bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of the READY-Girls Program on General Risk-Taking Behaviors, Condom Use, and Sexually Transmitted Infections Among Young Adolescent Females With Type 1 Diabetes
Authors: Thurheimer Jennifer , Sereika Susan M. , Founds Sandra , Downs Julie , Charron-Prochownik Denise 
Published: September 2016

Purpose The purpose of this study is to examine the short-term efficacy (3 months) of early diabetes-specific READY-Girls preconception counseling (RGPC) on more general risk-taking behaviors, condom use, and sexually transmitted infections (STIs) among adolescent females with type 1 diabetes. Methods Secondary analysis was performed with data pooled from 2 independent randomized controlled trials to evaluate the short-term impact of RGPC. The pooled sample had 136 participants (mean age, 16.9 years; range, 13-19 years) and compared those who received the RGPC (n = 76) with a control group who received standard care (n = 60). Both groups self-reported on demographic characteristics, risk-taking behaviors (eg, substance use and unsafe sex), birth control, and STIs. Results No effect of RGPC emerged on risk-taking behaviors, condom use, and STIs. Only 25% (n = 36) of the adolescents were sexually active at baseline, and 29% (n = 39) were sexually active at 3 months. Their overall mean age of sexual debut was 15.4 years, with more than half reporting an episode of unprotected sex. Condoms were the most frequent type of birth control used by both groups at both time points. By 3 months, only 4 participants had been diagnosed with an STI. Over time, subjects in both groups became more sexually active and used more condoms. Conclusion RGPC did not appear to directly affect general risk-taking behaviors or STIs, since it focuses on diabetes and reproductive health issues. Condom use did increase over time in both groups. More information on risk-taking behaviors and STIs should be included in diabetes-specific preconception counseling programs, including RGPC.
Behavior Risk Factors Among Russian University Students Majoring in Medicine, Education, and Exercise Science
Authors: Anischenko Aleksander , Gurevich Konstantin , Arhangelskaya Anna , Klenov Michael , Burdukova Ekaterina , Ogarev Valrii , Ignatov Nikolay , Osadchenko Irina 
Published: September 2016

Purpose To analyze the prevalence of select behavioral risk factors among Russian university students majoring in medicine, education, and exercise science. Methods A total of 834 students from five Federal universities located in four federal regions of Russia were included in the study. The purposive sample included future doctors, school teachers, and fitness trainers. Students were asked specifically about smoking, level of physical activity, and food preferences. To calculate body mass indices (BMIs), waist, hip, weight, and height were also measured. Results Smoking rates, level of activity, and nutritional habits were significantly different by age, but BMI was not. Smoking rates and BMI were significantly different by gender, but level of activity and nutritional habits were not. Like the differences found by age, smoking rates, level of activity, and nutritional habits were significantly different by ethnicity, but BMI was not. There were significant difference across all behavioral health risk factors by region. The results show significantly higher levels of physical inactivity, consumption of unhealthy foods, and high BMIs among medical students compared with future teachers and wellness instructors ( p < .05). In the same time, the smoking levels are the highest among future teachers. The highest prevalence of smoking was found to be associated with gender (for females living Moscow and for males in rural regions), and Russian ethnic group. Conclusion Tailored programs to prevent common health behavior risk factors among future medical doctors are urgently needed in the Russian Federation.
Blood Glucose Variability: A Strong Independent Predictor of Neurological Outcomes in Aneurysmal Subarachnoid Hemorrhage
Authors: Okazaki Tomoya , Hifumi Toru , Kawakita Kenya , Shishido Hajime , Ogawa Daisuke , Okauchi Masanobu , Shindo Atsushi , Kawanishi Masahiko , Tamiya Takashi , Kuroda Yasuhiro 
Published: September 2016

Purpose: In patients with aneurysmal subarachnoid hemorrhage (SAH), increased glucose variability (GV) is associated with increased mortality and cerebral infarction; however, there are no reports demonstrating an association between GV and neurological outcome. This study investigated whether GV had an independent effect on neurological outcomes in patients with SAH in the intensive care unit. Materials and Methods: Consecutive adult patients hospitalized with SAH between January 1, 2009, and May 31, 2015 (N = 122) were retrospectively reviewed. Univariate/multivariate analyses were performed to identify independent predictors of poor neurological outcome. Patients were divided according to the mean glucose level (80-139 vs 140-200 mg/dL) and further subdivided using quartiles (Q) of the standard deviation (SD, representing variability) of the glucose level (Q1, Q2 + 3, and Q4). Results: Unfavorable neurological outcomes occurred in 44.2% of the patients. On multiple regression analysis, age, Hunt and Kosnik grade, SD of glucose (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.02-1.17; P < .01), and minimum blood glucose level (OR, 0.95; 95% CI, 0.91-0.99; P < .01) were significantly associated with unfavorable neurological outcomes. Both groups (mean glucose levels: 80-139 and 140-200 mg/dL groups) had increasing unfavorable neurological outcomes with increasing SD of glucose (Q1, 15.0%; Q2 + 3, 40.0%; Q4, 52.4% and Q1, 44.4%; Q2 + 3, 50%; Q4, 88.9% in the 80-139 and 140-200 mg/dL groups, respectively). Patients with minimum glucose of <90 mg/dL comprised >50% of unfavorable neurological outcome. Conclusion: Increased GV was an independent predictor of unfavorable neurological outcomes in patients with SAH.
Path Analysis of Campus Walkability/Bikeability and College Students’ Physical Activity Attitudes, Behaviors, and Body Mass Index
Authors: Horacek Tanya M. , Dede Yildirim E. , Kattelmann K. , Brown O. , Byrd-Bredbenner C. , Colby S. , Greene G. , Hoerr S. , Kidd T. , Koenings M. M. , Morrell J. , Olfert M. D , Phillips B. , Shelnutt K. , White A. 
Published: September 2016

Purpose: The purpose of this study was to assess the relationship between the walkability/bikeability of college campuses and students’ body mass index (BMI) with student physical activity (PA) attitudes and behaviors as potential mediators. Design: Cross-sectional. Setting: Thirteen university campuses. Participants: A total of 1384 student participants. Measures: Walkability/bikeability environmental score (ES): 12-item audit assessed an average of 44 path segments per campus. Students were measured for height and weight and completed online surveys. Physical activity stage of change/behavior intentions were assessed using the transtheoretical model. The Cognitive Behavioral Physical Activity Questionnaire assessed outcome expectations, self-regulation, and personal barriers. International Physical Activity Questionnaire assessed walking-, moderate-, and vigorous-intensity PA. Analysis: Descriptive statistics, zero-order correlations, and path analysis with maximum likelihood estimation. Results: The overall model fit was good with χ2 of 171.388 ( df = 18), P < .001, comparative fit index value of .95, and a root mean square of approximation of .079. After controlling for gender, there was a direct negative association between walkability/bikeability ES and BMI (β = −.085) and positive association between personal barriers and BMI (β = .134). Walkability/bikeability ES was positively associated with walking-intensity PA (β = .010). Self-regulation was positively associated with moderate-intensity PA (β = .213), which, in turn, was negatively associated with BMI (β = −.057). Conclusions: The ease of walking and biking on a campus was related to college students’ walking behavior and their BMI. Students’ PA behavioral intentions were associated with moderate PA and lower BMI. These results provide evidence to focus on policies and structural supports for walkable/bikeable environments to supplement and enhance interventions encouraging individual behavior change for PA and weight management.
Food Service Guideline Policies on State Government–Controlled Properties
Authors: Zaganjor Hatidza , Bishop Kendrick Katherine , Warnock Amy Lowry , Onufrak Stephen , Whitsel Laurie P. , Ralston Aoki Julie , Kimmons Joel 
Published: September 2016

Purpose: Food service guideline (FSG) policies can impact millions of daily meals sold or provided to government employees, patrons, and institutionalized persons. This study describes a classification tool to assess FSG policy attributes and uses it to rate FSG policies. Design: Quantitative content analysis. Setting: State government facilities in the United States. Participants: Participants were from 50 states and District of Columbia in the United States. Measures: Frequency of FSG policies and percentage alignment to tool. Analysis: State-level policies were identified using legal research databases to assess bills, statutes, regulations, and executive orders proposed or adopted by December 31, 2014. Full-text reviews were conducted to determine inclusion. Included policies were analyzed to assess attributes related to nutrition, behavioral supports, and implementation guidance. Results: A total of 31 policies met the inclusion criteria; 15 were adopted. Overall alignment ranged from 0% to 86%, and only 10 policies aligned with a majority of the FSG policy attributes. Western states had the most FSG policies proposed or adopted (11 policies). The greatest number of FSG policies were proposed or adopted (8 policies) in 2011, followed by the years 2013 and 2014. Conclusion: The FSG policies proposed or adopted through 2014 that intended to improve the food and beverage environment on state government property vary considerably in their content. This analysis offers baseline data on the FSG landscape and information for future FSG policy assessments.
Identifying and Understanding the Health Information Experiences and Preferences of Individuals With TBI, SCI, and Burn Injuries
Authors: Coffey Nathan T , Weinstein Ali A , Cai Cindy , Cassese Jimmy , Jones Rebecca , Shaewitz Dahlia , Garfinkel Steven 
Published: September 2016

Introduction: Traumatic brain injury, spinal cord injury, and burn injury can cause lifelong disability and changes in quality of life. In order to meet the challenges of postinjury life, various types of health information are needed. We sought to identify preferred sources of health information and services for persons with these injuries and discover how accessibility could be improved. Methods: Thirty-three persons with injury participated in semistructured interviews. Responses to interview questions were coded using NVivo. Results: Participants’ difficulties accessing health information varied by injury type and individually. The majority of respondents found information via the Internet and advocated its use when asked to describe their ideal health information system. Nearly all participants supported the development of a comprehensive care website. When searching for health information, participants sought doctor and support group networks, long-term health outcomes, and treatments specific to their injury. Conclusion: To optimize the quality of health information resources, Internet-based health-care platforms should add or highlight access points to connect patients to medical professionals and support networks while aggregating specialized, injury-specific research and treatment information.
Alteration of compacted GMZ bentonite by infiltration of alkaline solution
Authors: Bao Chen , Jiaxing Guo , Huixin Zhang 
Published: September 2016

AbstractConcepts for geological disposal of high-level radioactive waste usually include bentonite buffer materials. Numerous studies have been performed with most usingWyoming bentonite. Gaomiaozi (GMZ) bentonite has been selected as a potential buffer/backfill material for the deep geological repository of high-level radioactive waste in China. In this context, the highly alkaline environment induced by cementitious materials in the repository is likely to alter montmorillonite, the main clay mineral in GMZ bentonite. This alteration may result in deterioration of the physical and/or chemical properties of the buffer material. To acquire quantitative data which would allow us to assess the dissolution of montmorillonite and changes in the diffusivity of hydroxide ions as well as their effects on the swelling pressure and permeability of the compacted GMZ bentonite, an experimental study was conducted under highly alkaline (NaOH solutions with various pH values were used), simulated groundwater conditions. The GMZ bentonite also contains cristobalite which may also have been dissolved. The microstructure of the compacted bentonite samples after the experiments was determined by mercury intrusion porosimetry (MIP) and scanning electron microscopy (SEM). Energy dispersive spectroscopy (EDX) was carried out to identify mineralogical changes. At pH >13, the permeability of specimens increased significantly; the swelling potential decreased with increasing pH. Furthermore, the pore volume and pore size of GMZ bentonite changed when exposed to alkaline solution, resulting in an increase in porosity and permeability. The main alteration mechanisms of compacted GMZ bentonite undergoing infiltration by highly alkaline solution are likely to be dissolution and modifications in terms of the microstructure and mineralogy.
Using direct oral anticoagulants (DOACs) in cancer and other high-risk populations
Authors: van Es Nick , Büller Harry R. 
Published: September 2016

Abstract
The major practical advantage of the direct oral anticoagulants (DOACs), comprising the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban, edoxaban, and rivaroxaban, over vitamin K antagonists is their fixed dosing without the need for laboratory monitoring. With the recent, rapid introduction of the DOACs for the treatment of acute venous thromboembolism (VTE), clinicians are now faced with various questions regarding the efficacy and safety of these compounds overall and in specific high-risk populations. The collective evidence from 6 large clinical trials involving 27,000 patients has demonstrated that DOACs are as effective as vitamin K antagonists (VKA) in preventing recurrent VTE while being associated with a significantly lower risk of major bleeding. These findings are consistent in subgroups of patients with pulmonary embolism, the elderly, and those patients with a high body weight or moderate renal insufficiency, making these agents suitable for a broad spectrum of patients with VTE. DOACs are also an attractive treatment option in patients with VTE and concomitant cancer, thrombotic antiphospholipid syndrome, or heparin-induced thrombocytopenia, but the currently available clinical data is insufficient to make evidence-based recommendations on the use of DOACs in these settings. Several studies evaluating the efficacy and safety of DOACs in these high-risk populations are underway.
Incidentally found pulmonary embolism: what's the clinician to do?
Authors: O'Connell Casey 
Published: September 2016

Abstract
Incidental pulmonary embolism (IPE) is a management challenge for the unsuspecting clinician. Patients with IPE frequently have signs or symptoms that are unrecognized as PE related, and their clots occur predominantly in the proximal pulmonary vasculature. There is uniformity in recommending anticoagulation for patients with IPE proximal to the subsegmental pulmonary vasculature, but prospective data are not currently available to guide the duration of therapy in this population. Several studies suggest that outcomes, including recurrence, mortality, and bleeding, are similar for patients with IPE and suspected PE, especially among those who also have cancer. Patients with isolated incidental subsegmental pulmonary embolism (ISSPE) are particularly challenging because some studies suggest that they can be managed without anticoagulation. Therefore, an algorithm is proposed to guide the evaluation and treatment of patients with ISSPE.
Is there a best TKI for chronic phase CML?
Authors: Larson Richard A. 
Published: September 2016

Abstract
The development of BCR/ABL1 tyrosine kinase inhibitors (TKIs) over the past 20 years has dramatically improved the outcomes for patients with every stage of Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML). Clinicians now have access to 5 oral, generally well-tolerated, and highly effective TKIs. How should these agents be used for an individual patient to ensure the best possible duration and quality-of-life, to avoid treatment-related complications, and potentially to achieve a cure at an affordable cost? Because CML patients may need to continue TKI therapy indefinitely, the long-term safety of each treatment option must be considered. Evidence-based care requires an understanding of the optimal use of these drugs, their specific early and late toxicities, the prognostic significance of achieving treatment milestones, and the critical importance of molecular monitoring. Efficacy is important, but treatment choice does not depend only on efficacy. Choosing among various treatment options is informed by understanding the distinct benefits and risks of each agent, along with careful consideration of patient-specific factors, such as risk status, age, and comorbidities.
Patterns of resistance to B cell–receptor pathway antagonists in chronic lymphocytic leukemia and strategies for management
Authors: Woyach Jennifer A. 
Published: September 2016

AbstractSmall-molecule kinase inhibitors, especially the two Food and Drug Administration–approved agents idelalisib and ibrutinib, have changed the treatment landscape for patients with relapsed or refractory chronic lymphocytic leukemia (CLL). However, with these positive changes comes the new challenge of managing patients who relapse after these agents. The number of patients who have relapsed after taking idelalisib and ibrutinib is low, but as the drugs gain wider use and patients are treated for longer, this number is likely to grow. Because these patients can be challenging to manage effectively, coordinated efforts now to determine how and why patients relapse along with optimal treatment strategies are required to better serve our patients in the future. As well, identification of mechanisms of resistance is crucial to develop rational strategies for management. Current work has identified mechanisms of resistance to ibrutinib, and resistance to idelalisib is also under active investigation. In this review, we will discuss these mechanisms of resistance, as well as current and potential strategies for the management of kinase inhibitor-resistant CLL.
Prognostic markers and standard management of chronic lymphocytic leukemia
Authors: Stilgenbauer Stephan 
Published: September 2016

Abstract
Chronic lymphocytic leukemia (CLL) is usually diagnosed in early stage, asymptomatic patients, and, although a wealth of prognostic parameters have been identified, the standard approach is a “watch and wait” strategy irrespective of risk factors. Therapy is only indicated if “active disease” criteria (International Workshop on Chronic Lymphocytic Leukemia guidelines) are met, and the routine upfront treatment is a combination of CD20 antibody (rituximab, ofatumumab or obinutuzumab) and chemotherapy (fludarabine /cyclophosphamide, bendamustine, chlorambucil), with the choice mainly determined by physical fitness of the patient. The major subgroup in which this approach does not result into satisfactory efficacy is in CLL with 17p deletion (17p−) or TP53 mutation (TP53mut). Likewise, patients with a short initial response duration (i.e., <24-26 months) have a dismal outcome with chemoimmunotherapy salvage. Therefore, these patients have been referred to as “ultra high risk,” and, in these subgroups, novel agents such as signaling kinase inhibitors (also termed B-cell receptor signaling inhibitors; e.g., ibrutinib targeting Bruton tryosine kinase, idelalisib targeting phosphoinositide 3-kinase) and BCL2 antagonists (venetoclax, formerly ABT-199/GDC-0199) have shown dramatic efficacy. Ibrutinib and idelalisib are currently approved for the treatment of relapsed or refractory CLL or frontline treatment of 17p−/TP53mut CLL regardless of fitness. Therefore, these agents are challenging the concept of adjusting treatment to fitness and TP53 status, because they offer remarkable efficacy combined with exceptional tolerability. Nevertheless, it appears that 17p−/TP53mut retains an adverse prognostic impact, making additional improvement a primary research goal aimed at the development of the best combinations and/or sequences of these new agents, as well as prognostic and predictive markers guiding their use.
The five key things you need to know to manage adult patients with sickle cell disease
Authors: Lanzkron Sophie , Haywood Carlton 
Published: September 2016

AbstractThe lack of a strong evidence base to guide the management of adults with sickle cell disease (SCD) makes it difficult for patients to receive high quality care outside of specialty centers. As there is a dearth of providers with sickle cell expertise, the purpose of this article is to identify some of the key things every provider who manages the care of adults with SCD should know. Managing adults with SCD requires excellent clinical skills, as it can affect every organ and cause life-threatening complications but it also requires a willingness to manage patients who often have psychosocial issues that are complex and impact care and care delivery in very significant ways. We have chosen topics for which there is a limited evidence base but which have significant clinical consequences if left unrecognized or poorly managed. The topics that will be addressed include chronic pain, neurocognitive dysfunction, renal disease, venous thromboembolism, and avoiding the inappropriate use of red cell transfusions.
Implementing a blood utilization program to optimize transfusion practice
Authors: Savage William 
Published: September 2016

AbstractBlood utilization review programs educate clinicians on guidelines for appropriate transfusion, review local transfusion practice, and provide feedback on transfusion trends. To gather data on transfusion practice, modern blood utilization programs leverage electronic medical records and computerized physician order entry with automated decision support. Data may be collected and feedback may be given in real-time for individual transfusions or retrospectively with aggregated data. Important elements for a successful program include a multidisciplinary group that can champion the effort, adequate documentation and data capture for transfusions, and regular discussions about trends with ordering clinicians. Blood utilization programs are popular because they can lower transfusion risk, improve quality outcomes, and lower costs.