bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between Immigration Status and Office-based Medical Provider Visits for Cancer Patients in the United States
Authors: Wang Yang , Wilson Fernando A. , Chen Li-Wu 
Published: February 2017

Objectives:
We examined differences in cancer-related office-based provider visits associated with immigration status in the United States.

Methods:
Data from the 2007–2012 Medical Expenditure Panel Survey and National Health Interview Survey included adult patients diagnosed with cancer. Univariate analyses described distributions of cancer-related office-based provider visits received, expenditures, visit characteristics, as well as demographic, socioeconomic, and health covariates, across immigration groups. We measured the relationships of immigrant status to number of visits and associated expenditure within the past 12 months, adjusting for age, sex, educational attainment, race/ethnicity, self-reported health status, time since cancer diagnosis, cancer remission status, marital status, poverty status, insurance status, and usual source of care. We finally performed sensitivity analyses for regression results by using the propensity score matching method to adjust for potential selection bias.

Results:
Noncitizens had about 2 fewer visits in a 12-month period in comparison to US-born citizens (4.0 vs. 5.9). Total expenditure per patient was higher for US-born citizens than immigrants (not statistically significant). Noncitizens (88.3%) were more likely than US-born citizens (76.6%) to be seen by a medical doctor during a visit. Multivariate regression results showed that noncitizens had 42% lower number of visiting medical providers at office-based settings for cancer care than US-born citizens, after adjusting for all the other covariates. There were no significant differences in expenditures across immigration groups. The propensity score matching results were largely consistent with those in multivariate-adjusted regressions.

Conclusions:
Results suggest targeted interventions are needed to reduce disparities in utilization between immigrants and US-born citizen cancer patients.
Efficacy and Safety of Combined Oral Chelation With Deferiprone and Deferasirox in Children With β-Thalassemia Major: An Experience From North India
Authors: Parakh Nupur , Chandra Jagdish , Sharma Sunita , Dhingra Bhavna , Jain Rajesh , Mahto DeoNath 
Published: February 2017

Objective:A combination of desferrioxamine with either deferiprone (DFP) or deferasirox (DFX) for patients with β-thalassemia major who do not achieve negative iron balance with monotherapy has been studied widely. However, poor compliance resulting from the need for parentral administration of desferrioxamine and its cost necessicitates combining 2 oral chelators.Methods:A prospective study was conducted in patients with transfusion-dependent β-thalassemia major in a tertiary care center over 2 years. Patients on either DFP or DFX who were not improving on monotherapy over a long period and persistently maintaining serum ferritin >2500 µg/L were enrolled. Efficacy was assessed by serum ferritin levels assessed at 12 months and 2 years. Complete blood counts and liver and kidney function tests were monitored to assess the safety of the combination of drugs.Results:In total, 33 patients with a mean age of 12.67 years (7.5 to 17.5 y) and a mean ferritin of 4835.2394±1443.85 µg/L formed the study cohort.In total, 28 patients completed the 1-year study period; and 12 patients completed 2 years. Mean serum ferritin reduction at 1 and 2 years was 34.99%±18.13% (range, −34.36% to 56.17%) and 44.67%±13.78% (range, 22.17% to 62.74%), respectively. The combination therapy was well tolerated.Conclusions:Combined oral chelation with DFP and DFX has better efficacy than either drug used alone. The combination of drugs was well tolerated and no new adverse effects were observed.
Health-related Quality of Life and its Predictors Among Transfusion-dependent Thalassemia Patients
Authors: Tuysuz Gulen , Tayfun Funda 
Published: February 2017

Purpose:
With regular blood transfusions and modern medical management strategies, transfusion-dependent thalassemia (TDT) patients are currently living into adulthood, but they still suffer from the chronicity of the disease and its complications. This study was aimed to assess the health-related quality of life (HRQoL) scores in pediatric TDT patients compared with healthy controls.

Patients and Methods:
The PedsQL 4.0 Generic Core Scales were administered to 80 pediatric TDT patients (aged 5 to 18 y, child self-report) and their parents (parent-proxy report), as well as age-matched and sex-matched healthy controls (80 participants and their parents).

Results:
Patients with TDT and their parents rated lower HRQoL scores in all domains (physical, emotional, social, and school functioning) compared with the healthy population (P<0.01). The univariate analysis indicated that the total HRQoL score for children’s self-reports was negatively predicted by high ferritin levels and the presence of any complication. The only negative predictor of the total HRQoL score in multivariate analyses was a high ferritin level (>1800 ng/dL).

Conclusions:
This study showed that thalassemia has a negative impact on HRQoL when compared with a healthy population. For a better quality of life, intensive treatment should be applied for complications and high ferritin levels.
The Nourishing Role
Authors: Hopkinson Jane B. 
Published: February 2017

Background:
Family carers of patients with advanced cancer living at home have an important role in providing the patient’s food and drink. Little attention has been paid to the support needs, particularly of the nutrition needs, of family carers.

Objective:
The aim of this study was to report support needs of family carers of patients with advanced cancer and eating problems.

Methods:
The research is an inductive secondary analysis of baseline interview data from an exploratory trial conducted in the south of England. The interviews explored the management of eating problems in the home. A sample of 31 patients was selected where the patient’s partner/spouse had also agreed to take part in the primary study.

Results:
The analysis and interpretation reveal family carers to have a nourishing role, which is taken for granted by the patient and the carer themselves. This role is typically seen as an extension of the normal role of wife, mother, or homemaker in the family and no more than what a family carer should do. This obscures a need for information and advice on the nutritional care of patients with cancer with fickle appetite and other eating problems that are difficult to manage. Family carers may also be at a nutritional risk because their own dietary intake was found to mirror the patient’s with some of them losing weight.

Conclusions:
Family cancer carers have a nourishing role that requires knowledge and skill beyond the everyday.

Implications for Practice:
Cancer carers need education in how best to provide nutritional care. They also need support in managing their own nutritional risk.
Validation of the European Health Literacy Survey Questionnaire in Women With Breast Cancer
Authors: Huang Yi-Jing , Lin Gong-Hong , Lu Wen-Shian , Tam Ka-Wai , Chen Chiehfeng , Hou Wen-Hsuan , Hsieh Ching-Lin 
Published: February 2017

Background:
Health literacy enables effective communication, participation, and cooperation with clinicians of patients with breast cancer in healthcare processes. The European Health Literacy Survey Questionnaire (HLS-EU-Q) comprehensively assesses multiple conceptual domains of health literacy in a diverse range of health contexts. However, the HLS-EU-Q has not been validated in women with breast cancer.

Objectives:
We examined the psychometric properties, particularly the factorial validity, of the HLS-EU-Q in women with breast cancer.

Methods:
We performed a first-order confirmatory factor analysis (CFA) to verify the 12-subdomain model of the 47-item HLS-EU-Q. A second-order CFA was conducted to investigate whether the 12 subdomains reflected the 3 domains of healthcare, disease prevention, and health promotion correspondingly.

Results:
A total of 475 women with breast cancer participated in this study. The first-order CFA fitted with the HLS-EU-Q containing 47 items. However, item 29, with a low factor loading (−0.05), was deleted. The modified first-order CFA adequately fitted the data of the HLS-EU-Q with 46 items. The second-order CFA model acceptably fitted with the data, but the 3 domains with high correlations (0.92–1.00) were merged into a single domain, health literacy.

Conclusions:
Our results supported the factorial validity of the 12-subdomain HLS-EU-Q with 46 items in women with breast cancer. It is recommended that the 12 subdomain scores be summed up to represent overall health literacy.

Implications for Practice:
The HLS-EU-Q with 46 items is recommended for use in capturing the diverse health literacy competencies of women with breast cancer in different health contexts.
Experiences of Patients With Breast Cancer of Participating in a Lifestyle Intervention Study While Receiving Adjuvant Chemotherapy
Authors: Vassbakk-Brovold Karianne , J. Antonsen Anne , Berntsen Sveinung , Kersten Christian , Fegran Liv 
Published: February 2017

Background:
Lifestyle interventions are suggested to reduce the symptom burden and comorbidities in patients with breast cancer and as an empowerment tool. However, undergoing chemotherapy is associated with low compliance to lifestyle recommendations. Importantly, few studies have documented the experiences of patients with breast cancer of participating in a comprehensive lifestyle intervention study while undergoing curative chemotherapy.

Objective:
The aim of this study was to explore the experiences of patients with breast cancer of participating in an individualized comprehensive lifestyle intervention study focusing on diet, physical activity, mental stress management, and smoking cessation while undergoing curative chemotherapy.

Methods:
A qualitative design with semistructured interviews of 10 patients with breast cancer undergoing curative chemotherapy was conducted 3 to 4 months after inclusion to the lifestyle intervention. Interviews were transcribed verbatim, and qualitative content analysis with a hermeneutic perspective was applied.

Results:
Two main themes emerged: (1) breast cancer treatment may put motivation for lifestyle changes on hold, and (2) individualization is the key.

Conclusions:
Participating in a lifestyle intervention may impose additional burdens on patients with cancer undergoing adjuvant chemotherapy. Despite this, most women experienced participation as beneficial, and importantly, all would recommend that patients in the same situation should participate.

Implications for Practice:
Healthcare professionals should have the patients’ individual needs in mind when implementing lifestyle interventions, and the timing of lifestyle interventions should be implemented thoughtfully in patients with breast cancer undergoing chemotherapy in an adjuvant setting. Furthermore, the participants’ experiences described here are valuable for the design of future lifestyle intervention studies.
Analysis of Patient Visits and Collections After Opening a Satellite Pediatric Emergency Department
Authors: Nichols Katherine M. , Caperell Kerry , Cross Keith , Duncan Scott , Foster Ben , Liu Gil , Pritchard Hank , Southard Gary , Shinabery Ben , Sutton Brad , Kim In K. 
Published: February 2017

Objective
Satellite pediatric emergency departments (PEDs) have emerged as a strategy to increase patient capacity. We sought to determine the impact on patient visits, physician fee collections, and value of emergency department (ED) time at the primary PED after opening a nearby satellite PED. We also illustrate the spatial distribution of patient demographics and overlapping catchment areas for the primary and satellite PEDs using geographical information system.

Methods
A structured, financial retrospective review was conducted. Aggregate patient demographic data and billing data were collected regarding physician fee charges, collections, and patient visits for both PEDs. All ED visits from January 2009 to December 2013 were analyzed. Geographical information system mapping using ArcGIS mapped ED patient visits.

Results
Patient visits at the primary PED were 53,050 in 2009 before the satellite PED opened. The primary PED visits increased after opening the satellite PED to 55,932 in 2013. The satellite PED visits increased to 21,590 in 2013. Collections per visit at the primary PED decreased from $105.13 per visit in 2011 to $86.91 per visit in 2013. Total collections at the satellite PED decreased per visit from $155.41 per visit in 2011 to $128.53 per visit in 2013.

Conclusions
After opening a nearby satellite PED, patient visits at the primary PED did not substantially decrease, suggesting that there was a previously unrecognized demand for PED services. The collections per ED visit were greater at the satellite ED, likely due to a higher collection rate.
Epidemiologic Characteristics of Pediatric Trauma Patients Receiving Prehospital Care in Kigali, Rwanda
Authors: Aluisio Adam R. , Umuhire Olivier Félix , Mbanjumucyo Gabin , George Naomi , Kearney Alexis , Karim Naz , Nyinawankusi Jeanne D'Arc , Uwitonze Eric , Enumah Sam , Scott John W. , Mutabazi Zeta , Ntakiyiruta Georges , Jayaraman Sudha , Riviello Robert , Byiringiro Jean Claude , Levine Adam C. 
Published: February 2017

Background
Pediatric trauma is a significant public health problem in resource-constrained settings; however, the epidemiology of injuries is poorly defined in Rwanda. This study describes the characteristics of pediatric trauma patients transported to the emergency department (ED) of the Centre Hospitalier Universitaire de Kigali by emergency medical services in Kigali, Rwanda.

Methods
This cohort study was conducted at the Centre Hospitalier Universitaire de Kigali from December 2012 to February 2015. Patients 15 years or younger brought by emergency medical services for injuries to the ED were included. Prehospital and hospital-based data on demographics, injury characteristics, treatments, and outcomes were gathered.

Results
Data from 119 prehospital patients were accrued, with corresponding hospital data for 64 cases. The median age was 9.5 years, with most patients being male (67.2%). Injured children were most frequently brought from a street setting (69.6%). Road traffic injuries accounted for 69.4% of all mechanisms, with more than two thirds due to pedestrians being struck. Extremity trauma was the most common region of injury (53.1%), followed by craniofacial (46.8%). The most frequent ED interventions were analgesia (66.1%) and intravenous fluids (43.6%). Half of the 16 obtained head computed tomography scans demonstrated acute pathology. Twenty-eight patients (51.9%) were admitted, with 57.1% requiring surgery and having a median in-hospital care duration of 9 days (range, 1–122 days).

Conclusions
In this cohort of Rwandan pediatric trauma patients, injuries to the extremities and craniofacial regions were most common. Theses traumatic patterns were predominantly due to road traffic injury, suggesting that interventions addressing the prevention of this mechanism, and treatment of the associated injury patterns, may be beneficial in the Rwandan setting.
Characteristics and Triage of Children Presenting in Mental Health Crisis to Emergency Departments at Detroit Regional Hospitals
Authors: Williams Kristen , Levine Amanda R. , Ledgerwood David M. , Amirsadri Alireza , Lundahl Leslie H. 
Published: February 2017

Objectives
The number of children in the United States utilizing emergency department (ED) services for psychiatric crises is increasing, and psychiatric-related ED visits disproportionately burden hospital resources. Yet, there is limited available information on the epidemiology and outcomes of pediatric mental health emergencies. The present study sought to characterize pediatric mental health–related ED presentations in a large urban center and identify factors predictive of inpatient hospitalization.

Methods
Data were analyzed from a sample of 225 children (120 female and 105 male children), aged 5 to 18 years, who presented in mental health crisis to Detroit regional EDs over a 27-month period. A trained mental health professional used the Crisis Assessment Tool to assess all children.

Results
Thirty-eight percent of children presented with severe depression symptoms, and 52% were judged to be at acute risk of suicide, most of whom were female. Sixteen percent of the sample presented with severe psychotic features, and 34% were assessed as being at risk of harming others. Following assessment, 86% of the sample was directed to inpatient treatment, and no sex differences were found in treatment disposition. Risk of suicide, poor judgment, symptoms of psychosis, and risk of danger to others were all found to be significant predictors of subsequent inpatient hospitalization.

Conclusions
Results provide descriptive information regarding child psychiatric emergency presentations in the city of Detroit. The identified factors that help determine triage to inpatient hospitalization suggest areas for possible resource allocation and potential ED-based intervention.
Factors Predicting Pelvic Lymph Node Metastasis, Relapse, and Disease Outcome in Pattern C Endocervical Adenocarcinomas
Authors: Alvarado-Cabrero Isabel , Roma Andres A. , Park Kay J. , Rutgers Joanne K.L. , Silva Elvio G. 
Published: February 2017

Summary
A pattern-based classification system has recently been proposed for invasive endocervical adenocarcinoma (EAC), which is predictive of the risk for lymph node metastases (LNM). The main utility of the system lies in separating cases with very low risk for LNM (pattern A) from those with higher risk (pattern B and C). Different growth patterns (GPs) are found in pattern C cases. The aim of the study was to evaluate the effect of GP on the behavior of pattern C EAC. By reevaluating 189 pattern C EACs, we documented 6 architectural GPs: diffuse destructive (DD), confluent (CON), extensive linear destructive (ELD), band-like lymphocytic infiltrate (BLL), solid (SOL), and micropapillary (MP). When an EAC had an appreciable second component (≤50%) the designation of a mixed EAC was used. We found 32 (17%) tumors to be DD, 23 (12%) CON, 27 (14%) ELD, 9 (5%) SOL, 7 (4%) BLL, and 7 (4%) micropapillary. A total of 84 (44%) EACs were mixed (DD+CON). All micropapillary EACs had LNM versus none of the patients with EAC with an ELD GP (P=0.002). Recurrent disease was seen in 44% of EACs with a DD GP, whereas 0% of EACs with BLL GP developed recurrent disease. Mixed (DD+CON) tumors had a significantly worse 6-year overall survival. This study demonstrated that not all pattern C EACs have an aggressive behavior. These patients should be treated with radical hysterectomy and sentinel lymph node biopsy.
Posttraumatic Stress Disorder, Orientation to Pain, and Pain Perception in Ex-Prisoners of War Who Underwent Torture
Authors: Tsur Noga , Defrin Ruth , Ginzburg Karni 
Published: February 2017

ABSTRACT

Objective
Studies suggest that torture survivors often experience long-term chronic pain and increased pain perception. However, it is unclear whether the actual experience of torture or rather the subsequent posttraumatic stress disorder (PTSD) explains these pain problems. Furthermore, although catastrophic and fearful orientations to pain have been suggested to play a significant role in the association between trauma and pain, the underlying mechanisms remain unclear. This study examined whether chronic pain and pain perception among torture survivors are associated with torture experience or PTSD and whether catastrophic and fearful orientations mediate or moderate these associations.

Methods
Fifty-nine ex-prisoners of war who underwent torture and 44 matched veterans participated in this study. Pain perception was evaluated by assessing pain threshold and reactivity to experimental suprathreshold noxious stimuli. Participants completed self-administered questionnaires assessing PTSD, chronic pain, pain catastrophizing, and fear of pain.

Results
Although chronic pain was associated with PTSD (0.44 < β < 0.49, p < .002), increased pain perception was correlated with torture (0.33 < β < 0.65, p < .05). Pain catastrophizing was found to mediate the association between PTSD and chronic pain (β = 0.18 and 0.19, respectively; p < .05). Fear of pain moderated the association between torture and pain perception (β = 0.41 and 0.42, respectively; p < .017).

Conclusions
The findings suggest that chronic pain is contingent upon the psychological toll of torture, that is, PTSD. This study also indicates that PTSD exacerbates catastrophic orientation, which in turn may amplify chronic pain. Reactivity to experimental noxious stimuli was related to previous experiences of torture, which enhances perceived pain intensity when interacting with a fearful pain orientation. These findings highlight the significance of orientation to bodily experiences after trauma.
Laboratory cultivation of acidophilic nanoorganisms. Physiological and bioinformatic dissection of a stable laboratory co-culture
Authors: Krause Susanne , Bremges Andreas , Münch Philipp C. , McHardy Alice C. , Gescher Johannes 
Published: February 2017

AbstractThis study describes the laboratory cultivation of ARMAN (Archaeal Richmond Mine Acidophilic Nanoorganisms). After 2.5 years of successive transfers in an anoxic medium containing ferric sulfate as an electron acceptor, a consortium was attained that is comprised of two members of the orderThermoplasmatales, a member of a proposed ARMAN group, as well as a fungus. The 16S rRNA of one archaeon is only 91.6% identical toThermogymnomonas acidicolaas most closely related isolate. Hence, this organism is the first member of a new genus. The enrichment culture is dominated by this microorganism and the ARMAN. The third archaeon in the community seems to be present in minor quantities and has a 100% 16S rRNA identity to the recently isolatedCuniculiplasma divulgatum. The enriched ARMAN species is most probably incapable of sugar metabolism because the key genes for sugar catabolism and anabolism could not be identified in the metagenome. Metatranscriptomic analysis suggests that the TCA cycle funneled with amino acids is the main metabolic pathway used by the archaea of the community. Microscopic analysis revealed that growth of the ARMAN is supported by the formation of cell aggregates. These might enable cross feeding by other community members to the ARMAN.