***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose The aims of this study are to compare self-reported sleep quality in adult survivors of childhood brain tumors and a population -based comparison group , to identify treatment-related factors associated with sleep disturbances , and to identify the impact of post-treatment obesity and depression on sleep scores in adult survivors of childhood brain tumors . Methods R and omly selected adult survivors of childhood brain tumors ( n = 78 ) and age- , sex- , and zip code-matched population -group members ( n = 78 ) completed the Pittsburgh Sleep Quality Index and the Brief Symptom Inventory .  Sleep quality and the effect of demographic , treatment , and post-treatment characteristics were evaluated with linear and logistic regression analyses . Results Brain tumor survivors were 2.7 ( 95 % CI , 1.1 , 6.5 ) times more likely than the comparison group to take greater than 30 min to fall asleep . Females in both groups reported worse sleep quality and impaired daytime functioning . Among survivors , post-treatment obesity was associated with daytime dysfunction . Conclusions These results agree with previous studies associating sleep , sex , and obesity and identified longer sleep latency as being a problem among childhood brain tumor survivors . Further study identifying factors contributing to sleep latency , and its impact on quality of life among adult survivors of childhood brain tumors is needed BACKGROUND Febrile neutropenia ( FN ) is a frequent , serious complication of intensive pediatric chemotherapy regimens . The aim of this trial was to compare quality of life ( QOL ) between inpatient and outpatient intravenous antibiotic management of children and adolescents with low risk febrile neutropenia ( LRFN ) . PROCEDURE In this r and omised non-blinded trial , patients between 1 and 21 years old , receiving low/moderate intensity chemotherapy were pre-consented and , on presentation to emergency ( ED ) with FN satisfying low risk criteria , r and omised to either outpatient or inpatient care with intravenous cefepime 50 mg/kg ( 12 hourly ) . All patients continued antibiotics for at least 48 hours , until afebrile for 24 hours and demonstrating a rising absolute neutrophil count ≥200/mm(3 ) . Several domains of QOL were examined by daily question naire . RESULTS Eighty-one patients presented to ED with 159 episodes of fever . Thirty-seven FN presentations involving 27 patients were r and omised to inpatient ( 18 ) and outpatient ( 19 ) management  . Combined QOL mean scores for parents were higher for the outpatient group and scores for three specific parent variables ( keeping up with household tasks/time spent with partner/time spent with other children ) were higher among out patients . There was no difference in parent confidence/satisfaction in care between groups . Patients scored better in the outpatient group overall and for sleep and appetite . The mean length of fever was equivalent between groups and there were no serious adverse events attributable to cefepime or outpatient care . CONCLUSION Outpatient cefepime management of LRFN provided significant benefit to parents and patients  across several QOL domains and appeared both feasible and safe PURPOSE / OBJECTIVES To determine the feasibility of collecting symptom data at home from school-age children with acute lymphoblastic leukemia ( ALL ) and from their fathers and mothers and to obtain initial descriptions of pain , sleep disturbance , and fatigue experienced by the family members at home . DESIGN Prospect i ve and descriptive . SETTING Children 's homes in Oregon and southwestern Washington . SAMPLE 9 children with ALL ( aged 8 - 16 years ) , 6 fathers , and 7 mothers . The children received vincristine during the maintenance phase of their outpatient chemotherapy treatments . METHODS With age-appropriate , paper- and -pencil diaries and wrist actigraphy , data were collected for three days in the families ' homes . Families were reminded by telephone to complete their sleep and activity diaries . MAIN RESEARCH VARIABLES Pain , sleep disturbance , and fatigue in school-age children and their fathers and mothers . FINDINGS Most of the families who were approached indicated willingness to participate in the study . After receiving outpatient chemotherapy , the children reported pain , sleep disturbance , and fatigue data over three days . Fathers and mothers also reported symptoms . Actigraphy showed children waking more often during the night than mothers or fathers . CONCLUSIONS Children 's pain , sleep disturbance , and fatigue suggest that the symptoms are influencing families ' quality of life . Larger studies are needed to examine the symptom patterns and health outcomes of children , fathers , and mothers over the course of chemotherapy . IMPLICATION S FOR NURSING Improving sleep and managing pain and fatigue after chemotherapy treatment for children with ALL may improve health outcomes for children and parents OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity 8523 Background : An increased risk for strokes has not been previously reported among HD survivors . This report examines the rate and risk factors for stroke in long-term survivors of HD . METHODS The CCSS is a multi-institutional cohort study of long-term ( ≥ 5 years ) survivors who were diagnosed between 1970 - 1986 . The rate of first occurrence of self-reported strokes was determined for HD survivors ( N=1665 ) and compared with a r and om sample of siblings of childhood cancer survivors ( N=3846 ) . The mean age at interview of the HD survivors was 31.9 years of age , with a mean age at diagnosis of 14.6 years . The incidence rates of HD survivors at ≥ 5 years post diagnosis and siblings were calculated separately . Cox proportional hazards models were used to estimate rate ratio ( RR ) of developing stroke between HD survivals and siblings . RESULTS Fifteen HD survivors reported a stroke : one during therapy , 13 occurring ≥ 5 years after HD diagnosis , and one without an age at stroke reported . The rate of stroke in HD survivors ≥ 5 years post diagnosis was 0.68 per 1000 person-years ( 95 % CI , 0.40 - 1.18 ) . Of the 13 late occurring strokes , all had chest/mantle radiation ( median dose 40 Gy ) , with a median interval of 15 years from HD diagnosis to stroke . The median age of stroke was 31 years ( range 21 - 40 ) . Seven siblings reported a previous stroke , with a rate of 0.069 per 1000 person-years ( 95 % CI , 0.03 - 0.15 ) . The RR of stroke for all HD survivors , in comparison with siblings , was 3.88 ( 95 % CI , 1.46 - 10.3 ; p = 0.0065 ) . The rate of stroke for HD survivors who were treated with chest radiation therapy ( RT ) was 0.82 per 1000 person-years ( 95 % CI , 0.48 - 1.41 ) . Compared to siblings , the RR of HD survivors treated with chest RT was 4.28 ( 95 % CI , 1.6 - 11.2 ; p=0.0031 ) . Anthracycline exposure , treatment with chemotherapy only , hypertension and diabetes mellitus were not associated with an increased risk of stroke . CONCLUSIONS Though an infrequent outcome , survivors of childhood HD may be at an increased risk of stroke . In this study , previous exposure to chest RT was strongly associated with risk of stroke . Because the risk may be modified by prevention , it is imperative to further study this process . No significant financial relationships to disclose PURPOSE Long-term survivors of childhood Hodgkin lymphoma ( HL ) are at risk for cardiopulmonary complications and CNS stroke , although neurocognitive function has not been previously examined . The aim of this study was to examine neurocognitive and brain imaging outcomes in adult survivors of childhood HL . PATIENTS AND METHODS In all , 62 adult survivors ( mean age , 42.2 years ; st and ard deviation [ SD ] , 4.77 ; mean age at diagnosis , 15.1 years ; SD , 3.30 ) were identified by stratified r and om selection from a large cohort treated with either high-dose ( ≥ 30 Gy ) thoracic radiation ( n = 38 ) or lower-dose ( < 30 Gy ) thoracic radiation combined with anthracycline ( n = 24 ) . Patients underwent neurocognitive evaluations , brain magnetic resonance imaging ( MRI ) , echocardiograms , pulmonary function tests , and physical examinations . RESULTS Compared with national age-adjusted norms , HL survivors demonstrated lower performance on sustained attention ( P = .004 ) , short-term memory ( P = .001 ) , long-term memory ( P = .006 ) , working memory ( P < .001 ) , naming speed ( P < .001 ) , and cognitive fluency ( P = .007 ) . MRI revealed leukoencephalopathy in 53 % of survivors , and 37 % had evidence of cerebrovascular injury . Higher thoracic radiation dose was associated with impaired cardiac diastolic function ( E/E ' ; ratio of peak mitral flow velocity of early rapid filling [ E ] to early diastolic velocity of the mitral annulus [ E ' ] ; P = .003 ) , impaired pulmonary function ( diffusing capacity of lungs for carbon monoxide [ DL(co)(corr ) ; P = .04 ) , and leukoencephalopathy ( P = .02 ) . Survivors with leukoencephalopathy demonstrated reduced cognitive fluency ( P = .001 ) . Working memory impairment was associated with E/E ' , although impaired sustained attention and naming speed were associated with DL(co)(corr ) . Neurocognitive performance was associated with academic and vocational functioning . CONCLUSION These results suggest that adult long-term survivors of childhood HL are at risk for neurocognitive impairment , which is associated with radiologic indices suggestive of reduced brain integrity and which occurs in the presence of symptoms of cardiopulmonary dysfunction This prospect i ve , two-site , r and omized , controlled pilot study assessed the feasibility of an enhanced physical activity ( EPA ) intervention in hospitalized children and adolescents receiving treatment for a solid tumor or for acute myeloid leukemia ( AML ) , and assessed different statistical techniques to detect the intervention 's sleep and fatigue outcomes .  Twenty-nine patients ( 25 with a solid tumor and 4 with AML ) participated . Data were collected from actigraph ; patient , parent , and staff nurse reports of patient fatigue ; parent sleep diaries ; and patient charts . The intervention was successfully implemented 85.4 % of the scheduled times . We used two different statistical methods to analyze the longitudinal data . Using an ANOVA model , sleep was significantly more efficient in the experimental arm than in the control arm when daily differences from baseline sleep efficiency values were averaged and compared ( F=4.17 , P=0.053 ) . However , in a mixed model ( repeated measures ) analysis , sleep duration ( F=0.54 , P=0.47 ) and sleep efficiency ( F=0.04 , P=0.85 ) were not seen to differ between study arms . We conclude that an inpatient intervention of EPA can be delivered to children and adolescents receiving chemotherapy . Our findings identify design and statistical considerations for a future effectiveness study of the EPA intervention in hospitalized pediatric oncology patients PURPOSE / OBJECTIVES To examine the influence of the 
    Output:
    
Data from objective and subjective assessment s of sleep showed that child sleep was disrupted in the hospital when compared to previously established age-related norms .
Noise , light levels , and staff room interruptions were associated with decreased total sleep minutes and increased nighttime awakenings .
This may help to minimize the role that hospitalization plays in precipitating and perpetuating chronic sleep disturbances in pediatric cancer patients .