bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic Barriers to Democratization in MENA
Authors: Çelik Ahmet Alkan
Published: February 2013

The literature on regime change in the MENA region had claimed the occurrence of political liberalization and democratization during the 1990s, foreseeing a transition from the dominant authoritarianism in the region to politically more liberal regimes. These analyses neglect the state of permanent authoritarian political regimes with the centralized economic power and their role as periphery states in the world system. In this paper, we have reassessed the existing literature on regime change in the MENA region taking into account the economic and political impacts of rentier economies, with a close look at the countries in the region where popular uprisings took place to overthrow authoritarian leaders during the first half of 2011. We have followed Schlumberger's (2002) method of classification and comparative approach in order to pinpoint a correlation between the authoritarian regime's economic power based on resource allocation, its political dominance and the leaders' role in neo-liberal global political economy.
Le concept d'habitus chez Michel Henry
Authors: Ducharme Olivier
Published: February 2013

Cet article cherche à rendre compte de la signification du concept d'habitus que nous retrouvons chez Michel Henry en tentant de le situer par rapport aux principaux concepts qui sont au fondement de la phénoménologie matérielle.
Le "Pathos-avec" Intersubjectivité, intropathie et regard clinique
Authors: Tarditi Claudio
Published: February 2013

Cet article cherche à appliquer la phénoménologie matérielle de Michel Henry à la question du rapport entre médicin et patient. A partir de la réflexion sur le statut de l'intersubjectivité en tant que intropathie, l'auteur propose un nouveau modèle de "regard clinique" et de "démarche thérapeutique".
What about Non-Human Life? An "Ecological" Reading of Michel Henry's Critique of Technology
Authors: Gschwandtner Christina M.
Published: February 2013

This paper takes its departure from Michel Henry’s criticism of a technological view that “extends its reign to the whole planet, sowing desolation and ruin everywhere” (I am the Truth, 271). It argues that although Henry’s critique of technology is helpful and important, it does not go far enough, inasmuch as it excludes all non-human beings from the Truth of “Life” he advocates against the destructive truths of technology and therefore cannot fully articulate the way in which technology does in fact cause “desolation and ruin” on the entire planet. At the same time I suggest that this strict division between human and non-human life is not essential to Henry’s project, which may well have resources for a more environmentally friendly proposal. The first part of the paper lays out Henry’s critique of technology in some detail, highlighting the ways in which it contains important insights for our contemporary situation. The second part of the paper explores the stark division Henry draws between human generation from the divine life and the creation of everything else, including his rejection of any identification of humans with “protozoa and honey bees,” which would seem to suggest a complete lack of concern for non-human life. The final part of the paper seeks to find a way beyond this dichotomy by showing how non-human life may be included in Henry’s proposal in a way that extends his critique of technology in environmentally conscious ways without losing his phenomenological insights about the human condition.
Literary Practice according to Michel Henry: A Philosophical Introduction to his Novels
Authors: Dussert Jean-Baptiste
Published: February 2013

Although the author of four novels, Michel Henry never produced an aesthetics of literature. The purpose of this article is, after a presentation of his philosophy of immanence and his concept of life, to locate where the literary practice takes place in his system. In this study, we are not interested in the poetic quality of his works, but in the possibility to base his singular creativity on his philosophical reflection. This leads us to insert literature in the vast phenomenon of culture and ethics, and to grasp the function of poetics in the struggle against barbarism.
Sur la situation phénoménologique du Marx de Michel Henry : Étude de " Notes" inédites
Authors: Jean Grégori , Leclercq Jean
Published: February 2013

Étude de  "Notes" inédites.
Book Review: Jean-François Lyotard, Pourquoi philosopher?
Authors: McLennan Matthew R.
Published: February 2013

The posthumous Pourquoi Philosopher? collects Jean-François Lyotard’s previously unpublished four-part introductory course in philosophy, delivered to students of the Sorbonne in 1964. The interest of this text is both historical (appearing at an important juncture in French thought) and meta-philosophical (answering the question "why philosophize?" in such a way that a philosophy of philosophy - or rather several - is offered for consideration). The text will be of interest to readers of various levels of philosophical sophistication.
Les concepts fondamentaux de la phénoménologie: Entretien avec Claude Romano
Authors: Dika Tarek R. , Hackett William C. , Romano Claude
Published: February 2013

Entretien avec Claude Romano.
From the Desert: Confessions of a Recovering Trainer / What about Decisional Balance?
Authors: Miller William R.
Published: February 2013

N/A
Motivational Interviewing with Adolescents and Young Adults
Authors: Johnson Rachel
Published: February 2013

N/A
Worker “Right to Know” in 30-year Retrospect: Did We Get it Right, with What We Know Today?
Authors: O'Reilly James T.
Published: February 2013

Three decades later, did we negotiators get it right? When in 2007 we passed the 30th anniversary of the first “right to know” workplace disclosure rules, 1 should we who negotiated the rule reflect favorably on what was produced? And which of the competing sides, once labeled Doomsayers or Pollyannas, has been proven correct by the miraculous clarity of hindsight? We who were “present at the creation” of the Occupational Safety & Health Administration (“OSHA”) Hazard Communication Standard2 find the saga a mixture of success, frustration and unmet expectations. This essay offers one player’s historical and policy retrospective, and I draw an ambiguous conclusion about an unsettled controversy.
Introduction
Authors: Meisel Alan
Published: February 2013

As recently as the mid- to late-nineteenth century, it could honestly be said that there was no medical profession in the United States. Yes, there were doctors. And of course there were patients with illness and injuries. But if it is contentious today as to how best to treat various conditions, a century and a half ago it was nothing short of a circus. Although the American Medical Association had been founded in 1847, allopathic medicine could hardly be said to be the dominant school of thought. Others abounded, some of which still exist today, but none of them were capable of doing very much in the way of treating illness.
Non-Profit Hospitals, Tax Exemption and Access for the Uninsured
Authors: Crossley Mary
Published: February 2013

I want to approach the topic of tax exemption for non-profit hospitals from the perspective of the 46 plus million Americans who have no health insurance and the significant additionalnumber whom we might characterize as underinsured. In essence, persons who are underinsured have some form of health coverage but they remain at serious risk for significant out-of-pocket expenditures when they become sick. From this perspective, the key question is what role, if any, do the non-profit health care sector and, more particularly, non-profit hospitals have to play in addressing the vexing problems posed by the large number of uninsured and underinsured. We tend to think of these problems primarily, although not exclusively, as problems of access.
The Public Health Aspects of Environmental Enforcement
Authors: Craig Robin Kundis
Published: February 2013

Beyond being an environmental concern, pollution is a public health problem. As a result, enforcement of anti-pollution statutes, such as the Clean Air Act and the Clean Water Act, not only protects the environment, but also furthers fundamental public health goals. Moreover, public health benefits provide politically salient arguments for continuing and even strengthening environmental protection that can counteract any political opposition that can arise as a result of the costs of environmental regulation and compliance to regulated entities and the taxpayers.Thus, it is worth examining the extent to which the Environmental Protection Agency (“EPA”) considers the public health in its environmental enforcement priorities and decisions. Focusing on the Clean Air Act and the Clean Water Act, this Article undertakes such an examination by: (1) outlining the statutory connections between public health considerations and environmental regulation; (2) examining the EPA’s enforcement priorities and guidance; and (3) criticizing the EPA’s presentation of its own enforcement effectiveness over the last decade.This Article concludes that public health considerations do play a significant role in environmental enforcement policies and decisionmaking. However, the EPA’s commitment to presenting the public health benefits of its enforcement actions has varied considerably over the last decade. With the release of its FY2009 enforcement assessment, however, the EPA has both expanded its analysis of the connection between environmental pollution enforcement and public health benefits and created new tools to enhance the transparency of these benefits to the affected public.
The Evolution of NEPA in the Fight Against Climate Change
Authors: Reiley Robert
Published: February 2013

The National Environmental Policy Act (“NEPA”) is the first environmental charter of the United States. 1 Signed into law on January 1, 1970, NEPA addresses the need for overarching national environmental guidance in the country. During the course of its forty year history, NEPA has been used to challenge a wide range of federal actions including the issuance of operating permits under the Clean Air Act,2 the approval of forest management plans approved under the National Forest Management Act,3 the construction of highways under the Federal-Aid Highways Act,4 and the issuance of oil leases under the Outer Continental Shelf Lands Act.5 Given the breadth of NEPA’s applicability, it was inevitable that NEPA would become a tool to combat climate change. The use of NEPA to require federal agencies to take a “hard look” at greenhouse gas (“GHG”) emissions makes perfect sense because many federal actions directly or indirectly contribute to GHG emissions. Since 1990, in City of Los Angeles v. NHTSA,6 plaintiffs have used NEPA, successfully and unsuccessfully, to challenge federal actions that might have an impact on the global climate.
Federal Contractor Liability: The Hanford Decision
Authors: Goetz Caitlin
Published: February 2013

During World War II, the U.S. Government sought out contractors in the name of “patriotism” to research and develop nuclear materials for this country’s defense. Nearly seventy years later, we are still dealing with the effects of that research. However, the issue of who should bear responsibility for the long-term effects is still being argued. One of the major issues is whether those contractors are allowed to raise the federal contractor defense.The common law federal contractor defense arises out of basic principles of governmental immunity. The defense protects government contractors from liability for any harm arising out the performance of a government contract, specifically in the areas of military and defense work, if the contractor was following the government’s directions and the work performed was in an area of “uniquely federal” concern.
Underage Binge Drinking Adolescents: Sociodemographic Profile and Utilization of Family Doctors
Authors: Fuller-Thomson Esme , Sheridan Matthew P. , Sorichetti Cathy , Mehta Rukshan
Published: February 2013

Context. Binge drinking (more than five drinks on one occasion) is a major public health problem among teenagers in the US, Canada, and Europe. Negative outcomes to binge drinking include alcohol related injuries and accidental death. Family physicians are the main point of contact between binging adolescents and the health care system. Design and Setting. This study was based on a secondary analysis of 6,607 respondents aged 15–17 from the regionally representative data acquired through the Canadian Community Health Survey 1.1. Results. According to our findings, one in every eight teens aged 15–17 binge drank monthly. The odds of binge drinking were higher among males, Whites, those living away from parents, teens who reported a decline in health status, and those experiencing back problems and depression. Smoking status was strongly associated with the binge drinking behavior. Three-quarters of binge drinking adolescents had seen their family doctor in the past year but only one in ten had spoken with any health professional about a mental health issue. Conclusions. Family physicians need to screen their adolescent patients for binge drinking in order to provide timely and effective interventions. Awareness of the profile of binge drinkers could improve the accuracy of targeting and outreaching strategies.
Seasonal Patterns of Energy in China
Authors: Herrerias Maria Jesus , Girardin Eric
Published: February 2013

This paper provides evidence on the relevance of modeling adequately the seasonal character of coal and electricity production across Chinese regions. Unlike other work, this paper relaxes the assumption ofdeterministic seasonality, allowing for time and regional variation in this economy. More specifically, we analyze and distinguish the type of seasonality around the year that prevails in the case of coal and electricity production of each individual Chinese province. Our results indicate that for the majority of the provinces seasonality is stochastic in both types of energy considered. Our findings provide new evidence of a Lunar New-Year effect in February and Summer as well as Winter effects in coal and electricity production. However, in terms ofseasonal patterns and their evolution over time, there are significant differences between the Northern Southern regions. Besides for each type of energy, regional clusters matter for the appropriate design of energy-development policy.
The Energy, Economic Growth, Urbanization Nexus Across Development: Evidence from Heterogeneous Panel Estimates Robust to Cross-Sectional Dependence
Authors: Liddle Brantley
Published: February 2013

This paper combines two aggregate production function models—one with urbanization as a shift factor and one that includes energy/electricity consumption and physical capital—to estimate the macro-level relationship among urbanization, energy/electricity consumption, and economic growth using a panel method that is robust to both cointegration and cross-sectional dependence. For four panels (comprising in turn high, upper middle, lower middle, and low income countries) GDP per capita, total final energy and electricity consumption per capita, gross fixed capital formation per capita, and urbanization were found to be 1(1), cross-sectionally dependent, and cointegrated. The long-run elasticity estimates suggest (i) that urbanization is important to and associated with economic growth, (ii) that urbanization’s impact on economic growth ranges from substantially negative to nearly neutral to positive as countries develop—an “urbanization ladder” effect, and (iii) that less developed countries are over-urbanized (their elasticities being negative).
Gender Classification by Fuzzy Inference System
Authors: Moallem Payman , Mousavi B. Somayeh
Published: February 2013

Gender classification from face images has many applications and is thus an important research topic. This paper presents an approach to gender classification based on shape and texture information gathered to design a fuzzy decision making system. Beside face shape features, Zernik moments are applied as system inputs to improve the system output which is considered as the probability of being male face image. After parameters tuning of the proposed fuzzy decision making system, 85.05% classification rate on the FERET face database (including 1199 individuals from different poses and facial expressions) shows acceptable results compare to other methods.
Easy and Effective Endoscopic Retrieval of Ingested Sharp Foreign Bodies
Authors: Leiming Xu  , Chao Huang  , Chunying Qu  , Yi Zhang  , Min Zhou  , Ying Chen
Published: February 2013

Here we reported two cases of successful removal of accidentally ingested sharp foreign body. The swallowed objects were dentures with clasps which increased the risk of gastroesophageal bleeding or perforation in both cases. After several unsuccessful attempts of removal with normal assistant apparatus, the foreign bodies were eventually retrieved by using modified ship-form semitransparent plastic bags without any complications.
Impact of Different Pollutant Sources on Human Health Using Solid Aerosol’s Elemental Analysis
Authors: Muhammad Attique Khan Shahid  , Khadim Hussain  , Ahmad Raza
Published: February 2013

Atomic absorption spectroscopy (AAS) was used in this study to find out the metal constituents and concentration for Seven (7) trace metals in the atmosphere of Faisalabad. The maximum elemental constituents and concentration for Zn, Cu, Cr, Ni, Pb, Mg and Cd in ppm were found to be Cadmium Cd(1) in amounts ranging between (2.596→1.95475) in Pool (5→3), Chromium Cr(2) in amounts ranging between (0.0145→0.01125) in Pool (2→3), Nickel Ni(3) in amounts ranging between (0.9925→0.35575) in Pool (5→3), Lead Pb(4) in amounts ranging between (1.33675→0.2632) in Pool (2→3), Zinc Zn(5) in amounts ranging between (2.515→1.38825) in Pool (4→5), Magnesium Mg(6) in amounts ranging between (1.22125→1.15875) in Pool (4→5), Calcium Ca(7) in amounts ranging between (11.46725→3.53875) in Pool (4→3) respectively. Following pool wise trend pattern of identified elements in solid aerosols is given in Table 1 & 2. The comparison of results reported in literature with the obtained results showed some differences in concentrations which could be explained on the basis of climatological and meteorological set up of different pools under investigations. Furthermore, the health hazards due to identified trace metals were also investigated and were found that the metals were highly toxic and generating serious health hazards.
Efficacy of Metronidazole in Combination with Amoxicillin and Doxycycline in Adult Periodontitis
Authors: Sarah Moideen  , Rafeeq Alam Khan  , Afaq Ahmed Siddiqui
Published: February 2013

Objective:Periodontal diseases are amongst most prevalent diseases in the world. They are caused by poor oral hygiene, accumulation of dental plaque and virulent putative pathogens on the teeth and gums Systemic antibiotics are used as adjuncts for the treatment of this infective disease. The objective of this study was to compare the efficacy of two antibiotic drug combinations i.e., Metronidazole with Amoxicillin and Metronidazole with Doxycycline in patients with adult periodontitis.Method:50 patients were divided in two groups. They were given fixed doses for 7 days to patients with Adult Periodontitis. Readings were taken before treatment and two weeks prior to the treatment. The result was evaluated on the basis of periodontal Pocket depth, Bleeding Index and Mobility Index. The readings were taken using Periodontal Probe, dental Mirror and dental Explorer.Result: There was significant reduction (p
Los amuletos de tipo egipcio de la Colección Pérez-Cabrero i Tur del Museo de Prehistoria de Valencia
Authors: Ortiz García Jónatan
Published: February 2013

La Colección Pérez-Cabrero i Tur, depositada en el Servicio de Investigación Prehistórica de Valencia, consta de un conjunto de materiales arqueológicos procedentes de la isla de Ibiza, entre los cuales se encuentran doce amuletos de tipo egipcio. El objetivo de nuestro trabajo es la publicación completa del repertorio, resolviendo las dudas planteadas en cuanto a la identificación de algunas piezas.
Estudio tecnológico de los útiles fabricados sobre asta y hueso en el Magdaleniense Superior de la Cova de les Cendres (Teulada-Moraira, Alicante).
Authors: Borao Álvarez Maria Isabel
Published: February 2013

El estudio tecnológico de la industria ósea es una de las ramas de la investigación arqueológica en auge en las dos últimas décadas. En el caso de La Cova de les Cendres, el importante registro de industria ósea recuperado en los últimos años nos ha hecho plantearnos la importancia de llevar a cabo un estudio de estas características. El conjunto arqueológico perteneciente al Magdaleniense superior final ha sido el elegido para este trabajo por su riqueza y diversidad tanto en útiles acabados como en elementos tecnológicos, que posibilitan la reconstrucción de la cadena operativa de fabricación de los útiles. En este artículo describimos la metodología de trabajo llevada a cabo, la descripción de los materiales y la reconstrucción de la cadena operativa de producción. A continuación exponemos las conclusiones de tipo económico generales a las que se pueden llegar a partir de los datos.
El uso de conchas marinas como soporte de útiles pulimentados: una pieza recuperada en Costamar (Castellón)
Authors: Clemente Conte Ignacio , Orozco Köhler Teresa
Published: February 2013

La singularidad de un instrumento pulimentado recuperada en los niveles neolíticos del yacimiento de Costamar (Castellón) suscitó un análisis detallado tanto de la naturaleza del soporte, que se ha identificado como concha marina correspondiente a la especie Spondylus gaederopus, como de los rastros de uso conservados en la zona activa, que permiten redefinir el útil como una azuela.
La cronología y variedad de los sistemas funerarios en Marroquíes. Una aproximación desde las excavaciones del Sistema Tranviario de Jaén.
Authors: Cámara Serrano Juan Antonio , Sánchez Susí Rafael , Laffranchi Zita , Martín Flórez Sebastián , Riquelme Cantal José Antonio , Spanedda Liliana , García Cuevas María Fernanda , González Herrera Antonia , Jiménez Brobeil Sylvia Alejandra , Nicás Perales Juan
Published: February 2013

Este trabajo ofrece información sobre tres aspectos dentro de la complejidad arqueológica del yacimiento de Marroquíes (Jaén, España): 1) la composición de la población inhumada en las estructuras excavadas en la roca y el diferente tratamiento que los individuos sufrieron especialmente en cuanto a su integración en enterramientos múltiples o colectivos y su afección o no por estrategias de remoción de los huesos; 2) la composición de la cabaña ganadera y el uso diferencial de ésta en cuanto al ritual; 3) la contextualización cronológica de las inhumaciones como paso imprescindible para elaborar (y sobre todo sustentar) cualquier hipótesis sobre las poblaciones prehistóricas, y para comprender las alteraciones que muchos cadáveres sufrieron a lo largo del periodo de culto que les afectó. Las dataciones han mostrado que estas estrategias se desarrollaron fundamentalmente a partir de la segunda mitad del III Milenio A.C.
Joves Investigadors i Difusió Arqueològica. Primer Seminari d’Arqueologia (UVEG)
Authors: Borao Álvarez María , Machause Sonia , Moreno Martín Andrea
Published: February 2013

Report of workshop activities.
Tercera campaña de excavación en el asentamiento ibérico final de La Casa de la Cabeza (Requena, València)
Authors: Quixal Santos David , Mata Parreño Consuelo , Albelda Borrás Vanessa , Pérez Reyes Adrián , Sancho Cebrián Leandro
Published: February 2013

Preliminary report.
Cutaneous Inflammatory Manifestations of Chronic Granulomatous Disease
Authors: Dev Anubha , Aggarwal Ridhima , Vignesh Pandiarajan , Vinay Keshavamurthy , Rawat Amit , Chatterjee Debajyoti , Dogra Sunil
Published: July 2024

This cross-sectional study examines cutaneous inflammatory presentations of chronic granulomatous disease.
Web-Based Cognitive Behavioral Treatment for Bulimia Nervosa
Authors: Hartmann Steffen , Timm Christina , Barnow Sven , Rubel Julian A. , Lalk Christopher , Pruessner Luise
Published: July 2024

Importance

Despite the existence of effective treatments, many individuals with bulimia nervosa (BN) do not receive evidence-based therapies. Integrating digital interventions into routine care might reach more patients and reduce the clinical burden of BN.

Objective

To evaluate the effectiveness of a web-based cognitive behavioral self-help intervention for individuals with BN.

Design, Setting, and Participants

A 2-group randomized clinical trial without follow-up was conducted between February 2, 2021, and July 9, 2022, in Germany. Participants aged between 18 and 65 years who met the diagnostic criteria for BN were enrolled online via self-referral. Data analyses were conducted from October 24, 2022, to December 23, 2023.

Interventions

A web-based cognitive behavioral self-help intervention including 12 weekly modules was compared with a waiting-list control group only having access to routine care.

Main Outcomes and Measures

The primary outcome was the change in the number of bulimic episodes between baseline and posttreatment. Secondary outcomes included changes in global eating disorder symptoms, clinical impairment, well-being, work capacity, comorbid symptoms, self-esteem, and emotion regulation complemented by weekly measures and ecological momentary assessment. Intention-to-treat analyses were performed.

Results

Participants (N = 154; mean [SD] age, 29.6 [8.6] years; 149 [96.8%] female) receiving the web-based intervention demonstrated a significantly greater decrease in bulimic episodes compared with the control group (Cohen d = −0.48; 95% CI, −0.75 to −0.20; P < .001), representing a significant change in binge-eating episodes (Cohen d = −0.61; 95% CI, −0.89 to −0.33; P < .001), but not in compensatory behaviors (Cohen d = −0.25; 95% CI, −0.51 to 0.02; P = .21). The intervention was superior in improving global eating disorder symptoms (Cohen d = −0.61; 95% CI, −0.89 to −0.32; P < .001) and clinical impairment (Cohen d = −0.62; 95% CI, −0.92 to −0.33; P < .001). No significant effects were found for well-being (Cohen d = −0.08; 95% CI, −0.37 to 0.22; P > .99) and work capacity (Cohen d = −0.01; 95% CI, −0.68 to 0.66; P = .99). Exploratory analyses indicated significant changes in self-esteem and emotion regulation difficulties, but not in comorbid symptoms.

Conclusions and Relevance

In this randomized clinical trial, a web-based cognitive behavioral self-help intervention effectively decreased eating disorder symptoms and illness-related burden in individuals with BN, underlining the potential of digital interventions to complement established treatments.

Trial Registration

ClinicalTrials.gov Identifier: NCT04876196
Pancreatic Cancer Surveillance and Survival of High-Risk Individuals
Authors: Blackford Amanda L. , Canto Marcia Irene , Dbouk Mohamad , Hruban Ralph H. , Katona Bryson W. , Chak Amitabh , Brand Randall E. , Syngal Sapna , Farrell James , Kastrinos Fay , Stoffel Elena M. , Rustgi Anil , Klein Alison P. , Kamel Ihab , Fishman Elliot K. , He Jin , Burkhart Richard , Shin Eun Ji , Lennon Anne Marie , Goggins Michael
Published: July 2024

Importance

Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease with increasing incidence. The majority of PDACs are incurable at presentation, but population-based screening is not recommended. Surveillance of high-risk individuals for PDAC may lead to early detection, but the survival benefit is unproven.

Objective

To compare the survival of patients with surveillance-detected PDAC with US national data.

Design, Setting, and Participants

This comparative cohort study was conducted in multiple US academic medical centers participating in the Cancer of the Pancreas Screening program, which screens high-risk individuals with a familial or genetic predisposition for PDAC. The comparison cohort comprised patients with PDAC matched for age, sex, and year of diagnosis from the Surveillance, Epidemiology, and End Results (SEER) program. The Cancer of the Pancreas Screening program originated in 1998, and data collection was done through 2021. The data analysis was performed from April 29, 2022, through April 10, 2023.

Exposures

Endoscopic ultrasonography or magnetic resonance imaging performed annually and standard-of-care surgical and/or oncologic treatment.

Main Outcomes and Measures

Stage of PDAC at diagnosis, overall survival (OS), and PDAC mortality were compared using descriptive statistics and conditional logistic regression, Cox proportional hazards regression, and competing risk regression models. Sensitivity analyses and adjustment for lead-time bias were also conducted.

Results

A total of 26 high-risk individuals (mean [SD] age at diagnosis, 65.8 [9.5] years; 15 female [57.7%]) with PDAC were compared with 1504 SEER control patients with PDAC (mean [SD] age at diagnosis, 66.8 [7.9] years; 771 female [51.3%]). The median primary tumor diameter of the 26 high-risk individuals was smaller than in the control patients (2.5 [range, 0.6-5.0] vs 3.6 [range, 0.2-8.0] cm, respectively; P < .001). The high-risk individuals were more likely to be diagnosed with a lower stage (stage I, 10 [38.5%]; stage II, 8 [30.8%]) than matched control patients (stage I, 155 [10.3%]; stage II, 377 [25.1%]; P < .001). The PDAC mortality rate at 5 years was lower for high-risk individuals than control patients (43% vs 86%; hazard ratio, 3.58; 95% CI, 2.01-6.39; P < .001), and high-risk individuals lived longer than matched control patients (median OS, 61.7 [range, 1.9-147.3] vs 8.0 [range, 1.0-131.0] months; 5-year OS rate, 50% [95% CI, 32%-80%] vs 9% [95% CI, 7%-11%]).

Conclusions and Relevance

These findings suggest that surveillance of high-risk individuals may lead to detection of smaller, lower-stage PDACs and improved survival.
Adjuvant Gemcitabine Plus Cisplatin and Chemoradiation in Patients With Gallbladder Cancer
Authors: Ostwal Vikas , Patkar Shraddha , Engineer Reena , Parulekar Manali , Mandavkar Sarika , Bhargava Prabhat , Srinivas Sujay , Krishnatry Rahul , Gudi Shivakumar , Kapoor Akhil , Pandey Durgatosh , Patel Swapnil , Singhal Abhishek , Goel Alok , Dora Tapas Kumar , Chaudhary Debashish , Chaugule Deepali , Naughane Deepali , Daddi Anuprita , Patil Rajshree , Ankathi Suman Kumar , Ramaswamy Anant , Goel Mahesh
Published: July 2024

Importance

There is limited evidence with regard to the benefit of adjuvant chemotherapy chemoradiotherapy in resected gallbladder cancers (GBCs).

Objective

To establish a baseline survival rate for operated GBCs in patients receiving either gemcitabine plus cisplatin (GC) or capecitabine and capecitabine concurrent with chemoradiation (CCRT).

Design, Setting, and Participants

The GECCOR-GB study was a multicenter, open-label, randomized phase 2 noncomparator “pick the winner” design trial of adjuvant GC and CCRT in patients with resected histologically confirmed adenocarcinoma or adenosquamous carcinoma of the gallbladder, (stage II/III) with no local residual tumor (R0) or microscopic residual tumor (R1). The study was carried out in 3 tertiary cancer institutions in India. Patients 18 years or older with adequate end-organ functions, and Eastern Cooperative Oncology Group Performance Status of 1 or lower between May 2019 and February 2022 were enrolled. The cutoff date for data analysis was February 28, 2023.

Interventions

Patients were randomized 1:1 to receive either GC every 3 weeks (maximum of 6 cycles) or CCRT comprising capecitabine with concurrent chemoradiation (capecitabine concurrent with radiotherapy) sandwiched between capecitabine chemotherapy.

Main Outcomes and Measures

The primary outcome was disease-free survival (DFS) at 1 year in randomized patients. This study was conducted as 2 parallel, single-stage phase 2 clinical trials. Within each treatment arm, a 1-year DFS rate of less than 59% was considered as insufficient activity, whereas a 1-year DFS rate of 77% or higher would be considered as sufficient activity.

Results

With a median follow-up of 23 months, 90 patients were randomized, 45 in each arm. Overall, there were 31 women (69%) and 14 men (31%) in the GC arm with a mean (range) age of 56 (33-72) years and 34 women (76%) and 11 men (24%) in the CCRT group with a mean (range) age of 55 (26-69) years. In the GC and CCRT arms, 1-year DFS and estimated 2-year DFS was 88.9% (95% CI, 79.5-98.3) and 74.8% (95% CI, 60.4-89.2), and 77.8% (95% CI, 65.4-90.2) and 74.8% (95% CI, 59.9-86.3), respectively. Completion rates for planned treatment was 82% in the GC arm and 62% in the CCRT arm.

Conclusions and Relevance

In this randomized clinical trial, GC and CCRT crossed the prespecified trial end points of 1-year DFS in patients with resected stage II/III GBCs. The results set a baseline for a larger phase 3 trial evaluating both regimens in operated GBCs.

Trial Registration

ClinicalTrials.gov Identifier: CTRI/2019/05/019323I
Caregiver Burden—Within and Without
Authors: George Reena , Mathew Shefali
Published: July 2024

This essay describes the experience of an oncologist in India and palliative care involving grieving families and coconuts.
Obesity and Survival After Immune Checkpoint Inhibition for Head and Neck Squamous Cell Carcinoma
Authors: Mastrolonardo Eric V. , Llerena Pablo , Lu Joseph , Nunes Kathryn , Choi Grace K. , Amin Dev , Bridgham Kelly M. , Campbell Daniel , Philips Ramez , Cognetti David M. , Luginbuhl Adam J. , Curry Joseph M.
Published: July 2024

Importance

For patients treated with immune checkpoint inhibitors (ICIs), recent data suggest that obesity has a beneficial effect on survival outcomes in various cancer types. Reports on this association in head and neck cancer are limited.

Objectives

To compare overall survival (OS) to 5 years and functional outcomes in patients with head and neck squamous cell carcinoma (HNSCC) treated with ICIs based on pretreatment body mass index (BMI).

Design, Setting, and Participants

This retrospective population-based cohort study used data obtained from the TriNetX Global Collaborative Network database to identify patients with HNSCC who received ICI treatment between January 1, 2012, and December 31, 2023, resulting in a total of 166 patients (83 with BMI of 20.0-24.9 [normal BMI] and 83 with BMI of ≥30.0 [obesity BMI]) after propensity score matching (PSM) for pretreatment medical comorbidities and oncologic staging.

Exposure

Normal BMI vs obesity BMI.

Main Outcomes and Measures

Overall survival and functional outcomes (dysphagia, tracheostomy dependence, and gastrostomy tube dependence) were measured to 5 years after ICI treatment and compared between patients with obesity BMI and normal BMI. Additional analyses compared OS and functional outcomes in the cohort with normal BMI and cohorts with overweight BMI (25.0-29.9) and underweight BMI (<20.0).

Results

Among the 166 patients included in the PSM analysis (112 men [67.1%]; mean [SD] age, 62.9 [15.4] years), obesity BMI was associated with significantly improved OS at 6 months (hazard ratio [HR], 0.54 [95% CI, 0.31-0.96]), 3 years (HR, 0.56 [95% CI, 0.38-0.83]), and 5 years (HR, 0.62 [95% CI, 0.44-0.86]) after ICI treatment, compared with patients with normal BMI. Obesity BMI was also associated with decreased risk of gastrostomy tube dependence at 6 months (odds ratio [OR], 0.41 [95% CI, 0.21-0.80]), 1 year (OR, 0.41 [95% CI, 0.21-0.78]), 3 years (OR, 0.35 [95% CI, 0.18-0.65]), and 5 years (OR, 0.34 [95% CI, 0.18-0.65]). Obesity was also associated with decreased risk for tracheostomy dependence at 1 year (OR, 0.52 [95% CI, 0.28-0.90]), 3 years (OR, 0.45 [95% CI, 0.45-0.90]), and 5 years (OR, 0.45 [95% CI, 0.45-0.90]). There were no differences in rates of dysphagia or immune-related adverse events between cohorts at any points.

Conclusions and Relevance

Using population-level data for patients with HNSCC treated with ICIs, these results suggest that having obesity was associated with improved 6-month, 3-year, and 5-year OS compared with having normal BMI. Additionally, obesity was associated with decreased gastrostomy and tracheostomy tube dependence compared with normal BMI. Further investigation is required to understand the mechanism of these findings.
Gratitude and Mortality Among Older US Female Nurses
Authors: Chen Ying , Okereke Olivia I. , Kim Eric S. , Tiemeier Henning , Kubzansky Laura D. , VanderWeele Tyler J.
Published: July 2024

Importance

Supporting healthy aging is a US public health priority, and gratitude is a potentially modifiable psychological factor that may enhance health and well-being in older adults. However, the association between gratitude and mortality has not been studied.

Objective

To examine the association of gratitude with all-cause and cause-specific mortality in later life.

Design, Setting, and Participants

This population-based prospective cohort study used data from self-reported questionnaires and medical records of 49 275 US older female registered nurses who participated in the Nurses’ Health Study (2016 questionnaire wave to December 2019). Cox proportional hazards regression models estimated the hazard ratio (HR) of deaths by self-reported levels of gratitude at baseline. These models adjusted for baseline sociodemographic characteristics, social participation, physical health, lifestyle factors, cognitive function, and mental health. Data analysis was conducted from December 2022 to April 2024.

Exposure

Gratitude was assessed with the 6-item Gratitude Questionnaire, a validated and widely used measure of one’s tendency to experience grateful affect.

Main Outcomes and Measures

Deaths were identified from the National Death Index, state statistics records, reports by next of kin, and the postal system. Causes of death were ascertained by physicians through reviewing death certificates and medical records.

Results

Among the 49 275 participants (all female; mean [SD] age at baseline, 79 [6.16] years), 4608 incident deaths were identified over 151 496 person-years of follow-up. Greater gratitude at baseline was associated with a lower hazard of mortality in a monotonic fashion. For instance, the highest tertile of gratitude, compared with the lowest tertile, was associated with a lower hazard of all-cause deaths (HR, 0.91; 95% CI, 0.84-0.99) after adjusting for baseline sociodemographic characteristics, social participation, religious involvement, physical health, lifestyle factors, cognitive function, and mental health. When considering cause-specific deaths, death from cardiovascular disease was inversely associated with gratitude (HR, 0.85; 95% CI, 0.73-0.995).

Conclusions and Relevance

This study provides the first empirical evidence suggesting that experiencing grateful affect is associated with increased longevity among older adults. The findings will need to be replicated in future studies with more representative samples.
Biliary Dyskinesia—Controversies, Diagnosis, and Management
Authors: Richmond Bryan K.
Published: July 2024

Importance

Biliary dyskinesia is a disorder characterized by biliary pain, a sonographically normal gallbladder, and a reduced gallbladder ejection fraction on cholecystokinin-cholescintigraphy (CCK-HIDA) scan. Laparoscopic cholecystectomy remains a common treatment for biliary dyskinesia despite a lack of high-quality evidence supporting the practice. The following review summarizes the current biliary dyskinesia outcomes data, the diagnostic strategies and their limitations, biliary dyskinesia in the pediatric population, the emerging phenomenon of the hyperkinetic gallbladder, and suggestions for addressing identified knowledge gaps.

Observations

The majority of studies on the topic are retrospective, with wide variations in inclusion criteria and definition of biliary pain. Most report a very short follow-up interval, often a single office visit, with variable and nonstandardized definitions of a satisfactory outcome. Despite a published Society of Nuclear Medicine guideline for its performance, CCK-HIDA scan protocols vary among institutions, which has led to considerable variability in the consistency and reproducibility of CCK-HIDA results. The few prospective studies available, although small and heterogeneous, support a role for cholecystectomy in the treatment of adult biliary dyskinesia. Despite these knowledge gaps, biliary dyskinesia is now the number 1 indication for cholecystectomy in children. Cholecystectomy for the hyperkinetic gallbladder appears to be an emerging phenomenon, despite, as in biliary dyskinesia, a lack of quality data supporting this practice. Randomized trials addressing these gaps are needed but have been difficult to conduct owing to strong clinician and patient bias toward surgery and the lack of a criterion-standard nonsurgical treatment for the control arm.

Conclusions and Relevance

The use of cholecystectomy for adult biliary dyskinesia is reasonable based on the available data. Insufficient data exist regarding laparoscopic cholecystectomy for pediatric dyskinesia and the hyperkinetic gallbladder population. Large-scale prospective studies, either randomized trials or large prospectively followed cohort studies, are needed to address the knowledge gaps surrounding this controversial diagnosis.
Gastric Bypass vs Diet and Cardiovascular Risk Factors
Authors: Karlsson Cecilia , Johnson Line Kristin , Greasley Peter J. , Retterstøl Kjetil , Hedberg Jonatan , Hall Martin , Hawker Noele , Robertsen Ida , Havsol Jesper , Hertel Jens Kristoffer , Sandbu Rune , Skovlund Eva , Olsen Thomas , Christensen Hege , Jansson-Löfmark Rasmus , Andersson Shalini , Åsberg Anders , Hjelmesæth Jøran
Published: July 2024

Importance

Roux-en-Y gastric bypass (RYGB) is associated with reduced cardiovascular (CV) risk factors, morbidity, and mortality. Whether these effects are specifically induced by the surgical procedure or the weight loss is unclear.

Objective

To compare 6-week changes in CV risk factors in patients with obesity undergoing matching caloric restriction and weight loss by RYGB or a very low-energy diet (VLED).

Design, Setting, and Participants

This nonrandomized controlled study (Impact of Body Weight, Low Calorie Diet, and Gastric Bypass on Drug Bioavailability, Cardiovascular Risk Factors, and Metabolic Biomarkers [COCKTAIL]) was conducted at a tertiary care obesity center in Norway. Participants were individuals with severe obesity preparing for RYGB or a VLED. Recruitment began February 26, 2015; the first patient visit was on March 18, 2015, and the last patient visit (9-week follow-up) was on August 9, 2017. Data were analyzed from April 30, 2021, through June 29, 2023.

Interventions

VLED alone for 6 weeks or VLED for 6 weeks after RYGB; both interventions were preceded by 3-week LED.

Main Outcomes and Measures

Between-group comparisons of 6-week changes in CV risk factors.

Results

Among 78 patients included in the analyses, the mean (SD) age was 47.5 (9.7) years; 51 (65%) were women, and 27 (35%) were men. Except for a slightly higher mean (SD) body mass index of 44.5 (6.2) in the RYGB group (n = 41) vs 41.9 (5.4) in the VLED group (n = 37), baseline demographic and clinical characteristics were similar between groups. Major atherogenic blood lipids (low-density lipoprotein cholesterol, non–high-density lipoprotein cholesterol, apolipoprotein B, lipoprotein[a]) were reduced after RYGB in comparison with VLED despite a similar fat mass loss. Mean between-group differences were −17.7 mg/dL (95% CI, −27.9 to −7.5), −17.4 mg/dL (95% CI, −29.8 to −5.0) mg/dL, −9.94 mg/dL (95% CI, −15.75 to −4.14), and geometric mean ratio was 0.55 U/L (95% CI, 0.42 to 0.72), respectively. Changes in glycemic control and blood pressure were similar between groups.

Conclusions and Relevance

This study found that clinically meaningful reductions in major atherogenic blood lipids were demonstrated after RYGB, indicating that RYGB may reduce CV risk independent of weight loss.

Trial Registration

ClinicalTrials.gov Identifier: NCT02386917
Immune evasion: An imperative and consequence of MYC deregulation
Authors: Krenz Bastian , Lee Jongkuen , Kannan Toshitha , Eilers Martin
Published: July 2024

MYC has been implicated in the pathogenesis of a wide range of human tumors and has been described for many years as a transcription factor that regulates genes with pleiotropic functions to promote tumorigenic growth. However, despite extensive efforts to identify specific target genes of MYC that alone could be responsible for promoting tumorigenesis, the field is yet to reach a consensus whether this is the crucial function of MYC. Recent work shifts the view on MYC's function from being a gene‐specific transcription factor to an essential stress resilience factor. In highly proliferating cells, MYC preserves cell integrity by promoting DNA repair at core promoters, protecting stalled replication forks, and/or preventing transcription‐replication conflicts. Furthermore, an increasing body of evidence demonstrates that MYC not only promotes tumorigenesis by driving cell‐autonomous growth, but also enables tumors to evade the host's immune system. In this review, we summarize our current understanding of how MYC impairs antitumor immunity and why this function is evolutionarily hard‐wired to the biology of the MYC protein family. We show why the cell‐autonomous and immune evasive functions of MYC are mutually dependent and discuss ways to target MYC proteins in cancer therapy.
EPHB2 Knockdown Mitigated Myocardial Infarction by Inhibiting MAPK Signaling
Authors: Jiang Xiaoyan , Wang Wenhua , Kang Haofei
Published: July 2024

Myocardial infarction (MI) is a common type of cardiovascular disease. The incidence of ventricular remodeling dysplasia and heart failure increases significantly after MI. The objective of this study is to investigate whether erythropoietin hepatocellular receptor B2 (EPHB2) can regulate myocardial injury after MI and explore its regulatory pathways. EPHB2 is significantly overexpressed in the heart tissues of MI mice. The downregulation of EPHB2 alleviates the cardiac function damage after MI. Knockdown EPHB2 alleviates MI‐induced myocardial tissue inflammation and apoptosis, and myocardial fibrosis in mice. EPHB2 knockdown significantly inhibits the activation of mitogen activated kinase‐like protein (MAPK) pathway in MI mice. Moreover, EPHB2 overexpression significantly promotes the phosphorylation of MAPK pathway‐related protein, which can be reversed by MAPK‐IN‐1 (an MAPK inhibitor) treatment. In conclusion, silencing EPHB2 can mitigate MI‐induced myocardial injury by inhibiting MAPK signaling in mice, suggesting that targeting EPHB2 can be a promising therapeutic target for MI‐induced myocardial injury.