bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation of the combination of CT-derived tumor texture and vessel tortuosity on survival outcomes for immunotherapy but not for chemotherapy in metastatic non-small cell lung cancer (mNSCLC): Results from a CheckMate227 (CM227) subset.
Authors: Mutha Pushkar , Khorrami Mohammadhadi , Sonuga Babajide , Aggarwal Kshitij , Safta Wiem , Grootendorst Diederik J. , Paulucci David , Mustatea Oana , Nepon Sixt Brook , Witt David , Al-Shakhshir Hilmi , Viswanathan Vidya Sankar , Callahan Jeremy , Velcheti Vamsidhar , Madabhushi Anant
Published: June 2024

8610

Background: CM227 (NCT02477826) is a large multi-center phase 3 trial that evaluated the benefit of immunotherapy (IO) over chemotherapy (Ch) as first line therapy in stage IV NSCLC. While PD-L1 and tumor mutational burden (TMB) initially emerged as promising biomarkers, CM227 showed benefit of IO over Ch regardless of PD-L1 or TMB status. There is an unmet clinical need for predictive biomarkers to identify patients (pts) who will respond to IO. In this study, we report initial blinded validation results of a CT-derived biomarker combining change in textural radiomics (Δ-Rad) and quantitative vessel tortuosity (Δ-QVT) between baseline and 6-week post-treatment for predicting response and survival outcome of IO and Ch alone in a subset of patients enrolled in CM227. Methods: This retrospective study included baseline (B) and 6-week post-treatment (TP1) CT scans from (a) a multi-center training set (Dtr, N=110) of first line IO-treated mNSCLC pts and (b) a validation set consisting of a subset of mNSCLC from CM227 (Dv, N=224), of which 178 pts were treated with IO (DvIO) and 36 pts (DvCh) with Ch. Intra-tumoral, peri-tumoral texture radiomic (Khorrami et al., Cancer Immunol Res 2020) and QVT (Alilou et al., Sci Adv 2022) features were extracted from up to the two largest measurable lung lesions on each CT using an in-house MATLAB pipeline. Δ-Rad and Δ-QVT features were computed as the feature difference between B and TP1. A best objective IO response classifier, MCombo was trained on Dtr using a combination of Δ-Rad and Δ-QVT features. Kaplan-Meier analyses with log rank p-values, hazard ratio (HR) and its confidence interval (CI) were computed to assess the predictive benefit of MCombo with overall survival (OS) and progression free survival (PFS) in Dv, DvIO and DvCh. We also report area under the receiver operating characteristic (AUC) of IO response predictions compared against best overall response in Dv, DvIO and DvCh. Results: MCombo predicted best overall response with an AUC of 0.67, 0.68, 0.74 in Dv, DvIO, and DvCh, respectively. MCombo was statistically significantly associated with OS and PFS in Dv and DvIO but not in DvCh (Table). Conclusions: Our preliminary findings reveal that combination of CT-based textural and vessel tortuosity features are predictive of IO response over chemotherapy in a subset of CM227 pts. Validation on the entire CM277 cohort is warranted. [Table: see text]
Datopotamab deruxtecan (Dato-DXd) plus pembrolizumab (pembro) with or without platinum chemotherapy (Pt-CT) as first-line (1L) therapy for advanced non-small cell lung cancer (aNSCLC): Subgroup analysis from TROPION-Lung02.
Authors: Levy Benjamin Philip , Paz-Ares Luis G. , Su Wu-Chou , Herbert Scott M. , Yang Tsung-Ying , Tolcher Anthony W. , Lou Yanyan , Zenke Yoshitaka , Cortinovis Diego Luigi , Felip Enriqueta , Domine Manuel , Leventakos Konstantinos , Calvo Emiliano , Horiike Atsushi , Pan Edward , Lin Daisy , Jia Xiaoyu , Basak Priyanka , Chisamore Michael Jon , Goto Yasushi
Published: June 2024

8617

Background: Dato-DXd is an antibody-drug conjugate (ADC) composed of an anti-TROP2 monoclonal antibody linked to a potent topoisomerase I inhibitor payload. We report updated findings from TROPION-Lung02 (NCT04526691) evaluating Dato-DXd plus pembro with or without Pt-CT as 1L therapy for aNSCLC. Methods: Patients (Pts) received Dato-DXd (4 or 6 mg/kg) plus pembro 200 mg alone (doublet) or with Pt-CT (triplet; cisplatin 75 mg/m2 or carboplatin AUC 5) Q3W across 6 cohorts. Pts in the expansion stage were primarily treatment (tx)-naïve. PD-L1 expression was evaluated by tumor proportion score (TPS < 50% or ≥50%) using immunohistochemistry (22C3 assay). The primary objectives were safety and tolerability, with efficacy a secondary objective. Results: 96 pts were treated with doublet (n = 42) or triplet (n = 54) therapy in the 1L setting. At data cutoff (Oct 31, 2023), 45% and 20% of pts receiving doublet or triplet tx were ongoing. Median age was 66 years in both subgroups. Median treatment durations were 6.6 and 5.8 months. Across doublet and triplet tx, the most common any-grade (Gr) treatment-emergent adverse events (TEAEs) were stomatitis (57%, 33%) and nausea (40%, 46%), mainly Gr 1–2. Gr ≥3 TEAEs were seen in 57% and 76% of pts; serious TEAEs in 38% and 44%. TEAEs associated with Dato-DXd discontinuation occurred in 29% and 39% of pts receiving doublet or triplet tx. TEAEs associated with death were seen in 2% and 9%, none considered related to study drug. Efficacy outcomes, including ORR and preliminary PFS, in the 1L setting overall and by PD-L1 status are summarized in the Table. Conclusions: As 1L therapy for aNSCLC, Dato-DXd plus pembro with or without Pt-CT continues to demonstrate durable antitumor activity. Efficacy was observed regardless of PD-L1 expression. Tolerability of the combinations was as expected based on known profiles of the individual agents, with no new safety signals observed. To date, this is the largest dataset reported for any ADC combined with an anti-PD-1/L1 agent in the 1L setting for aNSCLC. Clinical trial information: NCT04526691 . [Table: see text]
Therapeutic activity of a new KRASG12C inhibitor JMKX001899 in brain metastases: Preclinical models of KRASG12C-mutant non-small cell lung cancer.
Authors: He Danming , Wang Jie , Zhu Yixiang , Zhong Jia , Bai Hua
Published: June 2024

8630

Background: Development of therapies targeting KRAS have transformed KRAS from undruggable to druggable. However, patients with KRASG12C-mutant non-small cell lung cancer (NSCLC) with brain metastasis (BM) have a poor prognosis. JMKX001899, a new potent oral small-molecule KRASG12C inhibitor, irreversibly and selectively binds KRASG12C, locking it in its inactive state. Its antitumor activity in the intracranial is unclear. Methods: In order to verify the activity of new KRASG12C inhibitor JMKX001899 in KRASG12C-mutant NSCLC with BM, murine models were employed for investigating the efficacy. 5-6 weeks old female Balb/c nude mice were implanted intracranially with H358-Luc and H23-Luc cells. Baseline bioluminescent imaging (BLI) was used to monitor the tumor burden and total flux was calculated by Living Image. Ten days after implantation, oral once-daily dosing of vehicle, sotorasib (AMG510) at 100 mg/kg, 30 mg/kg and JMKX001899 at 100 mg/kg, 30 mg/kg, 10 mg/kg was started and continued for 21 days. The tumor burden was monitored by BLI weekly. The mice were weighed per 3 days. Results: At the 30mg/kg and 100mg/kg dose level, the mean cerebrospinal fluid (CSF)-to-unbound plasma ratios (Kp,uu) was 0.18-0.50, which determined JMKX001899 CSF exposure was sufficient to mediate regression tumors in experimental BM models. In mice bearing intracranial xenografts of H358-Luc and H23-Luc, oral JMKX001899 100mg/kg once daily treatment for 21 days resulted in significant inhibition of brain tumor growth revealed by BLI, compared with vehicle and AMG510. H358-Luc xenografts responded particularly well to the JMKX001899 treatment, showed by the ratio of 14 days and 0 days total bioluminescence flux (vehicle vs. AMG510 100mg/kg vs. JMKX001899 100mg/kg, 0.85 vs. 0.89 vs. 0.01, p < 0.05). In addition, JMKX001899 at 100mg/kg once daily demonstrated an increase in over survival. JMKX001899 100 mg/kg once daily treatment was well tolerated with minimal sign of overt toxicity or animal weight loss. Conclusions: The preclinical models in vivo suggest the new KRASG12C inhibitor JMKX001899 penetrates the central nervous system and show great inhibition of KRASG12C-mutant NSCLC with BM, which demonstrates therapeutic activity of JMKX001899 in BM. These data support further development of JMKX001899 in patients with KRASG12C-mutant NSCLC with BM.
International medical graduates (IMG) representation at international oncology conference meetings.
Authors: Roy Arya Mariam , Bakouny Ziad , Dizman Nazli , Ozay Zeynep Irem , Mohan Lal Bhavesh , Nawfal Rashad , Eid Marc , El Hajj Chehade Razane , Machaalani Marc , Butt Ayesha , Aggarwal Charu , Bekaii-Saab Tanios S. , Chavez-MacGregor Mariana , Lopes Gilberto , Marshall Ariela Lucy , Murphy Martina Cathryn , Owonikoko Taofeek K. , Lee Alfred Ian , CHOUEIRI Toni K.
Published: June 2024

9000

Background: Despite IMGs accounting for up to one-third of all practicing oncologists in the United States, little is known about their contributions to presentations at international oncology meetings, such as the American Society of Clinical Oncology (ASCO). Therefore, we investigated the representation of IMGs in invited faculty roles at ASCO Annual Meetings. Methods: Speaker presentation details at ASCO 2022 and 2023 Annual Meetings were collected using publicly available program guides. We collected presentation-level variables of invited faculty roles (discussant, moderator, chairmanship, session topic presenter) and original research type (oral abstract, poster discussion, plenary session). Speaker-level variables comprised presumed gender, academic rank, and institution. Speakers were categorized into the following groups - American Medical Graduate (AMG): currently affiliated with a US institution, completed medical school in the US; IMG: affiliated with a US institution, completed medical school outside the US; non-US based speakers: affiliated with an institution outside the US; non-MD speakers. Univariable and multivariable analyses were employed to assess factors associated with the selection of presenters for invited faculty roles. Results: A total of 3337 presentations (1649 from 2022, 1688 from 2023) were included. 71.6% of the speakers were US-based, 56.6% were male and 40.5% were full professors. The highest proportion of podium presentations was by AMGs (48.5%), followed by non-US based (28.3%), IMGs (14.1%), and non-MD (9.1%) speakers. 57% of IMG presentations consisted of original research compared to 48.7% for AMGs (Table). Notably, compared to AMGs, IMGs were significantly less likely to be included in invited faculty roles (odds ratio [OR] 0.72 [95% CI 0.58 – 0.88], p <0.01), a finding that remained significant after accounting for gender and academic rank (adjusted OR 0.75 [0.61 – 0.94], p= 0.01). Conclusions: Relative to IMGs’ original research output, IMGs appear to receive less invitations for ASCO Annual Meeting invited faculty roles compared to AMGs. Our findings suggest potential under-representation and under-recognition of IMGs in these roles, despite their contributions to the oncology workforce in the US. [Table: see text]
Evaluating speaker gender in scientific sessions at ASCO and ASCO GI (2019-2023).
Authors: Shroff Rachna T. , Morris Van K. , Lin Kangyu , Kunz Pamela L.
Published: June 2024

9009

Background: Gender disparities exist in medicine, including academic and medical society leadership, journal editorial boards, and research teams. Women are also underrepresented in clinical trial leadership and authorship, with one study reporting fewer than 10% female corresponding authors for randomized clinical trials in GI Oncology, GU oncology, and Hematology. Clinical trial leadership, subsequent podium presentations and authorship have downstream effects on promotion, reputation, and funding opportunities. We examined the gender of speakers in scientific sessions at the ASCO Annual Meeting (AM) and Gastrointestinal Symposium (ASCO GI) from 2019-2023. Methods: We examined speaker gender, role (session chair, abstract presenter, abstract discussant), speaker region (Asia, Europe, N. America), and presentation topic (colorectal cancer or non-colorectal cancer) for the ASCO AM GI scientific sessions and ASCO GI from 2019-2023. For the ASCO AM, we included GI oral abstracts and plenary sessions; for ASCO GI we included oral and rapid abstracts. Self-identified gender was not available; therefore, gender was assigned by physical appearance via ASCO video or institutional websites. Statistical analyses were performed using the two-proportions z-test with a p value <0.05 considered statistically significant. Results: 208 scientific abstracts were reviewed across both meetings over 5 years. There was a statistically significant difference in the % of men vs. women as abstract presenters (77% vs 23%, p <0.001). This did not differ when looking at ASCO and ASCO GI separately (ASCO 76% vs 24%, ASCO GI 78% vs 22%, p <0.001 for both) and was observed across all 5 years. Similarly, there was a predominance of men as abstract presenters regardless of speaker region (Asia 93%, Europe 74%, N. America 67%, p<0.001 for all) and presentation topic (CRC 76% vs 24%, non-CRC 78% vs. 22%; p <0.001 for both). The percent of men as repeat presenters for scientific abstracts was statistically higher than women (84% vs 16%, p <0.001). Importantly, there was no difference in men vs. women in the invited chair/discussant roles (51% vs 49%, p = 0.89). Conclusions: Our analysis of 5 years of scientific sessions for ASCO and ASCO GI shows a stark difference in the proportion of men vs women as abstract presenters regardless of presentation topic, region of presenter, and meeting year. Our data highlight the need for all trial sponsors to be more intentional in the selection of principal investigators and lead authors as these opportunities are critical to the promotion of women in GI Oncology and to diversifying approaches to clinical trial design and access. Our data is limited by how gender was assigned (i.e., not self-reported). Lastly, we commend ASCO on their efforts to ensure gender equity among the roles that are within their control, and we advocate for them to consider opportunities for self-identification of gender in their membership directory.
Utilizing data to drive solutions for healthcare worker wellbeing.
Authors: Gallagher Amy , Faller Julia , Cianchetti Kristin , Nurkin Steven J. , Mann Gary , Case Amy Allen
Published: June 2024

9012

Background: Oncology Healthcare Workers (HCWs) provide extraordinary treatment to patients coping with distinct challenges. While experiences of burnout, compassion fatigue, and moral distress are not new, the COVID-19 pandemic further emphasized that intentional effort is needed to mitigate these negative work-related consequences. While Roswell Park Comprehensive Cancer Center (Roswell) initiated pre-pandemic grassroots efforts to examine burnout and build organizational resilience, deliberate resources were deemed necessary to support HCW resilience and well-being. Roswell committed to building a division solely focused on employee resiliency and burnout prevention. Methods: Qualitative and quantitative data were collected to identify organizational needs and pain points. Qualitative data was collected by the Resiliency Director who held over 100 conversations in 100 days with diverse personnel across the institute. Discussions focused on two questions (e.g., What’s working well? and What are the pebbles in employees’ shoes?) to assess organizational strengths are growth areas. Quantitative data was obtained through the Mini-Z, a validated burnout screener. All employees were emailed an invitation to take the survey over an 8-week period starting in December 2022. Concerned employees could self-refer to the Employee Assistance Program at the screener’s conclusion. Results: Qualitative data was categorized into Maslach's burnout drivers (workload, relationships, recognition, fairness, autonomy, and values conflict). Highlights included staff shortages, eroding of relationships during the pandemic, siloed communication, inconsistent recognition, micromanagement, and use of antiquated systems. Mini-Z results are displayed in the table. An interactive dashboard helped further examine demographics, role, and departmental data. Press Ganey employee engagement data also supported improvements for staff well-being, transparent communication, collaboration, recognition, and enhanced technology. Conclusions: Quantitative and qualitative data can drive individual, departmental, and organizational interventions to support HCW well-being. The newly established MedStaff Satisfaction and Wellness group is using the data to focus on recognizing the needs of the medical staff on an organizational level and is preparing to offer solutions to key stakeholders. HCWs are now incorporating activities aiming to build psychological safety, enhance communication, and advance well-being into their work routines through training, wellness activities, and emotional support. The Mini-Z screener has been made available in the Employee Health Portal permitting ease of personal reassessment. [Table: see text]
Observing attending physician teaching behaviors during inpatient hematology/oncology consultation.
Authors: Trainer Michael , O'Sullivan Patricia , Brondfield Sam
Published: June 2024

9017

Background: Inpatient consultation is a primary responsibility of fellows and residents. Consults are complex tasks that impose significant cognitive load (CL) on trainees, potentially jeopardizing patient safety. We previously published strategies for attendings to optimize trainee CL during consults, and we also demonstrated that distractions are a prominent source of trainee CL during consults. Strategies to optimize CL have not been studied during inpatient consultation. Therefore, we aimed to observe and categorize attending behaviors that might affect trainee CL during consults using hematology/oncology as a model. Methods: After discussion with author SB (an oncologist who frequently performs and teaches inpatient oncology consultation), one author (MT, a neurology resident with experience performing consults outside of hematology/oncology) observed 10 new inpatient hematology and oncology consult discussions between attendings and fellows or residents at the University of California, San Francisco in 2023. The observer used our published set of strategies, divided into the three CL types (intrinsic load [IL] strategies to optimize the consult for the trainee, extraneous load [EL] strategies to reduce distractions, and germane load [GL] strategies to promote learning), as a checklist of attending behaviors and noted whether each behavior occurred during the discussions. Results: Discussions between four attendings and five trainees (three fellows and two residents) on inpatient hematology and oncology consult services were observed. Two attendings identified as female (one hematologist and one oncologist) and two male (one hematologist and one oncologist). Out of 18 attending behaviors on the checklist (six each of IL, EL, and GL), 13 (72%) were observed at least once. The median number of behaviors observed during one consult discussion was 3.5 (range 1-5, interquartile range 2-4.75). GL behaviors occurred most often (14 times across the 10 discussions), IL behaviors next most often (11 times), and EL behaviors least often (seven times). All four attendings exhibited at least one behavior from each CL type. The most commonly observed behavior was “teaching by sharing clinical reasoning” (GL). Conclusions: Hematology/oncology attendings exhibited observable behaviors related to optimizing trainee CL during inpatient consults and demonstrated behaviors intended to promote learning (GL) more frequently than behaviors intended to reduce trainee distractions (EL). Based on these data, hematology/oncology consult attendings may wish to augment their use of behaviors intended to reduce distractions, which are prominent during inpatient consults, to avoid trainee cognitive overload. Future research might correlate measured trainee CL with attending teaching behaviors to demonstrate the impact of these behaviors and optimize consult teaching interactions.
Understanding fellow hematology curriculums: Characterizing perspectives and defining opportunities for improvement.
Authors: Godby Richard , Lingamaneni Prasanth , Gangat Naseema , Paludo Jonas
Published: June 2024

9018

Background: Comprehensive hematology education during fellowship is paramount for providing high-quality care, especially in busy practices. Variability in fellow educational experiences is expected. However, fellowship programs must ensure a well-rounded, equitable educational experience for all fellows to prepare them for practice and board exams in the increasingly dynamic field of hematology. Methods: We administered an e-mail survey to hematology/oncology fellows (n=30) at Mayo (Rochester) to explore inpatient hematology education experiences and the Fellow Hematology Curriculum (FHC) during 2021-2022. Based on results, we designed a fellow-led, consultant-supervised quality improvement (QI) initiative to improve FHC. Responses were in a five-point Likert scale and open-ended format. Results: Twenty fellows completed the survey (66% response rate). Respondents were well distributed (35% PGY4, 25% PGY5, 40% PGY6). Resources most used for self-education were ASH SAP (85%), UpToDate (80%), and NCCN guidelines (50%). 100% of respondents agreed/strongly agreed that the FHC could be improved. 95% agreed/strongly agreed that there is a high degree of variability among consultants regarding engagement in fellows’ education. 45% agreed that education is adequately paired with relevant clinical duties to reinforce key concepts. 25% agreed that FHC had well-defined structure and objectives. In the open-ended responses, a structured curriculum covering a set list of topics paired with the relevant rotation was the most common recommendation by the fellows for improving the FHC and the inpatient hematology educational experience. This prompted a QI initiative to implement a structured, evidence-based curriculum covering essential topics required for hematology practice. Each week of a four-week rotation has a relevant theme (eg, “Marrow Failure week” during the inpatient leukemia service). Fellows selected a topic of interest and created a lecture to be used by all faculty and learners during the relevant rotation (eg, “Aplastic Anemia” during the Marrow Failure). Consultants and pharmacists in respective disease groups reviewed the topics and presentations. These lectures are now provided to fellows and faculty via e-mail prior to relevant rotations. Conclusions: Our survey demonstrated that trainees’ individual educational experiences on inpatient hematology services are widely variable and largely unsatisfying without some form of structured, relevant learning. We identified the need for deliberate, coordinated education as a gap to bridge toward achieving the goal of equitable, comprehensive learning. We intend to perform a post-implementation survey after one year of practicing a structured, relevantly paired FHC. This assessment will be used to make improvements in subsequent iterations of the FHC using the Plan-Do-Study-Act methodology.
Global interest in podcasts designed for medical oncology trainees.
Authors: Holstead Ryan , Quinn Ryann
Published: June 2024

9019

Background: Audio podcasts allow for medical education to be disseminated in an on-demand format and are globally accessible. There are currently a limited number of trainee-directed medical oncology podcasts and their global impact has not been shown. “Talking about Tumors with Ryann and Ryan” is an English language, evidence-based, free-to-use podcast that was initiated in April 2022 with a focus on education of trainees new to the field. Methods: Geographic statistics were collected for podcast episodes with greater than 30 days of availability. The proportion of listeners from different regions was compared between episodes. Trends in listeners from North America and global audiences were descriptively analyzed. Results: 34 episodes were included in this analysis, with content in gastrointestinal, breast, thoracic and cutaneous malignancies. Episodes had a median of 115 downloads, with consistently >30% from outside of Canada and the United States (median 37.3 +/- 6.4%). Twenty-four countries had greater than 10 downloads. The largest audience beyond North America was Australia (13%), Israel (4%), United Kingdom (3%), Pakistan (3%), Sweden (2%), India (1%), and Hong Kong (1%). A review of individual cities within countries was relatively constant, suggestive of persistent listenership. Conclusions: There is a global interest for introductory medical oncology education. Presentation in an evidence-based format and awareness of variation in regional approaches to systemic therapy can increase the impact of podcasts, which by their design can reach a global audience. The development of an index for early education oncology podcasts may improve visibility and access to those interested in this medium.
Educational intervention to facilitate clinician-patient discussions of lung cancer biomarker testing at safety net and non-safety net centers.
Authors: Trosman Julia R. , Martin Nikki A. , Pasquinelli Mary , Weinberg Frank , Lycan Thomas William , Sacks Ruth Lauren , Woodyard Jennifer , Prescott Kevin , Khosla Paramjeet Grewal , Lile Ashley , Shivakumar Latha , Fish-Steagall Ann Ann , Sorgi Marin , Ravelo Arliene , Weldon Christine B.
Published: June 2024

9023

Background: Biomarker testing is critical for optimal therapy selection in non small cell lung cancer, but it takes time and may delay treatment, causing patient anxiety and dissatisfaction. Patients want to understand the necessity and timing of biomarker testing and therapy decisions, but clinicians find these discussions challenging, especially with lower health literacy patients. As a solution, we deployed 4R Oncology model (4R = Right Info/Care/Patient/Time) at 10 centers (4 safety net, 6 non safety net). Under 4R, clinicians discuss with patients a Care Sequence, a predeveloped care checklist with visual timing of care, emphasizing biomarker testing within the overall care plan. It includes social and supportive care to address Social Determinants of Health (SDOH). Methods: Interviews with clinicians to examine whether / how Care Sequence helped discuss the need and timing for biomarker testing with patients, including lower health literacy patients. The cohort of clinicians (N=18) included oncologists, fellows and nurses; 10 worked at safety net centers. Results: All clinicians reported that Care Sequence helped explain timing of biomarker testing and the need to wait for results (Table). The majority reported that it helped discussions with lower literacy patients and to train fellows how to discuss these issues and place related referrals. These benefits and most of the rationale were reported at a similar rate by safety net and non safety net clinicians. Conclusions: The 4R Care Sequence is a promising educational tool that helps clinicians, including fellows, manage patients’ awareness and expectations for timing of biomarker testing and therapy decisions in lung cancer. The benefits in discussions with lower health literacy patients at both safety net and non safety net centers suggest that 4R can address disparities in patients’ understanding of these complex issues and may reduce anxiety while awaiting treatment. [Table: see text]
Alignment of patient-clinician perspectives in triple-negative breast cancer (TNBC).
Authors: Ackbarali Tariqa , Goins Chelsey , Walker Stephanie , Donahue Sara , Witt Jennifer , Vidal Gregory A. , Traina Tiffany A.
Published: June 2024

9032

Background: Despite recent advances in therapeutic strategies, TNBC remains difficult to treat due to a poor prognosis and a reduced number of effective treatments. Among racial and ethnic groups, Black and Hispanic women have a disproportionately higher risk of TNBC. To address this, a tethered educational initiative was designed to empower patients through navigation and treatment decision-making, and facilitate patient-clinician partnerships through education and the sharing of real-world outcomes. Methods: Two, one-hour online, interactive, video-based programs were designed for patients/caregivers, and clinicians in collaboration with TOUCH, the Black Breast Cancer Alliance and the National Breast Cancer Foundation. The patient/caregiver program was hosted on CancerCoachLive and MedLive and the provider program hosted on OMedLive; both launching in June 2023. Patient stories were embedded within the program. We report on an analysis of patient outcomes and the intersection of patient and clinician perspectives, including behavioral impact, and qualitative insights. Results: To date, more than 2,000 participants have engaged across both educational programs. Of participating patients/caregivers, 42% were non-White (non-Hispanic) and 76% were people diagnosed with breast cancer. Following the program, 82% felt confident discussing treatment and outcomes with their healthcare team, and 56% reported intent-to-change related to treatment, communication, and engagement with support resources. Patient/caregiver participants (56%) defined ‘providing resources and information about diagnosis and treatment options’as the most helpful role in working with a patient navigator. Qualitative data elucidating specific intended changes and patient experiences will be shared. Of the participants in the clinician program, 89% were physicians, 91% of whom noted their specialty as oncology. In assessing patient openness to discussions with their team; 42% of clinicians believed their patients would approach them, and 71% of patients were very likely to approach their team. Only 60% of clinicians believed their patients would participate in a clinical trial while 85% of patients reported they would be likely to participate. Clinicians reported challenges enrolling patients in clinical trials as: lack of access (33%), low awareness of available trials (17%), and patient lack of interest (15%). Conclusions: Discordances in patient and clinician perspectives were revealed by the outcomes related to willingness of patients to engage in clinical trials and openness in communication between patients and their healthcare teams. These educational programs positively impacted patient and clinician motivation to address areas of care within their control. Real-world accounts of patient experiences provided context and perspectives that can help improve shared decision-making approaches.
A national survey of obstetrics and gynecology resident perspectives on their preparedness to provide care for racially and socioeconomically diverse gynecologic oncology populations.
Authors: Ben Haj Frej Khaoula , Hardy Nicole Janell , Whitcomb Bradford
Published: June 2024

9037

Background: Despite 83% female representation, Obstetrics and Gynecology (Ob/Gyn) lags behind other residencies in racial diversity, with 35.2% of trainees classified as Underrepresented in Medicine (URM). Fellowships are markedly less diverse, with Gynecologic Oncology representing 26.1% URM. While studies have examined Ob/Gyn residents’ self-perceived preparedness for surgical skills, little is known about their confidence in treating vulnerable patients with gynecologic malignancies. This survey assessed resident confidence in providing Gynecologic Oncology care to patient populations diverse in racial/ethnic background and insurance status, while accounting for residents’ own racial/ethnic backgrounds. Methods: An anonymous, novel Qualtrics survey was disseminated to current US Ob/Gyn residents, to elicit their self-reported preparedness to provide NCCN guideline-based care to diverse Gynecologic Oncology patient populations. Subjects were asked multiple-choice questions to record their own demographics followed by Likert scale questions which ranged from strongly disagree (1) to strongly agree (5) regarding their perceived readiness to care for patients diverse in insurance and racial background. Differences in responses between racial groups were analyzed using the Kruskal-Wallis Rank Sum test while differences in responses between ethnic groups were evaluated using the Wilcoxon Rank Sum test. Results: 207 residents complete the survey, mirroring sample sizes of national surveys of Ob/Gyn residents. There was no statistical difference in self-perceived preparedness between Hispanic and non-Hispanic Ob/Gyn residents regarding providing care for diverse racial minorities (mean Likert Non-Hispanic = 4.1 vs. Hispanic = 4.2; p = 0.222) or insurance types (mean Likert Non-Hispanic= 4.0 vs. Hispanic = 4.0; p=0.563). There was a significant difference in the number of Hispanic residents who felt that patients with Medicaid insurance experienced more difficulty obtaining non-operative gynecologic care compared to those with other insurance types (Hispanic = 3.7 vs. non-Hispanic = 3.2; p = 0.044). Further, there was a significant difference in the number of Hispanic residents who felt that patients with Medicaid insurance had to wait longer for outpatient appointments with a gynecologic oncologist (Hispanic = 3.6 vs. non-Hispanic = 3.0; p=0.016). Conclusions: All Ob/Gyn residents will encounter, screen for, and diagnose gynecologic malignancies, regardless of pursuit of Gynecologic Oncology fellowship. This study evaluated Ob/Gyn resident perceptions, finding that they feel overall prepared to provide Gynecologic Oncology care to socioeconomically diverse patient populations, though differences exist when residents are compared based on their backgrounds.
Precision medicine preceptorship in breast and lung cancer for Latin American oncologists.
Authors: Gogineni Keerthi , Leal Ticiana , Dixon Margie D. , Rana Shaheen A. , Pentz Rebecca D.
Published: June 2024

9040

Background: Cancer is the second leading cause of death in Latin America. Integrating genomic discoveries into patient care could improve morbidity and mortality; however economic barriers to capacity development and access to therapeutics remain. In response to an RFP for a preceptorship for oncologists from Latin America, Emory’s Winship Cancer Institute (WCI) developed a 2-week immersion involving didactics, clinical exposures, and research meetings to increase knowledge and competence of breast and lung cancer genomics. Methods: Interviews with Latin American medical oncologists, Latin America Lung Cancer Association (LALCA) leadership, and literature review were conducted to understand areas of unmet need in oncology training. A gap in knowledge and practice of genomic management of breast and lung cancer was identified and informed development of didactic and clinical exposures. The WCI website, International Association for the Study of Lung Cancer (IASLC) and LALCA publicized the program. Medical oncologists within 6 years of final oncology training applied. Participants completed a baseline needs assessment, pre-program survey to assess goals and confidence in skills, and post-program interview to evaluate the program and reassess confidence in skills. Instruments were developed with WCI’s Intervention, Development, Dissemination and Implementation Shared Resource. WCI faculty were interviewed for feedback. Results: WCI hosted 12 Latin American oncologists over 3 two-week preceptorships between 2020-23, coinciding with local scientific meetings. All participants reported the program was a valuable use of time, valuable for career development and rated the program as excellent/very good. 92% reported the program met their goals and felt engaged all/most of the time. 75% rated attendance at breast and lung cancer clinics, didactics, research meetings, tumor boards as very/extremely valuable. Two-thirds intended to make changes (apply knowledge, improve communication, work with other providers like nurses, aid students in research, improve flow of activity when seeing patients, incorporate clinical research into daily practice, and add immunotherapy) in their practice at home institutions. Phase 1 and surgical oncology clinics were deemed least helpful. Themes emerged from faculty interviews: be strategic about the number of learners in clinic, characterize learner preferences and prior training/experience, articulate the preceptorship’s long-term goals, and include time to team-build. Conclusions: Participants gained exposure to the latest molecular diagnostics and systemic treatments, appreciation for optimal team-based cancer care, and how clinical research drives development of novel biomarkers and therapeutics. Future goals include expanding program access to oncologists from other low- and middle-income countries and promoting post-program collaborations.
The Impact of Benefit Generosity on Workers’ Compensation Claims: Evidence and Implications
Authors: Cabral Marika , Dillender Marcus
Published: June 2024

Leveraging unique administrative data and a sharp increase in benefit generosity in a difference-in-differences research design, we estimate the impact of workers’ compensation wage replacement benefits on individual behavior and program costs. We find that increased benefit generosity leads to longer income benefit durations and increased medical spending. Responses along these two margins are equally important drivers of increased program costs, collectively increasing program costs 1.4 times the mechanical increase in costs. Using these estimates and an estimate of the consumption drop among injured workers, our welfare calibrations suggest that a marginal increase in benefit generosity would not improve welfare. (JEL D91, I11, J28, J31)
The Human Capital Effects of Access to Elite Jobs
Authors: Xu Huayu , Adhvaryu Achyuta
Published: June 2024

We study the human capital effects of access to elite bureaucratic jobs in Taiwan, where performance on an examination determines entry into the civil service. Historically, quotas for successful applicants were set based on the 1948 populations of individuals’ native provinces in mainland China. This resulted in a higher probability of success on the exam—and, thus, greater access to elite positions—for descendants of certain migrant groups. These preferential quotas were replaced in 1962 with a uniform admissions policy. Using this variation, we find that the incentives created by preferential quotas increased human capital and improved long-run economic outcomes. (JEL D73, H83, J24, J45, M51)
O PRIMEIRO PRINCÍPIO DA RAZÃO PRÁTICA EM TOMÁS DE AQUINO
Authors: Santos Lucas Fonseca dos , Ribeiro Mário da Silva , Pinheiro Victor Sales
Published: June 2024

Objetivo: Investiga-se neste artigo a teoria da lei natural de Tomás de Aquino. Especificamente, visa-se a: (1) expor como Aquino aborda o primeiro princípio da razão prática; (2) expor a interpretação que os filósofos e jusfilósofos constitutivos da Nova Escola da Lei Natural oferecem a respeito do mencionado princípio; (3) expor as principais discordâncias quanto à interpretação da Nova Escola da Lei Natural; (4) argumentar por que a interpretação da Nova Escola da Lei Natural se adequa à abordagem de Aquino; e (5) expor as dificuldades nas interpretações alternativas.
Método: Abordagem teórica e reflexiva segundo bibliografia autorizada e atualizada. Utiliza-se das lições de Tomás de Aquino e de seus intérpretes contemporâneos, com destaque para aqueles que constituem a Nova Escola da Lei Natural.
Resultado: As posições tradicionais derivacionistas não são capazes de explicar adequadamente os atos humanos. Isso se dá porque não explicam a diretividade prática fornecida pelo primeiro princípio prático em um ato considerado imoral. Além disso, apresenta‑se um argumento hermenêutico adicional em favor da interpretação da Nova Escola da Lei Natural a respeito do primeiro princípio prático em Aquino: considerando-se a influência inegável de Aristóteles na obra do aquinate e uma continuidade relativa entre ambos, percebe‑se que há uma tese muito semelhante defendida por ambos – formulada de maneiras diferentes – e que tornam mais consistente a interpretação da teoria neoclássica da lei natural. Assim, compreende-se o papel do primeiro princípio da razão prática como um princípio estruturante e diretivo do ato humano em geral, seja para atos considerados moralmente adequados, seja para atos considerados moralmente inadequados. 
Contribuições: As linhas a seguir reúnem anotações preliminares, inobstante técnicas. Sua contribuição remonta ao necessário avanço de estudos atentos à estrutura da razão humana, a qual possui um aspecto teórico, que busca conhecer a verdade das coisas e das proposições filosóficas, e um aspecto prático, que busca orientar os atos humanos para certos fins. Ademais, este artigo contribui também devido às lacunas da literatura nacional a nível filosófico-jurídico e ético, fazendo-se indispensável a uma visão holística das lições do principal expoente da tradição da lei natural – Tomás de Aquino.
Η πρόσληψη του τραγικού μύθου στα αρχαιόθεμα και αρχαιόμυθα – δημοσιευμένα και αδημοσίευτα - θεατρικά έργα του Δημήτρη Δημητριάδη
Authors: Κωστόπουλος Βασίλειος
Published: June 2024

Η περίπτωση του Δημήτρη Δημητριάδη στη μεταπολιτευτική, θεατρική, ποιητική, πεζογραφική και μεταφραστική ιστορία των ελληνικών γραμμάτων είναι από κάθε άποψη sui generis. Ανήκει στη μειονότητα εκείνη των συγγραφέων που εκβίασαν με ριζοσπαστισμό, και πάνω απ’ όλα με προσωπικό κόστος, την έλευση του μεταμοντέρνου και αποδομητικού στοχασμού στη μεταπολιτευτική θεατρική γραφή. Η παρούσα διατριβή έχει ως σκοπό να προσεγγίσει ερμηνευτικά τον τρόπο πρόσληψης του αρχαιοελληνικού τραγικού μύθου όπως αυτός αποτυπώνεται στα αρχαιόμυθα-αρχαιόθεμα έργα του. Μάλιστα, το εύρος των υπό εξέταση πηγών μεγάλωσε αισθητά, καθώς ο συγγραφέας μάς εμπιστεύθηκε και το αρχείο του με το μέχρι στιγμής αδημοσίευτο υλικό, προκειμένου τα πορίσματα να είναι κατά το δυνατόν πληρέστερα.
Ανάπτυξη και εκπαίδευση ανθρώπινων πόρων στον τουρισμό μέσω της μετασχηματίζουσας μάθησης και της συναισθηματικής νοημοσύνης με τη χρήση ψηφιακών τεχνολογιών
Authors: Κάλλου Σοφία
Published: June 2024

Η τουριστική εκπαίδευση και κατάρτιση αποτελεί καθοριστικό παράγοντα για την ανάδειξη του τουριστικού προϊόντος και την ποιοτική αναβάθμιση των υπηρεσιών του τουρισμού. Παράλληλα, η υψηλή συναισθηματική νοημοσύνη οδηγεί σε συναισθηματικά ευφυείς απασχολούμενους, που παρέχουν υψηλής ποιότητας υπηρεσίες και συνεισφέρουν στην επίτευξη των στόχων της επιχείρησης. Η εστίαση στην καλλιέργεια της συναισθηματικής νοημοσύνης με την εφαρμογή καινοτόμων και αποτελεσματικών μεθόδων ανάπτυξής της σε σύγχρονα περιβάλλοντα μάθησης, αποτελεί πρόκληση για την επιστημονική κοινότητα και πεδίο για ενδελεχή διερεύνηση. Η παρούσα διδακτορική διατριβή εστιάζει στην τουριστική εκπαίδευση και κατάρτιση με κύριο σκοπό την εξέταση της αξιοποίησης της θεωρίας της Μετασχηματίζουσας Μάθησης για την ανάπτυξη της Συναισθηματικής Νοημοσύνης, μέσω της χρήσης ψηφιακών εκπαιδευτικών τεχνολογιών και την υιοθέτηση ενός πλαισίου για την ανάπτυξη των ανθρώπινων πόρων στον τομέα του τουρισμού. Πιο συγκεκριμένα, εξετάζεται η επίδραση της Μετασχηματίζουσας Μάθησης, ως εκπαιδευτικό μεθοδολογικό εργαλείο για την ανάπτυξη της συναισθηματικής νοημοσύνης με τη χρήση ψηφιακών τεχνολογιών μάθησης, συγκρινόμενη με παραδοσιακές μεθόδους διδασκαλίας. Συγχρόνως, διενεργείται πείραμα, στο οποίο εφαρμόζεται συνδυασμός εργαλείων ποιοτικής και ποσοτικής ανάλυσης δεδομένων. Κύριος στόχος είναι η μέτρηση της συναισθηματικής νοημοσύνης και η αξιολόγηση του προγράμματος εκπαίδευσης που υιοθετήθηκε. Παράλληλα, γίνεται διερεύνηση της ψηφιακής τεχνολογίας, που εφαρμόστηκε, με μέτρηση της αποτελεσματικότητάς της, του βαθμού αλληλεπίδρασής της, της ευχρηστίας και της αποδοχής της, καθώς και της παρουσίας συναισθημάτων στο ψηφιακό εκπαιδευτικό περιβάλλον. Τα ευρήματα και τα συμπεράσματα της παρούσας διδακτορικής διατριβής, θα είναι χρήσιμα και αξιοποιήσιμα στην εφαρμογή σύγχρονων και καινοτόμων μεθόδων σε προγράμματα ανάπτυξης της συναισθηματικής νοημοσύνης και ειδικότερα από εμπλεκόμενους φορείς στον τομέα της τουριστικής εκπαίδευσης και κατάρτισης. Η συμβολή της διατριβής επικεντρώνεται στην εξέταση, για πρώτη φορά, μεθόδων εκπαίδευσης και σχεδίασης εκπαιδευτικών προγραμμάτων, για την ανάπτυξη της συναισθηματικής νοημοσύνης, με την εφαρμογή της Μετασχηματίζουσας Μάθησης και σύγχρονων εργαλείων στην τουριστική εκπαίδευση και κατάρτιση. Επιπρόσθετα, συνεισφέρει στην ευρεία ακαδημαϊκή συζήτηση για τη θεωρία της Μετασχηματίζουσας Μάθησης, εμπλουτίζοντας τις εκπαιδευτικές πρακτικές, στη διερεύνηση της χρήσης εκπαιδευτικών ψηφιακών τεχνολογιών, μέσω της βέλτιστης αξιοποίησής τους στην τουριστική εκπαίδευση και στην εκπαίδευση ενηλίκων και στην ανάπτυξη και ευημερία του ανθρώπινου δυναμικού στον τομέα του τουρισμού.
Integrated circuit architectures for classical and neural computing with applications in artificial intelligence
Authors: Αλιμήσης Βασίλειος
Published: June 2024

Η δομή της παρούσας διδακτορικής διατριβής είναι η ακόλουθη. Αρχικά, πραγματοποιείται μια γενική εισαγωγή στην Μηχανική Μάθηση και τις παραδοσιακές μεθόδους υλοποίησης αλγορίθμων, την τάση που κυριαρχεί τα τελευταία χρόνια, τις νέες μεθόδους με την εισαγωγή hardware-friendly υλοποιήσεων αλλά και το κίνητρο της παρούσας διατριβής. Έπειτα η παρούσα Διατριβή συνεχίζει με μια βιβλιογραφική μελέτη και ταξινόμηση των κυκλωμάτων που υλοποιούν την Γκαουσιανή συνάρτηση. Μαζί με σχετικές εφαρμογές και προτεινόμενες αρχιτεκτονικές συμπληρώνουν το δεύτερο κεφάλαιο. Το τρίτο κεφάλαιο αναφέρεται σε μια σειρά από νέα κυκλώματα και αρχιτεκτονικές που πρώτη φορά σχεδιάστηκαν, μελετήθηκαν και αναλύθηκαν λεπτομερώς στην παρούσα Διατριβή, τα οποία συσχετίζονται με την υλοποίηση της Γκαουσιανής συνάρτησης. Το τέταρτο κεφάλαιο αναφέρεται σε αρχιτεκτονικές υλοποίησης ταξινομητών με χρήση των μοντέλων Gaussian Mixture Model και Bayes. Ως βασική κυκλωματική μονάδα έχουν τα κυκλώματα υλοποίησης Γκαουσιανής συνάρτησης. Όλες οι υλοποιήσεις είναι προσεγγίσεις του μαθηματικού μοντέλου που διέπει τους αλγορίθμους/μοντέλα μηχανικής μάθησης. Το πέμπτο κεφάλαιο περιγράφει αναλυτικά τις μεθόδους και τοπολογίες υλοποίησης των μοντέλων αλγορίθμων μηχανικής μάθησης, Radial Basis Function και Centroid-based Classifiers. Η συνάρτηση που περιγράφει την απόσταση υλοποιείται με την βοήθεια της Γκαουσιανής συνάρτησης. Στο έκτο κεφάλαιο παρουσιάζεται μια νέα προσέγγιση αρχιτεκτονικών με στόχο την υλοποίηση εκτός από την ταξινόμηση και την εκμάθηση στο υλικό. Με βάση το παραπάνω έγινε εισαγωγή σε νέες αρχιτεκτονικές για την υλοποίηση του αλγορίθμου Support Vector Machine και Threshold. Σε όλα τα μέχρι τώρα μελετήθηκε μια ποικιλία από εφαρμογές τόσο ιατρικές (θυροειδής, επιληψία, έλεγχος αναισθησίας και άλλες) όσο και διαθεματικές. Στο έβδομο κεφάλαιο παρουσιάζεται μια γενικευμένη μεθοδολογία σχεδίασης Bell-shaped ταξινομητών, η οποία έχει ως στόχο να ομαδοποιήσει τις προηγούμενες κατηγορίες. Στο όγδοο κεφάλαιο παρατίθεται το περιεχόμενο τριών εργασιών που αφορούν την υλοποίηση Edge detectors στο hardware με σκοπό την ανίχνευση κορυφών με κυκλώματα που λειτουργούν στην περιοχή του Υποκατωφλίου, προσφέροντας χαμηλή κατανάλωση. Στο ένατο κεφάλαιο, αναλύονται αρχιτεκτονικές βασισμένες στη Fuzzy Logic, με σκοπό την υλοποίηση ταξινομητών αλλά και ελεγκτών με τη χρήση κυκλωμάτων που λειτουργούν στην περιοχή Υποκατωφλίου. Στο δέκατο κεφάλαιο, παρουσιάζονται υλοποιήσεις Νευρωνικών Δικτύων αλλά και πιο πολύπλοκων μοντέλων. Επίσης προσφέρει μια γενικευμένη σύγκριση των προηγούμενων αρχιτεκτονικών σε διαθεματικές εφαρμογές Στην σύνοψη και μελλοντική δουλειά γίνεται η αποτίμηση της διεξαχθείσας έρευνας και η σύνοψη των συμπερασμάτων της αλλά και στόχοι για το μέλλον.