bluuebunny/crossref_metadata_2025 huggingface dataset:
School principals’ instructional leadership as a predictor of teacher’s professional development
Authors: He Ping , Guo Fangyun , Abazie Genevive Anulika
Published: June 2024

This study investigates the role of school principals’ instructional leadership as a predictor of teachers’ professional development. The research sample comprised 304 secondary school teachers and 19 principals in Awka South, Anambra State, Nigeria. The study adopts Hallinger and Murphy’s (1985) Instructional Leadership Model. Data were collected using the “Principal’s Instructional Leadership Practices and Teachers’ Professional Development” (PILPTPD) tool. Correlation analysis was utilized to explore the relationship between school principals’ instructional leadership and teachers’ professional development, while multiple regression analysis was employed to ascertain the predictive capacity of instructional leadership on teacher professional development. The results reveal significant associations between instructional leadership and teacher professional development and growth. Ultimately, instructional leadership emerges as a significant predictor of teacher professional development. This study contributes to the expanding literature emphasizing the nexus between principal instructional leadership and teacher professional development, shedding light on the mediating role of principals’ leadership in influencing teachers’ professional development and instructional practices.
Effects of task structure and confirmation bias in alternative hypotheses evaluation
Authors: Dhami Mandeep K. , Belton Ian K. , De Werd Peter , Hadzhieva Velichka , Wicke Lars
Published: June 2024

We empirically examined the effectiveness of how the Analysis of Competing Hypotheses (ACH) technique structures task information to help reduce confirmation bias (Study 1) and the portrayal of intelligence analysts as suffering from such bias (Study 2). Study 1 (N = 161) showed that individuals presented with hypotheses in rows and evidence items in columns were significantly less likely to demonstrate confirmation bias, whereas those presented with the ACH-style matrix (with hypotheses in columns and evidence items in rows) or a paragraph of text (listing the evidence for each hypothesis) were not less likely to demonstrate bias. The ACH-style matrix also did not confer any benefits regarding increasing sensitivity to evidence credibility. Study 2 showed that the majority of 62 Dutch military analysts did not suffer from confirmation bias and were sensitive to evidence credibility. Finally, neither judgmental coherence nor cognitive reflection differentiated between better or worse performers in the hypotheses evaluation tasks.
Application of fluidized-bed homogeneous crystallization technology to carbon sequestration and recovery from flue gas
Authors: Huang Po-Chun , Vilando Anabella C. , Ha Thi-Hanh , Lu Ming-Chun
Published: June 2024

The Earth’s energy balance produced by human activity is the main factor in the complex relationship between greenhouse gases and global warming. The Taiwan Environmental Protection Agency reports that carbon dioxide makes up more than 95% of Taiwan’s most recent greenhouse gas emissions. This study used fluidized-bed homogeneous crystallization (FBHC) technology to recover carbonate in a simulated CO2-enriched flue gas. It was specifically designed to determine how carbonate removal and crystallization efficiency were affected by carbonate surface loading, the influence of the source of calcium ions, and interfering substances. Results revealed that the best surface loading at 55 kg m− 2 h− 1 achieved 93% removal and 84% crystallization efficiency. At 50 mg L− 1 of sulfate ions, the presence of more interfering compounds tends to reduce carbonate removal to 97% and 91% crystallization. Regarding X-ray diffraction data, the recovered carbonate crystals resembled calcium carbonate crystals. It has been demonstrated that carbonate can be recovered using FBHC technology as a method of CO2 capture and storage.
Teleoncology in the Veterans Health Administration: Models of Care and the Veteran Experience
Authors: Parikh Divya A. , Rodgers Thomas D. , Passero Vida A. , Chang Jenni C. , Tisdale Rebecca , Kelley Michael J. , Das Millie
Published: June 2024

The Veterans Health Administration (VHA) has pioneered teleoncology to address access challenges faced by Veterans requiring cancer care. This ASCO Educational Book highlights the development of teleoncology programs within the VHA: the local VA Pittsburgh Healthcare System (VAPHS) Virtual Cancer Care Center, the National TeleOncology Program (NTO), and the regional Clinical Resource Hub (CRH) Oncology Program. These initiatives provide oncology care using a hub-and-spoke model, which centralizes expertise at hub sites and reaches Veterans at distant spoke sites through synchronous and asynchronous care. The deployment of these teleoncology programs has resulted in significant benefits, such as decreased travel for Veterans, high levels of patient satisfaction, and improved access to specialized treatments. Despite these advancements, disparities in teleoncology utilization and access to clinical trials persist. This educational manuscript highlights the successes and challenges of tele-oncology within the VHA, underscoring the critical role of telehealth in overcoming access barriers.
Impact of Medical Oncology–Focused Quality Programs on Cancer Care Around the World
Authors: O’Mahony Deirdre , Pinto Carlos Frederico , Orem Jackson , Mcleod Megan , Aggarwal Ajay , Gralow Julie R.
Published: June 2024

Quality cancer care is efficient, accessible, coordinated, and evidence-based. Recognizing the necessary key components, development of pathways and guidelines to incorporate these key domains, and finally respectful adaptation to cultural differences can ensure that cancer care globally is of the highest quality. This quality care should be judged not only on how it optimizes health outcomes for patients, but also its impact on the care providers and the global community.
Impact of a Regional Pediatric Hematology/Oncology Fellowship Program in Guatemala
Authors: Moreira Daniel C. , Garrido Claudia , Rosado Roy , Girón Verónica , Letona Tomás , Morales Gerson , Valverde Patricia , Velásquez Thelma , Alfaro Jeanine , Orellana Elizabeth , Ortega Miguel Angel , Salguero Paola , Fox Irwin Leeanna , Andujar Allyson , de Alarcón Pedro A. , Luna-Fineman Sandra , Manco-Johnson Marilyn , Conter Valentino , Verna Marta , Canesi Marta , Massimino Maura , Spreafico Filippo , Ferrari Andrea , Gassant Pascale Y. , Vásquez Roberto , Friedrich Paola , Mack Ricardo , Ribeiro Raul , Metzger Monika L. , Rodriguez-Galindo Carlos , Antillón-Klussmann Federico
Published: June 2024

PURPOSE

This study aimed to describe and assess the regional experience of a pediatric hematology/oncology fellowship program based in Guatemala.

METHODS

The Unidad Nacional de Oncología Pediátrica (UNOP) in Guatemala City, Guatemala, is the only hospital in Central America dedicated exclusively to childhood and adolescent cancer. To address the regional need for specialists, a fellowship program in pediatric hematology/oncology was launched in 2003. The UNOP fellowship program comprises 3 years of training. Although the program is based at UNOP, it also includes rotations locally and internationally to enhance clinical exposure. The curriculum is based on international standards to cover clinical expertise, research, professionalism, communication, and health advocacy. Trainees are selected according to country or facility-level need for pediatric hematologists/oncologists, with a plan for them to be hired immediately after completing their training.

RESULTS

Forty physicians from 10 countries in Latin America have completed training. In addition, there are currently 13 fellows from five countries in training. Of the graduates, 39 (98%) are now practicing in pediatric hematology/oncology in Latin America. Moreover, many of them have leadership positions within their institutions and participate in research, advocacy, and policy making. Graduates from the UNOP program contribute to institutions by providing care for an increasing number of patients with pediatric cancer. The UNOP program is the first pediatric hematology/oncology fellowship program in the world to be accredited by Accreditation Council for Graduate Medical Education-International, an international body accrediting clinical training programs.

CONCLUSION

The UNOP program has trained specialists to increase the available care for children with cancer in Latin America. This regional approach to specialist training can maximize resources and serve as a model for other programs and regions.
SARC037: Phase II results of trabectedin given as a 1-hour (h) infusion in combination with low dose irinotecan in patients (pts) with relapsed/refractory Ewing sarcoma (ES).
Authors: Grohar Patrick Joseph , Ballman Karla V. , Heise Rachel , Mascarenhas Leo , Glod John , Wedekind Mary Frances Frances , Gedminas Jenna Marie , DuBois Steven G. , Maki Robert G. , Crompton Brian D. , Figg William Douglas , Bagatell Rochelle , Laetsch Theodore Willis , Diamond Mark , Navid Fariba , Roberts Ryan David , Widemann Brigitte C. , Reinke Denise K. , Chugh Rashmi
Published: June 2024

11508

Background: Trabectedin(T) is a marine-derived minor groove DNA binding compound that alters transcription factor activity. Preclinical data suggests that T suppresses the oncogenic driver of ES, EWS::FLI1. This suppression requires a threshold concentration of T and is potentiated by low doses of Irinotecan(I). Preliminary clinical activity and reversal of the EWS::FLI1 transcriptome was seen in patients (pts) in the phase I portion of SARC037. Here we report the phase II results of T with I at the recommended dose in pts with relapsed/refractory ES. Methods: In this open-label multicenter study, T was given at 1 mg/m2 as a 1-h infusion on day(D)1 with I at 25 mg/m2 intravenously on D2 and D4 of a 21D cycle. Key eligibility criteria were EWS::FLI1 fusion transcript, age ≥6 years, ECOG ≤2, adequate organ function, and willing to have a research biopsy if safely accessible. The primary objective was to determine the objective response rate (ORR) assessed by RECIST v1.1. Secondary objectives were progression-free survival (PFS), duration of response (DOR), and safety. This study used a Simon two-stage design that required 4 or more responses (CR or PR) at the final analysis to establish treatment activity. Results: 18 pts enrolled from 12/2022-12/2023 across 6 sites, 8F/10M, median age 21y (9-43). Pts had a median of 3 (1-7) prior therapy lines, including I in 67% of pts. Of 16 pts evaluable for response at the cutoff date, 5 pts had a PR, and 2 pts had SD. Two pts have evaluations pending and two pts were removed for toxicity before the first evaluation. Median time to response was 2.6 months(m), 6-month PFS was 37.7% (95% CI 18.3%, 77.7%), and all responses were sustained at the time of data cutoff at 10.4+, 7.5+, 5.5+, 5.0+ and 4.6+ m. There were no G5 AEs. Most pts had molecular profiling, translocation testing, as well as ctDNA collection, quantitation, and analysis. A subset of pts had pre- and post-treatment biopsies for RNA sequencing and evaluation of the impact of drug exposure on the EWS::FLI1 transcriptome. Conclusions: T+I exhibited anti-tumor activity in heavily pretreated pts with ES and met its prespecified ORR with 5 PRs in 16 evaluable patients, all of which are ongoing at data cutoff. There were no unexpected safety signals. The combination of T given as a 1h infusion and low-dose I demonstrated meaningful clinical benefit and is worthy of further study in ES pts. Analysis of biological correlates is ongoing. Clinical trial information: NCT04067115 .
The CT-based multi-omics model for prognostic prediction and tumor microenvironmental alterations in retroperitoneal liposarcoma: A retrospective multicohort analysis.
Authors: Fan Peidang , Tao Ping , Wang Zhenyu , Wang Jiongyuan , Zhang Long Jiu , Hou Yong Ying , Hong Liang , Ma Lijie , Zhang Yong , Tong Hanxing
Published: June 2024

11564

Background: Retroperitoneal liposarcomas (RPLS) are tumours with a poor prognosis. Due to the tumour heterogeneity of RPLS, no effective prognostic index has been established. Radiomics has the potential to non-invasively characterize the so-called radiological phenotype of RPLS. We aimed to develop and independently validate a CT-based multi-omics model for predicting prognosis and tumour microenvironment (TIME) in RPLS to guide neoadjuvant therapy in clinical application. Methods: In this retrospective multicohort study, we used five independent cohorts of RPLS patients at our centre (n = 173, Zhongshan hospital, Fudan University, China), and the external validation cohort comprising RPLS patients from another medical centre (n = 184, Shanghai Public Health Clinical Center, Fudan University, China), to develop and validate a CT-based multi-omics model predictive of neoadjuvant chemotherapy (n = 10) and radiotherapy (n = 20) response by combining contrast-enhanced CT images and RNA-seq genomic data (n = 59) from tumour samples to assess the immune and metabolic landscape. Using the training dataset, a CT-based radiomics workflow was developed, including manual delineation, sub-segmentation, feature extraction, and predictive model building by LASSO, which was validated according to the area under the curve (AUC) for the internal validation set and external validation set. The clinical-radiomic model was developed through Univariate and Multivariate Cox regression analysis. Kaplan-Meier and log-rank tests were used for the survival analysis. Results: A total of 436 patients recruited between September 2009 and October 2021 were included in the training, internal validation, and external validation sets. The OS-related CT-based radiomics models in the training, internal validation, and external validation sets predicted the AUC values of postoperative 5-year OS as 0.71, 0.85, and 0.82, respectively. Strikingly, the clinical-CT radiomics model showed superior prognostic ability in predicting postoperative 5-year OS of 0.83, 0.85, and 0.86. Furthermore, the clinical-CT radiomics risk score was significantly decreased in post-neoadjuvant chemotherapy and radiotherapy with more tertiary lymphoid structures (TLS) and immune cell infiltration, such as plasma cells and B cells, compared to pretreatment. KEGG and ssGSEA analysis further indicated that retinol metabolism was most significantly inhibited in the high clinical-CT radiomics risk score group. Conclusions: Our validated clinical-CT radiomics model can predict the prognosis and TIME of RPLS with excellent performance. This may be a promising way to improve prognosis prediction and risk stratification of patients treated with neoadjuvant therapy, when validated by further prospective randomised trials.
The influence of yoga and cognitive behavioral therapy on mediational relationships between insomnia and cancer-related fatigue: A URCC NCORP RCT in 550 cancer survivors.
Authors: Lin Po-Ju , Altman Brian James , Dunne Richard Francis , Mattick Lindsey Jean , Chakrabarti Alisha , Samuel Stephen Rajan , Gada Umang , Culakova Eva , Jaslowski Anthony John , Kuzma Charles S. , Mustian Karen Michelle
Published: June 2024

12015

Background: Cancer-related fatigue (CRF) often co-occurs with insomnia and both are incapacitating adverse toxicities of cancer and its treatment which may persist months and years after the completion of treatment. Yoga and Cognitive Behavioral Therapy for Insomnia (CBT-I) are promising behavioral approaches for improving CRF and insomnia among cancer survivors. However, the influence of changes in insomnia resulting from participating in yoga or CBT-I on the subsequent changes in CRF is not fully understood. Methods: We conducted mediation analyses on data collected from a multicenter phase III RCT among cancer survivors who were randomized to receive 1) Yoga for Cancer Survivors (YOCAS, 75-min./session, 2x/wk. for 4 wks.), 2) CBT-I (90-min./session, 1x/wk. for 8 wks.), or 3) a behavioral placebo (ASCO recommended Survivorship Education, 75-min/session, 2x/wk. for 4 wks.). Brief Fatigue Inventory and Insomnia Severity Index were used to assess CRF and insomnia, respectively, at pre-, mid-, and post-intervention. Causal mediation analyses were conducted to estimate the influence of changes in insomnia at mid-intervention resulting from participating in YOCAS, CBT-I, or behavioral placebo on subsequent changes in CRF at post-intervention. Results: 550 survivors (93% female; mean age 57 years; 75% were breast cancer survivors) completed baseline and post-intervention assessments. YOCAS, compared to placebo, significantly improved CRF and insomnia at mid-intervention (CRF: -0.38±0.16, p = 0.01; Insomnia: -1.15±0.35, p < 0.01) and post-intervention (CRF: -0.35±0.17, p = 0.03; Insomnia: -1.43±0.41, p < 0.01). Among YOCAS participants, improvement in insomnia at mid-intervention significantly influenced the subsequent reduction in CRF (-0.14±0.06, p = 0.01) and accounted for 37% (95% CI: 0% - 78%) of the total reduction in CRF at post-intervention. CBT-I, compared to placebo, also significantly improved CRF and insomnia at mid- (CRF: -0.32±0.18, p = 0.06; Insomnia: -2.64±0.40, p < 0.01) and post-intervention (CRF: -0.59±0.18, p < 0.01; Insomnia: -4.95±0.46, p < 0.01). Among CBT-I participants, the improvement in insomnia at mid-intervention significantly influenced the subsequent reduction in CRF (-0.40±0.09, p < 0.01) and accounted for 60% (95% CI: 21% - 99%) of the total reduction in CRF at post-intervention. Conclusions: Both YOCAS and CBT-I effectively improve CRF and insomnia among survivors. 37%-60% of the reduction in CRF resulting from participating in YOCAS or CBT-I is due to improvement in insomnia. Clinicians should consider prescribing YOCAS yoga or CBT-I for survivors who experience CRF and insomnia. Clinical trial information: NCT02613364 .
Patient reported symptoms after cancer diagnosis and the risk of short- and long-term severe mental health events among adolescents and young adults (AYA): A population-based study.
Authors: Gupta Sumit , Li Qing , Sutradhar Rinku , Coburn Natalie G.
Published: June 2024

12019

Background: AYA with cancer are a vulnerable sub-population at risk of adverse mental health outcomes during and after cancer treatment. Tools to identify AYA at highest risk are required to guide screening and interventions. In a population-based cohort of AYA with cancer, we determined whether self-reported symptoms were associated with subsequent short- and long-term severe mental health events (SMHE). Methods: All Ontario, Canada AYA diagnosed with cancer aged 15-29 between 2010-2018 were identified and linked to healthcare databases, including one capturing self-reported Edmonton Symptom Assessment System (ESAS) scores at cancer-related visits. Scores for depression, anxiety, and poor well-being were categorized as not measured, mild (0-3), moderate (4-6), or severe (7-9). SMHE were defined as emergency room visits or hospitalizations for mental health reasons. First, we used Cox proportional hazard models to determine the association of ESAS scores (time-varying variable) with subsequent SMHE. Second, among 5-year survivors, we determined the association of maximum ESAS score within the first year of diagnosis with long-term SMHE (i.e. starting at 5 years from cancer diagnosis). All analyses were adjusted for patient and disease variables, including mental healthcare use prior to cancer diagnosis. Results: 5,435 AYA met inclusion criteria. Median age at cancer diagnosis was 25 years [interquartile range 22-27]. Hematologic cancers were most common (1,748; 32.2%). Symptom severity was associated with subsequent SMHE risk. For example, AYA reporting severe anxiety were at more than three-fold higher risk of SMHE compared to those reporting mild anxiety [adjusted hazard ratio (aHR) 3.6, 95th confidence interval (CI) 1.9-6.7; p < 0.001]. Similar risk was seen among AYA reporting severe vs. mild depression (aHR 3.5, 1.7-7.3; p < 0.001). Among 3,518 (64.7%) 5-year survivors, symptom severity also predicted long-term SMHE. For example, starting at 5 years post cancer diagnosis, the subsequent 3-year cumulative incidence of a SMHE among those who reported severe depression at any time during the first year post cancer diagnosis was 10.5% (95CI 6.9-15.9) compared to 2.4% (95CI 1.7-3.3) among those who only reported mild depression (aHR 3.0, 95CI 1.8-4.9; p < 0.0001). Similar results were seen pertaining to severe anxiety and severe impact on well-being. AYA endorsing severe anxiety represented 13.1% of the cohort but accounted for 25.8% of AYA experiencing SMHEs during the first three years of survivorship. Conclusions: Systematic symptom screening in the first year after cancer diagnosis identifies a proportion of AYA at high risk of both short and long-term SMHE who may benefit from targeted screening and interventions. Future work will determine whether interventions during cancer treatment mitigate this risk.
The predictive role of mammographic breast calcifications in cardiovascular disease among women undergoing breast cancer screening: Insights from a retrospective database analysis of breast cancer screening.
Authors: Akbar Usman Ali , Rizwan Umer , Hussain Rida , Umer Ahmed Muaaz , Dwiggins Andrea , Hussain Sabir , Cheshire Michael
Published: June 2024

12022

Background: Cancer screenings, particularly mammography, are crucial in early detection and management of breast cancer, the most common cancer among women worldwide. Despite advances, disparities persist in cancer outcomes and cardiovascular health, highlighting the need for an integrative approach to care. Methods: We conducted a retrospective cohort analysis of 22,118 female patients over 40 years of age diagnosed with breast arterial calcification (BAC) on mammography using the TriNetX database. Each patient with BAC was matched to a control based on age, lab values, socioeconomic class, and co-morbidities. None had ASCVD events before screening. Outcomes included acute myocardial infarction, heart failure, cardiomyopathy, and thromboembolic events. Results: Comparing cohorts with and without BAC, we found no significant difference in all-cause mortality (OR: 1.003, P=0.960). However, BAC was associated with increased risks of acute myocardial infarction (OR: 1.281, P=0.003), heart failure (OR: 1.106, P=0.021), cardiomyopathy (OR: 1.437, P<0.001), and DVT/PE (OR: 1.178, P=0.006), particularly DVT (OR: 1.243, P=0.003). Ischemic stroke, CVD, and other cardiovascular conditions showed no significant risk differences, highlighting BAC's predictive value for specific cardiovascular outcomes (Table). Conclusions: Our findings affirm BAC on mammography as a significant predictor of specific cardiovascular conditions, such as acute myocardial infarction and heart failure, highlighting its utility in cardiovascular risk stratification.[Table: see text]
End-of-life care preferences in patients with gallbladder cancer: Shifting patterns and disparities over two decades.
Authors: Jatwani Karan , Sukaina Mahnoor , Khosla Atulya Aman , Batra Nitya , Mishra Rahul , Ganiyani Mohammad Arfat , Kumar Madhan Srinivasan , Singh Rohit , Ahmed Shahid Sattar
Published: June 2024

12036

Background: Gallbladder cancer (GBC) is an aggressive malignancy with a combined survival rate of 20%. Some studies have reported less than 10 percent utilization of palliative care services in this population. Place of Death (PoD) is an important determinant of patient and caregiver preference and cost of caregiving at the end of life (EOL). We evaluate trends in PoD for patients with GBC in the U.S. from 2003 to 2020 based on the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Methods: We analyzed data using the CDC WONDER database from January 01, 2003, to December 31, 2020. The data for deaths due to GBC was pooled using the International Classification of Diseases-10th revision code as C23, including all Gallbladder Cancers. The inclusion criteria included patients aged > 18. PoD was defined as deaths at home or hospice versus medical facilities. Annual percentage change (APC), average annual percentage change (AAPC), and joint point analysis were done using the Joinpoint Regression Program, Version 5.0.2. Results: The analysis demonstrated a total of 37,576 deaths from GBC. Fifty-eight percent of deaths (21,805) were at home or hospice; AAPC: 3.23%, CI 1.4 to 5.0 (p = 0.0002). A significantly increasing trend of dying at medical facilities was seen amongst African Americans (AA); AAPC: 1.06%, CI 0.02 to 2.10, (p = 0.04), while Whites had a significant increase in the utilization of home or hospice-based care; AAPC: 2.7%, CI 2.1 to 3.2; p < 0.0001). On age stratification, there was a significant decline in using medical facilities as PoD for the > 65 yrs cohort; AAPC: -2.65% CI -3.1 to -2.1 (p < 0.0001). In contrast, the middle age group (45-64 yrs) had a trend towards decline, which was not significant in the usage of medical facilities as PoD with AAPC: -0.42% CI -1.24 to -0.4 (p = 0.29). Conclusions: To our knowledge, this is the first study providing valuable insights into the evolving PoD preferences among GBC patients in the U.S. The racial disparities highlight the need for targeted interventions and culturally sensitive end-of-life care for different demographic groups. The age-related trends underscore the importance of tailoring end-of-life care strategies to specific age cohorts. The findings emphasize the importance of policies promoting and supporting home and hospice-based care for GBC patients. Targeted efforts are warranted to address disparities in PoD preferences among racial and age groups.
When pain management meets harm reduction: Patients with cancer navigate the opioid crisis—2016 to 2020 National Inpatient Sample analysis.
Authors: Kharel Himal , Kharel Zeni , Bhandari Samikchhya Keshary , Pokhrel Nishan Babu , Shah Purva , Sanjeevi Aditya , Rao Aniket , Orakzai Abdullah Ahmad , Eltaher Basant , Jain Tripti , Jamshed Saad
Published: June 2024

12071

Background: The opioid crisis is a growing public health concern in the United States. In this retrospective study, we aim to look at the trends and predictors of opioid overdose-related mortality in cancer patients. Methods: A retrospective analysis of the National Inpatient Sample database (NIS) from 2016 to 2020 was conducted using International Classification of Diseases-10(ICD-10) codes to identify hospitalizations related to opioid overdose. The 2016-2020 mark was chosen because 2016 is the first NIS year with full implementation of ICD-10 code and there is absence of data after 2020. STATA version SE18.0 was used for statistical analysis. We used multivariate regression analysis to calculate the effects of various demographic and non-demographic variables including age, sex, Charlson Comorbidity Index(CCI), race, median household income, type of insurance, hospital bed size, hospital region, chronic lung disease, neuromuscular disease, and alcohol use disorder on opioid overdose-related mortality. Results: There were 6980 hospitalizations with opioid overdose in cancer patients. Mean age was 62.3 years and 49.9% were females. 97.9% of patients had high CCI. The trend of opioid overdose-related mortality in cancer patients is shown in the table. Unlike increasing opioid overdose related mortality in the general population (which, per CDC, increased by 62.44% from 2016 to 2020), we found that opioid-related admissions and mortality in cancer patients are stable over five years. Significant predictors of mortality (p-value <0.05) included male sex, African-American race, lower-median household income, and chronic lung disease with the odds ratio 1.64, 2.62, 2.13, and 1.69 respectively. Conclusions: The ongoing opioid crisis has led to tighter regulations regarding opioid prescriptions, subsequently creating increasing obstacles for cancer patients to access opioids. This analysis indicates that hospitalizations and deaths related to opioids in cancer patients have remained relatively stable, in contrast to the general population. Therefore, it is crucial to establish distinct regulations for cancer patients compared to the general population to ensure appropriate access to opioids for effective pain management. In addition, this study identified key predictors of mortality from opioid overdose in cancer patients, highlighting the complex interplay of socio-economic factors in medical care. The limitations of this study include multivariate model’s inability to account for all variables, coding errors, and an increased risk of bias due to the retrospective nature of the data. [Table: see text]
Cushing Syndrome Is Associated With a Higher Risk of Cancer—A Nationwide Cohort Study
Authors: Wu Wan-Chen , Wu Jia-Ling , Huang Tien-Shang , Li Chung-Yi , Li Hung-Yuan
Published: June 2024

Context

Patients with Cushing syndrome (CS) have higher risk of obesity and diabetes, which are important risk factors of cancers. However, if patients with CS have a higher incidence of cancer remains unknown.

Objective

To investigate whether endogenous CS is associated with increased cancer incidence.

Methods

A nationwide cohort study analyzing data retrieved from Taiwan's National Health Insurance program in 2006-2017. Between 2006 and 2017, 1278 patients with newly diagnosed endogenous CS were identified. Among them, 1246 patients without a history of malignancy were enrolled in this study. The age- and sex-standardized incidence rate of all-cause cancer and age-, sex-, and calendar year–standardized incidence ratio (SIR) of cancer in association with endogenous CS.

Results

The age- and sex-standardized incidences of CS decreased from 4.84 to 3.77 per million person-years between 2006 and 2017. The age at diagnosis of CS was 45.3 ± 14.8 years, and 80.0% of the patients were female. Cushing disease and adrenal CS accounted for 35.4% and 64.6% of patients with CS, respectively. The incidence rate of cancer in patients with CS was 7.77 (95% CI 5.84-10.14) per 1000 person-years, with a SIR of 2.08 (95% CI 1.54-2.75). The 3 most common cancer types were liver (27.7%), kidney (16.7%), and lung (13.0%).

Conclusion

Patients with endogenous CS have a higher incidence of cancer.
Incidence and Characteristics of Cerebral Infarction After Microsurgical Clipping of Unruptured Anterior Circulation Cerebral Aneurysms: Diffusion-Weighted Imaging-Based Analysis of 600 Patients
Authors: Han Hyun Jin , Chung Kyu Seon , Kim Solbi , Kim Jung-Jae , Park Keun Young , Kim Yong Bae
Published: June 2024

BACKGROUND AND OBJECTIVES:

Postclipping cerebral infarction (PCI) remains a major concern after treatment for unruptured intracranial aneurysms (UIAs). However, studies of microsurgical clipping based on diffusion-weighted imaging are limited. We aimed to present the incidence, risk factors, and types of PCI and its radiological and clinical characteristics.

METHODS:

This was a retrospective single-center study in which patients were scheduled to undergo microsurgical clipping for anterior circulation UIAs. The overall incidence and risk factors were calculated. Based on the operation and relevant artery, we categorized PCI on diffusion-weighted imaging into 4 types and presented their radiological and clinical characteristics.

RESULTS:

We reviewed the radiological and clinical data of 605 patients. The overall incidence of PCI was 16.7% (101/605), of which asymptomatic infarction was 14.9% (90/605) and symptomatic infarction was 1.8% (11/605). Hypertension (adjusted odds ratio [aOR], 2.258; 95% confidence interval [CI]: 1.330-3.833), temporary clipping (aOR, 1.690; 95% CI: 1.034-2.760), multiple aneurysm locations (aOR, 1.832; 95% CI: 1.084-3.095), and aneurysm dome size (aOR, 1.094; 95% CI: 1.006-1.190) were independent risk factors for PCI. Type II (perianeurysmal perforator) infarction was the most common type of PCI (48.6%) and the most common cause of symptomatic infarction (72.7%). Types II and III (distal embolic) infarctions correlated with atherosclerotic changes in the aneurysm wall and temporary clipping (62.4% and 70.6%, respectively). The type IV (unrelated) infarction group had a higher incidence of systemic atherosclerosis (55%).

CONCLUSION:

Microsurgical clipping is a safe and viable option for the treatment of anterior circulation UIAs. However, modification of the surgical technique, preoperative radiological assessment, and patient selection are required to reduce the incidence of PCI.
Feasibility of Endovascular Deep Brain Stimulation of Anterior Nucleus of the Thalamus for Refractory Epilepsy
Authors: Kashyap Varun , Ashby Mark , Stanslaski Scott , Nguyen Kevin , Hageman Kristin , Chang Yao-Chuan , Khalessi Alexander A.
Published: June 2024

BACKGROUND AND OBJECTIVES:

Deep brain stimulation (DBS) has developed into an effective therapy for several disease states including treatment-resistant Parkinson disease and medically intractable essential tremor, as well as segmental, generalized and cervical dystonia, and obsessive-compulsive disorder (OCD). Dystonia and OCD are approved with Humanitarian Device Exemption. In addition, DBS is also approved for the treatment of epilepsy in the anterior nucleus of the thalamus. Although overall considered an effective treatment for Parkinson disease and epilepsy, a number of specific factors determine the treatment success for DBS including careful patient selection, effective postoperative programming of DBS devices and accurate electrode placement. Furthermore, invasiveness of the procedure is a rate limiter for patient adoption. It is desired to explore a less invasive way to deliver DBS therapy.

METHODS:

Here, we report for the first time the direct comparison of endovascular and parenchymal DBS in a triplicate ovine model using the anterior nucleus of the thalamus as the parenchymal target for refractory epilepsy.

RESULTS:

Triplicate ovine studies show comparable sensing resolution and stimulation performance of endovascular DBS with parenchymal DBS.

CONCLUSION:

The results from this feasibility study opens up a new frontier for minimally invasive DBS therapy.
Disparities Associated with Decision to Undergo Oncologic Surgery: A Prospective Mixed-Methods Analysis
Authors: Van Haren Robert M. , Kovacic Melinda Butsch , Delman Aaron M. , Pratt Catherine G. , Griffith Azante , Arbili Lana , Harvey Krysten , Kohli Eshika , Pai Ahna , Topalian Alique , Rai Shesh N. , Shah Shimul A. , Kues John
Published: June 2024

Background

Underrepresented minority patients with surgical malignancies experience disparities in outcomes. The impact of provider-based factors, including communication, trust, and cultural competency, on outcomes is not well understood. This study examines modifiable provider-based barriers to care experienced by patients with surgical malignancies.

Methods

A parallel, prospective, mixed-methods study enrolled patients with lung or gastrointestinal malignancies undergoing surgical consultation. Surveys assessed patients’ social needs and patient-physician relationship. Semi-structured interviews ascertained patient experiences and were iteratively analyzed, identifying key themes.

Results

The cohort included 24 patients (age 62 years; 63% White and 38% Black/African American). The most common cancers were lung (n = 18, 75%) and gastroesophageal (n = 3, 13%). Survey results indicated that food insecurity (n = 5, 21%), lack of reliable transportation (n = 4, 17%), and housing instability (n = 2, 8%) were common. Lack of trust in their physician (n = 3, 13%) and their physician’s treatment recommendation (n = 3, 13%) were identified. Patients reported a lack of empathy (n = 3, 13%), lack of cultural competence (n = 3, 13%), and inadequate communication (n = 2, 8%) from physicians. Qualitative analysis identified five major themes regarding the decision to undergo surgery: communication, trust, health literacy, patient fears, and decision-making strategies. Five patients (21%) declined the recommended surgery and were more likely Black (100% vs. 21%), lower income (100% vs. 16%), and reported poor patient-physician relationship (40% vs. 5%; all p < 0.05).

Conclusions

Factors associated with declining recommended cancer surgery were underrepresented minority race and poor patient-physician relationships. Interventions are needed to improve these barriers to care and racial disparities.
Фразеология в русском криминальном жаргоне (арго). (Проблемы и задачи изучения)
Authors: Бирих Александр
Published: June 2024

At the end of the 20th and beginning of the 21st century, a large number of argotic lexemes and phraseologisms began to enter the Russian language, originating in the language of the criminal world and marginalized groups: criminals, thieves, swindlers, card cheats, prisoners, beggars, drug addicts, etc. In most cases, these linguistic means in figurative form reflect the world view of criminals, its philosophy and moral attitudes, value orientations and norms of behaviour, i.e. criminal subculture. The present article is devoted to the ideographical system of Russian argotic phraseological units and to the ways of their formation. The analysis that had been carried out confirmed the high degree of anthropocentrism of argotic phraseology. Most phraseosemantic fields are closely connected to traits, qualities and actions of a person. At the same time, certain semantic fields (“fraud”, “drunkenness”, “sex”, “theft”, “murder”, “fight”, etc.) appear to be rather elaborated in the argot than in standard and spoken language. This can be explained by a particular system of values and a specific world-view of argot speakers.
Resolving Tensions Between Heterogeneous Investors in a Startup
Authors: Chen Shiqi , Lambrecht Bart M.
Published: June 2024

Legal scholars highlight the tensions that exist between different classes of shareholders in startups. We model a startup owned by undiversified investors with heterogeneous capital contributions and risk preferences. A social planner runs the firm on behalf of all investors. We compare investors’ expected utility with a hypothetical first-best decentralized benchmark. The startup’s optimal investment policy is procyclical and a time-varying weighted average of shareholders’ optimal investment policies. The optimal contracts issued to investors are tailor-made, interdependent, and include equity claims resembling preferred stock with heterogeneous payout caps, leading to a complex capitalization table as more investors join the startup.

This paper was accepted by Will Cong, finance.

Funding: This work was supported by the Cambridge Endowment for Research in Finance and Keynes Fellowship.

Supplemental Material: The online appendices and data files are available at https://doi.org/10.1287/mnsc.2022.01724 .
Management of chronic kidney disease associated pruritus: it's time to ask ‘do you itch?’
Authors: Burton James O , Parker Kathrine
Published: June 2024

Prescribing information and adverse event reporting for Kapruvia®▾ (difelikefalin) can be found at the end of this article ((UK-DFK-2400065) April 2024)

Itchy skin is a common symptom for people with advanced chronic kidney disease (CKD), and it has a significant impact on outcomes of treatment. Due to a combination of patient and healthcare related factors, it remains under-reported, under-diagnosed and inadequately treated. Recently, the landscape for treatment has changed. Although the pathogenesis of CKD-associated pruritus (CKD-aP) is complex and multifactorial, the role of the endogenous opioid pathway is now much better understood. Difelikefalin is a peripherally acting kappa opioid receptor agonist indicated for the treatment of moderate-to-severe pruritus associated with chronic kidney disease in adult patients on in-centre haemodialysis with a favourable safety profile; it does not produce typical opioid side-effects and is the first approved therapy for CKD-aP in Europe. People on dialysis should be asked ‘do you itch?’, and evidence-based management pathways should be used to treat this debilitating symptom much more effectively.
Mezgitkale Anıtı nın Mimari Özellikleri ve Olba Bölgesi nin Kültürel Dokusu İçindeki Anlamı
Authors: Şubaşı Bilhan
Published: June 2024

Mersin’in 80 km batısında, Susanoğlu beldesinin yaklaşık 13 km kuzeyinde, Öztürkmenli köyü sınırları içerisinde yer alan Mezgitkale Anıtı, Roma İmparatorluk Dönemi’ne tarihlenen iyi korunmuş yapılardan biridir. Her ne kadar yapının durumu oldukça sağlam olsa da yapıyla ilişkili bilgi veren bazı önemli mimari unsurların da çevreye yayılmış olduğu tespit edilmiştir. Yapı, tüm bu unsurlarla birlikte ele alınmış ve bir rekonstrüksiyon önerisinde bulunulmuştur. Ayrıca yakın çevre ve Levant Bölgesi’ndeki benzer anıtlarla karşılaştırarak yapının fonksiyonu ile ilişkili kuşkular giderilmeye çalışılmıştır. Bu bağlamda Mezgitkale’nin, özellikle Levant Bölgesi’ndeki tapınaklarla benzerlikler taşıdığı görülse de, neden bir tapınak olamayacağı ve neden bir tapınak mezar olması gerektiği tartışılmıştır. Tartışmalar içerisinde yine Dağlık Kilikia Bölgesi’nde bulunan tapınaklar ile tapınak mezar yapılarının benzerlik ve farklılıkları, yerel kültürün özellikleri dikkate alınarak değerlendirilmiştir. Bir yapının fonksiyonu belirlenirken yapının konumu ve sosyolojik değerlendirilmesi de göz önüne alınmalıdır. Tüm bu saptamalar sonucunda Mezgitkale Anıtı ve bu anıtla benzerlik gösteren yapıların Olba Bölgesi’nde tapınak olarak değerlendirilemeyeceği, Mezgitkale’nin bir çiftlik kompleksinin içerisinde yer alan anıtsal mezar yapısı olarak değerlendirilmesinin daha anlamlı olduğu görülmüştür.
Milli Şef Dönemi Hükümetlerinde Ali Fuat Cebesoy un Nafia (Bayındırlık) ve Münakalat (Ulaştırma) Bakanlıkları
Authors: Bozkurt Birgül
Published: June 2024

Bu çalışmada, Ali Fuat Cebesoy’un Türk siyasal yaşamı içinde özellikle Milli Şef döneminde bakanlık faaliyetlerine odaklanılmaktadır. Cebesoy, Milli Müca¬de¬lenin önder kadrosu içinde yer almış başarılı bir komutan, Türkiye Büyük Millet Meclisi (TBMM) ile Sovyetler Birliği arasında ilişkilerin yürütülmesinde rol almış bir diplomattır. Cumhuriyetin ilanının ardından önder kadronun siyaseten yol ayrımı sürecinde Terakkiperver Cumhuriyet Halk Partisi’nin kurucuları arasında yer almıştır. Parti’nin kapatılmasıyla siyasal yaşama ara vermiştir. 1933 yılında Konya milletvekili seçilmesiyle siyasal yaşama geri dönen Cebesoy, Atatürk’ün ölümünün ardından İsmet İnönü’nün Tür¬kiye’nin ikinci Cumhurbaşkanı ve “Milli Şef” ilan edil¬diği dönemde bakanlık görevlerine getirilmiştir. Ali Fuat Cebesoy, 3 Nisan 1939 ile 9 Mart 1943 tarihleri arasında Nafia (Bayındırlık) Vekilliği, 9 Mart 1943 ile 7 Ağustos 1946 yılları arasında Münakalat (Ulaştırma) Vekilliği yapmıştır. Ülke içi siyasetin dinamiklerini de belirleyen, II. Dünya Savaşı yıllarını kapsayan dönem, son derece kritik bir tarihsel evreyi içermektedir. Dolayısıyla çalışmada, ülkenin kalkınma faaliyetlerinde önemli bir rol üstlenmiş olan bayındırlık ve ulaştırma politikaları ve uygulamaları, arşiv kaynakları, TBMM tutanakları, dönemin basını ve hatıratlar ışığında değerlendirilmiştir.
Analysis of animal-to-human translation shows that only 5% of animal-tested therapeutic interventions obtain regulatory approval for human applications
Authors: Ineichen Benjamin V. , Furrer Eva , Grüninger Servan L. , Zürrer Wolfgang E. , Macleod Malcolm R.
Published: June 2024

There is an ongoing debate about the value of animal experiments to inform medical practice, yet there are limited data on how well therapies developed in animal studies translate to humans. We aimed to assess 2 measures of translation across various biomedical fields: (1) The proportion of therapies which transition from animal studies to human application, including involved timeframes; and (2) the consistency between animal and human study results. Thus, we conducted an umbrella review, including English systematic reviews that evaluated the translation of therapies from animals to humans. Medline, Embase, and Web of Science Core Collection were searched from inception until August 1, 2023. We assessed the proportion of therapeutic interventions advancing to any human study, a randomized controlled trial (RCT), and regulatory approval. We meta-analyzed the concordance between animal and human studies. The risk of bias was probed using a 10-item checklist for systematic reviews. We included 122 articles, describing 54 distinct human diseases and 367 therapeutic interventions. Neurological diseases were the focus of 32% of reviews. The overall proportion of therapies progressing from animal studies was 50% to human studies, 40% to RCTs, and 5% to regulatory approval. Notably, our meta-analysis showed an 86% concordance between positive results in animal and clinical studies. The median transition times from animal studies were 5, 7, and 10 years to reach any human study, an RCT, and regulatory approval, respectively. We conclude that, contrary to widespread assertions, the rate of successful animal-to-human translation may be higher than previously reported. Nonetheless, the low rate of final approval indicates potential deficiencies in the design of both animal studies and early clinical trials. To ameliorate the efficacy of translating therapies from bench to bedside, we advocate for enhanced study design robustness and the reinforcement of generalizability.
Developing a logic model for communication-based interventions on antimicrobial resistance (AMR)
Authors: Virhia Jennika , Laurie Emma , Lembo Tiziana , Seni Jeremiah , Pollack Roxana , Davis Alicia , Mapunjo Siana , Mshana Stephen E. , Mmbaga Blandina T. , Hilton Shona
Published: June 2024

The importance of communication in enhancing people’s awareness and understanding of antimicrobial resistance (AMR) is consistently recognised in global and national action plans (NAPs). Despite this, there have been relatively few national AMR communication campaigns which use a structured approach to take account of the local context, encompass co-design with the target audience and use a logic model to help inform its design, implementation and evaluation. Designing a logic model for communication-based interventions can help map out the planning, resources, messaging, assumptions and intended outcomes of the campaign to maximise its impact, ensure it is fit for context and minimise any unintended consequences on individuals and society. Building on an AMR research project in Tanzania, Supporting the National Action Plan for AMR (SNAP-AMR), we co-designed the SNAP-AMR Logic Model with key stakeholders to implement AMR communication campaigns and related legacy materials to be employed in support of the Tanzanian NAP, but with broader relevance to a range of contexts. In developing the SNAP-AMR Logic Model, we reviewed relevant communication theories to create and target messages, and we considered behavioural change theories. We defined all key elements of the SNAP-AMR Logic Model as follows: (1) resources (inputs) required to enable the design and implementation of campaigns, e.g. funding, expertise and facilities; (2) activities, e.g. co-design of workshops (to define audience, content, messages and means of delivery), developing and testing of materials and data collection for evaluation purposes; (3) immediate deliverables (outputs) such as the production of legacy materials and toolkits; and (4) changes (outcomes) the campaigns aim to deliver, e.g. in social cognition and behaviours. The SNAP-AMR Logic Model efficiently captures all the elements required to design, deliver and evaluate AMR communication-based interventions, hence providing government and advocacy stakeholders with a valuable tool to implement their own campaigns. The model has potential to be rolled out to other countries with similar AMR socio-cultural, epidemiological and economic contexts.