bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between endothelial dysfunction and occurrence of no-reflow in patients undergoing post-thrombolysis early invasive percutaneous intervention for ST-elevation myocardial infarction
Authors: Elbendary Mohamed Abdel Wahab , Saleh Mohamed Ayman , Sabet Sameh Saleh , Bastawy Islam
Published: September 2022

Background

Endothelial dysfunction and no-reflow share microcirculatory obstruction as a common pathophysiological mechanism. This study evaluated the relationship between systemic peripheral endothelial dysfunction assessed by flow-mediated dilatation (FMD) of the brachial artery and no-reflow in patients with ST-segment elevation myocardial infarction (STEMI) who received successful fibrinolysis.

Results

This study included 150 patients managed by the percutaneous coronary intervention (PCI) after successful fibrinolysis. Patients were divided according to coronary angiographic success into normal flow versus no-reflow groups. According to FMD measured through brachial artery ultrasound, patients were divided based on their endothelial function into endothelial dysfunction versus normal endothelial function. No-reflow occurred in 44 patients (29.3%). No-reflow patients had longer pain to door time (6.52 ± 1.82 vs 5.19 ± 1.85 h), more Killip class II (36.4% vs 16%, p = 0.006), and lower FMD (7.26 ± 1.92 vs 8.23 ± 2.76%, p = 0.036). Also, they showed more endothelial dysfunction; however, this difference was statistically nonsignificant (97.7% vs 87.7%, p = 0.055). One hundred and thirty-six patients (90.7%) had endothelial dysfunction. They were older (57.51 ± 5.92 vs 50.86 ± 4.55 years, p value ≤ 0.001), more smokers (41.2% vs 14.3%, p = 0.04). Patients with normal endothelial function had a more myocardial blush grade (MBG) 3 (78.6% vs 26.5%, p value = 0.001) in comparison with more MBG 2 in those with endothelial dysfunction (41.9% vs 14.3%, p value = 0.001). Endothelial dysfunction patients had nonsignificant more no-reflow (31.6% vs 7.1%, p-value: 0.06). There was a significant weak positive correlation between thrombolysis in myocardial infarction (TIMI) flow and FMD (r = 0.174, p = 0.033) and a significant moderate positive correlation between MBG and FMD (r = 0.366, p < 0.001). Patients with TIMI I flow had significantly lower FMD compared with patients with TIMI II and TIMI III flow post-PCI. FMD ≤ 6% could predict post-procedural TIMI I flow.

Conclusions

In STEMI patients who underwent PCI within 24 h after successful fibrinolysis, those who had no-reflow showed worse peripheral systemic endothelial function as they had lower brachial artery FMD. Also, FMD showed a significant positive correlation with the post-procedural angiographic flow (TIMI flow and MBG). FMD ≤ 6% could predict TIMI I flow.
Air pollution and public health in Latin America and the Caribbean (LAC): a systematic review with meta-analysis
Authors: Husaini Danladi Chiroma , Reneau Kyle , Balam Daren
Published: September 2022

Background

Over the years, air pollution has garnered increased attention from researchers who continue to provide studies and suggestive data that prove there is an ever-increasing risk of air pollution on the health of humans, terrestrial, and aquatic animals. A measurement involved in the quantity of certain traceable particles within the air, namely: Particulate Matter (PM) 2.5 and 10, ozone (O3), Nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO) emissions, all converted to Air Quality Index. Most studies are predominantly from developed nations with limited research conducted in developing nations such as those in Latin America and the Caribbean.

Main body

In this systematic review, we examined the impact of air pollution on public health. A database search produced 1,118 studies, of which four were selected for a quantitative meta-analysis that explored hazard ratios concerning exposure to elevated levels of PM2.5. The meta-analysis results show that exposure to PM2.5 increases the risk of an adverse health event by as much as 2% five days after exposure. Results also indicated a consensus on the negative impacts of air pollution on public health. The results also suggest that more can be done within the region to combat or at the very least minimize the impact of air pollution to public health.

Conclusion

The pooled data from the studies reviewed show that there is an increased risk of an adverse health event on the day of exposure to PM2.5 and every subsequent day after exposure. A pattern exists between hospitalization and air pollution due to increased susceptibility to respiratory infections and asthma development. Combating the harmful effects of air pollution should be a top priority in Latin America and the Caribbean.
Management research and the impact of COVID-19 on performance: a bibliometric review and suggestions for future research
Authors: Appiah Kingsley Opoku , Addai Bismark , Ekuban Wesley , Aidoo Suzzie Owiredua , Amankwah-Amoah Joseph
Published: September 2022

Although there has been a burgeoning scholarly interest in the effects of COVID-19, the current stream of research remains scattered in different business and management fields and domains. Accordingly, integrative knowledge is needed to drive poignant and relevant examinations of the phenomenon. This study attempts to fill this gap by providing a synthesis of the literature, patterns of research studies, and direction for further development of the field. This study also provides a systematic identification and bibliometric and thematic review of literature, performance analysis, science mapping, and cluster analysis. The study additionally provides suggestions for future research to guide relevant discourse.
Online sales adoption and financial resilience in Sub-Sahara Africa: the moderating role of ownership and enterprise size during Covid-19 crisis
Authors: Forson Joseph Ato , Gadzo Samuel Gameli , Anaman Emmanuel Atta , Adams Abass
Published: September 2022

It is an established fact that the Covid-19 pandemic had a persistent economic uncertainty effect than health uncertainty. In this study, the researchers examined the effects of expanding sales online on the financial resilience of enterprises in sub-Sahara Africa (SSA) during the economic downturn. The researchers measured financial resilience by the extent of sales and cash-flows decline during the pandemic. The researchers collected 4751 unweighted data from the World Bank’s Enterprise Survey and it Covid-19 follow-up survey. Findings from the bivariate probit model and the predictive margin probabilities showed that most enterprises in SSA adopted or expanded proportion of sales online during the pandemic. Increasing the proportion of online sales exerted a decreasing effect on sales and cash-flow declines and thus improved financial resilience at a threshold of 40% during the pandemic. Large enterprises were observed to be more resilient than small and medium enterprises, yet domestic and foreign enterprises had the same level of financial resilience during the pandemic. For enterprises in Africa to realise the 40% threshold of online sales, the researchers encourage enterprises to invest in advertisement for product legitimacy.
Novel electrodiagnostic provocative techniques for the diagnosis of suspected tarsal tunnel syndrome
Authors: Hasab ElNaby Mona M. , Abdel Rahman Amr Farouk , Ibrahim Rehab Ali
Published: September 2022

Background

Electrodiagnostic tests  (EDXTs) have been considered the gold standard method for the diagnosis of tarsal tunnel syndrome (TTS); however, definitive tests has not yet been discovered. Our aim was to develop new nerve conduction provocative techniques in the double and single leg stance as well as combined ankle dorsiflexion with foot eversion accompanied by compression for the diagnosis of suspected TTS.

Results

Routine combined nerve conduction studies (NCSs) using medial plantar (MP) and lateral plantar (LP) nerves had a 60.9% sensitivity for the diagnosis of TTS. The diagnostic sensitivity increased when combining the three novel tests reaching 82.6% and 78.3% using either MP or LP NCSs respectively. The diagnostic sensitivity further increased to reach 100% when combining the MP and LP novel NCSs considering either the latency or amplitude.

Conclusion

The full diagnostic sensitivity for TTS reached 100% by using a battery of novel tests. The proposed diagnostic workup by this study recommends using these biomechanically challenging tests to complete the diagnostic battery of tests especially in symptomatic patients with negative routine tests.
Home design features post-COVID-19
Authors: Alhadedy Nancy H. , Gabr Hisham S.
Published: September 2022

The long stay at home during the COVID-19 pandemic implied that most people had to perform all their daily activities at home. That raised the need for special home features related to the health, safety, and well-being of residents. This study aimed to explore the most essential features of home design during the pandemic and to measure the perception of their importance by Cairenes (Egypt) and construction industry experts for their further implementation in the future home design as part of the buyers’ preferences and house quality features. The study employed an exploratory survey, identifying eight design features, followed by a quantitative questionnaire to measure the importance of each feature among the stakeholders. The results showed that all eight indicators were of a certain degree of importance. It was found that the availability of natural ventilation and natural light were the most essential features, followed by the availability of a private outdoor space, such as a terrace with a good-looking view or a private garden, and the availability of at least one bedroom with an enclosed bathroom for the isolation needs. In contrast, the availability of an extra storage space for food and supplies, as well as the availability of an indoor family entertainment space was reported as the least important.
Prediction of Adverse Pathology at Radical Prostatectomy in Grade Group 2 and 3 Prostate Biopsies Using Machine Learning
Authors: Paulson Nathan , Zeevi Tal , Papademetris Maria , Leapman Michael S. , Onofrey John A. , Sprenkle Preston C. , Humphrey Peter A. , Staib Lawrence H. , Levi Angelique W.
Published: September 2022

PURPOSE

There is ongoing clinical need to improve estimates of disease outcome in prostate cancer. Machine learning (ML) approaches to pathologic diagnosis and prognosis are a promising and increasingly used strategy. In this study, we use an ML algorithm for prediction of adverse outcomes at radical prostatectomy (RP) using whole-slide images (WSIs) of prostate biopsies with Grade Group (GG) 2 or 3 disease.

METHODS

We performed a retrospective review of prostate biopsies collected at our institution which had corresponding RP, GG 2 or 3 disease one or more cores, and no biopsies with higher than GG 3 disease. A hematoxylin and eosin–stained core needle biopsy from each site with GG 2 or 3 disease was scanned and used as the sole input for the algorithm. The ML pipeline had three phases: image preprocessing, feature extraction, and adverse outcome prediction. First, patches were extracted from each biopsy scan. Subsequently, the pre-trained Visual Geometry Group-16 convolutional neural network was used for feature extraction. A representative feature vector was then used as input to an Extreme Gradient Boosting classifier for predicting the binary adverse outcome. We subsequently assessed patient clinical risk using CAPRA score for comparison with the ML pipeline results.

RESULTS

The data set included 361 WSIs from 107 patients (56 with adverse pathology at RP). The area under the receiver operating characteristic curves for the ML classification were 0.72 (95% CI, 0.62 to 0.81), 0.65 (95% CI, 0.53 to 0.79) and 0.89 (95% CI, 0.79 to 1.00) for the entire cohort, and GG 2 and GG 3 patients, respectively, similar to the performance of the CAPRA clinical risk assessment.

CONCLUSION

We provide evidence for the potential of ML algorithms to use WSIs of needle core prostate biopsies to estimate clinically relevant prostate cancer outcomes.
Optimizing outpatient oncology consult workflow using time-driven activity-based costing: Efficiency and financial impacts.
Authors: Weng Julius , Mesko Shane , Das Prajnan , Chronowski Gregory , Lee Percy , Choi Seungtaek , Koong Albert C. , French Katy E. , Aloia Thomas A. , Ehlers Richard A. , Elrod-Joplin Dorothy , Kerr Ashley , Smith Regina , Martinez Wendi , Shah Shalin J. , Ning Matthew S. , Herman Joseph M. , Moningi Shalini , Moreno Amy Catherine , Nguyen Quynh ,   The MD Anderson TDABC Initiative
Published: September 2022

9

Background: Clinical efficiency is a key component of value-based healthcare, patient satisfaction, staff burnout, and institutional operational capacity. The objective of this study was to identify clinic inefficiencies using time driven activity-based costing (TDABC) and evaluate the implementation of a new clinical workflow in high volume, outpatient radiation oncology clinics. Methods: We conducted an IRB-approved quality improvement study in the Gastrointestinal (GI), Genitourinary (GU), and Thoracic Radiation (TRO) Oncology departments at a large academic cancer center and four additional network sites (HALs). TDABC methodology was used to create process maps and optimize consult workflow. Patient encounter metrics were captured utilizing a real-time status function in the electronic medical record (Epic Systems). Anonymous patient satisfaction telephone surveys were administered to patients at the HALs. Hourly wages were determined based on 2021 U.S. Bureau of Labor Statistics. Pre- vs post-implementation metrics were compared using the Mann-Whitney U test. Results: Consult data for 1328 patients pre-intervention and 1234 post-intervention across all sections was included. Median overall cycle time was reduced by 21% in GI (19 min, p < 0.001), 18% in GU (16 min, p < 0.001), and 12% in HALs (9 min, p < 0.001). The median interval between rooming and being seen by the attending physician decreased by 13% in GI (7 min, p < 0.001), 16% in GU (9 min, p < 0.001), 21% in TRO (10 min, p < 0.001), and 9% in HALS (4 min, p < 0.005). For each consult, there was a median financial savings of $29 for GI, $24 for GU, $5 for TRO, and $14 for HALs per consult. From patient satisfaction surveys (95/177), 99% of patients reported their providers spent adequate time with them, 85% reported their appointment began on time, and 91% reported being seen by a care provider in a timely manner. Conclusions: TDABC is a successful method to identify opportunities to improve clinical efficiency. Implementing workflow changes based upon these findings led to substantial reduction in overall encounter cycle times and patient wait times across multiple departments. Furthermore, patient satisfaction was high and there were significant financial savings with the new workflow. These findings may also have implications for reducing staff burnout and expanding clinical capacity across the magnitude of clinical enterprise.[Table: see text]
Cost-of-care analysis between patients with cancer with COVID-19 utilizing a remote patient-monitoring program versus usual care.
Authors: Pritchett Joshua , Khera Nandita , Moriarty James P. , Dholakia Ruchita , Haddad Tufia C. , Borah Bijan J.
Published: September 2022

26

Background: We previously demonstrated that utilization of a Remote Patient Monitoring (RPM) program – characterized by the use of in-home technology for symptom and vital signs assessments with a centralized care team responding to alerts – is associated with a significant reduction in 30-day hospitalization rate among cancer patients with COVID-19. We have subsequently performed a 90-day comparative cost-of-care analysis in this prospectively enrolled, validated cohort of 71 patients who received RPM and 116 patients who received usual care without RPM. Methods: Primary outcomes included 90-day all-cause costs (categorized as hospital and outpatient costs) following the index date (date of COVID-19 diagnosis). Differences in patient characteristics and baseline costs (incurred 90 days prior to index date) were determined using Standardized Differences and controlled for using Inverse Probability Weighting (IPW). IPW balancing was based on baseline covariates known to be associated with poorer COVID-19 outcomes, as previously described. Association of costs with RPM was examined by generalized linear modeling while adjusting for relevant variables. Outcomes are reported as the average treatment effect on the treated (ATET). Results: Differences in patient characteristics and baseline costs were well-balanced following IPW modeling. The index ATET was found to be comparable among patients receiving RPM and usual care on the date of COVID-19 diagnosis -$89.75 (95% CI: -$144.33 to $323.84; p = 0.452). However, patients receiving RPM experienced a 90-day ATET of -$6,994 (95% CI: -$14,635 to $646; p = 0.073) when compared with patients receiving usual care. Conclusions: There was a trend towards decreased 90-day all-cause costs for cancer patients with COVID-19 who utilized the RPM program as compared with usual care. Larger studies are needed to understand the true cost (and cost savings) associated with this innovative model of care delivery which can be leveraged for cancer care beyond COVID-19.
Characterization of an embedded clinical oncology pharmacy model across the State of Michigan.
Authors: Mackler Emily R. , Wietzke Julie , Schwartz Ashley , Young Katie , Reyes-Gastelum David , Griggs Jennifer J. , Choe Hae Mi , Farris Karen B.
Published: September 2022

58

Background: The oncology pharmacist role has evolved to address implications of newer cancer therapies by increased integration in direct patient care and management of cancer therapy side effects and adherence. Despite the ability of oncology pharmacists to provide high-value, high-quality care to patients with cancer, it remains difficult for community oncology practices to justify the cost of the pharmacist. The purpose of this study is to characterize a model, Pharmacists Optimizing Oncology Care Excellence in Michigan (POEM), that supports the integration of clinical oncology pharmacists into community practices via financial support to the practices, clinical support to the pharmacist team, and outcomes assessment. The results will provide insight into how pharmacists support patient care and how to substantiate a pharmacist in practices. Methods: This multicenter, retrospective analysis was conducted between October 2020 – March 2022. POEM pharmacists received support in the development of collaborative practice agreements, billing guidance, and ongoing oncology continuing education. Practices received support via a percentage of salary support for the pharmacist the first 3 years and value-based reimbursement for participation. A standardized method for collecting patient demographics, pharmacist encounter characteristics, and intervention information was created via RedCap. Patients receiving care by the pharmacist were provided a 4-item survey to rate their experience. Results: As of March 2022, POEM has 6 clinical oncology pharmacists representing 8 physician organizations, 24 oncology clinics, and 72 physicians. 1944 patients have been seen via 4296 encounters and 4380 interventions. 49% of patients were female, 93% white, and 74% > 60 years. The primary reasons for pharmacist care were treatment with oral anticancer agents (OAA) (52%), non-immunotherapy IV (22%), and immunotherapy (20%). Pharmacists recorded an average of 77 patient encounters/week over the last year and 108/week over the past quarter. 47% of these encounters were billed using care management codes. Additionally, pharmacists recorded an average of 82 interventions/week over the past year and 101/week over the last quarter. Interventions were Education and Referrals (49%), Medication Modification (24%), and Comprehensive Medication Review or Medication Reconciliation (20%). Patients were satisfied with the pharmacists’ care and felt it was important to meet with a pharmacist before beginning their cancer treatment. Conclusions: Early results indicate positive patient experiences from education sessions and medication interventions to improve patient symptoms. Future outcome analyses will quantify the return on investment of clinical pharmacist integration into oncology community practices by measuring pre- and post-intervention healthcare utilization and patient clinical outcomes.
Racial and ethnic disparities in the cervical cancer screening cascade in three U.S. health care settings.
Authors: Spencer Jennifer C. , Kim Jane , Wang Lei , Tiro Jasmin A. , Feldman Sarah , Kamimeni Aruna , Skinner Celette Sugg , McCarthy Anne Marie , Haas Jennifer
Published: September 2022

109

Background: There are wide disparities in cervical cancer incidence and mortality in the US by race and ethnicity. Our objective was to characterize racial and ethnic differences in routine cervical cancer screening and follow-up of abnormal findings across three US healthcare settings. Methods: We used 2016 to 2019 data from three sites participating in the METRICS research center, part of the PROSPR II consortium. We evaluated screening among average risk, screen-eligible patients receiving care at participating sites, by race and ethnicity as captured in the EHR. Among patients with a high-risk abnormal finding, we evaluated the proportion receiving colposcopy or biopsy within six months. We conducted multivariate regression to assess the extent to which clinical, socioeconomic, and structural characteristics mediate observed differences in screening. Results: We identified 188,415 eligible patients; 74.6% received cervical cancer screening during the 3-year study window. Screening use was lower among non-Hispanic Black (66.8%) patients and higher among Hispanic (82.5%), Asian/Pacific Islander (75.8%) patients, and those who identified as multi-racial or “other” race (75.8%) compared to non-Hispanic White (71.4%) patients. In multivariate regression, most differences were explained by the distribution of patients across sites, with the lowest screening rate observed at the site caring for the majority of both Black and Hispanic patients. However, Hispanic patients remained more likely to be screened even after controlling for a variety of clinical and sociodemographic factors (Risk Ratio: 1.14 [1.12, 1.16]). Among those receiving a screening test, Black and Hispanic patients were more likely to receive Pap-only testing (vs. HPV DNA co-testing) compared to non-Hispanic White patients and were more likely to have abnormal findings. Follow-up from abnormal results within six months was low for all groups (68.7%) but highest among Hispanic participants (77.7%). Conclusions: In a large cohort of patients receiving care in three community settings, cervical cancer screening and follow-up were lower than national targets. Lower screening for Black women is strongly driven by insurance and site of care, underscoring the value of addressing systemic inequity. More research is needed to characterize the relatively higher screening for Hispanic women, which is not explained by observed individual or systemic factors. Additionally, it is crucial to focus on follow-up after abnormalities are identified, which is low for all populations.
Palliative care utilization in metastatic prostate cancer: An analysis of the National Cancer Database.
Authors: Wu Xinxin , Swedek Michelle , Malouff Timothy Dean , Silberstein Peter T.
Published: September 2022

202

Background: Prostate cancer is one of the most prevalent cancers among males with an increasing incidence rate since 2007. Bone metastases are commonly associated with prostate cancer. Prostate cancer patients with painful bone metastases can be treated palliatively with external radiation being the standard of care. The role of palliative care can be beneficial in metastatic prostate cancer given its largely incurable course even after intensive multimodal therapy. There has yet to be a study that explores the impact of race, insurance status, education level, facility type, rural/urban geography, and income level on the overall utilization of palliative care for the cancer, the palliative treatment the patients were more likely to receive based on the different demographic variables, and the palliative care disparity between socioeconomic groups. Methods: This is a retrospective study of adults diagnosed with all subtypes of AJCC staged metastatic prostate cancer between 2004 and 2017 in the National Cancer Database (NCDB) to determine palliative care usage (n = 64,268). Demographic factors were studied in relation to the receipt of palliative care. Cross tabulation analysis was performed and evaluated using Pearson Chi-Square and ANOVA tests. Kaplan-Meier curves were utilized to calculate survival probabilities with log-rank analysis. Exclusion criteria included concurrent tumors and missing data. Results: Approximately 15.8% of the patients diagnosed with metastatic prostate cancer received palliative care (10180/64268). The number of cases diagnosed has grown every year between 2004 (n = 2140) and 2017 (n = 6,961). The same pattern was seen for palliative care usage in these patients (n = 352 in 2004 and n = 1325 in 2017). The patients that did not receive palliative care were older (71.3 vs 70.7, range 40-90+, p < 0.001). The patients who did receive PC were more likely to be non-Hispanic (94.6%, p < 0.001), white (78.6%, p < 0.001) patients at a comprehensive community cancer program (40.9%, p < 0.001). Palliative care was more likely utilized in rural settings (2% vs 1.6%, p < 0.001), higher Charlson-Deyo score (0.41 vs 0.38, p < 0.001), all facility locations excluding Mountain or Pacific, lower levels of high school degree attainment, lower overall survival, and those in age groups ranged 40-49, 50-59, and 60-69. There was no statistical significant difference in great circle distance between those that utilized palliative care and those that did not. Conclusions: We identified trends among patients receiving palliative or not. Factors that were correlated with palliative care usage included race, Charlson-Deyo score, treatment facility type, region, education level, rural setting, and specific age groups. As palliative care continues to be utilized more frequently, we hope that this study can serve as a useful baseline for preventing disparities in care.
Improving comprehensive genotyping in patients with newly diagnosed non-squamous NSCLC: Results from a prospective trial of a behavioral nudge intervention.
Authors: Aggarwal Charu , Carpenter Erica L. , Scholes Dylan G. , Hwang Wei-Ting , McWilliams Tara , Singh Aditi Puri , Sun Lova , Kosteva John A. , Costello Michael Robert , Doucette Abigail , Gabriel Peter Edward , Roy Megan , Martella Anthony O. , Thompson Jeffrey C. , Cohen Roger B. , Langer Corey J. , Shulman Lawrence N. , Marmarelis Melina Elpi
Published: September 2022

362

Background: Despite current guidelines, less than 50% of patients with metastatic (m) non-squamous (NSq) NSCLC undergo comprehensive molecular genotyping. At our institution, based on improved comprehensiveness of genotyping with use of concurrent tissue (T) and plasma (P) next generation sequencing (NGS), we designed an electronic medical record (EMR)-based nudge intervention to auto-generate an order for P NGS at the time of initial consultation, while T NGS was carried out reflexively based on institutional pathways. Methods: A prospective study was conducted at the Abramson Cancer Center and 2 community sites within the University of Pennsylvania Health System after IRB approval. A provider team-focused EMR-based nudge intervention was designed to order P NGS at the time of new patient consultation. Eligible patients for the nudge were identified using an EMR based checklist, that included 3 criteria i. newly diagnosed, ii. treatment naïve, iii. mNSq NSCLC. Results from the intervention period (4/2021-12/2021) were compared to baseline data from similar patients treated at our institution between 01/2019 and 03/2021. Categories of NCCN guideline recommended molecular genotyping were defined as: i) comprehensive: EGFR, ALK, BRAF, ROS1, MET, RET, NTRK testing, and ii) incomplete or no testing performed. The proportion of patients with comprehensive molecular genotyping prior to 1st-line therapy were compared in the pre- and post-intervention groups using the chi-square test. Results: 526 patients with mNSq NSCLC were included in this analysis: 381 in the pre-intervention cohort, 145 in the post-intervention cohort. After implementation of the EMR-based nudge, a higher proportion of patients underwent concurrent T+P testing resulting in improved comprehensive molecular genotyping. In addition, a greater proportion of patients had comprehensive genotyping available prior to 1st-line therapy in the post-intervention vs pre-intervention cohort (Table). Conclusions: Across 3 practice sites, a provider team-focused EMR-based nudge intervention was associated with a significantly higher proportion of patients with mNSq NSCLC undergoing comprehensive molecular genotyping, both overall and prior to 1st-line therapy. These findings demonstrate that behavioral, EMR-based nudges can promote guideline concordant diagnostic testing at both community and academic sites and should be studied further as a tool to improve rates of molecular testing in NSCLC.[Table: see text]
Variation in patient demographics across different modalities of tele-oncology.
Authors: Rodgers Thomas David , Burningham Zachary , Halwani Ahmad Sami , Kelley Michael J. , Passero Vida Almario
Published: September 2022

394

Background: TeleOncology encompasses the delivery of care virtually though modalities such as electronic consultation (e-consult), telephone and video visits. The National TeleOncology (NTO) program was created by Veterans Affairs (VA) to address growing disparities in care across the VA network. Through NTO, subspecialty hematologists/oncologists can provide recommendations and care for patients located at VA centers across the county. We aimed to investigate differences in patient utilization of available forms of TeleOncology. Methods: NTO was started in 2020 and offers virtual care to over 20 VA sites. Patient visits were catalogued across different forms of TeleOncology including telephone, e-consult (chart review only), VA Video Connect (VVC, synchronous video visit with patient at home), and Clinical Video Telehealth (CVT, synchronous video visit with patient at local VA). Total and unique patient encounters were analyzed based on patient age, gender, race, care assessment need (CAN) score (predictor for identifying patients at high-risk for poor outcomes), and patient rurality. Modalities of telehealth were then compared. Results: 3008 unique patients and 5921 encounters were recorded (October 2019-May 2022). The majority of patients accessed care by CVT visit (n = 1915). Patient characteristics were statistically different between the modes of TeleOncology. Patients participating in CVT were older (Mean 70.5 (95% CI 69.97-70.97) vs 65.5 years old (95% CI 64.62-66.68) and had higher CAN scores (mean score 82 (95% CI 80.96-82.74) vs 69 (95% CI 66.76-70.74)), compared to patients assessed through e-consult. Conversely black and female patients were overrepresented in the e-consult group compared to the CVT group (Table). Patients receiving care by telephone were more often located in a rural or highly rural region compared to those seen through VVC (71.5% vs 52%). Conclusions: The NTO program offers unique insights into utilization patterns of different forms of virtual care. Patient characteristics were not similar across the e-consult, telephone, and video visit groups. Importantly racial and gender disparities were noted, with African American and female patients, being disproportionately cared for through chart review only compared to a video visit. These results represent a first step in understanding how patients’ interface with virtual care modalities. Future studies could investigate how patient and system factors might influence observed patterns.[Table: see text]
Real-world versus clinical trial CAR T outcomes among patients diagnosed with diffuse large B-cell lymphoma.
Authors: McBride Kaitlyn , Snyder Sophie
Published: September 2022

413

Background: Chimeric antigen receptor (CAR) T cell therapy is a high-value innovative therapy for patients diagnosed with diffuse large B cell lymphoma (LBCL). The Federal Drug Administration (FDA) has approved three CAR T-cell therapies for these patients: axicabtagene ciloleucel, tisagenlecleucel and liso-cel. Data on real-world survival and adverse events (AEs) among Medicare beneficiaries receiving CAR T is limited. This study aims to compare real-world CAR T outcomes to clinical trial results. Methods: Retrospective cohort analysis using CMS 100% Medicare Fee-for-Service (FFS) Inpatient (Part A) and Outpatient (Part B) claim files. The database contains information on inpatient and outpatient diagnoses based on the International Classification of Diseases 10th Revision-Clinical Modification (ICD-10-CM). Inpatient files were used to identify Medicare FFS beneficiaries with LBCL diagnosis (ICD-10-CM code C83.3) who received inpatient CAR T procedure between January 2020 and March 2021. Demographic characteristics (age & sex), 12-month survival, and AEs were identified and compared to outcomes from three CAR T clinical trials (tisagenlecleucel: JULIET; axicabtagene ciloleucel (axi-cel): ZUMA-1; and lisocabtagene maraleucel (liso-cel): TRANSCEND NHL 001). Results: The real-world cohort (RW pts) consisted of 463 Medicare FFS beneficiaries with LBCL who were administered CAR T cell therapy inpatient between January 2020 and March 2021. A higher proportion of RW pts were aged 65 or older compared to clinical trial patients, and a lower proportion of RW pts were male (57% vs 65%). Overall, fewer RW pts experienced cytokine release syndrome (CRS) and anaemia compared to patients across the clinical trials (Table). Other common AEs, including neutropenia, fatigue, and thrombocytopenia, occurred at lower rates among RW pts compared to rates in the axicabtagene ciloleucel and liso-cel clinical trials. Survival at 12-months was comparable between RW pts and clinical trial patients. Conclusions: Study findings suggest that real-world occurrence of common AEs following inpatient CAR T administration, including CRS and anaemia, are lower compared to clinical trial outcomes. Real-world evidence of CAR T is critical for understanding real-world benefit, safety, and value of novel therapies.[Table: see text]
Development of an mHealth app integrating pain-cognitive behavioral therapy and opioid support for patients with advanced cancer (STAMP+CBT).
Authors: Azizoddin Desiree Rachel , Anderson Kris-Ann S. , Baltazar Ashton Riley , Beck Meghan R , Tulsky James A. , Edwards Robert R. , Businelle Michael , Enzinger Andrea Catherine
Published: September 2022

418

Background: Pain affects 40-90% of patients with advanced cancer. Supplementing pharmacologic therapy with behavioral skills may improve pain outcomes. We sought to evaluate patients’ perspectives of a pain-cognitive behavioral therapy (CBT) mobile health intervention for cancer pain. Methods: We recruited patients from the Dana-Faber Cancer Institute outpatient palliative care clinic to review the pain-CBT mHealth intervention. Eligible patients were >21 years old, had an incurable solid malignancy, chronic pain related to cancer, and were using opioids for cancer. We excluded hospitalized patients and those with pain from a recent surgery, dementia/delirium, or an opioid use disorder. In individual, qualitative interviews patients reviewed pain-CBT content modified for advanced cancer and mHealth delivery, and provided feedback on the relevance of the content in the context of their own pain. Results: Patients (n = 14) reviewed pain-CBT app content and wireframes. Most rated the content and user interface as highly usable, informative, aesthetically pleasing, convenient, and relevant to their experiences. Suggested improvement included revising technical content to increase clarity/reduce literacy, shortening length of texts, and including additional tracking for daily opioid use. Six subthemes regarding patients’ current pain management approaches were identified. Individuals endorsed using physical coping skills including engaging in physical activity and at times struggling to recognize physical limits. Many endorsed utilizing psychological coping such as accepting their pain, reframing thoughts about pain, and using distraction or relaxation to cope. Social support was relevant to coping for almost all patients, and many described COVID-19 distancing guidelines as disruptive. Patients endorsed complex relationships with opioids including guilt related to use or difficulty understanding prescription instructions. Most patients emphasized the relationship between sleep, stress, and pain as central to their pain management, and that they wished their clinicians reviewed the relationship between pain and stress earlier. Conclusions: MHealth delivery was viewed as an attractive method to both integrate and deliver behavioral pain management skills with opioid support to alleviate cancer pain. A future pilot study will evaluate the app’s feasibility and acceptability in patients with advanced cancer.
Aldosterone, Renin, and Aldosterone-to-Renin Ratio Variability in Screening for Primary Aldosteronism
Authors: Ng Elisabeth , Gwini Stella May , Libianto Renata , Choy Kay Weng , Lu Zhong X , Shen Jimmy , Doery James C G , Fuller Peter J , Yang Jun
Published: September 2022

Context

The plasma aldosterone concentration (PAC), renin, and aldosterone-to-renin ratio (ARR) are used to screen for primary aldosteronism (PA). Substantial intra-individual variability of PAC and ARR using plasma renin activity in the context of usual antihypertensive therapy has been described, but there is no data on ARR variability calculated using direct renin concentration (DRC).

Objective

To describe the intra-individual variability of PAC, DRC, and ARR in the absence of interfering medications in patients with and without PA.

Design

Retrospective cohort study.

Patients

Hypertensive patients referred for investigation of PA, with at least 2 ARR measurements while off interfering medications.

Setting

Endocrine hypertension service of a tertiary center, from May 2017 to July 2021.

Main outcome measures

PAC, DRC, and ARR variability was calculated as coefficient of variation (CV) and percent difference (PD).

Results

Analysis of 223 patients (55% female, median age 52 years), including 162 with confirmed PA, demonstrated high variability with a sample CV of 22-25% in the PAC and sample CV of 41% to 42% in the DRC and ARR in both the PA and non-PA groups. The degree of variability was substantially higher than the assays’ analytical CV. Sixty-two patients (38%) with PA had at least one ARR below 70 pmol/L:mU/L (2.4 ng/dL:mU/L), a cut-off for first-line screening of PA.

Conclusions

Significant intra-individual variability in PAC, DRC, and hence ARR occurs in a large proportion of patients being investigated for PA. These findings support the need for at least 2 ARR before PA is excluded or further investigated.
Modern Translations
Authors: Balboni Philip , Clements Henry
Published: September 2022

This article seeks to clarify how scholarship in postcolonial studies and new ontology (the “ontological turn”) has construed the problem of modernity as a problem of translation. Drawing on resources from the field of secular studies, it suggests that projects to provincialize or repudiate the universalism of modern thought, as well as the translations this universalism enables, tend to reinscribe the very translational problematic these projects aim to mitigate or overturn.
Single-motor and multi-motor motility properties of kinesin-6 family members
Authors: Poulos Andrew , Budaitis Breane G. , Verhey Kristen J.
Published: September 2022

Kinesin motor proteins are responsible for orchestrating a variety of microtubule-based processes including intracellular transport, cell division, cytoskeletal organization, and cilium function. Members of the kinesin-6 family play critical roles in anaphase and cytokinesis during cell division as well as in cargo transport and microtubule organization during interphase, however little is known about their motility properties. We find that truncated versions of MKLP1 (HsKIF23), MKLP2 (HsKIF20A), and HsKIF20B largely interact statically with microtubules as single molecules but can also undergo slow, processive motility, most prominently for MKLP2. In multi-motor assays, all kinesin-6 proteins were able to drive microtubule gliding and MKLP1 and KIF20B were also able to drive robust transport of both peroxisomes, a low-load cargo, and Golgi, a high-load cargo, in cells. In contrast, MKLP2 showed minimal transport of peroxisomes and was unable to drive Golgi dispersion. These results indicate that the three mammalian kinesin-6 motor proteins can undergo processive motility but differ in their ability to generate forces needed to drive cargo transport and microtubule organization in cells.
An alternative and effective method for extracting skeletal organic matrix adapted to the red coral Corallium rubrum
Authors: Ganot Philippe , Loentgen Guillaume , Marin Frédéric , Plasseraud Laurent , Allemand Denis , Tambutté Sylvie
Published: September 2022

Skeleton formation in corals is a biologically controlled process in which an extracellular organic matrix (OM) is entrapped inside the calcified structure. The analysis of OM requires a time-consuming and tedious extraction that includes grinding, demineralization, multiple rinsing and concentration steps. Here we present an alternative and straightforward method for the red coral Corallium rubrum that requires little equipment and saves steps. The entire skeleton is directly demineralized to produce a tractable material called ghost, which is further rinsed and melted at 80°C in water. The comparative analysis of the standard and alternative methods by electrophoresis, western blot, and FTIR of C. rubrum OM, shows that the ‘alternative OM’ is of higher quality. Advantages and limitations of both methods are discussed.
The RNA ligase RNA terminal phosphate cyclase B regulates mRNA alternative splicing and is required for mouse oocyte development and maintenance
Authors: Zhang Hua , Jiang Jun-Chao , Wu Yun-Wen , Yu Yuan-Song , Wang Hua-Nan , Ding Nai-Zheng , Fan Heng-Yu
Published: September 2022

Recent large-scale mRNA sequencing has shown that introns are retained in 5-10% of mRNA, and these events are named intron retention (IR). IR has been recognized as a key mechanism in the regulation of gene expression. However, the role of this mechanism in female reproduction in mammals remains unclear. RNA terminal phosphate cyclase B (RTCB) is a RNA ligase; we found that RTCB conditional knockout mice have premature ovarian failure and that RTCB plays a crucial role in follicular development. RTCB regulated the splicing of transcripts related to DNA methylation and DNA damage repair. In addition, it regulated the resumption of oocyte meiosis by affecting CDK1 activation. Moreover, the loss of RTCB suppressed zygotic genome activation (ZGA) and decreased translation at the global level. In addition, Rtcb deletion resulted in the accumulation of maternal mRNAs containing unspliced introns and in a decline in the overall level of transcripts. As a result, the Rtcb−/− females were sterile. Our study highlights the important role of RTCB-regulated noncanonical alternative splicing in female reproduction.
Single-nuclei transcriptome analysis of the shoot apex vascular system differentiation in Populus
Authors: Conde Daniel , Triozzi Paolo M. , Pereira Wendell J. , Schmidt Henry W. , Balmant Kelly M. , Knaack Sara A. , Redondo-López Arturo , Roy Sushmita , Dervinis Christopher , Kirst Matias
Published: September 2022

Differentiation of stem cells in the plant apex gives rise to aerial tissues and organs. Presently, we lack a lineage map of the shoot apex cells in woody perennials – a crucial gap considering their role in determining primary and secondary growth. Here, we used single-nuclei RNA-sequencing to determine cell type-specific transcriptomes of the Populus vegetative shoot apex. We identified highly heterogeneous cell populations clustered into seven broad groups represented by 18 transcriptionally distinct cell clusters. Next, we established the developmental trajectories of the epidermis, leaf mesophyll and vascular tissue. Motivated by the high similarities between Populus and Arabidopsis cell population in the vegetative apex, we applied a pipeline for interspecific single-cell gene expression data integration. We contrasted the developmental trajectories of primary phloem and xylem formation in both species, establishing the first comparison of vascular development between a model annual herbaceous and a woody perennial plant species. Our results offer a valuable resource for investigating the principles underlying cell division and differentiation conserved between herbaceous and perennial species while also allowing us to examine species-specific differences at single-cell resolution.
Biomechanical behaviour of lizard osteoderms and skin under external loading
Authors: Kéver Loïc , Olivier Damien , Marghoub Arsalan , Evans Susan E. , Vickaryous Matthew K. , Moazen Mehran , Herrel Anthony
Published: September 2022

Many species of lizards are partially enveloped by a dermal armour made of ossified units called osteoderms. Lizard osteoderms demonstrate considerable species-specific variation in morphology and histology. Although a physical/protective role (against predators, prey, conspecifics and impact loading during falls) is frequently advanced, empirical data on the biomechanics of lizard osteoderms are scarce, limiting our understanding of form–function relationships. Here, we report deformation recorded at the surface of temporal osteoderms during controlled external loading of preserved specimens of 11 lizard species (Tiliqua rugosa, Tiliqua scincoides, Corucia zebrata, Pseudopus apodus, Timon lepidus, Matobosaurus validus, Broadleysaurus major, Tribolonotus gracilis, Tribolonotus novaeguineae, Heloderma horridum and Heloderma suspectum). Based on the strain recorded in situ and from isolated osteoderms, the skin of the species investigated can be ranked along a marked stiffness gradient that mostly reflects the features of the osteoderms. Some species such as T. rugosa and the two Heloderma species had very stiff osteoderms and skin while others such as T. lepidus and P. apodus were at the other end of the spectrum. Histological sections of the osteoderms suggest that fused (versus compound) osteoderms with a thick layer of capping tissue are found in species with a stiff skin. In most cases, loading neighbouring osteoderms induced a large strain in the instrumented osteoderm, attesting that, in most species, lizard osteoderms are tightly interconnected. These data empirically confirm that the morphological diversity observed in lizard osteoderms is matched by variability in biomechanical properties.
Fiscal Rules and the Sovereign Default Premium
Authors: Hatchondo Juan Carlos , Martinez Leonardo , Roch Francisco
Published: September 2022

We study fiscal rules using a sovereign default model. A debt-brake (spread-brake) rule imposes a ceiling on the fiscal deficit when the sovereign debt (spread) is above a threshold. For our benchmark calibration, similar gains can be achieved with the optimal debt or spread brake. However, for a “Union” of heterogeneous economies, a common spread brake generates larger gains than a common debt brake. Furthermore, gains from abandoning a common debt brake may be significant for economies that are unnecessarily constrained by the rule. In contrast, abandoning a common spread brake would generate losses for any economy in the Union. (JEL E62, F34, F41, H61, H63)