bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socioeconomic Factors and Ninth Grade School Performance in Childhood Leukemia and CNS Tumor Survivors
Authors: Lindahl Merete , Addington Silas Victor , Winther Jeanette Falck , Schmiegelow Kjeld , Andersen Klaus Kaae 
Published: April 2018

Abstract

Background
Childhood cancer survivors can experience deficits in school performance in adolescence. Few studies have investigated how social and socioeconomic factors influence and modify school performance. This study investigates the hypothesis that social and parental socioeconomic factors influence ninth grade school performance in childhood leukemia and central nervous system (CNS) tumor survivors and that the effect is different from that in healthy peers.

Methods
We analyzed data from nationwide Danish registers on school grades for children who finished ninth grade during 2002–2015 in Denmark. Using a unique within-school matched design, we compared grades from childhood cancer survivors with grades from healthy peers. Social factors were maternal/paternal civil status, immigrant status, and country of origin. Parental socioeconomic factors were measured by education and income. The study consisted of 36 426 children, of whom 460 and 289 were leukemia and CNS tumor survivors, respectively.

Results
School grades varied considerably across social strata. However, the grades among CNS tumor survivors varied notably less in the following effect modifiers: parental educational attainment, income, and immigrant status. On the contrary, no significant effect modifiers were found among leukemia survivors as compared with healthy peers.

Conclusion
There is a strong effect of social and parental socioeconomic factors on school performance in healthy adolescence in Denmark. The same pattern is seen in survivors of leukemia, but a different pattern is seen in survivors of CNS tumors. This finding suggests that impairment of school-related functions differ between leukemia and CNS tumor survivors. This study contributes to knowledge on learning in adolescence in childhood cancer survivors by investigating several social and socioeconomic effect modifiers with nationwide register data and a unique statistical method particularly suitable for comparing school grades. Improved insight could make it possible to identify high-risk groups that may need different means of help.
Relationship Between Anthropometric Factors and Risk of Second Breast Cancer Among Women With a History of Ductal Carcinoma In Situ
Authors: Flanagan Meghan R , Tang Mei-Tzu C , Baglia Michelle L , Porter Peggy L , Malone Kathleen E , Li Christopher I 
Published: April 2018

AbstractBackgroundWomen with ductal carcinoma in situ (DCIS) have an elevated risk of a second breast cancer, but few data are available regarding the impact of modifiable lifestyle factors on this risk.MethodsIn a population-based case–control patient study of women with a history of DCIS in western Washington diagnosed between 1996 and 2013, 497 patients diagnosed with DCIS and a second ipsilateral or contralateral invasive or in situ breast cancer were enrolled. There were 965 matched control patients with one DCIS diagnosis. Associations between anthropometric factors and risk of an invasive or in situ second breast cancer event were evaluated using conditional logistic regression. Statistical tests were two-sided.ResultsObesity (body mass index [BMI] ≥ 30 kg/m2) at initial DCIS diagnosis was associated with a 1.6-fold (95% confidence interval [CI] = 1.2 to 2.2) increased risk of any second breast cancer and a 2.2-fold increased risk of a contralateral second breast cancer (95% CI = 1.4 to 3.3) compared with normal weight women (BMI < 25 kg/m2). BMI and weight, both at initial DCIS diagnosis and at the time of the second breast cancer diagnosis, were positively associated with risk of any second and second invasive breast cancers (odds ratio = 1.01–1.04, all P ≤ .03).ConclusionsAlthough additional confirmatory studies are needed, obesity appears to be an important contributor to the risk of second breast cancers within the growing population of women with DCIS. This has potential clinical relevance with respect to identifying which women with a history of DCIS may require more careful monitoring and who may benefit from lifestyle modifications.
The Neuroscience of Pain and Addiction
Authors: Waller R. Corey 
Published: April 2018

Abstract
This chapter addresses the neurological architecture of both pain and addiction. The components of the relationship between the two are manifold, and include substances ingested; neurotransmitters and their receptor sites; cells, tissues, and organs and their integrated function. The author focuses on the basic neuroscience. The opening discussion (“Progress in Understanding Pain and Addiction”) maps our present understanding of both the plasticity of brain circuits and the fixity of drug effects. There follows a review of the anatomical structure of the brain, integrated with the known addiction and pain sensation processing pathways; an anatomical figure of the brain is provided. These descriptions lead to a scenario-based discussion of the implications for treatment of both pain and addiction: a patient with high pain tolerance experiencing pain, a patient with low pain tolerance experiencing pain, and the consequences of administering opioids. It concludes with therapeutic recommendations for management.
Psychosocial Aspects of Pain and Addiction
Authors: Halpern Ross 
Published: April 2018

Abstract
This chapter addresses the problem of assessing opiate use and psychological comorbidity, and discusses psychological strategies for coping with chronic pain. In 1995, the American Pain Society and others embraced pain as the fifth vital sign; yet pain differs from the other vital signs by being subjective, as opposed to being objectively measured, implying a psychological aspect. Psychological evaluation of a pain patient assesses underlying psychosocial aspects that play a role in reported pain symptoms. Early childhood abuse increases the likelihood of chronic pain later in life; pain may be precipitated by an emotional or physical trauma that reawakens anxiety from the original childhood experience. Precipitating traumas can include divorce, job loss, legal issues, grief, or death anniversaries. The earlier and more extensive the childhood trauma, the earlier and more extensive the physical report of pain in adulthood, and the greater the perceived need for opioid analgesia.
The Language of Pain and Addiction
Authors: Miller Michael M. 
Published: April 2018

Abstract
The language employed in managing coexisting pain and addiction affects the management itself. Clinicians working with such patients may not realize that the two disorders share a terminology that can be confusing, imprecise, overlapping and/or stigmatizing. This chapter has two components:
1. A description of Pain Medicine as a specialized area of practice, research, and education, whose leaders try to clarify concepts and terminology to improve patient care, professional standards, and public policy.
2. The language of Addiction Medicine; arguably, even more complex than that of pain medicine because of the emotions, stigma, and discrimination attached to substance use disorders labels.
All physicians’ concern must be that the patient adheres to the treatment plan by using prescription medications in only safe and healthy ways. This requires counseling, and monitoring treatment adherence and the safety of prescriptions, even in the absence of a diagnosable substance use disorder.
Providing Integrated Care for Pain and Addiction
Authors: Wartenberg Alan A. 
Published: April 2018

Abstract
The central premise of this chapter on providing integrated care for both pain and addiction is that all patients presenting with pain are at risk for development of substance use disorders. Assessment and treatment of the complex interplay between pain syndromes and substance use disorders proceed most productively by employing an integrated model, with a multidisciplinary approach and with employment of multiple diagnostic instruments. The author describes an integrated care model as it applies to each of the common substances of use: opioids, tobacco, alcohol, benzodiazepines, cannabinoids, barbiturates, and stimulants. The basis for a decision to refer for evaluation or treatment is described. The chapter concludes with an argument for collaboration between disciplines, notably pain medicine and addiction medicine, as being the current standard of acceptable care for patients whose illnesses dwell in both camps. A separate text box provides additional information and resources bearing on this chapter’s topics.
Legal Issues in Treating Pain and Addiction
Authors: Salsitz Edwin A. 
Published: April 2018

Abstract
Competent treatment of both pain and addiction requires an understanding of applicable federal, state, and local laws and regulations. Key requirements of federal laws and regulations are outlined in this chapter; the authors emphasize the need for an understanding of local and regional laws and precedents, which goes beyond the scope of the chapter, and a separate text box is provided with resources. Also provided is a text box analyzing 2017 changes to the federal Rule 42, CFR, relating to confidentiality and re-disclosure of information specific to treatment of substance use disorders. Areas of chapter focus include: HIPAA, confidentiality, general medical recordkeeping principles and obligations, federal audits (DATA 2000 and buprenorphine), medication storage, reporting requirements and the duty to warn, reports to employers, and the management of an office closure.
Screening Patients for Opioid Risk
Authors: Fudin Jeffrey , Cleary Jacqueline , Kominek Courtney , Brooks Abigail , Pham Thien C. 
Published: April 2018

Abstract
The narrow therapeutic index associated with most analgesic opioids creates a high degree of risk, obliging caution in patient selection; this chapter describes screening practices. More attention is due to the use of opioid therapy for chronic non-cancer pain as episodes of respiratory arrest increase. Universal precautions are recommended for all patients. Before and throughout treatment, selected tools assessing risk and misuse should be employed. Increased access to the opioid antagonist naloxone has followed the increase in opioid poisoning deaths; the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (RIOSORD) helps determine the likelihood of an opioid overdose, serving to select candidates for at-home naloxone access. Urine drug testing aids treatment plan adherence. Tables include: a comparison of screening tools for risk stratification; a comparison of tools for assessment of opioid misuse; the scoring procedure for the RIOSORD; and a list of risk classes with predicted probabilities.
Drug Testing and Other Tools for Patient Monitoring
Authors: Baxter Louis E. 
Published: April 2018

Abstract
Chapter 12 describes patient monitoring in the setting of addiction or addiction risk, and pain management, to include drug testing. The advantages, disadvantages, and types of available testing for drug use are described, with a discussion of their limitations. Body fluids and tissues for sampling include hair, blood, saliva, sweat, and urine; all yield information regarding drug use within unique limitations and at different levels of convenience. The test methodology imposes a need to know respective sensitivities and specificities, particularly in a forensic setting. Breath testing (alcohol) is not within the scope of this chapter. Recommended frequencies of urine testing are addressed. The utility of other forms of monitoring (self-report, collateral sources, PDMP) is assessed in the final section. Two tables are provided, (1) urine drug detection times, and (2) sources of false positive tests in urine immunoassay studies. Supplemental information sources are cited in a text box.
Mindfulness as a Component of Addiction Treatment
Authors: Abramowitz Sharone 
Published: April 2018

Abstract
This compact chapter addresses patient selection and general principles of mindfulness-based interventions, specifically mindfulness-based stress reduction (MBSR). It describes mindfulness-oriented recovery enhancement (MORE) as a combination of mindfulness intervention and cognitive behavioral therapy, suggesting its effectiveness in reducing the perception of pain in more than half of the participants who complete training. While focusing principally on the patient, the chapter argues for the utility of mindfulness-based interventions in preserving the serenity and enhancing the effectiveness of the therapist. It also notes that while the therapeutic outcome may be modest, there is generally little cost and very little risk to initiation of mindfulness meditation and similar interventions. A text box is given with additional resources.
Pain and Addiction in Patients with Co-Occurring Psychiatric Disorders
Authors: Ziegler Penelope P. 
Published: April 2018

Abstract
Addressed equally to psychiatrists and to primary care providers, this chapter is intended to explore non–substance use disorder psychiatric diagnoses as they impact the perception of pain and the treatment of substance use disorders. A screening checklist emphasizing basic principles of psychiatric history-taking is provided to help identify the patient’s requirements. The author reviews the classes of psychiatric diagnoses most likely to be present in the pain/addiction and other comorbidly-ill patients, and reviews suicide risks. Similarly, the classes of medications employed in psychiatry and their capacity for alleviation or aggravation of substance use disorders are reviewed, with notations of drug–drug interactions. A final section addresses the role of emotions and psychiatric symptoms in the perception and management of pain.
Pain and Addiction in Patients with Post-Traumatic Stress Disorder
Authors: Eraker Steven A. 
Published: April 2018

Abstract
Addressed equally to psychiatrists and to primary care providers, this chapter is intended to explore non–substance use disorder psychiatric diagnoses as they impact the perception of pain and the treatment of substance use disorders. A screening checklist emphasizing basic principles of psychiatric history-taking is provided to help identify the patient’s requirements. The author reviews the classes of psychiatric diagnoses most likely to be present in the pain/addiction and other comorbidly-ill patients, and reviews suicide risks. Similarly, the classes of medications employed in psychiatry and their capacity for alleviation or aggravation of substance use disorders are reviewed, with notations of drug–drug interactions. A final section addresses the role of emotions and psychiatric symptoms in the perception and management of pain.
Pain and Addiction in Older Adults
Authors: Buckalew Nelly A. 
Published: April 2018

Abstract
Addressing unique effects of both addiction and analgesia on older adults, this chapter defines the geriatric population and proceeds to discuss the recognition of addiction or substance misuse in it. There is little argument that the elderly have special diagnostic concerns and management needs that are imposed upon those of younger adults. The concept of the pain signature is introduced as a measure of the functions with which the individual’s pain interferes. Four instruments serving as diagnostic aids are included in tabular format: the pain signature elements; a list of recommended patient history queries; suggested components of the review of systems; and special components of the physical examination. The tables are geared specifically toward geriatric patients. The two central themes of the chapter are treatment of pain, and the treatment of opioid misuse and addiction.
Effects of a dietary supplement on gastric ulcer number and severity in exercising horses1
Authors: Conner Alysia L , Davis Amanda J , Porr Cheryl A 
Published: April 2018

AbstractThis study evaluated the effect of a dietary supplement on the treatment of equine gastric ulcer syndrome (EGUS). Gastroscopy was performed on university riding horses of mixed breeds at two locations and only horses exhibiting gastric ulcers were selected to participate in this study (location A, n = 13; location B, n = 15). Gastric ulcer severity was assessed using two different methods depending on location before treatment (Pre). After gastroscopy, horses were fed the supplement in addition to their regular diet for 44 d (14-d adaptation period followed by 30-d feeding period). All horses were subjected to gastroscopy again at the end of the feeding period (Post) to evaluate changes in gastric lesions. Statistical analysis was performed using SAS. Individual horses were the experimental unit with dependent variables including severity and number of gastric ulcers. At location A, dependent variable included severity of gastric lesions with fixed effects of time (Pre and Post) and location (stall or pasture). For location B, dependent variables included severity and number of gastric lesions with fixed effects of time. Severity of gastric ulcers decreased at both locations in horses following the feeding period. Gastric lesion scores decreased from 2.2990 to 1.3760 (P = 0.0015) at location A and gastric lesion severity from 3.8000 to 2.5667 (P = 0.0322) at location B. No differences were found in gastric lesion scores at location A between horses housed in stalls or pastures (1.8750 and 1.8000; P = 0.7783). The number of gastric ulcers observed at location B were similar Pre and Post treatment (3.4667 and 3.5333; P = 0.8363). There were no changes in body condition score (P ≥ 0.2607), BW (P ≥ 0.4551), or behavior at either location. Results suggest that oral supplementation may decrease severity of gastric ulcers in horses participating in university riding programs.
The Art (and Artifice) of Seeking Feedback: Clerkship Students’ Approaches to Asking for Feedback
Authors: Bing-You Robert , Hayes Victoria , Palka Tamara , Ford Marybeth , Trowbridge Robert 
Published: April 2018

Purpose
As attention has shifted to learners as significant partners in feedback interactions, it is important to explore what feedback-seeking behaviors medical students use and how the faculty–student relationship affects feedback-seeking behaviors.

Method
This qualitative study was inspired by the organizational psychology literature. Third-year medical students were interviewed at Maine Medical Center in April–May 2017 after completing a traditional block rotation clerkship or a nine-month longitudinal integrated clerkship (LIC). A constructivist grounded theory approach was used to analyze transcripts and develop themes.

Results
Fourteen students participated (eight LIC, six block rotation). Themes associated with why students sought feedback included goal orientations, perceived benefits and costs, and student and feedback provider characteristics. Factors influencing the way students sought feedback included busy environments, timing, and cues students were attuned to. Students described more inquiry than monitoring approaches and used various indirect and noninquiry techniques (artifice) in asking for feedback. Students did not find summative feedback as helpful as seeking feedback themselves, and they suggested training in seeking feedback would be beneficial. Faculty–student relationship dynamics included several aspects affecting feedback-seeking behaviors, and relationship differences in the LIC and block models affected feedback-seeking behaviors.

Conclusions
Medical students have many motives to seek feedback and adapt their feedback-seeking behaviors to actively participate in an intricate dialogic interaction with feedback providers. Students gradually refine the art (and artifice) of obtaining the specific feedback information that meets their needs. The authors offer a prototype curriculum that may facilitate students’ development of feedback-seeking skills.
What Factors Influence Union and Refracture of Congenital Pseudarthrosis of the Tibia? A Multicenter Long-term Study
Authors: Shah Hitesh , Joseph Benjamin , Nair Binu V.S. , Kotian Devaki B. , Choi In Ho , Richards Benjamin Stephens , Johnston Charles , Madhuri Vrisha , Dobbs Matthew B. , Dahl Mark 
Published: April 2018

Objective:
To identify factors influencing union of congenital pseudarthrosis of the tibia (CPT), refractures, and integrity of the tibia at maturity.

Methods:
Data of 119 children operated for Crawford-type IV CPT and followed-up till skeletal maturity were analyzed. Logistic regression and recursive partitioning analyses were used to test associations between several variables and the outcome.

Results:
Primary union occurred in 86% of children. At maturity, 69% remained soundly united. The odds ratio for failure of primary union was 3.89 (95% confidence interval, 1.05-14.40; P=0.042) when bone morphogenetic protein was used, and children who had a combination of the Ilizarov technique and intramedullary nailing were at risk for unsound union at maturity (odds ratio, 6.19; 95% confidence interval, 1.24-30.83; P=0.026). No other association reached statistical significance. On recursive partitioning, use of the Ilizarov technique, transfixing the ankle and subtalar joints, use of cortical graft and not operating on the fibula were associated with a better outcome; use of bone morphogenetic protein and combining intramedullary nailing with the Ilizarov technique were associated with poor results.

Conclusions:
A larger sample is needed to confirm which factors truly influence the outcome of CPT. This may be feasible if data are collected prospectively through a multicenter registry.
Spinal Sagittal Alignment in Patients With Dropped Head Syndrome
Authors: Murata Kazuma , Kenji Endo , Suzuki Hidekazu , Takamatsu Taichiro , Nishimura Hirosuke , Matsuoka Yuji , Sawaji Yasunobu , Tanaka Hidetoshi , Yamamoto Kengo 
Published: April 2018

Study Design.
This is a retrospective radiographic study of a consecutive case series of dropped head syndrome (DHS) at a single tertiary referral center.

Objective.
The aim was to clarify the spinal sagittal alignment of DHS.

Summary of Background Data.
DHS is characterized by chin-on-chest deformity and devastatingly impedes activities of daily living in affected individuals. Among various forms of DHS, isolated neck extensor myopathy (INEM) is considered to cause the chin-on-chest symptom in the absence of specific abnormality. There is a paucity of literature about spinal sagittal alignment, of this condition however.

Methods.
Thirty-seven patients diagnosed with INEM DHS were enrolled. Radiographic measurements were made, including the following parameters: C2 slope (C2S), C2-C7 A, C2-C7 sagittal vertical axis (SVA), T1 slope (T1S), C7-S1 SVA, T1-T4 thoracic kyphosis (TK), T4-T12 TK, lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Sixty-one patients with cervical spondylosis were enrolled as a control group.

Results.
C2-C7 SVA was greater in INEM DHS (52.0 ± 2.9 vs. 18.6 ± 1.9 mm). C2S and T1S were larger to the control (C2S: 52.6° ± 2.0° vs. 13.0° ± 1.4°, T1S: 37.3° ± 2.2° vs. 22.7° ± 1.4°). C2-C7 A was smaller in INEM DHS (−7.8° ± 2.6° vs. 15.2° ± 2.7°). Among sagittal parameters, C2S, T1S, and T1-T4 TK positively correlated with C2-C7 SVA (r = 0.63, r = 0.54, and r = 0.58). For these correlations with C2-C7 SVA, both logistic and linear regression models predicted threshold of 40° for C2S, 40° for T1S, and 15° for T1-T4 TK responsible for C2-C7 SVA > 40 mm, respectively.

Conclusion.
Increased offset of the gravity axis of the head represented by C2-C7 SVA was observed in INEM DHS. Magnified offset of the gravity axis of the head was affected by enlarged C2S, T1S, and T1-T4 TK for the strong correlation with C2-C7 SVA, respectively. Cervical kyphosis was considered as some of the anthropometric characteristics due to regressive changes in affected individuals; a correlation between C2-C7 A and C2-C7 SVA was exhibited.

Level of Evidence: 4