypesthesia, DMA, and pressure hyperalgesia. Dynamic mechanical allodynia and pinprick hypalgesia were mutually exclusive. Postherpetic neuralgia was associated with DMA (38.5% vs 6.7%; P = 0.010) and vibratory hypesthesia (38.5% vs 11.1%; P = 0.036) at the control site, with mechanical gain and/or loss combined with normal thermal detection (affected site: 69.2% vs 31.1%; P = 0.023; control site: 53.8% vs 15.5%; P = 0.009). Pain Disability Index (P = 0.036) and SES affective pain perception scores (P = 0.031) were over 50% higher, and 6 of 8 SF-36 subscores were over 50% lower (P < 0.045) in PHN. Sensory profiles in AHZ indicate deafferentation and central but not peripheral sensitization. Sensory signs at distant body sites, strong affective pain perception, as well as reduced quality of life and physical functioning in the acute phase may reflect risk factors for the transition to PHN.
Clustering a large Spanish sample of patients with fibromyalgia using the Fibromyalgia Impact Questionnaire–Revised: differences in clinical outcomes, economic costs, inflammatory markers, and gray matter volumes
Authors: Pérez-Aranda Adrián , Andrés-Rodríguez Laura , Feliu-Soler Albert , Núñez Christian , Stephan-Otto Christian , Pastor-Mira María A. , López-Roig Sofía , Peñacoba Cecilia , Calandre Elena P. , Slim Mahmoud , Salgueiro Monika , Feixas Guillem , Luciano Juan V. 
Published: December 2018

AbstractThe main objective of this study is to identify fibromyalgia syndrome (FMS) clusters using the Revised Fibromyalgia Impact Questionnaire (FIQR), and to examine whether the clusters differ in sociodemographic characteristics, clinical measures, direct and indirect costs, levels of inflammatory markers, and brain morphometry. A hierarchical cluster analysis was performed to classify a large, pooled Spanish sample of patients with FMS (N = 947) using the FIQR as clustering variable. A latent profile analysis was subsequently conducted to confirm the optimal number of FMS clusters. To examine external validity, a battery of clinical measures, economic costs, inflammatory markers, and gray matter volumes of relevant cortical and subcortical areas were analyzed. We also compared the discriminant validity of the clusters with the original FIQR severity categories. To promote the implementation in real-world clinical practice, we built a free online cluster calculator. Our findings indicated that a four-cluster solution more clearly captured the heterogeneity of FIQR data and provided the best fit. This cluster solution allowed for detection of differences for most clinical outcomes and economic costs. Regarding the inflammatory and brain-based biomarkers, differences were found in C-reactive protein, and tendencies were found in the right medial prefrontal cortex, the right parahippocampal gyrus, and the right middle cingulate cortex; brain regions associated with executive functions and pain processing. The original FIQR categories presented similar results, although their precision in discriminating among the nonextreme categories (ie, moderate and severe) was not sound. These findings are discussed in relation to previous research on FMS clustering.
The Cardiovascular Reserve Index—A Noninvasive Clinical Insight Into Heat Intolerance
Authors: Schiffmann Nathan , Schermann Haggai , Mazgaoker Savyon , Shaulov Yafim , Gabbay Uri , Epstein Yoram , Yanovich Ran 
Published: December 2018

Objective:
To noninvasively explore the heat intolerance condition during exercise-heat stress by assessing cardiovascular (CV) performance.

Design:
Prospective study of participants undergoing a standard heat-tolerance test (HTT).

Setting:
Institutional study.

Participants:
Ninety-five young males: 16 heat-intolerant (HI) and 79 heat-tolerant (HT).

Interventions:
Cardiovascular performance during an HTT was estimated by heart rate (HR) and blood pressure measurements.

Main Outcome Measures:
The sensitivity of the cardiovascular reserve index (CVRI) and the dynamic heart rate reserve (dHRR) index to predict heat intolerance was compared.

Results:
A significant difference in the CV reserve during exercise-heat stress was exhibited between the HI and the HT groups. Starting at a similar level, the reduction in the CV reserve at HTT endpoint was much greater in the HI than the HT individuals (P < 0.0001), as depicted by both the CVRI and the dHRR. This result indicates a greater utilization of the CV reserve by HI individuals. The CVRI is likely to be better predictor of heat intolerance than the dHRR because the partial area under the curve in the high sensitivity (>90%) region of its receiver operating characteristic curve is higher (93.2 vs 76.8).

Conclusions:
More than being a predictor, the CVRI may provide a new clinical insight into heat intolerance because it noninvasively characterizes the efficiency of an individual's thermoregulatory mechanism and hints that an impaired CV reserve might underlie heat intolerance. The CVRI provides a noninvasive measurement of thermoregulation, which has been long awaited to enable on-field studies and dynamic monitoring of heat-exposed task forces.
Meta-analysis in Physical Therapy Education Research: Using the Pearson's Product–Moment Correlation Coefficient as a Measure of Effect Size
Authors: Wolden Mitch , Hill Brent , Farquhar Voorhees Sara 
Published: December 2018

Background and Purpose.
Practicing physical therapists seek the highest levels of evidence (ie, systematic review and meta-analysis) to inform clinical decision making. Performing a meta-analysis with assimilated data from a systematic review is important for comprehensive decision making in clinical and educational practice. In educational practice, the Pearson's product–moment correlation coefficient (r) is often used as the measure of effect size to examine causal relationships between variables. Our purpose was to present the best model for conducting a meta-analysis using r.

Model Description and Evaluation.
A meta-analysis is prescribed through five steps: (1) calculation of the effect sizes, (2) selecting the appropriate effects model and computational method, (3) applying the computational method, (4) performing heterogeneity analysis, and (5) assessing for publication bias.

Outcomes.
Key statistical outcomes include: (1) total sample size, (2) number of correlations, (3) mean true score correlation, (4) variance of true score correlations, (5) 80% credibility interval, and (6) 95% confidence interval. To help with the interpretation of these results, figures (ie, forest plots and funnel plots) are used.

Discussion and Conclusion.
Central to achieving evidence-based practice is the selection and application of high-quality research. A systematic review with random-effects meta-analysis using high-quality cohort studies can provide high-quality evidence to physical therapy educators to answer their pertinent education questions.
Advances in hematopoietic cell transplant for the treatment of hematologic malignancies
Authors: Taraseviciute Agne , Pulsipher Michael A. 
Published: December 2018

Purpose of review
Incorporation of minimal residual disease (MRD) testing in acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) has transformed the landscape of hematopoietic cell transplantation (HCT). Pre-HCT MRD has allowed prognostication of HCT outcomes for high-risk leukemia patients, whereas the detection of post-HCT MRD has allowed for interventions to decrease relapse.

Recent findings
In this review, we emphasize studies from the past two decades that highlight the critical role of MRD in HCT in pediatric ALL and AML. Advances in MRD detection methodology, using next-generation sequencing, have improved the sensitivity of MRD testing allowing for more accurate predictions of HCT outcomes for patients with relapsed and refractory ALL and AML. In addition, novel pre-HCT therapies, especially immunotherapy in ALL, have dramatically increased the number of patients who achieve MRD-negative remissions pre-HCT, resulting in improved HCT outcomes. Post-HCT MRD remains a challenge and new therapeutic interventions are needed to reduce post-HCT relapse.

Summary
As immunotherapy increases pre-HCT MRD-negative remissions, and next-generation sequencing-MRD is incorporated to improve the sensitivity of MRD detection, future clinical studies will investigate less toxic HCT approaches to reduce long-term sequelae and to identify which patients may benefit most from early post-HCT intervention to reduce relapse.
Augmenting Atrial Fibrillation Care After an Emergency Department Visit
Authors: Hart Danielle , Hopman Wilma M. , Hammond Sharlene , Redfearn Damian P. 
Published: December 2018

Background:
Between 2010 and 2012, the Heart Rhythm team in a tertiary care hospital completed a retrospective study that found that atrial fibrillation (AF) care can be episodic and heavily reliant on hospital resources, particularly the emergency department (ED).

Problem:
Patients who attend the ED with AF are at high risk of hospital admission.

Approach:
A nurse practitioner (NP) was added to the Heart Rhythm team to create a program to improve AF care after an ED visit. Telephone practice was one of the many processes created.

Outcomes:
Findings revealed that 37 of 90 patients presented to the ED with AF prior to telephone contact and 7 of 90 patients did so post–telephone contact (P < .001).

Conclusion:
Telephone practice led by an NP provides an opportunity to improve assessment and management of patient with AF and offers a promising cost-effective method to reduce ED visits in the AF patient population.
Interleukin-17A and Chronic Stress in Pregnant Women at 24–28 Weeks Gestation
Authors: Moore Tiffany A. , Case Adam J. , Mathews Therese L. , Epstein Crystal Modde , Kaiser Katherine Laux , Zimmerman Matthew C. 
Published: December 2018

Background
Allostatic load (AL) is a biopsychosocial model that suggests chronic psychosocial stress leads to physiological dysregulation and poor outcomes. The purpose of this study was to examine AL in pregnant women operationalized using proinflammatory cytokines and psychosocial indicators and perinatal outcomes.

Objectives
The aim of the study was to identify relationships between circulating cytokines/chemokines and the Prenatal Distress Questionnaire, the Maternal Antenatal Attachment Scale, the Emotional Quotient Inventory, the Life Experiences Scale, and demographics in pregnant women.

Methods
A cross-sectional design was used to recruit pregnant women between 24 and 28 weeks of gestation. Blood and stress/emotional indicators were obtained after informed consent. Plasma was abstracted to simultaneously measure 29 cytokines/chemokines using a multiplex array. Cytokine/chemokine levels were compared with continuous variables using Spearman’s rho and with categorical variables using Mann–Whitney U.

Results
Twenty-five women with medically high-risk (n = 16) and low-risk (n = 9) pregnancies consented. Most women were White (68%) with a mean age of 29 years (SD = 5.9). Although several cytokines and chemokines showed significant correlations with the stress/emotional indicators, only interleukin-17A (IL-17A) was significantly associated with all of the indicators (Prenatal Distress Questionnaire: r
s = .528, p = .012; Maternal Antenatal Attachment Scale: r
s = −.439, p = .036; Emotional Quotient Inventory total: r
s = −.545, p = .007), Life Experiences Scale (r
s = .458, p = .032), birth weight (r
s = −.499, p = .013), and race (p = .01).

Discussion
Increased levels of IL-17A, a known cytokine associated with chronic stress and with poor perinatal outcomes, were associated with high prenatal distress, low maternal attachment, and lower emotional intelligence in pregnant women. Increased levels of IL-17A also were associated with lower birth weight and non-White race. Results support the model of AL in pregnant women and highlight IL-17A as a potential biomarker of AL during pregnancy.
Genomics of Reproductive Traits and Cardiometabolic Disease Risk in African American Women
Authors: Hardy Theresa M. , de Mendoza Veronica Barcelona , Sun Yan V. , Taylor Jacquelyn Y. 
Published: December 2018

Background
Age at menarche and age at natural menopause occur significantly earlier in African American women than in other ethnic groups. African American women also have twice the prevalence of cardiometabolic disorders related to the timing of these reproductive traits.

Objectives
The objectives of this integrative review were to (a) summarize the genome-wide association studies of reproductive traits in African American women, (b) identify genes that overlap with reproductive traits and cardiometabolic risk factors in African American women, and (c) propose biological mechanisms explaining the link between reproductive traits and cardiometabolic risk factors.

Methods
PubMed was searched for genome-wide association studies of genes associated with reproductive traits in African American women. After extracting and summarizing the primary genes, we examined whether any of the associations with reproductive traits had also been identified with cardiometabolic risk factors in African American women.

Results
Seven studies met the inclusion criteria. Associations with both reproductive and cardiometabolic traits were reported in or near the following genes: FTO, SEC16B, TMEM18, APOE, PHACTR1, KCNQ1, LDLR, PIK3R1, and RORA. Biological pathways implicated include body weight regulation, vascular homeostasis, and lipid metabolism.

Discussion
A better understanding of the genetic basis of reproductive traits in African American women may provide insight into the biological mechanisms linking variation in these traits with increased risk for cardiometabolic disorders in this population.
Global Transcriptomic Profile of Dorsal Root Ganglion and Physiological Correlates of Cisplatin-Induced Peripheral Neuropathy
Authors: Lessans Sherrie , Lassiter Cameron B. , Carozzi Valentina , Heindel Patrick , Semperboni Sara , Oggioni Norberto , Chiorazzi Alessia , Thompson Carleveva , Wagner Monica , Holden Janean , Rahn Elizabeth , Sweatt J. David , Cavaletti Guido , Renn Cynthia L. , Dorsey Susan G. 
Published: December 2018

Background
Multiple cell signaling pathways are implicated in the development, progression, and persistence of cisplatin-induced peripheral neuropathy. Although advances have been made in terms of understanding specific neurotoxic mechanisms, there are few predictive factors identified that can help inform the clinician approach to symptom prevention or management.

Objective
We investigate the differential sensitivity to cisplatin-induced peripheral neuropathy and examine the contribution of dorsal root ganglion (DRG) transcriptional profiles across two inbred strains of mice.

Methods
Cisplatin (4 mg/kg intraperitoneal or vehicle control) was administered twice a week for 4 weeks to adult female C57BL/6J and A/J mice—the C57BL/6J strain of mice characterized by a robust mechanical allodynia and the A/J with a mild largely resistant allodynia phenotype. Peripheral nerve conduction velocities (NCVs), electrophysiological evaluation of wide dynamic range (WDR) neurons, morphological examination of DRG neurons, and microarray analysis of spinal cord tissues were compared across the 4 weeks.

Results
The A/J strain presents with an early, mild nocifensive response to cisplatin with reduced neuronal activity in WDR neurons and small changes in cross-sectional nucleus size in DRG neurons at 4 weeks. The more nocifensive-sensitive C57BL/6J strain presents with no early changes in WDR neuron responsiveness; however, there were significant changes in DRG size. Both strains demonstrate a drop in NCV after 4 weeks of treatment, with the greatest reduction present in the A/J strain. Transcriptome data implicate neuroimmune modulation in the differential response to cisplatin in the DRGs of A/J and C57BL/6J mice.

Discussion
Nocifensive responses in both strains implicate involvement of small myelinated and unmyelinated fibers in neurotoxic cisplatin response, whereas reductions in NCV reflect involvement of the largest myelinated fibers in the peripheral nerves. Microarray data analysis identifies neuropathy-relevant gene sets with differential activation of pathways, suggesting a role for antigen presentation in the differential neurotoxic response to cisplatin across strains. Further research is indicated to determine the relative contributions of each of these potential pathological mechanisms to both the neurotoxic response to cisplatin and to the potential for targeted therapy.
The Effect of a Primary Care Provider Incentive Program on Pediatric Emergency Medicine Visits
Authors: Li Joyce , Patel Binita , Giardino Angelo P. , Camp Elizabeth A. , Macias Charles G. 
Published: December 2018

Objective
The aim of the study was to analyze the effect of a financial incentive program targeting primary care providers (PCPs) with the goal of decreasing emergency department (ED) utilization.

Methods
We performed a retrospective cohort analysis in a single health maintenance organization comparing ED visit/1000 member-months before and after the physician incentive program in 2009. We compared the median ED visit rate between physicians who did (PIP) and did not participate (non-PIP) from 2009 to 2012. We used 2008 data as a baseline study period to compare the ED visit rate between PIP and non-PIP providers to detect any inherent difference between the 2 groups.

Results
A total of 1376 PCPs were enrolled. A total of US $18,290,817 was spent in total on incentives. Overall, the median ED visit rate for all providers was statistically significantly lower during the study period (baseline period, study period: 56.36 ED visits/1000 member-months vs 45.82, respectively, P < 0.001). During the baseline period in our fully adjusted linear regression for degree, specialty, education, and board status, PIP versus non-PIP visits were not statistically significantly different (P = 0.17). During the study period in our fully adjusted model, we found that PIP had statistically significant fewer ED visits compared with non-PIP (P = 0.02). In a subgroup analysis of providers who did and did not receive an incentive payment, in the fully adjusted linear regression, providers who received any payment had statistically significant fewer ED visits/1000 member-months (P < 0.001). In addition, we found in the fully adjusted analysis that those providers who received at least 1 incentive payment for meeting after-hours criteria had statistically significantly fewer ED visits/1000 member-months (P < 0.001).

Conclusions
A financial incentive program to provide PCPs with specific targets and goals to decrease pediatric ED utilization can decrease ED visits.
Is a Fundamental Change in the Interpretation of Rheumatoid Arthritis Disease Activity Necessary?
Authors: Wilke William S. 
Published: December 2018

AbstractDisease Activity Score (DAS) composite models are moderately precise and robust measures of disease severity when they are used in rheumatoid arthritis (RA) cohorts. They are less so when used for individual patients. This is because subjective components, patient global assessment of well-being and tender joint count, modified by factors other than RA biological disease activity, often obfuscate interpretation of disease activity. Comorbidities, especially distress, can disproportionately inflate these components. Fibromyalgia, essentially synonymous with distress, pain augmentation, and depression, is a common comorbidity. Its presence and severity can be determined by the Polysymptomatic Distress Scale (PSD). The differential effects of distress and fibromyalgia syndrome on the DAS can be demonstrated by manipulating information already there: the arithmetic differences or ratios of the tender joint count and swollen joint count and comparison of the modified disease activity score with 28 joints to the disease activity score with 28 joints-patient (DAS28-derived indices that measure the contribution of the relatively objective or relatively subjective components, respectively). The potentially more objective multibiomarker disease activity might also be used to test the severity of biological RA disease activity. These tools may be used to elucidate disproportionate values for subjective DAS model components, which then should facilitate identification of the underlying process factors, including depression, for potential treatment.