bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cognitive Behavioral Therapy for Prenatal Insomnia
Authors: Manber Rachel , Bei Bei , Simpson Norah , Asarnow Lauren , Rangel Elizabeth , Sit Anita , Lyell Deirdre 
Published: April 2019

OBJECTIVE:
To evaluate the effectiveness of cognitive behavioral therapy for insomnia during pregnancy.

METHODS:
Randomized, unmasked, 3-site controlled trial. Participants were randomly allocated to cognitive behavioral therapy for insomnia (a first-line, empirically supported psychosocial intervention that addresses sleep-related behaviors and cognitions) or a control intervention consisting of imagery exercises that paired patient-identified distressing nighttime experiences with patient-identified neutral images. Participants were eligible if they met diagnostic criteria for insomnia disorder and were between 18 and 32 weeks of gestation. Patients were ineligible if they met diagnostic criteria for major psychiatric disorders, including depression, or were receiving nonstudy treatments that could affect sleep (or both). The primary outcome was the Insomnia Severity Index score, a validated brief questionnaire, with scores between 14 and 21 representing clinically meaningful insomnia of moderate severity, scores higher than 21 representing severe insomnia, and scores less than 8 representing no insomnia. Secondary outcomes included remission of insomnia (Insomnia Severity Index score less than 8), objectively measured and self-reported time awake (ie, total wake time), and the Edinburgh Postnatal Depression Scale score. All outcomes were measured weekly. Analysis included 48 participants who did not complete treatment. We estimated that 184 women would be required to have 80% power, with a two-tailed test, to detect a moderate Cohen's d effect size (.5) with α=.05.

RESULTS:
Between May 2013 and April 2017, 194 pregnant women were randomized and 149 completed treatment; 179 with available baseline data (92%) were ultimately analyzed, 89 in the cognitive therapy group and 90 in the control group. Women assigned to cognitive behavioral therapy for insomnia experienced significantly greater reductions in insomnia severity (scores decreased from 15.4±4.3 to 8.0±5.2 in the cognitive behavioral therapy group vs from 15.9±4.4 to 11.2±4.9 in the control therapy group [P<.001, d=0.5]). Remission of insomnia (to an Insomnia Severity Index score less than 8) disorder was attained by 64% of women in the cognitive behavioral therapy for insomnia group vs 52% in the control group. Women receiving cognitive behavioral therapy for insomnia experienced faster remission of insomnia disorder, with a median of 31 days vs 48 days in the control therapy (P<.001). Cognitive behavioral therapy for insomnia led to significantly greater reduction in self-reported but not objective total wake time and a small but significantly greater decline in Edinburgh Postnatal Depression Scale scores vs the control group.

CONCLUSION:
Cognitive behavioral therapy for insomnia is an effective nonpharmacologic treatment for insomnia during pregnancy.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01846585.
Use of Active Learning and Sequencing in a Weekly Continuing Medical Education/Graduate Medical Education Conference
Authors: Austin Jared P. , Carney Patricia A. , Thayer Erin K. , Rozansky David J. 
Published: April 2019

Introduction:
Active learning and sequencing have been described as effective techniques for improving educational conferences. However, few departmental continuing medical education/graduate medical education (CME/GME) conferences, such as Grand Rounds (GR), have adopted these techniques. The purpose of this study was to describe the development, implementation, and evaluation of Friday Forum (FF), a weekly CME/GME conference that incorporated active learning and sequencing techniques into a new educational offering, complementary to GR, within a medium-sized academic pediatrics department.

Methods:
Implemented in 2013, FF was designed to address 5 medically relevant themes in a sequential, rotating, interactive format, and included: (1) clinical reasoning, (2) evidence-based medicine, (3) morbidity & mortality, (4) research in progress, and (5) ethics. In 2018, at the conclusion of its fifth year, a survey and focus groups of faculty, residents, and fellows explored the relative value of FF compared with the departmental GR.

Results:
Survey response rates for residents/fellows and faculty were 37/76 (48.7%) and 57/112 (50.9%), respectively. FF was rated highly for helping participants develop rapport with colleagues, exposing participants to interactive strategies for large-group teaching and value for time spent. GR was rated highly for helping participants learn about academic endeavors outside the department and emerging challenges in pediatrics. Qualitatively, two key themes emerged for FF: desire for interaction (community building) and topical variety.

Discussion:
Using active learning and sequencing techniques, we implemented a novel CME/GME conference that enhanced our learning community by integrating the education of faculty and trainees, and achieved complementary objectives to GR.
Effects of 90Sr on Tree Swallow Nestlings Near Groundwater Contaminant Plumes
Authors: Lee David R. , Haughton Jennifer , Valente Andrew , Bellan Lee , Stuart Marilyne , Beaton Danielle , Chen Hui Qun , Gosselin Isabelle , Festarini Amy 
Published: April 2019

Abstract
Discharge of groundwater contaminant plumes has created elevated concentrations of 90Sr in some aquatic sediments at Chalk River Laboratories. Tree swallows (Tachycenita bicolor) feed and supply their nestlings almost exclusively with airborne insects that developed as larvae in aquatic sediments. To monitor the uptake and test for potential detriment due to 90Sr in a terrestrial animal, we measured the gross beta concentrations in the bone of 12-d-old tree swallow nestlings in areas having sediments with elevated levels of gross beta (90Sr and 90Y) and in several control areas where sediment gross beta was primarily due to naturally occurring 40K. Nesting behavior and reproductive success of the tree swallows were similar regardless of the gross beta concentrations in sediments near their nest boxes. Radiation can damage DNA and cause micronuclei to form in cells, so we examined the frequency of micronuclei in erythrocytes of nestlings. The formation of micronuclei in the erythrocytes of the nestlings was also similar wherever nestlings were analyzed. The results revealed no significant increases even near sediments with the highest gross beta levels. At Perch Lake, where Chalk River Laboratories has a large area of 90Sr-contaminated sediments, the bones of 12-d-old nestlings contained gross beta concentrations as high as 29 Bq g−1. This would produce a skeletal dose rate of 9 μGy h−1, which is one-fourth of the threshold dose rate of 40 μGy h−1, above which detriment could occur. Failing to find any indication of detriment in the field study, we irradiated wild eggs in the lab and returned them to their nest for natural incubation, hatching, and feeding by the parents. There was an increase in formation of micronuclei following a dose of 3.2 Gy, and the other results were consistent with existing literature.
EARLY VITAMIN A SUPPLEMENTATION IMPROVES THE OUTCOME OF RETINOPATHY OF PREMATURITY IN EXTREMELY PRETERM INFANTS
Authors: Sun Huiqing , Cheng Rui , Wang Zhansheng 
Published: April 2019

Purpose:
This study assessed the efficacy and safety of early vitamin A (VA) supplementation to improve outcomes of retinopathy of prematurity in extremely preterm infants.

Methods:
A total of 262 eligible extremely preterm infants underwent randomization; of these, 132 were assigned to the VA group and 130 to the control group. The infants were administered a solution of VA (1,500 IU/day), added to their enteral feeds as soon as minimal feeding was introduced and continued for 28 days or until discharge.

Results:
With no adverse effects occurring, serum VA of the VA-supplemented infants on Days 14, 28, and postmenstrual 36 weeks was higher than that of the placebo group (P < 0.001). No signs of VA toxicity or increased intracranial pressure were reported. The VA group had lower unadjusted rates of Type 1 retinopathy of prematurity (1.6 vs. 6.9%, P = 0.030) and bronchopulmonary dysplasia (18.9 vs. 33.8%, P = 0.008) than the control group. Regression analysis revealed an association between serum VA levels and risk of Type 1 retinopathy of prematurity (beta = −2.37).

Conclusion:
Vitamin A supplementation reduced VA deficiency in extremely preterm infants; it was associated with a decreased incidence of Type 1 retinopathy of prematurity and may also have a positive impact on reducing bronchopulmonary dysplasia.
Development of a Question Prompt List for Patients Living With HIV and Assessment of Their Information Needs
Authors: Kim Gwang Suk , Choi Jae-Phil , Yi Jeong Min , Shim Mi-So 
Published: April 2019

Abstract
A question prompt list (QPL) is an efficient method to facilitate patient active participation and communication by providing patients with questions to ask their health care providers. We developed a QPL based on the information needs of patients living with HIV in Korea. A mixed method study design was used, involving five sequential steps: literature review, focus group interview with experienced nurses, in-depth interviews with patients, expert reviews, and a survey of 170 patients. A QPL with 27 questions was developed through literature reviews and expert reviews, and 12 questions were identified based on the Borich needs assessment model. Questions included items regarding diagnosis and prognosis, medication, depressive symptoms, sexual relationships, and family and social life. Our findings suggest that a QPL should be used as a tool to encourage effective communication for patients living with HIV.
Heads Up Football Training Decreases Concussion Rates in High School Football Players
Authors: Shanley Ellen , Thigpen Charles , Kissenberth Michael , Gilliland Robert Gil , Thorpe John , Nance Darryl , Register-Mihalik Johna K. , Tokish John 
Published: April 2019

Objective:
The objective of this study was to determine whether football players receiving heads up (HU) training would display a lower rate of sport-related concussion (SRC) compared to those without HU training.

Design:
Prospective cohort.

Setting:
Scholastic football fields.

Patients:
Two thousand five hundred fourteen scholastic football players during the 2015 to 2016 football season were monitored throughout the football season.

Interventions:
Before the preseason, 1 coach from 14 schools received HU training from US football. These schools were matched with 10 control schools performing standard football training [non–heads up (NHU)]. Random monitoring for proper coaching instruction was performed during the season. School athletic trainers monitored injuries and return to sport over the season for all schools.

Main Outcome Measures:
The outcome measures of concussions and associated time loss were determined before data collection began. Injury incidence and rate ratios were calculated to determine program effectiveness.

Results:
During the season, football players sustained 117 concussions (HU = 75; NHU = 42). The HU players displayed a significantly lower concussion rate (4.1 vs 6.0/100 players) compared with NHU teams [rate ratio = 1.5; 95% confidence interval (CI), 1.1-5.4]. The HU group returned to full participation 27% faster than athletes in the NHU group [time loss: 18.2 days (95% CI, 15.8-20.6) vs 24.8 days (95% CI, 19.9-29.7)], respectively.

Conclusions:
This is the first study to evaluate the impact of the HU program on the incidence of SRC in high school football players. Our data demonstrated that the HU program reduced SRC rates by 33% supporting the use of US HU football training as an effective method to decrease the rate of SRCs in scholastic football.

Clinical Relevance:
This study is the first to prospectively explore the effect of HU training on the incidence and recovery from SRC in high school football players.
Androgens and depression: a review and update
Authors: Nead Kevin T. 
Published: April 2019

Purpose of reviewThe aim of this study is to summarize recently published literature examining androgens and depression.Recent findingsThe impact of androgen levels, androgen replacement therapy and pharmacologic androgen deprivation on depression and depressive symptoms remain active areas of investigation. Recent publications support the finding that testosterone replacement therapy in men with low testosterone may improve depression, and that androgen deprivation therapy in men with prostate cancer may contribute to depression.SummaryWe review the recent literature on androgens and depression and highlight key developments.
The Rise and Fall of the Diagnosis of Psychoneurosis of Childhood
Authors: Hirshbein Laura D. 
Published: April 2019

Abstract
American child and adolescent psychiatry was dominated in most of its first century by a psychoanalytic framework. Child psychiatrists, as well as their treatment team partners in social work and psychology, assumed that children developed mood and behavior problems based on unconscious conflicts, which were driven by difficulties in early childhood experiences within their families. Treatment depended on a painstaking untangling of the strands of the conflict in each individual child. Diagnosis per se was not initially a goal for child mental health providers. Instead, a broad concept of psychoneurosis was central to emphasize the depth and complexity of childhood psychiatric problems. Psychoneurosis did not translate into the 1980 nosology of the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition [DSM-III]), however, and mostly disappeared from child psychiatry by the 1990s. The loss of the developmental, individual, and contextual perspective embedded in psychoneurosis (and other childhood disorders) has been a loss because the widespread use of the DSM symptom criteria has unintended consequences when applied to children.
Most of the variation in length of stay in emergency general surgery is not related to clinical factors of patient care
Authors: Achanta Aditya , Nordestgaard Ask , Kongkaewpaisan Napaporn , Han Kelsey , Mendoza April , Saillant Noelle , Rosenthal Martin , Fagenholz Peter , Velmahos George , Kaafarani Haytham M.A. 
Published: April 2019

BACKGROUND
Hospital length of stay (LOS) is currently recognized as a key quality indicator. We sought to investigate how much of the LOS variation in the high-risk group of patients undergoing Emergency general surgery could be explained by clinical versus nonclinical factors.

METHODS
Using the 2007 to 2015 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we included all patients who underwent an emergency appendectomy, cholecystectomy, colectomy, small intestine resection, enterolysis, or hernia repair. American College of Surgeons National Surgical Quality Improvement Program defines emergency surgery as one that is performed no later than 12 hours after admission or symptom onset. Using all the ACS-NSQIP demographic, preoperative (comorbidities, laboratory variables), intraoperative (e.g., duration of surgery, wound classification), and postoperative variables (i.e., complications), we created multivariable linear regression models to predict LOS. LOS was treated as a continuous variable, and the degree to which the models could explain the variation in LOS for each type of surgery was measured using the coefficient of determination (R
2).

RESULTS
A total of 215,724 patients were included. The mean age was 47.1 years; 52.0% were female. In summary, the median LOS ranged between 1 day for appendectomies (n = 124, 426) and cholecystectomies (n = 21,699) and 8 days for colectomies (n = 19,557) and small intestine resections (n = 7,782). The R
2 for all clinical factors ranged between 0.28 for cholecystectomy and 0.44 for hernia repair, suggesting that 56% to 72% of the LOS variation for each of the six procedures studied cannot be explained by the wide range of clinical factors included in ACS-NSQIP.

CONCLUSION
Most of the LOS variation is not explained by clinical factors and may be explained by nonclinical factors (e.g., logistical delays, insurance type). Further studies should evaluate these nonclinical factors to identify target areas for quality improvement.

LEVELS OF EVIDENCE
Epidemiological study, level III.
Identifying risk factors involved in the common versus specific liabilities to substance abuse: A genetically informed approach
Authors: Iob Eleonora , Schoeler Tabea , Cecil Charlotte M. , Walton Esther , McQuillin Andrew , Pingault Jean-Baptiste 
Published: April 2019

ABSTRACTThe co-occurrence of abuse of multiple substances is thought to stem from a common liability that is partly genetic in origin. Genetic risk may indirectly contribute to a common liability through genetically influenced individual vulnerabilities and traits. To disentangle the aetiology of common versus specific liabilities to substance abuse, polygenic scores can be used as genetic proxies indexing such risk and protective individual vulnerabilities or traits. In this study, we used genomic data from a UK birth cohort study (ALSPAC, N=4218) to generate 18 polygenic scores indexing mental health vulnerabilities, personality traits, cognition, physical traits, and substance abuse. Common and substance-specific factors were identified based on four classes of substance abuse (alcohol, cigarettes, cannabis, other illicit substances) assessed over time (age 17, 20, and 22). In multivariable regressions, we then tested the independent contribution of selected polygenic scores to the common and substance-specific factors. Our findings implicated several genetically influenced traits and vulnerabilities in the common liability to substance abuse, most notably risk taking (bstandardized=0.14; 95%CI: 0.10,0.17), followed by extraversion (bstandardized =-0.10; 95%CI: −0.13,-0.06), and schizophrenia risk (bstandardized=0.06; 95%CI: 0.02;0.09). Educational attainment (EA) and body mass index (BMI) had opposite effects on substance-specific liabilities such as cigarettes (bstandardized-EA= −0.15; 95%CI: −0.19,-0.12; bstandardized-BMI=0.05; 95%CI: 0.02,0.09), alcohol (bstandardized-EA=0.07; 95%CI: 0.03,0.11; bstandardized-BMI= −0.06; 95%CI: −0.10, −0.02), and other illicit substances (bstandardized-EA=0.12; 95%CI: 0.07,0.17; bstandardized-BMI= −0.08; 95%CI:-0.13,-0.04). This is the first study based on genomic data that clarifies the aetiological architecture underlying the common versus substance-specific liabilities, providing novel insights for the prevention and treatment of substance abuse.
Discovery of UFO Proteins: Human-Virus Chimeric Proteins Generated During Influenza Virus Infection
Authors: Ma Yixuan , Angel Matthew , Wang Guojun , Ho Jessica Sook Yuin , Zhao Nan , Noel Justine , Moshkina Natasha , Gibbs James , Wei Jiajie , Rosenberg Brad , Johnson Jeffrey , Chang Max , Peralta Zuleyma , Krogan Nevan , Benner Christopher , van Bakel Harm , Łuksza Marta , Greenbaum Benjamin D. , Miraldi Emily R. , Garcìa-Sastre Adolfo , Yewdell Jonathan W. , Marazzi Ivan 
Published: April 2019

ABSTRACTInfluenza A virus (IAV) is a threat to mankind because it generates yearly epidemics and poorly predictable sporadic pandemics with catastrophic potential. IAV has a small RNA genome composed of 8 mini-chromosomes (segments) that constitute a 5’UTR followed by a coding region and a 3’UTR. Transcription of IAV RNA into mRNA depends on host mRNA, as the viral polymerase cleaves 5’m7G-capped nascent transcripts to use as primers to initiate viral mRNA synthesis. We hypothesized that captured host transcripts bearing AUG could drive the expression of upstream ORFs in the viral segments, a phenomenon that would depend on the translatability of the viral 5’UTRs. Here we report the existence of this mechanism, which generates host-virus chimeric proteins. We label these proteins asUpstreamFluORFs (UFO). Depending on the frame, two types of host-virus UFO proteins are made: canonical viral proteins with human-derived N term extensions or novel uncharacterized proteins. Here we show that both types are made during IAV infection. Sequences that enable chimeric protein synthesis are conserved across IAV strains, indicating that selection allowed the expansion of the proteome diversity of IAV in infected cells to include multiple human-virus proteins.
Murine cytomegalovirus infection of melanoma lesions delays tumor growth by recruiting and re-polarizing monocytic phagocytes in the tumor
Authors: Wilski Nicole A , Del Casale Christina , Purwin Timothy J , Aplin Andrew E , Snyder Christopher M 
Published: April 2019

AbstractCytomegalovirus (CMV) is a ubiquitous β-herpesvirus that infects many different cell types. CMV has been found in several solid tumors and it has been hypothesized that it may promote cellular transformation or exacerbate tumor growth. Paradoxically, in some experimental situations, CMV infection delays tumor growth. We previously showed that wild-type murine (M)CMV delayed the growth of poorly immunogenic B16 melanomas via an undefined mechanism. Here we show that MCMV delayed the growth of these immunologically “cold” tumors by recruiting and modulating tumor-associated macrophages. Depletion of monocytic phagocytes with clodronate completely prevented MCMV from delaying tumor growth. Mechanistically, our data suggest that MCMV recruits new macrophages to the tumor via the virus-encoded chemokine MCK2, and viruses lacking this chemokine were unable to delay tumor growth. Moreover, MCMV infection of macrophages drove them toward an M1-like state. Importantly, adaptive immune responses were also necessary for MCMV to delay tumor growth as the effect was substantially blunted in Rag-deficient animals. However, viral spread was not needed and a spread-defective MCMV strain was equally effective. In most mice, the anti-tumor effect of MCMV was transient. Although the recruited macrophages persisted, tumor regrowth correlated with a loss of viral activity in the tumor. However, an additional round of MCMV infection further delayed tumor growth, suggesting that tumor growth delay was dependent on active viral infection. Together, our results suggest that MCMV infection delayed the growth of an immunologically “cold” tumor by recruiting and modulating macrophages in order to promote anti-tumor immune responses.ImportanceCytomegalovirus (CMV) is an exciting new platform for vaccines and cancer therapy. Although CMV may delay tumor growth in some settings, there is also evidence that CMV may promote cancer development and progression. Thus, defining the impact of CMV on tumors is critical. Using a mouse model of melanoma, we previously found that murine (M)CMV delayed tumor growth and activated tumor-specific immunity, although the mechanism was unclear. We now show that MCMV delayed tumor growth not by infecting and killing tumor cells, but rather by recruiting macrophages to the tumor. A viral chemokine was necessary to recruit macrophages and delay tumor growth. Furthermore, MCMV infection altered the functional state of the macrophages. Finally, we found that repeated MCMV injections sustained the anti-tumor effect suggesting that active viral infection was needed. Thus, MCMV altered tumor growth by actively recruiting and infecting macrophages in the tumor.