bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breast Cancer Survivors’ Experiences of Acceptance Following Recurrence
Authors: Matbouei Mahsa , Samsami Majid , Soleimani Mohsen 
Published: March 2023

Background
Breast cancer recurrence is a traumatic event for patients, and its treatment depends on the patient’s ability to accept the circumstances.

Objective
The aim of this study was to explore how patients experience breast cancer recurrence and go through a process of negotiating acceptance.

Methods
This study explored the experiences of 16 patients with breast cancer recurrence regarding the acceptance of recurrence in a hospital in Tehran, Iran. Purposive sampling with maximum diversity was used. Data were collected through semistructured telephone interviews from November 2020 to November 2021 and analyzed using the qualitative content analysis.

Results
Four themes emerged that described the process of accepting cancer recurrence: (1) response to recurrence (emotional reactions and loss of trust); (2) psychological preparedness (confirmation of medical diagnosis and acceptance of fate); (3) mobilizing supports (using spiritual capacities, utilizing supportive resources, and seeking relationships to promote knowledge); and (4) return to the path of treatment (rebuilding trust and continuation of treatment).

Conclusions
The acceptance of breast cancer recurrence is a process that begins with emotional reactions and ends with returning to the treatment path. The patient’s psychological preparation, support systems, behavior of healthcare providers, and rebuilding trust are the determining factors in acceptance of recurrence.

Implications for Practice
Nurses can compensate for the failures created in the primary treatment of breast cancer by spending time with patients and paying attention to their concerns, providing effective education, strengthening communication between patients with similar conditions and using the spiritual capacities of patients, and mobilizing the support of family and relatives.
Adolescent and Caregiver Perspectives on Living With a Limb Fracture
Authors: Bharadia Manisha , Golden-Plotnik Stevi , van Manen Michael , Sivakumar Mithra , Drendel Amy L. , Poonai Naveen , Moir Mackenzie , Ali Samina 
Published: March 2023

Background
Fractures occur in up to half of children by age 16 years. After initial emergency care for a fracture, function is universally impaired in children, and impacts extend to the immediate family. Knowledge of expected functional limitations is key to providing proper discharge instructions and anticipatory guidance to families.

Objectives
The primary objective of this study was to understand how changes in functional ability impact youth with fractures.

Methods
We conducted individual, semistructured interviews from June 2019 to November 2020 with adolescents and their caregivers 7 to 14 days following their initial visit to a pediatric emergency department. We used qualitative content analysis methodology; recruitment proceeded until thematic saturation was achieved. Coding and analysis were concurrent with recruitment and interviews. The interview script was modified in an iterative process, to reflect emerging themes.

Results
Twenty-nine interviews were completed. The most frequently affected functions were (a) showering and hygiene (requiring the most caregiver support), (b) sleep (due to pain and cast-related discomfort), and (c) exclusion from sports/activities. Many adolescents experienced disruptions to social activities and gatherings. Youth valued independence and took more time to complete tasks, regardless of inconvenience. Both adolescents and caregivers reported feelings of frustration from day-to-day impacts of the injury. Generally, caregivers' perspectives were in keeping with the experiences that adolescents described for themselves. Notable family impacts included “sibling burden,” or conflicts that arose when a sibling had to take on extra chores/tasks.

Conclusions
Overall, caregivers' perspectives were congruent with the self-described experiences of adolescents. Key messages for optimized discharge instructions include pain and sleep management, allowing extra time to complete tasks independently, considering impact on siblings, preparing for changes in activities and social dynamics, and normalizing frustration. These themes highlight an opportunity to better tailor discharge instructions for adolescents with fractures.
Building Public Health Emergency Preparedness, Response, and Recovery Capabilities Through Disaster Citizen Science: Perspectives From Local Health Department, Academic, and Community Representatives
Authors: Siddiqi Sameer M. , Kareddy Vishnupriya , Uscher-Pines Lori , Chari Ramya 
Published: March 2023

Context:
Disaster citizen is the use of scientific methods by the public to address preparedness, response, or recovery needs. Disaster citizen science applications with public health relevance are growing in academic and community sectors, but integration with public health emergency preparedness, response, and recovery (PHEPRR) agencies is limited.

Objective:
We examined how local health departments (LHDs) and community-based organizations have used citizen science to build public health preparedness and response (PHEP) capabilities. The purpose of this study is to help LHDs make use of citizen science to support PHEPRR.

Design:
We conducted semistructured telephone interviews (n = 55) with LHD, academic, and community representatives engaged or interested in citizen science. We used inductive and deductive methods to code and analyze interview transcripts.

Setting:
US and international community-based organizations and US LHDs.

Participants:
Participants included 18 LHD representatives reflecting diversity in geographic regions and population sizes served and 31 disaster citizen science project leaders and 6 citizen science thought leaders.

Main Outcomes:
We identified challenges LHDs and academic and community partners face in using citizen science for PHEPRR as well as strategies to facilitate implementation.

Results:
Academic and community-led disaster citizen science activities aligned with many PHEP capabilities including community preparedness, community recovery, public health surveillance and epidemiological investigation, and volunteer management. All participant groups discussed challenges related to resources, volunteer management, collaborations, research quality, and institutional acceptance of citizen science. The LHD representatives noted unique barriers due to legal and regulatory constraints and their role in using citizen science data to inform public health decisions. Strategies to increase institutional acceptance included enhancing policy support for citizen science, increasing volunteer management support, developing best practices for research quality, strengthening collaborations, and adopting lessons learned from relevant PHEPRR activities.

Conclusions:
There are challenges to overcome in building PHEPRR capacity for disaster citizen science but also opportunities for LHDs to leverage the growing body of work, knowledge, and resources in academic and community sectors.
Recommendations to Improve the Nature and Extent of Relationships Among Organizations Within a Network to Enhance Supports for Transgender Survivors of Sexual Assault
Authors: Du Mont Janice , Coelho Madelaine , Lebel Nicholas , Friedman Burley Joseph , Kosa Sarah Daisy , Macdonald Sheila 
Published: March 2023

Context:
To enhance the provision of comprehensive supports to transgender (trans) survivors of sexual assault, a structurally marginalized group with complex care needs, we developed an intersectoral network of trans-positive health care and community organizations in Ontario, Canada.

Objective:
As a baseline evaluation of the network, we conducted a social network analysis to determine the extent and nature of collaboration, communication, and connection among members.

Design:
Relational data (eg, activities of collaboration) were collected from June to July 2021, and analyzed using a validated survey tool, Program to Analyze, Record, and Track Networks to Enhance Relationships (PARTNER). We shared findings in a virtual consultation session with key stakeholders and facilitated discussion to generate action items. Consultation data were synthesized into 12 themes through conventional content analysis.

Setting:
An intersectoral network in Ontario, Canada.

Participants:
Of the 119 representatives of trans-positive health care and community organizations invited to participate in this study, 78 (65.5%) completed the survey.

Main Outcome Measures:
Proportion/count of organizations collaborating with other organizations. Network scores for value and trust.

Results:
Almost all (97.5%) invited organizations were listed as collaborators, representing 378 unique relationships. The network achieved a value score of 70.4% and trust score of 83.4%. The most prominent themes were “Communication and knowledge exchange channels,” “Clearer roles and contributions,” “Indicators of success,” and “Client voices at the centre.”

Conclusion:
As key antecedents of network success, high value and trust indicate that network member organizations are well positioned to further foster knowledge sharing, define their roles and contributions, prioritize the integration of trans voices in all activities, and, ultimately, achieve common goals with clearly defined outcomes. There is great potential to optimize network functioning and advance the network's mission to improve services for trans survivors by mobilizing these findings into recommendations.
Epidemiology of Culture-Negative Pulmonary Tuberculosis—Alameda County, 2010-2019
Authors: Chen Jennie , Marusinec Rachel , Brown Robert , Shiau Rita , Jaganath Devan , Chitnis Amit S. 
Published: March 2023

Context:
Patients with culture-negative pulmonary TB (PTB) can face delays in diagnosis that worsen outcomes and lead to ongoing transmission. An understanding of current trends and characteristics of culture-negative PTB can support earlier detection and access to care.

Objective:
Describe epidemiology of culture-negative PTB.

Design, Setting, Participants:
We utilized Alameda County TB surveillance data from 2010 to 2019. Culture-negative PTB cases met clinical but not laboratory criteria for PTB per US National Tuberculosis Surveillance System definitions. We calculated trends in annual incidence and proportion of culture-negative PTB using Poisson and weighted linear regression, respectively. We further compared demographic and clinical characteristics among culture-negative versus culture-positive PTB cases.

Results:
During 2010-2019, there were 870 cases of PTB, of which 152 (17%) were culture-negative. The incidence of culture-negative PTB declined by 76%, from 1.9/100 000 to 0.46/100 000 (P for trend <.01), while the incidence of culture-positive PTB reduced by 37% (6.5/100 000 to 4.1/100 000, P for trend =.1). Culture-negative PTB case-patients were more likely than culture-positive PTB case-patients to be younger (7.9% were children <15 years old vs 1.1%; P < .01), recent immigrants within 5 years of arrival (38.2% vs 25.5%; P < .01), and have a TB contact (11.2% vs 2.9%; P < .01). Culture-negative PTB case-patients were less likely than culture-positive PTB case-patients to be evaluated because of TB symptoms (57.2% vs 74.7%; P < .01) or have cavitation on chest imaging (13.1% vs 38.8%; P < .01). At the same time culture-negative PTB case-patients were less likely to die during TB treatment (2.0% vs 9.6%; P < .01).

Conclusions:
The incidence of culture-negative PTB disproportionately declined compared with culture-positive TB and raises concern for gaps in detection. Expansion of screening programs for recent immigrants and TB contacts and greater recognition of risk factors may increase detection of culture-negative PTB.
Comparing State-Level and Facility-Based Review to Assess Quality of Severe Maternal Morbidity Reviews
Authors: Garland Caitlin E. , Craemer Katherine A. , Koch Abigail R. , Locher Stephen , Geller Stacie E. 
Published: March 2023

Objective:
To compare results from facility-level and state-level severe maternal morbidity (SMM) reviews in Illinois.

Design:
We report descriptive characteristics about SMM cases and compare the results of both review processes, including the primary cause, assessment of preventability, and factors that contributed to the severity of the SMM cases.

Setting:
All birthing hospitals in Illinois.

Participants:
A total of 81 SMM cases were reviewed by a facility-level committee and the state-level review committee. SMM was defined as any intensive care or critical care unit admission and/or transfusion of 4 or more units of packed red blood cells from conception to 42 days postpartum.

Results:
Among the cases reviewed by both committees, hemorrhage was the primary cause of morbidity, with 26 (32.1%) and 38 (46.9%) hemorrhage cases identified by the facility-level and state-level committees, respectively. Both committees identified infection/sepsis (n = 12) and preeclampsia/eclampsia (n = 12) as the next most common causes of SMM. State-level review found more cases potentially preventable (n = 29, 35.8% vs n = 18, 22.2%) and more cases not preventable but improvement in care needed (n = 31, 38.3% vs n = 27, 33.3%). State-level review found more provider and system opportunities to alter the SMM outcome and fewer patient opportunities than facility-level review.

Conclusion:
State-level review found more SMM cases potentially preventable and identified more opportunities to improve care than facility-level review. State-level review has the potential to strengthen facility-level reviews by identifying opportunities to improve the review process and develop recommendations and tools to aid facility-level reviews.
Effectiveness of an External Urinary Device for Female Anatomy and Trends in Catheter-Associated Urinary Tract Infections
Authors: Beeson Terrie , Pittman Joyce , Davis Carmen R. 
Published: March 2023

PURPOSE:
The purpose of this study was to examine the effectiveness of an external female urinary management system (external urinary device for female anatomy [EUDFA]) in critically ill women unable to self-toilet and to identify rates of indwelling catheter use, catheter-associated urinary tract infections (CAUTIs), urinary incontinence (UI), and incontinence-associated dermatitis (IAD) before and after the introduction of the EUDFA.

DESIGN:
Prospective, observational, and quasi-experimental design.

SUBJECTS AND SETTING:
The sample comprised 50 adult female patients in 4 critical/progressive care units using an EUDFA at a large academic hospital in the Midwestern United States. All adult patients in these units were included in the aggregate data.

METHODS:
Prospective data collected from the adult female patients over 7 days included urine diverted from the device to a canister and total leakage. Aggregate unit rates of indwelling catheter use, CAUTIs, UI, and IAD were retrospectively examined during 2016, 2018, and 2019. Means and percentages were compared using t tests or chi-square tests.

RESULTS:
The EUDFA successfully diverted 85.5% of patients' urine. Indwelling urinary catheter use was significantly lower in 2018 (40.6%) and 2019 (36.6%) compared with 2016 (43.9%) (P < .01). The rate of CAUTIs was lower in 2019 than in 2016, but not significantly (1.34 per 1000 catheter-days vs 0.50, P = .08). The percentage of incontinent patients with IAD was 69.2% in 2016 and 39.5% in 2018-2019 (P = .06).

CONCLUSIONS:
The EUDFA was effective in diverting urine from critically ill female incontinent patients and indwelling catheter utilization.
A tumor focused approach to resolving the etiology of DNA mismatch repair deficient tumors classified as suspected Lynch syndrome
Authors: Walker Romy , Mahmood Khalid , Joo Jihoon E. , Clendenning Mark , Georgeson Peter , Como Julia , Joseland Sharelle , Preston Susan G. , Antill Yoland , Austin Rachel , Boussioutas Alex , Bowman Michelle , Burke Jo , Campbell Ainsley , Daneshvar Simin , Edwards Emma , Gleeson Margaret , Goodwin Annabel , Harris Marion T. , Henderson Alex , Higgins Megan , Hopper John L. , Hutchinson Ryan A. , Ip Emilia , Isbister Joanne , Kasem Kais , Marfan Helen , Milnes Di , Ng Annabelle , Nichols Cassandra , O’Connell Shona , Pachter Nicholas , Pope Bernard J. , Poplawski Nicola , Ragunathan Abiramy , Smyth Courtney , Spigelman Allan , Storey Kirsty , Susman Rachel , Taylor Jessica A. , Warwick Linda , Wilding Mathilda , Williams Rachel , Win Aung K. , Walsh Michael D. , Macrae Finlay A. , Jenkins Mark A. , Rosty Christophe , Winship Ingrid M. , Buchanan Daniel D. ,   the Family Cancer Clinics of Australia
Published: March 2023

AbstractRoutine screening of tumors for DNA mismatch repair (MMR) deficiency (dMMR) in colorectal (CRC), endometrial (EC) and sebaceous skin (SST) tumors leads to a significant proportion of unresolved cases classified as suspected Lynch syndrome (SLS). SLS cases (n=135) were recruited from Family Cancer Clinics across Australia and New Zealand. Targeted panel sequencing was performed on tumor (n=137; 80xCRCs, 33xECs and 24xSSTs) and matched blood-derived DNA to assess for microsatellite instability status, tumor mutation burden, COSMIC tumor mutational signatures and to identify germline and somatic MMR gene variants. MMR immunohistochemistry (IHC) andMLH1promoter methylation were repeated. In total, 86.9% of the 137 SLS tumors could be resolved into established subtypes. For 22.6% of these resolved SLS cases, primaryMLH1epimutations (2.2%) as well as previously undetected germline MMR pathogenic variants (1.5%), tumorMLH1methylation (13.1%) or false positive dMMR IHC (5.8%) results were identified. Double somatic MMR gene mutations were the major cause of dMMR identified across each tumor type (73.9% of resolved cases, 64.2% overall, 70% of CRC, 45.5% of ECs and 70.8% of SSTs). The unresolved SLS tumors (13.1%) comprised tumors with only a single somatic (7.3%) or no somatic (5.8%) MMR gene mutations. A tumor-focused testing approach reclassified 86.9% of SLS into Lynch syndrome, sporadic dMMR or MMR-proficient cases. These findings support the incorporation of tumor sequencing and alternateMLH1methylation assays into clinical diagnostics to reduce the number of SLS patients and provide more appropriate surveillance and screening recommendations.
Differential cognitive effects of unilateral left and right subthalamic nucleus deep brain stimulation for Parkinson disease
Authors: Del Bene Victor A , Martin Roy C. , Brinkerhoff Sarah A. , Olson Joseph W. , Nelson Matthew J. , Marotta Dario , Gonzalez Christopher L. , Mills Kelly A. , Kamath Vidyulata , Bentley J. Nicole , Guthrie Barton L. , Knight Robert T. , Walker Harrison C. 
Published: March 2023

ABSTRACTObjectiveTo investigate hemispheric effects of directional versus ring subthalamic nucleus (STN) deep brain stimulation (DBS) surgery on cognitive function in patients with advanced Parkinson’s disease (PD).MethodsWe examined 31 PD patients (Left STN n = 17; Right STN n = 14) who underwent unilateral subthalamic nucleus (STN) DBS as part of a NIH-sponsored randomized, cross-over, double-blind (ring vs directional) clinical trial. Outcome measures were tests of verbal fluency, auditory-verbal memory, and response inhibition. First, all participants were pooled together to study the effects of directional versus ring stimulation. Then, we stratified the groups by surgery hemisphere and studied the longitudinal changes in cognition post-unilateral STN DBS.ResultsRelative to pre-DBS cognitive baseline performances, there were no group changes in cognition following unilateral DBS for either directional or ring stimulation. However, assessment of unilateral DBS by hemisphere revealed a different pattern. The left STN DBS group had lower verbal fluency than the right STN group (t(20.66 = -2.50,p= 0.02). Over a period of eight months post-DBS, verbal fluency declined in the left STN DBS group (p= 0.013) and improved in the right STN DBS group over time (p< .001). Similarly, response inhibition improved following right STN DBS (p= 0.031). Immediate recall did not significantly differ over time, nor was it affected by implant hemisphere, but delayed recall equivalently declined over time for both left and right STN DBS groups (left STN DBSp= 0.001, right STN DBS differ from left STN DBSp= 0.794).ConclusionsDirectional and ring DBS did not differentially or adversely affect cognition over time. Regarding hemisphere effects, verbal fluency decline was observed in those who received left STN DBS, along with the left and right STN DBS declines in delayed memory. The left STN DBS verbal fluency decrement is consistent with prior bilateral DBS research, likely reflecting disruption of the basal-ganglia-thalamocortical network connecting STN and inferior frontal gyrus. Interestingly, we found an improvement in verbal fluency and response inhibition following right STN DBS. It is possible that unilateral STN DBS, particularly in the right hemisphere, may mitigate cognitive decline.
Combining models to generate a consensus effective reproduction numberRfor the COVID-19 epidemic status in England
Authors: Manley Harrison , Park Josie , Bevan Luke , Sanchez-Marroquin Alberto , Danelian Gabriel , Bayley Thomas , Bowman Veronica , Maishman Thomas , Finnie Thomas , Charlett André , Watkins Nicholas A , Hutchinson Johanna , Riley Steven ,   Nowcasts Model Contributing Group, Panovska-Griffiths Jasmina 
Published: March 2023

AbstractThe effective reproduction numberRwas widely accepted as a key indicator during the early stages of the COVID-19 pandemic. In the UK, theRvalue published on the UK Government Dashboard has been generated as a combined value from an ensemble of epidemiological models via a collaborative initiative between academia and government. In this paper we outline this collaborative modelling approach and illustrate how, by using an established combination method, a combinedRestimate can be generated from an ensemble of epidemiological models. We analyse theRvalues calculated for the period between April 2021 and December 2021, to show that thisRis robust to different model weighting methods and ensemble size, and that using heterogeneous data sources for validation increases its robustness and reduces the biases and limitations associated with a single source of data. We discuss howRcan be generated from different data sources and is therefore a good summary indicator of the current dynamics in an epidemic.