bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge-guided mutation in classification rules for autism treatment efficacy
Authors: Engle Kelley , Rada Roy
Published: February 2016

Data mining methods in biomedical research might benefit by combining genetic algorithms with domain-specific knowledge. The objective of this research is to show how the evolution of treatment rules for autism might be guided. The semantic distance between two concepts in the taxonomy is measured by the number of relationships separating the concepts in the taxonomy. The hypothesis is that replacing a concept in a treatment rule will change the accuracy of the rule in direct proportion to the semantic distance between the concepts. The method uses a patient database and autism taxonomies. Treatment rules are developed with an algorithm that exploits the taxonomies. The results support the hypothesis. This research should both advance the understanding of autism data mining in particular and of knowledge-guided evolutionary search in biomedicine in general.
Damage detection sensitivity characterization of acousto-ultrasound-based structural health monitoring techniques
Authors: Janapati Vishnuvardhan , Kopsaftopoulos Fotis , Li Frank , Lee Sang Jun , Chang Fu-Kuo
Published: February 2016

Reliability quantification is a critical and necessary process for the evaluation and assessment of any inspection technology that may be classified either as a nondestructive evaluation or structural health monitoring technique. Based on the sensitivity characterization of nondestructive evaluation techniques, appropriate processes have been developed and established for the reliability quantification of their performance with respect to damage/flaw detection in materials or structures. However, in the case of structural health monitoring methods, no such well-defined and general applicable approaches have been established for neither active nor passive sensing techniques that allow for their accurate reliability quantification. The objective of this study is to characterize the sensitivity of active-sensing acousto-ultrasound-based structural health monitoring techniques with respect to damage detection, as well as to identify the parameters that influence their sensitivity. With such an understanding, it is believed that adequate quantitative methods could then be established to enable the practical use of acousto-ultrasound structural health monitoring methods in the aerospace and mechanical engineering communities. In order to evaluate the sensitivity of a pre-selected active-sensing acousto-ultrasound structural health monitoring system, both numerical simulations and experiments were performed on 30 aluminum coupons each outfitted with a pair of lead zirconate titanate piezoelectric sensors/actuators. A damage index versus damage size relationship was investigated numerically and experimentally to assess the applicability of the traditional nondestructive evaluation linear regression framework for probability of detection for an active-sensing structural health monitoring system. The results of the study show that the position of each sensor–actuator pair with respect to a known damage location and the damage growth pattern are the two most critical parameters influencing the reliability of the same structural health monitoring system applied to identical structural components under the same environmental conditions.
ΠΙΣΤΙΣ ΧΡΙΣΤΟΥ: The Current State of Play and the Key Arguments
Authors: Kugler Chris
Published: February 2016

The pistis Christou debate involves numerous debate partners and a shockingly voluminous amount of secondary literature. At this point, I thought it necessary to provide a survey of the current state of the debate, not least so as to summarize in one place the main arguments for both sides of the debate. At the beginning of the article I gather together and present the main arguments for those advocating an objective reading of the phrase, while the second half of the essay mainly involves a presentation of the arguments for the subjective camp. Having provided this summary, with many comments of my own alongside, I conclude by emphasizing the two pieces of evidence that seem still to push in the direction of the subjective construal. When the survey comes to a close, I arrive at the conclusion that, while debate is certainly not over, those advocating a subjective reading of the expression have the momentum of the scholarly guild.
Masculinity Studies of the Hebrew Bible: The First Two Decades
Authors: Haddox Susan E.
Published: February 2016

Masculinity studies of the Hebrew Bible has emerged in the past two decades as a complement to feminist criticism, focusing on the ways men and masculinity in the biblical texts are social constructs. Masculist interpretation has utilized materials and methods taken from the field of masculinity studies, especially psychoanalytic and anthropological cross-cultural approaches. In the early development of the field, the emphasis has been on gathering data and examining the constructs of particular men in specific books. From these studies, several common traits have emerged as representative of biblical masculinity. As the field matures, scholars are broaching broader theoretical and structural concerns and questioning some of the assumptions of earlier studies, while still valuing the insights they provide. Additional methods are also being brought into conversation with masculist interpretation.
Sensitive Assembly: Gamifying the design and assembly of façade wall prototypes
Authors: Savov Anton , Tessmann Oliver , Nielsen Stig Anton
Published: February 2016

The article describes a method for gamifying the design and assembly of computationally integrated structures built out of discrete identical blocks. As a case study, the interactive installation Sensitive Assembly was designed and built at the Digital Design Unit (Prof. Dr Oliver Tessmann) at the Technische Universität of Darmstadt and exhibited during the digital art festival NODE 2015 in Frankfurt in 2015. Sensitive Assembly invites people to play a Jenga-like game: starting from a solid wall, players are asked to remove and replace the installation’s building blocks to create windows to a nurturing light while challenging its stability. A computational system that senses the current state of the wall guides the physical interaction and predicts an approaching collapse or a new light beam breaking through. The installation extends the notion of real-time feedback from the digital into the physical and uses machine-learning techniques to predict future structural behaviour.
Pragmatism, Realism and Moralism
Authors: Festenstein Matthew
Published: February 2016

Pragmatism is often seen as an unpolitical doctrine. This article argues that it shares important commitments with realist political theory, which stresses the distinctive character of the political and the difficulty of viewing political theory simply as applied ethics, and that many of its key arguments support realism. Having outlined the elective affinities between realism and pragmatism, the article goes on to consider this relationship by looking at two recent elaborations of a pragmatist argument in contemporary political theory, which pull in different directions, depending on the use to which a pragmatist account of doxastic commitments is put. In one version, the argument finds in these commitments a set of pre-political principles, of the sort that realists reject. In the other version, the account given of these commitments more closely tracks the concerns of realists and tries to dispense with the need for knowledge of such principles.
Voluntary pulmonary function screening identifies high rates of undiagnosed asymptomatic chronic obstructive pulmonary disease
Authors: Wang Shengyu , Gong Wei , Tian Yao
Published: February 2016

Chronic obstructive pulmonary disease (COPD) is projected to be the third leading cause of death by 2020. Early detection and screening may alter the course and prognosis associated with lung disease. We investigated the effectiveness of a voluntary public lung function screening program and factors that had a predictive value for asymptomatic COPD in Xi’an, China. Pulmonary function testing (PFT) was conducted on volunteers recruited from four community centers in Xi’an, China, between July and August 2012. Participants underwent three forced vital capacity maneuvers. The maneuver with the best forced expiratory volume in first second was retained. Participants filled out a medical history and environmental exposure survey before undergoing the PFT. Patients who self-reported lung disease on the health survey were excluded from the analysis. Logistical regression was used to determine associations with airway obstruction. A total of 803 volunteers participated in this study, and 33 subjects were excluded as the participants did not meet the requirements of PFT. Of the 770 volunteers, 44 participants had been diagnosed with chronic respiratory diseases previously, and 144 participants (18.7%) met COPD criteria. Four hundred forty-four participants did not self-report any respiratory symptoms, and the remaining 282 participants self-reported respiratory symptoms. Of the asymptomatic participants, 98 volunteers had PFT results that were consistent with COPD and 68.1% of asymptomatic participants were undiagnosed. A greater percentage of women than men had moderate or severe airway obstruction ( p = 0.004).Only smoking status (odds ratio = 2.64, 95% confidence interval 1.20–6.04) was associated with asymptomatic COPD. Voluntary public lung function screening programs in China are likely to identify a large number of undiagnosed, asymptomatic COPD. Smoking status is associated with airway obstruction and a greater percentage of women than men had moderate or severe airway obstruction.
Comparison of the six-minute walk test with a cycle-based cardiopulmonary exercise test in people following curative intent treatment for non-small cell lung cancer
Authors: Cavalheri Vinicius , Jenkins Sue , Cecins Nola , Gain Kevin , Hill Kylie
Published: February 2016

This study is aimed to (i) compare both the magnitude of impairment in exercise capacity and exercise responses measured during the six-minute walk test (6MWT) and the cardiopulmonary exercise test (CPET) and (ii) investigate the effect of test repetition on six-minute walk distance (6MWD) in people following curative intent treatment for non-small cell lung cancer (NSCLC). Twenty participants (67 ± 10 years; 14 females), 6–10 weeks following lobectomy, underwent a CPET and two 6MWTs. Peak exercise responses, dyspnoea and leg fatigue, as well as heart rate (HR) and oxygen saturation (SpO2) during the 6MWT, were compared to those during the CPET. Compared with exercise capacity when expressed as peak rate of oxygen consumption (%pred) measured during the CPET, exercise capacity when expressed as 6MWD (%pred) was less impaired (81 ± 10 vs. 63 ± 15 %pred; p < 0.001). Compared with the CPET, the 6MWT elicited lower peak HR (119 ± 15 vs. 128 ± 18 beats minute−1; p = 0.02), lower SpO2 (93 ± 2 vs. 95 ± 3%; p < 0.05), less dyspnoea (3.1 ± 1.6 vs. 6.9 ± 2.6; p < 0.01) and less leg fatigue (2.0 ± 1.9 vs. 6.8 ± 2.4; p < 0.01). The 6MWD increased 19 ± 19 metre (4 ± 4%) with test repetition ( p < 0.001). In people following curative intent treatment for NSCLC, the 6MWT appears to elicit sub-maximal exercise responses when compared with the CPET. There is a significant effect of test repetition on 6MWD.
Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy
Authors: Ratcliff Chelsea G. , Milbury Kathrin , Chandwani Kavita D. , Chaoul Alejandro , Perkins George , Nagarathna Raghuram , Haddad Robin , Nagendra Hongasandra Ramarao , Raghuram N. V. , Spelman Amy , Arun Banu , Wei Qi , Cohen Lorenzo
Published: February 2016

Hypothesis. This study examines moderators and mediators of a yoga intervention targeting quality-of-life (QOL) outcomes in women with breast cancer receiving radiotherapy. Methods. Women undergoing 6 weeks of radiotherapy were randomized to a yoga (YG; n = 53) or stretching (ST; n = 56) intervention or a waitlist control group (WL; n = 54). Depressive symptoms and sleep disturbances were measured at baseline. Mediator (posttraumatic stress symptoms, benefit finding, and cortisol slope) and outcome (36-item Short Form [SF]-36 mental and physical component scales [MCS and PCS]) variables were assessed at baseline, end-of-treatment, and 1-, 3-, and 6-months posttreatment. Results. Baseline depressive symptoms ( P = .03) and sleep disturbances ( P < .01) moderated the Group × Time effect on MCS, but not PCS. Women with high baseline depressive symptoms in YG reported marginally higher 3-month MCS than their counterparts in WL ( P = .11). Women with high baseline sleep disturbances in YG reported higher 3-months MCS than their counterparts in WL ( P < .01) and higher 6-month MCS than their counterparts in ST ( P = .01). YG led to greater benefit finding than ST and WL across the follow-up ( P = .01). Three-month benefit finding partially mediated the effect of YG on 6-month PCS. Posttraumatic stress symptoms and cortisol slope did not mediate treatment effect on QOL. Conclusion. Yoga may provide the greatest mental-health–related QOL benefits for those experiencing pre-radiotherapy sleep disturbance and depressive symptoms. Yoga may improve physical-health–related QOL by increasing ability to find benefit in the cancer experience.
Development of a flattening system for sheet metal with free-form surface
Authors: Liu Xinhua , Li Shengpeng , Zheng Xianhua , Lin Mingxing
Published: February 2016

In order to improve the flattening quality of sheet metal with free-form surface, a flattening system was developed. The system framework was proposed and the key technologies such as mesh quality measuring criterion, center triangle indexing algorithm, coordinate transforming principle, and initial flattening method were elaborated. Moreover, a planar spring–mass model was presented to optimize the initial flattening result, and the flowchart of the proposed flattening method was designed. Finally, three simulation examples were carried out and the comparison results indicated that the proposed system was proved feasible and efficient.
The effect of pre-operative methylprednisolone on the incidence of delayed graft function in renal transplantation
Authors: Fong Nigel Jie Ming , Fan Petrina Yuen Wai , Fook-Chong Stephanie Man Chung , Kee Terence Yi Shern
Published: February 2016

Introduction:

This study explores the effect of different corticosteroid administration timings on the incidence of slow/delayed graft function.

Methods:

One hundred and twelve kidney transplants from January 2011 to March 2014 were retrospectively analysed. Thirty-six cases were excluded because they were donor-specific antibody positive ( n=16), received thymoglobulin/plasma exchange ( n=11), were ABO-incompatible ( n=6) or suffered graft loss from vascular thrombosis within the first week post-transplant ( n=3). The study period straddled three eras of corticosteroid administration, from intra-operative intravenous (IV) hydrocortisone (Era 1; n=26), to intra-operative IV methylprednisolone (Era 2; n=38) and pre-operative IV methylprednisolone (Era 3; n=12). The primary endpoint was the incidence of slow/delayed graft function. Secondary outcomes included estimated glomerular filtration rate at discharge and 120 and 365 days, rejection (acute and one-year), wound complications, post-transplant diabetes, increase in low-density lipoprotein or body mass index, and cytomegalovirus or BK viraemia within one year.

Results:

On univariate analysis, pre-operative methylprednisolone was associated with lower incidence of slow/delayed graft function (17%, 55%, 58% in Eras 3, 2, 1 respectively; p=0.041), superior estimated glomerular filtration rate at discharge (median 56, 37 and 43 ml/min for Eras 3, 2, 1 respectively; p=0.033) and at 120 days (median 60, 52, and 46 ml/min for Eras 3, 2, 1 respectively; p=0.017). On multivariate analysis, pre-operative IV methylprednisolone ( vs. Eras 1 and 2 combined; odds ratio 4.79 (90% confidence interval 1.16–19.80); p=0.07) and living donor type ( vs. deceased; odds ratio 5.56 (90% confidence interval 2.25–13.77); p=0.002) were associated with lower incidence of slow/delayed graft function.

Conclusion:

Pre-operative methylprednisolone was associated with reduced slow/delayed graft function and improved early estimated glomerular filtration.
Unmasking One’s True Self Facilitates Positive Relational Outcomes
Authors: Plasencia M. Leili , Taylor Charles T. , Alden Lynn E.
Published: February 2016

Individuals with social anxiety disorder (SAD) are motivated to conceal what they perceive to be personal inadequacies. They recognize, however, that their behavior does not convey who they genuinely are. Here, we examined whether increasing perceived authenticity facilitates positive social functioning in these individuals. Participants diagnosed with SAD ( N = 72) engaged in two social interactions with experimental confederates. Prior to the second interaction, participants were randomly assigned to one of two conditions equated on all elements except a safety behavior reduction procedure intended to increase self-authenticity. As hypothesized, increased authenticity led to beneficial changes in the cognitive, affective, and motivation processes that promote relational functioning. These results suggest that the experience of expressing one’s authentic self may reduce SAD-related social impairment.
Measuring the Gap
Authors: She Xinshu , Zhao Deqing , Scholnick Jenna
Published: February 2016

China is a large country where rapid development is accompanied by growing inequalities. How economic inequalities translate to health inequalities is unknown. Baseline health assessment is lacking among rural Chinese children. We aimed at assessing baseline student health of rural Chinese children and comparing them with those of urban children of similar ages. A cross-sectional study was conducted using the 2003 Global School-Based Student Health Survey among 100 students Grade 4 to 6 from rural Guizhou, China. Results were summarized and compared with public data from urban Beijing using multivariate logistic regression models. Rural children are more likely to not wash their hands before a meal (odds ratio [OR] = 5.71, P < .01) and after using the toilet (OR = 5.41, P < .01). They are more likely to feel sick or to get into trouble after drinking (OR = 7.28, P < .01). They are more likely to have used drugs (OR = 8.54, P < .01) and to have no close friends (OR = 8.23, P < .01). An alarming percentage of rural (8.22%) and urban (14.22%) children have had suicidal ideation in the past year (OR = 0.68, P > .05). Rural parents are more likely to not know their children’s whereabouts (OR = 1.81, P < .05). Rural children are more than 4 times likely to have serious injuries (OR = 4.64, P < .01) and to be bullied (OR = 4.01, P < .01). In conclusion, school-age rural Chinese children exhibit more health risk behaviors and fewer protective factors at baseline compared to their urban counterparts. Any intervention aimed at improving child health should take this distributive gap into consideration.
Inflammatory bowel disease and risk of mortality in COPD
Authors: Vutcovici Maria , Bitton Alain , Ernst Pierre , Kezouh Abbas , Suissa Samy , Brassard Paul
Published: February 2016

Patients with chronic obstructive pulmonary disease (COPD) have higher incidence and prevalence of other chronic inflammatory diseases, including inflammatory bowel disease (IBD). We assessed whether IBD onset increases mortality risk in patients with COPD or asthma-associated COPD.

Two population-based cohorts of COPD and asthma-COPD subjects were identified using the administrative health databases in Québec, Canada, 1990–2007. Death records were retrieved from the death certificate registry. Cox proportional hazards models were used to assess the impact of newly developed IBD on mortality risk.

The COPD and asthma-COPD cohorts included 273 208 and 26 575 patients, respectively, of which 697 and 119 developed IBD. IBD increased the risk of all-cause mortality in both COPD (hazard ratio 1.23, 95% CI 1.09–1.4) and asthma-COPD (hazard ratio 1.65, 95% CI 1.23–2.22). In asthma-COPD patients, IBD increased the risk of mortality from respiratory conditions (hazard ratio 2.18, 95% CI 1.31–3.64); in COPD patients, IBD increased the risk of death from digestive conditions (hazard ratio 4.45, 95% CI 2.39–8.30).

IBD is a risk factor for mortality in patients with pre-existing COPD or asthma-COPD. IBD increased mortality by respiratory and digestive conditions in patients with asthma-COPD and COPD, respectively.
A powerful score-based statistical test for group difference in weighted biological networks
Authors: Ji Jiadong , Yuan Zhongshang , Zhang Xiaoshuai , Xue Fuzhong
Published: February 2016

Background

Complex disease is largely determined by a number of biomolecules interwoven into networks, rather than a single biomolecule. A key but inadequately addressed issue is how to test possible differences of the networks between two groups. Group-level comparison of network properties may shed light on underlying disease mechanisms and benefit the design of drug targets for complex diseases. We therefore proposed a powerful score-based statistic to detect group difference in weighted networks, which simultaneously capture the vertex changes and edge changes.

Results

Simulation studies indicated that the proposed network difference measure (NetDifM) was stable and outperformed other methods existed, under various sample sizes and network topology structure. One application to real data about GWAS of leprosy successfully identified the specific gene interaction network contributing to leprosy. For additional gene expression data of ovarian cancer, two candidate subnetworks, PI3K-AKT and Notch signaling pathways, were considered and identified respectively.

Conclusions

The proposed method, accounting for the vertex changes and edge changes simultaneously, is valid and powerful to capture the group difference of biological networks.
Chemerin in peritoneal sepsis and its associations with glucose metabolism and prognosis: a translational cross-sectional study
Authors: Horn Paul , Metzing Uta Barbara , Steidl Ricardo , Romeike Bernd , Rauchfuß Falk , Sponholz Christoph , Thomas-Rüddel Daniel , Ludewig Katrin , Birkenfeld Andreas L. , Settmacher Utz , Bauer Michael , Claus Ralf Alexander , von Loeffelholz Christian
Published: February 2016

Background

Stress hyperglycaemia (SHG) is a common complication in sepsis associated with poor outcome. Chemerin is an adipocytokine associated with inflammation and impaired glucose homeostasis in metabolic diseases such as type 2 diabetes (T2D). We aimed to investigate how alterations of circulating chemerin levels and corresponding visceral adipose tissue (VAT) expression are linked to glucose metabolism and prognosis in sepsis.

Methods

Clinical data and tissue samples were taken from a cross-sectional study including control, T2D and sepsis patients, all undergoing laparotomy. A second independent patient cohort of patients with sepsis was included to evaluate associations with prognosis. This was complemented by a murine model of peritoneal infection and a high-fat diet. We analysed circulating chemerin by enzyme-linked immunosorbent assay and VAT messenger RNA (mRNA) expression by real-time polymerase chain reaction.

Results

Circulating chemerin was increased in sepsis 1.69-fold compared with controls (p = 0.012) and 1.47-fold compared with T2D (p = 0.03). Otherwise, chemerin VAT mRNA expression was decreased in patients with sepsis (p = 0.006) and in septic diabetic animals (p = 0.009). Circulating chemerin correlated significantly with intra-operative glucose (r = 0.662; p = 0.01) and in trend with fasting glucose (r = 0.528; p = 0.052). After adjusting for body mass index or haemoglobin A1c, chemerin correlated in trend with insulin resistance evaluated using the logarithmised homeostasis model assessment of insulin resistance (r = 0.539, p = 0.071; r = 0.553, p = 0.062). Chemerin was positively associated with Acute Physiology and Chronic Health Evaluation II score in patients with sepsis (p = 0.036) and with clinical severity in septic mice (p = 0.031). In an independent study population, we confirmed association of chemerin with glucose levels in multivariate linear regression analysis (β = 0.556, p = 0.013). In patients with sepsis with SHG, non-survivors had significantly lower chemerin levels than survivors (0.38-fold, p = 0.006), while in patients without SHG, non-survivors had higher chemerin levels, not reaching significance (1.64-fold, p = 0.089). No difference was apparent in patients with pre-existing T2D (p = 0.44).

Conclusions

We show, for the first time to our knowledge, that chemerin is increased in sepsis and that it associates with impaired glucose metabolism and survival in these patients. It could be further evaluated as a biomarker to stratify mortality risk of patients with SHG.
Balloon dilation of the eustachian tube: A tympanometric outcomes analysis
Authors: Williams Blair , Taylor Benjamin A. , Clifton Neil , Bance Manohar
Published: February 2016

Background

Eustachian tube dysfunction (ETD) is a common medical issue, occurring in at least 1 % of the adult population. Patients suffering from ET dysfunction typically present with complaints of hearing loss or sensation of pressure or plugged ear, which can lead to impaired quality of life. Over time ETD can result in conductive hearing loss or choleastatoma formation. Effective theraputic options for ET dysfunction are few. Eustachian tube balloon dilation is a novel surgical technique being used to treat ETD. The aim of our study is to objectively measure the success of Eustachian tube balloon dilation by comparing pre and post-operative middle ear pressures using tympanometric testing.

Methods

RA retrospective chart review was preformed on all patients who underwent balloon dilation of the Eustachian tube by authors NC or MB from 2010 to 2014. Pre and post-operative tympanograms were analyzed and categorized based on type (Type A, Type B, Type C). Success was defined by an improvement in tympanogram type: Type B or C to Type A, or Type B to type C. Pre and post-operative tympanograms were further analyzed using middle ear pressure values. Follow-up ranged from 3 to 15 months.

Results

Twenty-five ears (18 patients) were included in the study. Overall 36 % of ears had improvement in tympanogram type, and 32 % had normalization of tympanogram post-operatively. The Jerger tympanogram type improved significantly following the procedure ( p = 0.04). Patients also had statistically significant improvement in measured middle ear pressure post-operatively ( P = 0.003).

Conclusion

The natural history of Eustachian tube dysfunction is poorly understood, and evidence for current treatments are limited. Eustachian tube balloon dilation is a safe procedure, and produces significant improvement in tympanogram values up to 15 months post-operatively. Further refinement of patient selection and standardization of technique is required to optimize the effect of this therapy. Longterm follow-up data will clarify the persistence of the effect.
Differentiation of epithelial ovarian cancer subtypes by use of imaging and clinical data: a detailed analysis
Authors: Tanaka Yumiko Oishi , Okada Satoshi , Satoh Toyomi , Matsumoto Koji , Oki Akinori , Saida Tsukasa , Yoshikawa Hiroyuki , Minami Manabu
Published: February 2016

Background

Primary epithelial ovarian carcinoma is sub-classified into serous, mucinous, endometrioid and clear cell subtypes. Neoadjuvant chemotherapy has become an alternative treatment option past several years, as serous carcinoma, the most common subtype, is known as chemotherapy-sensitive tumor. On the other hand, mucinous and clear cell carcinoma are known as chemotherapy-resistive. Therefore, it may be meaningful to estimate subtype of ovarian carcinoma using imaging modality. The purpose of this study is to study whether CT or MRI can determine the subtypes of epithelial ovarian cancers.

Methods

The imaging and clinical findings obtained from 125 consecutive patients with primary ovarian carcinoma were retrospectively analyzed. Forty-four of the patients had serous carcinoma; 13, mucinous carcinoma; 53, clear cell carcinoma; and 15, endometrioid carcinoma. We studied the bilateralism, morphological type, tumor diameter, solid portion ratio, relative signal intensity on T2WI and DWI, contrast ratio, and endometriosis on MRI and the calcification, peritoneal dissemination and lymph node metastasis, clinical staging, and thromboembolism on CT. We also studied the tumor markers and serum calcium concentrations. Each parameter was statistically analyzed by univariate and multivariate analyses.

Results

Serous carcinoma showed a significantly higher incidence of bilateral disease, smaller tumor size, higher signal intensity on DWI, and less frequent hypercalcemia. The CA19-9 level was significantly higher in mucinous carcinoma, in which most of the tumors appeared as multilocular cystic masses. Clear cell carcinoma appeared as unilateral disease with a larger solid portion and hypercalcemia in younger patients. Endometrioid carcinoma only showed a lower incidence of intraperitoneal dissemination.

Conclusions

CT and MRI combined with clinical data especially tumor markers and presence of paraneoplastic syndrome could partly predict epithelial ovarian cancer subtypes.
ReCAP: Feasibility and Accuracy of Extracting Cancer Stage Information From Narrative Electronic Health Record Data
Authors: Warner Jeremy L. , Levy Mia A. , Neuss Michael N. , Warner Jeremy L. , Levy Mia A. , Neuss Michael N.
Published: February 2016

QUESTION ASKED:

Cancer stage, one of the most important prognostic factors for cancer-specific survival, is often documented in narrative form in electronic health records (EHRs), and as such is difficult to abstract by registrars and other secondary data users, including clinicians participating in quality reporting activities. Can the cancer stage be accurately extracted by natural language processing (NLP) of the text from EHRs?

SUMMARY ANSWER:

In a combined dataset of N = 2,323 patients with lung cancer (training set: n = 1,103; validation set n = 1,220), we analyzed 751,880 documents and discovered at least one stage statement for 98.6% of patients (median of 24 documents with stage statements per patient). Despite a high degree of discordance in patient records (83.6% of patients had conflicting stage statements in their HER; Fig 2 ), algorithmically derived stage accuracy was very high in the validation set, κ = 0.906 (95% CI, 0.873 to 0.939), as compared with the gold standard of tumor registrar–derived stage.

METHODS:

We developed an NLP algorithm to extract stage statements from machine-readable EHR documents, including automated rules to choose the most likely stage when discordance was present in the EHR; the algorithm was developed on a training set of patients with lung cancer and independently validated on a test set of patients with lung cancer who were seen at our institution.

BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:

An exact stage (eg, stage I, stage IV) could be calculated for only 72% of the patients; the remainder were assigned an inexact stage (eg, “early stage”). In an exploratory analysis, we were able to distinguish stage IIIA from stage IIIB, but the accuracy was not as good, in the 64% to 79% range. The experiments were carried out only on patients with lung cancer, so it is unknown whether other tumor types would have a similar level of performance. We did not explicitly consider the provenance of the information, (eg, was the stage documented by a medical student, an attending oncologist, etc). Finally, given that this was performed at a single tertiary care institution, there may be significant differences in documentation patterns at other institutions that could affect the reproducibility of the results.

REAL-LIFE IMPLICATIONS:

This new approach to the determination of summary stage in patients with lung cancer can be applied rapidly and broadly to a patient population with large amounts of EHR data. Despite the presence of significant discordance in documentation, the results were highly accurate. This proof-of-concept suggests that NLP may augment and enhance manual abstraction efforts and may even replace them for certain targeted applications. [Figure: see text]
ReCAP: Feasibility and Effectiveness of a Pilot Program to Facilitate Quality Improvement Learning in Oncology: Experience of the American Society of Clinical Oncology Quality Training Program
Authors: Kamal Arif H. , Quinn Doris , Gilligan Timothy D. , Davis Barbara Corning , Dalby Carole K. , Bretsch Jennifer , McNiff Kristen K. , Jacobson Joseph O. , Kamal Arif H. , Quinn Doris , Gilligan Timothy D. , Corning Davis Barbara , Dalby Carole K. , Bretsch Jennifer , McNiff Kristen K. , Jacobson Joseph O.
Published: February 2016

CONTEXT AND QUESTION ASKED:

Improving quality of oncology delivery is an important responsibility for busy oncology practices. Is it feasible to construct a training program for oncology professionals to teach quality improvement that is applicable to practice?

SUMMARY ANSWER:

Using a longitudinal, project-based program with a mix of in-person and distance-learning components, the ASCO Quality Training Program is a highly feasible method to facilitate quality improvement learning in oncology.

METHODS:

The ASCO Quality Training Program (QTP) consisted of three in-person Learning Sessions and four phases: pre-work, planning, implementation, and sustain and spread. We measured two primary outcomes: program feasibility and effectiveness.

BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:

Although we observed high participation, satisfaction, and applicability of content to the needs of the oncology learners, it should be noted that this represents a small, pilot project.

REAL-LIFE IMPLICATIONS:

Even busy oncology clinicians find a structured program to learn and practice quality improvement skills valuable. Conclusions regarding long-term applicability effectiveness and feasibility among non-early adopters require further study.
ReCAP: Comparison of Independent Error Checks for Oral Versus Intravenous Chemotherapy
Authors: Griffin Melissa C. , Gilbert Rachel E. , Broadfield Larry H. , Easty Anthony E. , Trbovich Patricia L. , Griffin Melissa C. , Gilbert Rachel E. , Broadfield Larry H. , Easty Anthony E. , Trbovich Patricia L.
Published: February 2016

QUESTION ASKED:

In the United States, research has found that oral chemotherapy is subject to fewer safeguards than are in routine use for intravenous (IV) chemotherapy; however, less is known about the Canadian context. The objective of this study was to determine whether similar safeguards, in the form of independent checks, existed to identify potential errors related to IV and oral chemotherapy formulations in a particular cancer system.

SUMMARY ANSWER:

In the cancer system studied, a total of 57 systematic checks were identified for IV chemotherapy, whereas only six systematic checks were identified for oral chemotherapy. Community pharmacists were the only qualified professionals involved in independent, systematic checking of oral chemotherapy, which occurred during ordering and dispensing.

METHODS:

Human factors specialists conducted observations and interviews in cancer center clinics, a cancer center pharmacy, and four community pharmacies across Nova Scotia. Processes were analyzed to determine whether an independent check was performed, which qualified provider completed the check, and at what point of the process the check occurred.

BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:

This study had some limitations. Although there are many forms of safeguards (eg, preprinted orders), only one type of safeguard (ie, independent checks) was examined in the cancer system studied. We chose to focus on independent checks because they were observable and were defined in the cancer center’s policies. Another limitation was that just a single jurisdiction (Nova Scotia), and four community pharmacies were examined. We examined each community pharmacy in detail, and sites were chosen to be representative (eg, rural versus urban). Further, the model used to deliver oral chemotherapy in Nova Scotia is not unique; a number of other provinces share similar models.

REAL-LIFE IMPLICATIONS:

There is an enormous opportunity for pharmacists and other qualified professionals to take on an expanded role in improving patient safety for oral chemotherapy. Oral chemotherapy, like IV chemotherapy, is known to be potentially hazardous, but in the cancer system studied, there were dramatically fewer independent checks associated with all aspects of oral chemotherapy–related processes. Greater involvement of pharmacists, both in the clinic environment and the community, would facilitate increased systematic checking, which could improve patient safety related to oral chemotherapy. [Figure: see text]
ReCAP: Detection of Potentially Avoidable Harm in Oncology From Patient Medical Records
Authors: Lipitz-Snyderman Allison , Weingart Saul N. , Anderson Christopher , Epstein Andrew S. , Killen Aileen , Classen David , Sima Camelia S. , Fortier Elizabeth , Atoria Coral L. , Pfister David , Lipitz-Snyderman Allison , Weingart Saul N. , Anderson Christopher , Epstein Andrew S. , Killen Aileen , Classen David , Sima Camelia S. , Fortier Elizabeth , Atoria Coral L. , Pfister David
Published: February 2016

QUESTION ASKED:

Although medical record–based measurement of adverse events (AEs) associated with cancer care is desirable, condition-specific triggers in oncology care are needed. We sought to develop a screening tool to facilitate efficient detection of AEs across settings of cancer care via medical record review. We hope to use this tool to understand the frequency, spectrum, and preventability of AEs with the goal of helping improve the quality and safety of cancer care.

SUMMARY ANSWER:

We developed a cancer-specific screening tool to help identify candidate preventable AEs that occur during cancer care from patients’ medical records. Our oncology screening tool consists of 76 triggers—readily identifiable findings to screen for possible AEs that occur during cancer care ( Table 1 ).

METHODS:

We sought to develop a screening tool to facilitate the detection of AEs across settings of cancer care via medical record review. We obtained structured and unstructured input from clinical experts to develop our tool, using a modified Delphi process.

BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:

Our oncology tool requires further evaluation in order to understand its usefulness for population-based assessments of AEs in oncology and quality improvement.

REAL-LIFE IMPLICATIONS:

Information obtained from structured record reviews using an oncology trigger tool could help to prioritize quality improvement activities, identify high-risk groups, and generate cancer-focused quality measures. Ultimately, the goals of this work are to prevent AEs and allow timely, automated identification of these events so that clinicians can intervene promptly to improve patient outcomes. [Table: see text]
Reducing the Time From Diagnosis to Treatment of Patients With Stage II/III Rectal Cancer at a Large Public Hospital
Authors: Hoffmann Marc S. , Leslie Lori A. , Jacobs Ryan W. , Millas Stefanos , Surabhi Venkateswar , Mok Henry , Jhaveri Pavan , Kott Marylee M. , Jackson Lymesia , Rieber Alyssa , Bhadkamkar Nishin A.
Published: February 2016

Curative-intent therapy for stage II/III rectal cancer is necessarily complex. Current guidelines by the National Comprehensive Cancer Network recommend preoperative concurrent chemoradiation followed by resection and additional adjuvant chemotherapy. We used standard quality improvement methodology to implement a cost-effective intervention that reduced the time from diagnosis to treatment of patients with stage II/III rectal cancer by approximately 30% in a large public hospital in Houston, Texas. Implementation of the program resulted in a reduction in time from pathologic diagnosis to treatment of 29% overall, from 62 to 44 days. These gains were cost neutral and resulted from improvements in scheduling and coordination of care alone. Our results suggest that: (1) quality improvement methodology can be successfully applied to multidisciplinary cancer care, (2) effective interventions can be cost neutral, and (3) effective strategies can overcome complexities such as having multiple sites of care, high staff turnover, and resource limitations.
Where Do Programmed Death-1 Inhibitors Fit in the Management of Malignant Lymphoma?
Authors: Ansell Stephen M.
Published: February 2016

Tumor-specific cytotoxic T cells have the capacity to target and eradicate malignant B cells in patients with Hodgkin and non-Hodgkin lymphoma; however, multiple mechanisms, including regulatory T cells, immunosuppressive ligands, and immune exhaustion, suppress an effective antitumor immune response. One mechanism that is used by malignant cells to inhibit the immune response is overexpression of programmed death ligand 1 or 2 (PD-L1 or PD-L2) on the cancer cell surface. These ligands interact with the programmed death-1 (PD-1) receptor expressed on intratumoral T cells and provide an inhibitory signal, thereby suppressing the antitumor immune response. Monoclonal antibodies that block PD-1 signaling prevent T-cell inhibition and promote a T-cell–mediated antilymphoma response. Blocking antibodies that are directed against PD-1 or PD-L1 are currently being tested in patients with lymphoma and have shown remarkable efficacy, particularly in patients with relapsed Hodgkin lymphoma. On the basis of the promising activity of this approach, PD-1 inhibitors are being used as single-agent therapy in patients with relapsed Hodgkin lymphoma, and these inhibitors are also being tested in combination with standard chemotherapy or targeted agents in ongoing clinical trials.
Endothelial Estrogen Receptor-α Does Not Protect Against Vascular Stiffness Induced by Western Diet in Female Mice
Authors: Manrique Camila , Lastra Guido , Ramirez-Perez Francisco I. , Haertling Dominic , DeMarco Vincent G. , Aroor Annayya R. , Jia Guanghong , Chen Dongqing , Barron Brady J. , Garro Mona , Padilla Jaume , Martinez-Lemus Luis A. , Sowers James R.
Published: February 2016

Consumption of a diet high in fat and refined carbohydrates (Western diet [WD]) is associated with obesity and insulin resistance, both major risk factors for cardiovascular disease (CVD). In women, obesity and insulin resistance abrogate the protection against CVD likely afforded by estrogen signaling through estrogen receptor (ER)α. Indeed, WD in females results in increased vascular stiffness, which is independently associated with CVD. We tested the hypothesis that loss of ERα signaling in the endothelium exacerbates WD-induced vascular stiffening in female mice. We used a novel model of endothelial cell (EC)-specific ERα knockout (EC-ERαKO), obtained after sequential crossing of the ERα double floxed mice and VE-Cadherin Cre-recombinase mice. Ten-week-old females, EC-ERαKO and aged-matched genopairs were fed either a regular chow diet (control diet) or WD for 8 weeks. Vascular stiffness was measured in vivo by pulse wave velocity and ex vivo in aortic explants by atomic force microscopy. In addition, vascular reactivity was assessed in isolated aortic rings. Initial characterization of the model fed a control diet did not reveal changes in whole-body insulin sensitivity, aortic vasoreactivity, or vascular stiffness in the EC-ERαKO mice. Interestingly, ablation of ERα in ECs reduced WD-induced vascular stiffness and improved endothelial-dependent dilation. In the setting of a WD, endothelial ERα signaling contributes to vascular stiffening in females. The precise mechanisms underlying the detrimental effects of endothelial ERα in the setting of a WD remain to be elucidated.
Comparative Assessment of Female Mouse Model of Graves' Orbitopathy Under Different Environments, Accompanied by Proinflammatory Cytokine and T-Cell Responses to Thyrotropin Hormone Receptor Antigen
Authors: Berchner-Pfannschmidt Utta , Moshkelgosha Sajad , Diaz-Cano Salvador , Edelmann Bärbel , Görtz Gina-Eva , Horstmann Mareike , Noble Alistair , Hansen Wiebke , Eckstein Anja , Banga J. Paul
Published: February 2016

We recently described a preclinical model of Graves' orbitopathy (GO), induced by genetic immunization of eukaryotic expression plasmid encoding human TSH receptor (TSHR) A-subunit by muscle electroporation in female BALB/c mice. The onset of orbital pathology is characterized by muscle inflammation, adipogenesis, and fibrosis. Animal models of autoimmunity are influenced by their environmental exposures. This follow-up study was undertaken to investigate the development of experimental GO in 2 different locations, run in parallel under comparable housing conditions. Functional antibodies to TSHR were induced in TSHR A-subunit plasmid-immunized animals, and antibodies to IGF-1 receptor α-subunit were also present, whereas control animals were negative in both locations. Splenic T cells from TSHR A-subunit primed animals undergoing GO in both locations showed proliferative responses to purified TSHR antigen and secreted interferon-γ, IL-10, IL-6, and TNF-α cytokines. Histopathological evaluation showed orbital tissue damage in mice undergoing GO, manifest by adipogenesis, fibrosis, and muscle damage with classic signs of myopathy. Although no inflammatory infiltrate was observed in orbital tissue in either location, the appearances were consistent with a “hit-and-run” immune-mediated inflammatory event. A statistically significant increase of cumulative incidence of orbital pathology when compared with control animals was shown for both locations, confirming onset of orbital dysimmune myopathy. Our findings confirm expansion of the model in different environments, accompanied with increased prevalence of T cell-derived proinflammatory cytokines, with relevance for pathogenesis. Wider availability of the model makes it suitable for mechanistic studies into pathogenesis and undertaking of novel therapeutic approaches.
“This Beautiful and Rapidly Improving Section of Our City”: Race, Labor, and Colonizationists in Early Industrializing New Haven, 1800–1830
Authors: Hinks Peter
Published: February 2016

What contemporary historians aptly discern as an unprecedented surge of hostility against blacks in the urban North in the 1820s—grounded in new scalings of the meaning of white and black—was in fact rooted fundamentally in more than just race and newly aggressive racialized thinking. That surge can actually be understood as one vital facet of an increased hostility toward the laboring poor as a whole once that racialized hostility is placed more expressly within the broad context of the profound transformations that the launch of industrial capitalism in these centers wrought upon work, space, and class. As elites in New Haven, Connecticut, sought to dislocate a black neighborhood that by 1825 also included white laboring poor and transients from the center of a district that early manufacturing was rapidly transforming, they evinced this new racialized hostility. This essay probes these events and interprets them explicitly in terms of this broader context of emerging industrial capitalism.