bluuebunny/crossref_metadata_2025 huggingface dataset:
Comprehensive institution-wide adoption of an ePRO treatment symptom reporting solution.
Authors: Kudel Ian , Lahelma Mari , Curry Heather A. , Christianson Annette , Pennanen Paula , Shamsi Zoya , Barlund Maarit Tuulikki
Published: October 2023

567

Background: A cloud-based bidirectional app (ePRO) communicating real-time patient-reported cancer treatment symptom(s)/severity and clinical care team (CCT) recommendation(s) can lessen treatment burden. Previous studies have focused on a single diagnosis or treatment modality, but not institution-wide, multi-modal use. Methods: Tampere University Hospital oncology patients (Pt; n=1,873) receiving radiotherapy (RT), systemic therapy (chemo-, immune-, or hormone therapy; ST) or both (RT+ST) modalities with active ePRO accounts between 2015-2021 were asked to complete an app-based treatment-specific questionnaire administered regularly. It was also available ad hoc. Items assessed overall distress (11-point scale; 0=none,10=Worst Possible), physical function (ECOG-based), and treatment symptoms (CTCAE-based; v5). Prespecified responses were programmed to alert the CCT, which in turn, provided customized, app-based recommendations. All data were analyzed descriptively. Results: Pts were predominantly female and middle-aged. The two most common cancer types were breast and prostate; each of the others comprised <5% of the sample and were grouped into “other”. Most received RT+ST (concurrent or sequential). Mean time on active treatment ranged from 4.2 to 11.4 months. The response rate ranged from 82.2% to 87.3%. The most common symptoms were fatigue and pain, with almost a quarter of Pts reporting severe pain. Higher severity levels were reported by patients receiving any ST (Table 1). Conclusions: Pt’s high engagement rate with the app demonstrates that a single, actionable solution can be successfully employed across the continuity of care, despite varying regimens and schedules, and is a behavioral indicator of its value.[Table: see text]
Awareness of racial/ethnic inequities in time to treatment among breast cancer providers.
Authors: Cohen Inessa , Canavan Maureen , Jacob Alexandra , Sondhi Arjun , Silver Heather , Bramwell Lindsay Gaido , Lustberg Maryam B. , Adelson Kerin B.
Published: October 2023

584

Background: Cancer patients who self-identify as Black and Latinx are more likely to receive delays in care compared with Non-Latinx White patients. Research suggests that while providers are aware of racial/ethnic inequities in access to treatment at a national-level, they fail to recognize these differences at the hospital- or individual-level. This phenomenon is not well understood and has yet to be studied among oncologists. We sought to evaluate awareness of national and local time-to-treatment inequities in breast cancer providers. Methods: We conducted an educational intervention at the Smilow Cancer Hospital, the clinical arm of the Yale Cancer Center, in February 2023. Breast cancer providers (including breast surgeons, medical oncologists, radiation oncologists, breast radiologists, and advanced practice nurses) completed an online survey that assessed their understanding of treatment inequities at three levels (national, hospital, and individual) before and after they watched a 20-minute live presentation. The presentation included real-world national and breast-team specific data on differences in time-to-treatment metrics by race/ethnicity from the Flatiron electronic health record-derived de-identified database. Differences between surveys were evaluated with Fisher’s exact tests. Results: Among 18 providers, most were female (78%), Non-Latinx White (83%), had an average of 15 years of experience (SD=10), and half reported at least 10-25% of the patients they care for were non-White. Awareness of race/ethnicity as a factor in influencing differences in oncological care increased significantly (33% to 77 %, p = 0.02) pre-to-post intervention at the hospital-level but did not significantly change at the national- (78% to 83%, p > 0.05) or individual- (17% to 28%, p > 0.05) level. Providers identified adverse social determinants of health, such as housing insecurity, poor employment conditions, and food insecurity, as the main cause of inequities both nationally and within their disease team. On average, at the post-survey, most providers agreed that patient factors (62%) rather than provider factors (30%) were driving differences in oncological care metrics. However, they reported that larger systems, such as healthcare agencies, government, and providers (all 89%), rather than patients, were responsible for reducing these inequities. Conclusions: In this pilot study, a brief educational intervention increased awareness of local hospital-level factors, but not national- and individual-level factors, associated with racial/ethnic inequities in time to cancer treatment. As the oncology field continues to address inequities in care, it is crucial for providers to not only acknowledge the existence of these inequities but also to establish successful interventions to reduce these inequities within their own disease team.
Development and initial evaluation of a visualization tool for multidisciplinary treatment discussion of patients with pancreatic cancer.
Authors: Fouladi Roxanna , Korah Bobby , Herman Joseph M. , King Daniel , Deperalta Danielle , Pinto Danielle , Weiss Matthew John , Lowy Andrew M. , Sarno Shirley , Soldano Debbie A. , Stricker Carrie Tompkins
Published: October 2023

585

Background: Pancreatic cancer is the third leading cause of cancer death in the United States; it is a complex disease requiring coordinated patient care. Multidisciplinary tumor boards (MTB) are today's gold standard in pancreatic cancer but are frequently criticized for being time-intensive and inefficient. To address this issue, Cancer Collective and Hive Networks have developed a novel patient-information visualization tool designed to improve the communication and efficiency of multidisciplinary tumor board meetings. This pilot study investigated the patient-information visualization tool's usability, efficiency, and feasibility in pancreatic cancer tumor board meetings. Methods: A prospective multi-center pilot study was conducted at Northwell Health (a comprehensive community cancer program [NCCCP] in the Northeastern United States) and the University of California San Diego (an NCI-designated comprehensive cancer center in [NCCC] in the Southwestern United States. The feasibility of the tool was assessed by measuring the percentage of MTB cases discussed that used the patient-information visualization tool. The usability and efficiency of the tool were assessed via Likert scale questions. Acceptable usability and effectiveness were defined as a 70% score or higher. Additionally, MTB participants were queried for input on design improvements for future iterations and expected future directions of tool use. Results: The patient-information visualization tool was rolled out on 07/22/2022 at the NCCP and NCCC. From 07/22/2022-05/31/2023, 170 (92%) MTB cases were reviewed at the NCCP. From 07/22/2022-05/31/2023, 74 cases (100%) of MTB cases were reviewed using the patient-information visualization tool at the NCCP. The NCCP (n=9) mean scores for usability and efficiency were 4.31 (86%) and 4.17 (83%) respectively. The NCCC (n=6) mean scores for usability and efficiency were 4.04 (81%) and 3.96 (79%) respectively. Qualitative feedback, reported on survey open-ended questions, included suggested enhancements to improve the tool’s usability, such as leveraging data automation to reduce data entry burden, improving the user interface for ease of data visualization, and adding additional data elements (e.g., specific procedure and appointment details) to improve decision-making utility. Conclusions: Implementing the novel digital dashboard to visualize pancreatic cancer patient data was highly feasible, usable, and efficient. Future directions of tool use include refining based on qualitative feedback from end users and planning for data automation and interoperability with the EMR.
Multi-task machine learning of the electronic medical record to predict future symptoms among patients with cancer.
Authors: Yuan Baijiang , Kabir Muammar , He Kevin , Grant Benjamin , Narine Sharon , Ajaj Rami , Zhan Luna Jia , Fawzy Aly , Xu Janine , Zhang Yuhua , Yu Vivien , French Conor , Xu Wei , Krishnan Rahul G. , Gallinger Steven , Krzyzanowska Monika K. , Truong Tran , Liu Geoffrey , Grant Robert C
Published: October 2023

587

Background: Cancer and its treatments often cause symptoms. Automated warning systems could mitigate symptoms by alerting healthcare teams and enabling personalized preventative interventions. We developed a general-purpose longitudinal system for predicting symptomatic deterioration among outpatients undergoing intravenous systemic anti-cancer therapy. Methods: Patients treated for aerodigestive cancers at the Princess Margaret Cancer Centre were randomly divided into development and testing cohorts. For each treatment, machine learning was applied to preceding electronic medical record (EMR) data to predict patient-reported symptom deterioration, defined as at least a four point worsening on the Edmonton Symptom Assessment Scale. Features included diagnostic and treatment characteristics, laboratory tests, and patient-reported symptoms. Single-task (e.g., LASSO and XGboost) and multi-task (e.g., temporal CNNs, LSTM and Transformer) models were trained, tuned, and evaluated based on discrimination, calibration, and net benefit. Results: The cohort consisted of 3,998 patients who underwent 45,904 treatment sessions, with data across 400 features. Among these patients, 1,547 (38.6%) were female; median age was 64.0 (interquartile range 13.0). The most common diagnoses were lung (1,505, 37.6%), head and neck (696, 17.4%), and pancreatic cancers (685, 17.1%). The best model, a multi-task transformer, predicted symptom deterioration with an AUROC range of 0.732-0.822, marking a 1.4-6.2% improvement over the best single-task model. At a 10% alert rate, treatments associated with alerts would be enriched 4-13 fold for symptom deterioration (P<0.001). The system was calibrated and would provide a net benefit across a wide range of threshold probabilities in decision curve analysis. Conclusions: Longitudinal general-purpose multi-task machine learning systems trained using EMR data can accurately predict a wide range of symptoms. Based on these results, automated warning systems for symptoms should be implemented and evaluated in real-time clinical practice to guide preventative interventions.[Table: see text]
Clinical pharmacist prescription review and modification for oral antineoplastic medications at an academic medical center.
Authors: Kaymakcalan Marina D. , Thomas Jenafer , Nowakowski Kristin , Shukla Shital , Le Anne C. , Cibotti Christina , Syngal Monica , Doolin Jim W
Published: October 2023

64

Background: Collaboration between oncology providers and pharmacy teams has improved the safety of oral antineoplastic (OA) prescribing, but opportunities remain for improvements in care delivery. To this end, starting in March 1, 2021, the Dana Farber Cancer Institute Specialty Pharmacy implemented a new workflow - clinical verification of new specialty prescriptions by dedicated OA clinical pharmacists (OAPs) prior to prescription processing. To reduce the impact of initial prescription errors on efficiency and safety, one component of clinical verification was to expand the purview of OAPs to make certain modifications to prescriptions that could be automatically processed without requiring prescriber re-signing. Automatically processed prescription modifications include corrections to quantity or days supply, indication of cycle length or days on/off therapy, and clarification of directions. Here we report on the impact of this portion of the clinical verification program. Methods: OAP prescription modification (OAP-PM) was introduced on November 1, 2022. To assess the impact on efficiency, we conducted a pre-post analysis of the proportion of prescription modifications taking > 60 minutes to complete for 6 months before and after OAP-PM introduction. Using prescription-level data, we analyzed co-variates including pre-/post-OAP-PM, patient age (continuous), site (academic vs. network), communication with someone other than the primary prescriber (y/n), and medication category (anti-neoplastic vs. supportive). We used control charts to explore the contribution of specific medications and sites that might share best practices or be the focus of subsequent, more focused improvement projects. Results: From May 1, 2022 to May 1, 2023, 458 prescription modifications were completed, 180 pre- and 278 post-OAP-PM. The proportion of prescriptions requiring > 60 minutes to complete decreased from 29.4% to 19.8% (p = 0.0184). In multivariable regression, the significant predictors of prescription taking > 60 minutes to complete were pre-OAP-PM (LR 4.9, p = 0.027); network (LR 20.8, p < 0.0001); and communication with someone other than the primary provider (LR 18.6, p < 0.0010). Control charts demonstrated all sites were within 3-sigma limits pre- and post-OAP-PM, but with wide limits at many sites. Individual medications could not be meaningfully analyzed due to the small sample sizes. Conclusions: OAP-PM successfully reduced the proportion of OA prescriptions taking more than an hour to modify. This may be a useful workflow change for other specialty pharmacies to adopt to improve the efficiency of OA care. Additional work is needed to understand whether site-, provider- or medication-specific changes can improve upon this model.
Heterogeneity in costs of standard-of-care drug regimens within high volume Enhancing Oncology Model disease groups: Implications for performance risk outside of a provider’s control.
Authors: Baker Katherine , Young Garrett , Bilbrey Larry Edward , Mullangi Samyukta , Lyss Aaron J. , Dickson Natalie R. , Owens Leah , Schleicher Stephen Matthew
Published: October 2023

70

Background: The Enhancing Oncology Model (EOM) is a voluntary two-sided risk model that compares practice expenditures relative to calculated benchmarks for seven cancer types. To account for changes in cancer costs based on clinical characteristics, the EOM applies metastatic (M0 vs. M1) and HER2 clinical adjustments. These adjustments modify lung and small intestine/colorectal episodes for ever-metastatic status by a factor of 1.06 and 1.10, respectively, and breast cancer episodes by a factor of 1.23 for ever-metastatic status and HER2 positivity. However, it is unclear how well these methodological additions capture indication-specific treatment costs of care within an EOM disease group. Methods: Medicare Part B Drug and Biological Average Sales Price (ASP) data were analyzed to estimate total cost to Medicare for a six-month course of systemic therapy within three common EOM disease groups: breast cancer, lung cancer, and colorectal cancer. Diseases were further broken down by M0 vs. M1 and HER2 status consistent with EOM methodology. All treatment regimens selected for analysis are concordant with National Comprehensive Cancer Network guidelines and considered standard of care based on clinical phenotypes – including PD-L1 status, lymph node status, and tumor size – which are not captured by EOM methodology. Results: Within common EOM disease groups and after accounting for EOM clinical adjusters, six-month episode costs of standard of care systemic treatments vary widely based on clinical features not captured in the model. For instance, the cost of care from drug treatment alone varies by over 220-fold for M0 NSCLC, 72-fold for M0 HER2- high risk breast cancer, 7-fold for M0 HER2+ high risk breast cancer, 270-fold for M1 HER2- high risk breast cancer, and 6-fold for M1 colorectal cancer based on clinical features that guide treatment decisions in real practice. Conclusions: Despite methodological attempts to reduce the influence of case mix on performance in EOM, the variability in cost of indication-specific treatments based on clinical characteristics not captured in the model might create performance risk for participating practices. [Table: see text]
Does financial advocacy improve appointment keeping in patients receiving chemotherapy?
Authors: Doherty Meredith , Bresz Kellie , Guglielmo Kimberly , Davella Christopher , Cadet Tamara , Walker Suzanne , Wileyto Paul
Published: October 2023

75

Background: Financial hardship leads to treatment nonadherence including missed medical appointments. This study describes a financial advocacy intervention, developed in response to Medicare’s Oncology Care Model’s price estimate requirement, and measures its effect on patient-initiated missed appointments (no-shows/cancellations). Methods: Logistic regression was used to analyze the clinical records of 2523 chemotherapy patients, before and after program implementation, at one semi-rural cancer center (2015 – 2018). Cluster-correlated covariance was used to correct variances for repeated measures. Results: Patients were assigned an advocate who provided out-of-pocket price estimates, health insurance education, and followed-up with the patient every 30 days for 6 months. 1,271 patients (50.4%) received the intervention. Average age was 64.1 and the average number of missed appointments was 8.7. After accounting for age, gender, marital status, insurance type, and number of chemotherapy infusions, receiving financial advocacy was associated with a 9% reduction in the odds of a missed appointment (OR = 0.91; 95% CI= 0.84 – 0.98; p = 0.013). Medicaid (OR = 1.36; 95% CI = 1.17 – 1.58; p = 0.000) and divorce (OR = 1.19; 95% CI = 1.03 – 1.37; p = 0.015) increased the odds of missed appointments, older age (OR = 0.99; 95% CI = 0.99 – 1.00, p = 0.000) and male gender (OR = 0.90; 95%CI = 0.84 – 0.98; p = 0.011) reduced the odds of missed appointments. Conclusions: The intervention provided some protection against missed appointments. However, marital status, age, gender, and insurance type remained significantly associated with missed appointments, even after accounting for financial advocacy. These findings indicate the need for more research on financial advocacy to identify the effective core components, target at-risk populations, and understand the effect of implementation on intervention effectiveness.[Table: see text]
Disparities in clinical trial participation beyond first-line treatment among patients with metastatic breast or colorectal cancer.
Authors: Wang Jennifer S. , Johnson Benny , Barcenas Carlos Hernando , Betts Andrea , Murphy Caitlin C.
Published: October 2023

97

Background: Disparities in clinical trial participation beyond first-line (1L) treatment of metastatic cancer have not been well studied. Using real-world data from patients diagnosed with metastatic breast cancer (mBC) or metastatic colorectal cancer (mCRC), this study evaluated 1) patterns of participation in trials by treatment line and 2) factors associated with participation in trials of second-line (2L) and subsequent lines of treatment. Methods: Patients diagnosed with mBC or mCRC between 2013 and 2021 who received at least 2L treatment were retrospectively identified from the Flatiron Health electronic health record database. Clinical trial participation was defined as receipt of “clinical study drug.” Participation in trials for treatment lines 2L to 6L were assessed, and multivariable logistic regression models were used to evaluate associations between sociodemographic and clinical factors, including age, race/ethnicity, socioeconomic status (SES), stage at diagnosis, year of metastatic diagnosis, practice type, and total lines of treatment, with participation in trials of 2L and subsequent lines of treatment. Results: Overall, participation in trials was low for patients with mBC or mCRC. For patients with mBC (n=14,590), participation in trials was similar from 2L (2.6%) to 6L (2.7%) (Table 1). Among these patients, age, race/ethnicity, and practice type were associated with participation in trials, while SES was not. For example, women age 18-49, 50-64, and 65-74 years were more likely to participate than women 75 or older (aORs: 2.88, 2.45, 1.84), and non-Hispanic Asian, non-Hispanic Black, and Hispanic women were less likely to participate than non-Hispanic white women (aORs: 0.41, 0.47, 0.61). In contrast to patients with mBC, participation in trials increased from 2.0% (2L) to 6.6% (6L) for patients with mCRC (n=7,303; Table 1). Among these patients, age, practice type, and SES were associated with participation in trials. Specifically, patients treated in academic compared to community settings (aOR: 4.25, 95% CI: 3.33, 5.42) and patients with higher SES (aOR: 2.00, 95% CI: 1.29, 3.08) were more likely to participate. For both patients with mBC (aOR: 5.00, 95% CI, 3.87, 6.46) or mCRC (aOR: 7.91, 95% CI: 5.63, 11.10), those who received more than five treatment lines compared to only two treatment lines were more likely to participate in a trial. Conclusions: These real-world findings highlight disparities in participation in clinical trials of 2L and subsequent lines of treatment by age, race/ethnicity, practice type, and SES among patients with mBC or mCRC. Further policy efforts and interventions are needed to address systematic barriers to increase participation of underrepresented groups in clinical trials.[Table: see text]
Deep and Repeated Response to Trastuzumab Deruxtecan in a Patient With Human Epidermal Growth Factor Receptor 2–Amplified Large-Cell Neuroendocrine Carcinoma With Brain Metastases: A Case Report
Authors: Algarin-Perneth Sandra , Suleiman Riham , Abeykoon Jithma P. , Halfdanarson Thorvardur , Fuentes-Bayne Harry E. , Yi Joanne E. , Peikert Tobias , McGarrah Patrick W.
Published: October 2023

Metastatic CUP is complex, especially NCUP. Precision oncology is crucial for rare, aggressive cancers. A 54-year-old had HER2+ neuroendocrine carcinoma of unknown origin. T-DXd treatment, response, re-challenge show importance of genomics and caution.
The Prognosis of Glutamic Acid Decarboxylase Antibodies in Women With Hyperglycemia in Pregnancy
Authors: Cosson Emmanuel , Thioye Elhadji Mamadou Moussa , Tatulashvili Sopio , Vicaut Eric , Larger Etienne , Sal Meriem , Pinto Sara , Fabre Emmanuelle , Lalatonne Yoann , Sutton Angela , Nachtergaele Charlotte , Portal Jean-Jacques , Zerguine Mohamed , Carbillon Lionel , Bihan Hélène
Published: October 2023

Context

We recently reported that the presence of glutamic acid decarboxylase antibodies (GADA) was not associated with large-for-gestational-age infants in women with hyperglycemia in pregnancy (HIP).

Objective

We explored the association between the presence of GADA and other HIP-related adverse pregnancy outcomes.

Methods

This observational prospective study, conducted at a university hospital in a suburb of Paris, France, included 1182 consecutive women with HIP measured for GADA at HIP care initiation between 2012 and 2017. Post hoc analyses for outcomes included gestational weight gain, insulin therapy, cesarean delivery, hypertensive disorders, small-for-gestational-age infant, prematurity, and neonatal hypoglycemia.

Results

Of the 1182 women studied, 87 (7.4%) had positive (≥ 1 IU/mL) GADA. Although socioeconomic, clinical, and biological characteristics were similar across women in the positive and negative GADA groups, higher fasting plasma glucose values during early HIP screening were observed in the former (5.5 ± 1.5 vs 5.2 ± 0.7 mmol/L respectively, P < .001). At HIP care initiation, fructosamine levels were higher in women with positive GADA (208 ± 23 vs 200 ± 18 µmol/L; P < .05). In the homeostatic model assessment, insulin resistance (HOMA-IR) and beta secretion (HOMA-B) rates were similar in both groups. Gestational weight gain and the rates of all adverse outcomes were similar in both groups except for cesarean delivery (18.4 and 27.3% for positive and negative GADA, respectively; adjusted odds ratio 0.49 [95% CI, 0.26-0.92], P = .026).

Conclusion

Universal measurement of GADA in women with HIP highlighted that 7.4% had positive GADA. No association was observed between GADA and HIP-related adverse pregnancy outcomes, except a lower risk of cesarean delivery.
The Power of the Heterogeneous Stock Rat Founder Strains in Modeling Metabolic Disease
Authors: Wagner Valerie A , Holl Katie L , Clark Karen C , Reho John J , Lehmler Hans-Joachim , Wang Kai , Grobe Justin L , Dwinell Melinda R , Raff Hershel , Kwitek Anne E
Published: October 2023

Metabolic diseases are a host of complex conditions, including obesity, diabetes mellitus, and metabolic syndrome. Endocrine control systems (eg, adrenals, thyroid, gonads) are causally linked to metabolic health outcomes. N/NIH Heterogeneous Stock (HS) rats are a genetically heterogeneous outbred population developed for genetic studies of complex traits. Genetic mapping studies in adult HS rats identified loci associated with cardiometabolic risks, such as glucose intolerance, insulin resistance, and increased body mass index. This study determined underappreciated metabolic health traits and the associated endocrine glands within available substrains of the HS rat founders. We hypothesize that the genetic diversity of the HS rat founder strains causes a range of endocrine health conditions contributing to the diversity of cardiometabolic disease risks. ACI/EurMcwi, BN/NHsdMcwi, BUF/MnaMcwi, F344/StmMcwi, M520/NRrrcMcwi, and WKY/NCrl rats of both sexes were studied from birth until 13 weeks of age. Birth weight was recorded, body weight was measured weekly, metabolic characteristics were assessed, and blood and tissues were collected. Our data show wide variation in endocrine traits and metabolic health states in ACI, BN, BUF, F344, M520, and WKY rat strains. This is the first report to compare birth weight, resting metabolic rate, endocrine gland weight, hypothalamic–pituitary–thyroid axis hormones, and brown adipose tissue weight in these rat strains. Importantly, this work unveils new potential for the HS rat population to model early life adversity and adrenal and thyroid pathophysiology. The HS population likely inherited risk alleles for these strain-specific traits, making the HS rat a powerful model to investigate interventions on endocrine and metabolic health.
Police Whistleblowers, the Lamplighter Project, and Twitter: Exposing Misconduct and Corruption in American Law Enforcement
Authors: Teruelle Rhon
Published: October 2023

As a result of George Floyd's senseless killing, countless individuals took to the streets to protest. Coinciding with the protests, a number of police whistleblowers utilized social media to speak out about the transgressions and brutality that they had witnessed firsthand. For these individuals, social media provides a space to voice their concerns with law enforcement in America and is a place to tell their stories and critique the police. Moreover, social media empowers whistleblowers by allowing anonymity while affording a safe space for effective community building. This article is a case study involving seven whistleblowers interviewed by the author. Social media has become the primary communication tool they use to expose malfeasance and corruption in policing. The pervasive culture of law enforcement condemns any kind of vocal critique of policing, so social media functions in strong juxtaposition to the silencing of complaints, placing it in direct opposition to the thin blue line and the blue wall of silence. This article highlights the Lamplighter Project and Twitter as resources that assist police whistleblowers who speak out against wrongdoings perpetrated by other members of law enforcement.
Bound by the Commons of Death
Authors: Bhattacharya Debaditya
Published: October 2023

This article springs from a larger project attempting to rethink the university conceptually. It proceeds by resignifying the cardinal registers through which the public university may realize the meanings of its publicness—that is, in its relationship with community, secularity, solidarity, and freedom. The focus here is on the basic theoretical scaffolding for understanding how the university has historically addressed the claims of community. The groundwork for such theoretical reflections is provided by the current policy conjuncture in Indian higher education, faced as it is with a dangerous encounter with the anti–citizenship law protests in 2019–20 and the subsequent impact of the pandemic.
Hiding (from the Present) in the Past
Authors: Kleinberg Ethan
Published: October 2023

This intervention takes up the recent controversy over “presentism” in the historical discipline. It argues that the focus on “presentism” conceals and thus ignores a larger problem. The discipline of history has become misaligned with the task of historical representation in the public sphere.
Introduction
Authors: Huffman Kristin Love
Published: October 2023

As an urban portrait, Jacopo de’ Barbari’s View of Venice describes the city’s unique forma urbis as it celebrates Venice and its architectural monuments. The composite bird’s-eye view permits more of the city to be seen, and visual enhancements and optical alterations enliven and enrich a viewer’s observations. This introduction first moves through the volume’s plates to discuss the significance of detailed sites highlighted throughout the woodcut print. It then considers the two parts of the volume as broadly conceived, offering a succinct description of each scholarly contribution. While the first part contextualizes the View as an advanced product of the artistic, humanist, and scientific culture of the Renaissance world, the second part relates the urban systems and lived experiences of early modern Venice—its topographic idiosyncrasies; its social, political, and economic infrastructures; and its cosmopolitan residents. As the essays in this volume highlight, the portrait of Venice documents places and spaces and calls attention to its own artifice as a Renaissance masterpiece. At the same time, the View celebrates a distinctive city and its self-constructed identity.
A City as a World
Authors: Falchetta Piero
Published: October 2023

Chapter 2 argues that the View of Venice is surprisingly new compared to portraits of cities produced during the late fifteenth and early sixteenth centuries. In it, Venice is surrounded by the heads of the principal winds, a concept borrowed from the world maps of Ptolemy’s Geography, for which the heads encircling the Old World represent and indicate the cardinal directions. Similarly, the View depicts Venice as the fulcrum of the world—not only a city-world but the city-world of Renaissance Europe. The urban space of Venice is conceived as a realistic portrait of the city and as a metaphor for the space of geography; analysis of some peculiarities of the View reveals how the concept of Ptolemaic space influenced its making. For example, perceived errors in the apparent perspective view of the map can be linked to Ptolemaic geometry of a curved space projected on a flat surface.
An Artist's Address Book
Authors: Tagliaferro Giorgio
Published: October 2023

Considering that the author of the View of Venice was Venetian, the printed representation of the city can be understood as a reflection of its form in relation to its urban function, especially as experienced from within its confines. As a built-in citizen, the author is somewhat embodied in the image itself inasmuch as he conflates the topographical description with the representation of an idea of Venice as it emerges from his own lived experience. The View in its virtual spatial framework, therefore, encapsulates the transitive relationship between the artist and his habitat; it reflects the artist’s cultural capital. Based on a preliminary survey of the geographical distribution of figurative painters in Venice around 1500, chapter 4 presents methodological remarks about how we can investigate the interconnections between the urban configuration and socioeconomic networks, ones that could affect, either directly or indirectly, a painter’s creative activity.
Santa Lucia and Corpus Domini at the Turn of the Sixteenth Century
Authors: Weddle Saundra
Published: October 2023

The Venetian lagoon’s geography isolated the city’s earliest convent complexes, but over time, networks of bridges and calli ultimately wove these monastic houses into the urban fabric. In Venice, as in most Italian cities, almost all convents founded during the fifteenth and sixteenth centuries were sited around urban edges that were later filled in, although some were established within already densely developed areas, thereby altering the character of their neighborhood in significant ways. Focusing on the convents of Corpus Domini and Santa Lucia, which exemplify both foundation models, chapter 15 relies on archival documents, de’ Barbari’s View, and urban plans to examine neighborhood development, patterns of convent foundation, and architectural and urban adjacencies, revealing how the built environment shaped and was shaped by relationships between convent communities.
Two Palaces, a Chapel, and an Art Collection on the Grand Canal
Authors: Damen Giada
Published: October 2023

Domenico di Piero (1406–97) was a jeweler, an antiquarian, and a collector active in Venice during most of the fifteenth century. By the end of his life, he had amassed a huge fortune consisting of a collection of precious objects, cash, and real estate holdings. Chapter 19 establishes that archival documents attest to Domenico di Piero’s prominence in the city and shed light into his business dealings in Venice and throughout Europe with the most important collectors of the time. Jacopo de’ Barbari’s View of Venice, completed just a few years after Domenico di Piero’s death, clearly depicts the world in which the jeweler lived and worked. By following clues provided by archival documents, it is possible to accurately identify on the View the spaces in which Domenico’s life took place: his home, the private chapel he had built, and other architectural buildings he had commissioned during his lifetime.
Induced regeneration of articular cartilage – identification of a dormant regeneration program for a non-regenerative tissue
Authors: Lin Yu-Lieh , Yu Ling , Yan Mingquan , Zimmel Katherine , Qureshi Osama , Imholt Felisha , Li Tao , Ivanov Ivan , Brunauer Regina , Dawson Lindsay , Muneoka Ken
Published: October 2023

A mouse organoid culture model was developed to regenerate articular cartilage by sequential treatment with BMP2 and BMP9 (or GDF2) that parallels induced joint regeneration at digit amputation wounds in vivo. BMP9-induced chondrogenesis was used to identify clonal cell lines for articular chondrocyte and hypertrophic chondrocyte progenitor cells from digit fibroblasts. A protocol that includes cell aggregation enhanced by BMP2 followed by BMP9-induced chondrogenesis resulted in the differentiation of organized layers of articular chondrocytes, similar to the organization of middle and deep zones of articular cartilage in situ, and retained a differentiated phenotype following transplantation. In addition, the differentiation of a non-chondrogenic connective tissue layer containing articular chondrocyte progenitor cells demonstrated that progenitor cell sequestration is coupled with articular cartilage differentiation at a clonal level. The studies identify a dormant endogenous regenerative program for a non-regenerative tissue in which fibroblast-derived progenitor cells can be induced to initiate morphogenetic and differentiative programs that include progenitor cell sequestration. The identification of dormant regenerative programs in non-regenerative tissues such as articular cartilage represents a novel strategy that integrates regeneration biology with regenerative medicine.
Motor–Respiratory Coupling Improves Endurance Performance during Rhythmic Isometric Handgrip Exercise
Authors: LI ZHIBIN , LI WEI , LIN PING-JU , JIA TIANYU , JI LINHONG , LI CHONG
Published: October 2023

Purpose

This study aimed to evaluate whether motor–respiratory coupling exists in rhythmic isometric handgrip exercises and its effect on endurance performance. In addition, the mechanism underlying observed effects was to be investigated if higher motor–respiratory coupling rate could enhance endurance performance.

Methods

Eleven subjects completed three rhythmic isometric handgrip trials to task failure in a randomized manner. After one pretraining session to determine personal grip frequency, one trial was performed without respiration requirement (CON), and two trials were performed with inspiration–motor coupling (IMC) or expiration–motor coupling. Changes in maximal voluntary contraction (MVC) and EMG were used to measure neuromuscular fatigue. Force data during test were used to assess exercise intensity. Another 10 subjects completed electrical stimulation-induced finger flexion and extension during normal inspiration, normal expiration, fast inspiration, fast expiration, and breath holding. Force changes of different breathing conditions were compared.

Results

Normalized exercise time to exhaustion was significantly longer in IMC (1.27 ± 0.23) compared with expiration–motor coupling (0.82 ± 0.18) and CON (0.91 ± 0.18, P < 0.001). ΔMVC, grip frequency, force, and EMG indices were not different among conditions (all P > 0.05). Electrical stimulation-induced finger extensor force was significant higher during fast inspiration (1.11 ± 0.09) than normal respiration (1.00 ± 0.05) and fast expiration (0.94 ± 0.08, P < 0.05).

Conclusions

IMC is an effective way to improve endurance performance of rhythmic handgrip exercise. This is likely due to a reduction in the energy consumption of motion control, as evidenced by similar peripheral fatigue in different conditions and modulation of corticospinal excitability by respiration.
Obsession to fairness and topical steroid induced acne: A situation analysis of patients presenting in dermatology clinic at a private hospital in Karachi
Authors: Naureen Ghouse Afza , Ashraf Erum , Khan Zara Iqbal , Sidiqqui Sitwat
Published: October 2023

Objective: To determine the frequency of acne and other relevant side effects as well as the pattern of topical steroid and fairness cream use among patients presenting with steroid and fairness cream use at dermatology OPD in a tertiary care private hospital in Karachi.

Methods: A cross-sectional survey was conducted from April, 2020 to December, 2020 in a private tertiary care hospital in Karachi. In total, 226 patients with a positive history of topical steroids and/or fairness creams use in the past six months were included in the study. Information was collected about sociodemographic characteristics; topical corticosteroid uses while clinical examination of facial skin was performed by a dermatologist. Data were analyzed using SPSS version-19.

Results: The median age of study participants was 26 years with an interquartile range of 10 years. This frequency of corticosteroid induced acne was highest i.e., 83.6% (n=189) followed facial erythema and telangiectasia i.e., 50.9% (n=115) 47.8% (n=108) respectively. The estimated median duration of using topical steroids or fairness creams or both was six months with an IQR of four months. The study found statistically significant differences in the reasons of using topical corticosteroids or fairness creams on the face on the basis of differences in the level of education and marital status.

Conclusion: In Karachi, both, men and women are equally obsessed with fair skin tone and use topical steroids and fairness cream. The use of corticosteroid or fairness cream-induced facial acne is alarmingly high among patients presenting in a dermatology clinic in Karachi.

doi: https://doi.org/10.12669/pjms.40.1.7074

How to cite this: Ghouse AN, Ashraf E, Khan ZI, Sidiqqui S. Obsession to fairness and topical steroid induced acne: A situation analysis of patients presenting in dermatology clinic at a private hospital in Karachi. Pak J Med Sci. 2024;40(1):---------.  doi: https://doi.org/10.12669/pjms.40.1.7074

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reconstruction of soft tissue defects of hand: A systematic approach
Authors: Khan Mansoor , Hayat Waqas , Ullah Hidayat , Hayat Khan Nasir
Published: October 2023

Background and Objective: A thorough insight into the management of hand injuries can shape the approach of a surgeon in order to achieve optimal outcomes for the patients. The aim of this study was to share our experience in reconstruction of the hand and establishing an algorithm for classification and treatment of hand injuries.

Methods: This is a descriptive cross sectional study and was conducted from January 2020 to August 2022 at Burns and Plastic Surgery center, Peshawar. Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (<5cm), medium (5cm to 10 cm) and large (>10cm). The defect site and size was cross tabulated against the method of soft tissue reconstruction in order to make the algorithm for reconstruction of hand injuries. Data was analyzed using SPSS.

Results: The study population included 41 (75.9%) male and 13 (24.1%) female patients, mean age 31.56±14.1. Machine injuries (33.3%) and electric burns (24.1%) were the most common cause of hand soft tissue defects. The most commonly performed flap was Posterior introsseous artery (PIA) flap, followed by First dorsal metacarpal artery (FDMA) flap. Flap necrosis was observed in three cases (5.6%).

Conclusion: This treatment algorithm for coverage of soft tissue defects in hand injuries will help with the decision making process of hand reconstruction and has didactic value for novice surgeons. It will also form the foundation for further work on this aspect of hand injuries.

doi: https://doi.org/10.12669/pjms.40.1.7484

How to cite this: Khan M, Hayat W, Hidayat Ullah, Khan NH. Reconstruction of soft tissue defects of hand: A systematic approach. Pak J Med Sci. 2024;40(1):---------. doi: https://doi.org/10.12669/pjms.40.1.7484

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Recurrence of portosystemic encephalopathy in cirrhotic patients and its risk factors
Authors: Karim Masood , Bin Khalid Abdullah , Essani Zahabia Sohail , Mohammad Yasrab
Published: October 2023

Objectives: Recurrent episodes of Portal Systemic Encephalopathy (PSE), poses a significant burden of illness on the patients and healthcare system. The objective of this study was to assess the recurrence of PSE in cirrhotic patients after index episode of PSE and to identify various risk factors associated with it.

Methods: A retrospective, single-centre study was conducted at Aga Khan University Hospital over a span of one year. Patients who were admitted first time with PSE and admitted within three months of index PSE were enrolled in the study. Variables assessed were demographic data, associated comorbid conditions, aetiology of cirrhosis, Child-Turcotte-Pugh (CTP) score, Model of End-Stage Liver Disease (MELD) score, PSE grade, laboratory tests, ascites with spontaneous bacterial peritonitis (SBP), variceal bleeding. Statistical analysis was done and variables of those who developed recurrence were compared with those who did not.

Results: Fifty one patients were recruited. Thirty three (64.7%) were readmitted with PSE. On comparative analysis of both groups; infection, Meld score, low albumin, and raised total bilirubin showed significant P-value (<0.05).

Conclusion: Identification of risk factors during assessment can reduce the recurrence of PSE. We would recommend to validate result of our study on a large scale prospectively.

doi: https://doi.org/10.12669/pjms.40.1.8025

How to cite this: Karim MM, Khalid AB, Sohail Z, Yasrab M. Recurrence of portosystemic encephalopathy in cirrhotic patients and its risk factors. Pak J Med Sci. 2024;40(1):---------. doi: https://doi.org/10.12669/pjms.40.1.8025

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Mediators of Periodontitis complementing the development of Neural Disorders
Authors: Ayesha Sadiqa  , Khalid Khan Munsara
Published: October 2023

As a common oral health concern, periodontitis has been a source of attention for the global health community because of its linkage with systemic and neurological diseases. The purpose of the present study is to reveal the mediating role of specific cytokines, neuropeptides, and pathogens in the association of chronic periodontitis and neural disorders. To find the related literature different search engines namely PMC, Science Direct, PubMed, Research Gate, and Google Scholar were explored for a study period of five months from October 2022 to February 2023. This review offers a summary of those neuronal diseases that were more related to human behaviors in association with chronic periodontitis. Those neuronal pathologies mainly included Alzheimer’s disease, psychosis, stress, anxiety, dementia, Alzheimer’s, major depressive disorder, and diabetic peripheral neuropathy, which may otherwise remain subside or even control in the absence of chronic periodontitis and its mediators. Specifically, periodontitis related specific cytokines i.e. IL-6, IL-1, Tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), and alpha1-antichymotrypsin, neuropeptides such as insulin-like growth factor-2 (IGF-2), neuropeptide Y, substance P, neurokinin A, calcitonin gene-related peptide (CGRP), and vasoactive intestinal polypeptide (VIP), and a polybacterial pathogenic consortium of porphyromonas gingivalis, tannerella forsythia, and treponema denticola, were involved in the mediation and exacerbation of the associated neuronal cognitive pathologies.

doi: https://doi.org/10.12669/pjms.40.1.8097

How to cite this: Sadiqa A, Khan MK. Mediators of Periodontitis complementing the development of Neural Disorders. Pak J Med Sci. 2024;40(1):---------. doi: https://doi.org/10.12669/pjms.40.1.8097

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.