bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of medical cannabis for cancer-related pain in the elderly: A single-center retrospective analysis.
Authors: Mupamombe Charles Tonderai , Nathan Rachel Andrea , Case Amy Allen , Walter Michelle , Hansen Eric 
Published: November 2019

13 Background: Use of medical cannabis (MC) for cancer-related symptoms is growing, yet many prior studies used formulations not available in the United States (US). Clinical data on formulation, dosing and efficacy for formulations available in the US is limited. Furthermore, though interest is growing in the use of MC for elderly patients, data on safety and efficacy in this population is limited. We aimed to assess the clinical characteristics of elderly people using MC, formulations prescribed, and efficacy for cancer-related pain, insomnia and anxiety. Methods: We conducted a retrospective chart review of patients age 65 and older prescribed MC in the year 2018 in an outpatient palliative care clinic at a tertiary comprehensive cancer center. Pain intensity and anxiety were measured by numerical rating (0-10), and insomnia was assessed by self-reported hours of sleep per night, with data collected at consecutive clinic visits before and after MC use. Results: Eighty-three patients aged 65 and over were included in our analysis. Half of patients were age 65-70, while 12% were age 76 or older. Slightly more than half were male (58%), while the majority were Caucasian (92%). For patients with pain, two thirds were already prescribed opioids; 28% were using gabapentin/pregabalin, 22% duloxetine, and 7% nortriptyline/amitriptyline. Two-thirds (65%) reported never using cannabis previously. The most common MC product used was oil (35%), followed by vape (13%), pill (6%) and powder (3%). The most common initial concentrations were equal THC/CBD (41%) and high THC (43%); 8% of patients used high CBD, and 8% used a combination. The median delta pain score did not change with use of MC (delta pain = 0.0, p = 0.72), nor did anxiety (delta anxiety = -0.2, p = 1.00) nor insomnia (delta hours sleep = -0.1, p = 1.000). Conclusions: In this study of elderly patients prescribed MC, the majority of whom were cannabis naïve and already prescribed opioids, most were initially prescribed high THC or 1:1 THC/CBD, with oil and vape the most common formulations used. Use of MC was not associated with changes in pain, anxiety nor insomnia scores.
Long-term and late effects (LLEs), anxiety, and depression among long-term survivors of pediatric, adolescent, and young adult (P-AYA) cancer.
Authors: Jacobs Linda A. , Blauch Abigail N. , Pucci Donna A. , Palmer Steven C 
Published: November 2019

143 Background: Adult P-AYA cancer survivors report numerous LLEs, as well as potential decrements in psychological well-being. The relationship between LLEs and psychological well-being, however, has not been well described in this population. We examined this relationship and predictors of LLEs and well-being in a sample of adult survivors of P-AYA cancer. Methods: Survivors of P-AYA cancer > 2 years from end of treatment completed the Hospital Anxiety and Depression Scale (HADS) and a measure of presence and severity of 11 common LLEs following a survivorship visit. LLEs included fatigue, pain, insomnia, numbness, joint or muscle pain, difficulties with concentration or memory, body image concerns, decreased sexual interest, and weight. Results: Participants (N = 237) were predominately white (89%), college educated (76%), single (63%), and had an annual income of > $60,000 (69%). A plurality had diagnoses of leukemia (30%) or Hodgkin's lymphoma (29%) treated 17 years previously. Treatment included surgery (35%), chemotherapy (91%), XRT (59%), and BMT (17%). Anxiety (M = 6.02; SD = 3.07) and depression (M = 2.54; SD = 2.85) scores were generally low and below the cutpoint of 8 (all t < -7.8; all p < .001 ), although 21% and 9% screened positively for anxiety or depression, respectively. 91% of participants reported at least 1 LLE (M = 4.8, SD = 3.1), most commonly fatigue (73%), concentration (57%) and memory difficulties (53%), and body image problems (48%). Total number LLEs was associated with elevations in both anxiety and depression, as was severity for each individual LLE (all p < 0.001). Only one LLE, difficulty with body image, produced large effects for both anxiety and depression. Low income status were associated with both LLEs and elevations in anxiety and depression (all p < 0.01). Conclusions: Most P-AYA survivors report LLEs. Although anxiety and depression are modest, elevations occur in a substantial number of survivors. Presence of LLEs is associated with worse psychosocial outcomes, particularly difficulties with body image. Lower income individuals and those with body image concerns may be at particular risk of poorer psychosocial outcomes.
End-of-life palliative care resource utilization in cancer care: A focus on the urban-rural continuum.
Authors: Cerni Jessica , Rhee Joel , Hosseinzadeh Hassan 
Published: November 2019

52 Background: Despite the advances in end-of-life cancer care, disparities exist in the availability, accessibility and use of palliative care services across the urban-rural continuum. This review explores this disparity by synthesising retrospective quantitative studies on palliative care patterns of resource use for adults during end-of-life cancer care. Methods: Five databases were searched and data analysed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria involved; a) original research; b) quantitative studies; c) English-language; d) study assessed palliative care related service use in adult (18yrs+) cancer patients with any malignancy excluding non-melanoma skin cancer; e) exclusive end of life focus and f) urban-rural focus. Narrative reviews and discussions were excluded. Results: After reviewing all titles and abstracts ( N= 816) and full text review ( N= 163) 44 studies met the inclusion criteria and were included in the analysis. End-of-life palliative care access and utilisation patterns varied across the geographical urban-rural continuum. Geographical region of residence had the strongest association with multiple ED visits and hospitalizations in rural or remote areas. Most common palliative care services used within the last 30 days of death were ED visits and hospital admissions. Two studies assessed palliative radiotherapy and one study assessed palliative care pharmacotherapy. The odds of palliative service use were lowest for males and individuals with a survival diagnosis (0-3months). The largest inequities were explained by individual level factors including gender as assessed in ( N= 44 studies), socioeconomic status ( N= 15), proximity to service ( N= 10) and survival time from cancer diagnosis ( N= 9). Conclusions: Rurality was an important predictor for poorer outcomes in the quality of end-of-life cancer care. Findings suggest that addressing the urban-rural continuum is critical for equitable, timely and efficient palliative cancer care. Further research is required to understand barriers to service usage to achieve optimal palliative care.
Integration of specialty palliative care in a phase I ovarian cancer population.
Authors: Moroney Marisa R , Hill Breana , Sheeder Jeanelle , Diamond Jennifer Robinson , Avella-Howell Melony , Corr Bradley , Lefkowits Carolyn 
Published: November 2019

75 Background: ASCO guidelines recommend patients with advanced cancer receive early integrated specialty palliative care based on evidence of multiple clinical benefits. To our knowledge, there is no literature evaluating utilization of specialty palliative care in Phase I clinical trial patients, but there is limited data demonstrating underutilization of palliative care services in patients with life-threatening diseases including advanced cancer. Methods: A retrospective review of ovarian cancer patients enrolled in Phase I clinical trials at one institution from 2008 to 2018. Charts were reviewed for patient and disease characteristics including age, disease stage, number of chemotherapy regimens and date of death. Charts were also reviewed to determine if and when patients received specialty palliative care services. Results: A total of 121 patients with ovarian cancer were enrolled in Phase I clinical trials. Median age at time of Phase I enrollment was 59 years (range 33-88). 87% of patients had advanced stage disease: 60% Stage III and 27% Stage IV. Median number of chemotherapy regimens received prior to Phase I enrollment was 5 (range 1-13). Median survival was 311 days (95%CI 225.9-396.1). Of the 121 patients, 4 (3.3%) received specialty palliative care prior to Phase I enrollment, 7 (5.8%) within 30 days after enrollment, and 53 (43.8%) more than 30 days after enrollment. 57 patients (47.1%) never received specialty palliative care. Conclusions: Ovarian cancer patients enrolled in Phase I clinical trials have advanced cancer – defined by ASCO as disease that is late-stage and life limiting with a prognosis less than 24 months – and should therefore receive early integrated specialty palliative care. This study demonstrates that a significant portion of Phase I ovarian cancer patients are either receiving no or late integration of specialty palliative care. Further work needs to focus on increasing early integration of specialty palliative care in this population.
Integrating Touchscreen-Based Geriatric Assessment and Frailty Screening for Adults With Multiple Myeloma to Drive Personalized Treatment Decisions
Authors: Nathwani Nitya , Kurtin Sandra E. , Lipe Brea , Mohile Supriya Gupta , Catamero Donna D. , Wujcik Debra , Birchard Kristy , Davis Agnes , Dudley William , Stricker Carrie Tompkins , Wildes Tanya Marya 
Published: November 2019

PURPOSE: Geriatric assessment (GA) results predict toxicity/survival in older adults, yet GA is not routinely used in care for patients with multiple myeloma (MM). We tested a tablet-based modified GA (mGA) providing real-time results to clinicians. METHODS: One hundred sixty-five patients with MM aged ≥ 65 years facing a treatment decision from 4 sites completed a tablet-based mGA with Katz Activities of Daily Living (ADL), Lawton Instrumental ADL, Charlson Comorbidity Index, and variables from the Cancer and Aging Research Group’s Chemotherapy Toxicity Calculator. Providers reviewed the assessment results at the treatment visit. RESULTS: Patients were white (72%; n = 86), mean age was 72 years (range, 65-85 years), and averaged 7.71 minutes (range, 2-17 minutes) for survey completion. Providers averaged 3.2 minutes (range, 1-10 minutes) to review mGA results. Using International Myeloma Working Group frailty score, patients were fit (39%; n = 64), intermediate fit (33%; n = 55), or frail (28%; n = 46). Providers selected more aggressive treatments in 16.3% of patients and decreased treatment intensity in 34% of patients; treatment intensification was more common for fit patients and milder treatments for frail patients (χ2 = 20.02; P < .0001). Transplant eligibility significantly correlated with fit status and transplant ineligibility with frail status ( P = .004). Outcomes on 144 patients 3 months post study visit showed 19.4% (n = 28) had grade ≥ 3 hematologic toxicities, 38.9% (n = 56) had dose modifications, and 18% (n = 26) had early therapy cessation. CONCLUSION: Limited patient time required for survey completion and provider time for results review show mGA can be easily incorporated into clinical workflow. Real-time mGA results indicating fit/frailty status influenced treatment decisions.
“It’s More Difficult…”: Clinicians’ Experience Providing Palliative Care to Adolescents and Young Adults Diagnosed With Advanced Cancer
Authors: Avery Jonathan , Geist Arielle , D’Agostino Norma Mammone , Kawaguchi Sarah K. , Mahtani Ramona , Mazzotta Paolo , Mosher Pamela J. , al-Awamer Ahmed , Kassam Alisha , Zimmermann Camilla , Samadi Mahsa , Tam Seline , Srikanthan Amirrtha , Gupta Abha 
Published: November 2019

PURPOSE: Adolescents and young adults (AYAs; age 15-39 years) with advanced cancer are a population in whom quality of life is uniquely affected because of their stage of life. However, training focused on palliative care for AYAs is not routinely provided for health care providers (HCPs) in oncology. This study aims to explore the experiences of HCPs involved in introducing and providing palliative care caring for AYAs with advanced cancer and their families to understand the unique challenges HCPs experience. METHODS: Using a qualitative descriptive design, semistructured interviews were conducted with medical and radiation oncologists, palliative care physicians, psychiatrists, and advanced practice nurses involved in caring for AYAs diagnosed with advanced cancer (N = 19). Interviews were transcribed verbatim and analyzed using thematic analysis in combination with constant comparative analysis and theoretical sampling. RESULTS: There were 19 participants, 9 men and 10 women, with a median age of 45 years (range, 24-67 years). Six were palliative care physicians, 5 medical oncologists, 4 nurse practitioners, and 2 each radiation oncologists and psychiatrists. Overall, participants perceived the provision of palliative care for AYAs to be more difficult compared with older adults. Four themes emerged: (1) challenges helping AYAs/families to engage in and accept palliative care, (2) uncertainty regarding how to involve the family, (3) HCP sense of tragedy, and (4) HCP sense of emotional proximity. CONCLUSION: Findings from this study support the development of dedicated training for HCPs involved in palliative care for AYA.
Activation of β-Catenin Signaling and its Crosstalk With Estrogen and Histone Deacetylases in Human Uterine Fibroids
Authors: Ali Mohamed , Shahin Sara Mahmoud , Sabri Nagwa Ali , Al-Hendy Ayman , Yang Qiwei 
Published: November 2019

Abstract

Context
Uterine fibroids (UF) are the most common benign tumor of the myometrium (MM) in women of reproductive age. However, the mechanism underlying the pathogenesis of UF is largely unknown.

Objective
To explore the link between nuclear β-catenin and UF phenotype and β-catenin crosstalk with estrogen and histone deacetylases (HDACs).

Design
Protein/RNA levels of β-catenin (CTNNB1 gene), its responsive markers cyclin D1 and c-Myc, androgen receptor (AR), p27, and class-I HDACs were measured in matched UF/MM tissues or cell populations. The effects of chemical inhibition/activation and genetic knockdown of CTNNB1 on UF phenotype were measured. The anti-UF effect of 2 HDAC inhibitors was evaluated.

Main Outcome Measure
β-catenin nuclear translocation in response to β-catenin inhibition/activation, estrogen, and HDAC inhibitors in UF cells.

Results
UF tissues/cells showed significantly higher expression of nuclear β-catenin, cyclin D1, c-Myc, and HDACs 1, 2, 3, and 8 than MM. Estradiol induced β-catenin nuclear translocation and consequently its responsive genes in both MM and UF cells, while an estrogen receptor antagonist reversed this induction effect. Treatment with β-catenin or HDAC inhibitors led to dose-dependent growth inhibition, while Wnt3a treatment increased proliferation compared with control. Chemical inhibition of β-catenin decreased cyclin D1 and c-Myc expression levels, while β-catenin activation increased expression of the same markers. Genetic knockdown of CTNNB1 resulted in a marked decrease in β-catenin, cyclin D1, c-Myc, and AR expression. Treatment of UF cells with HDAC inhibitors decreased nuclear β-catenin, cyclin D1, and c-Myc expression. Moreover, HDAC inhibitors induced apoptosis of UF cells and cell cycle arrest.

Conclusion
β-catenin nuclear translocation contributes to UF phenotype, and β-catenin signaling is modulated by estradiol and HDAC activity.
E3 ubiquitin ligase MDM2 acts through p53 to control respiratory progenitor cell number and lung size
Authors: Sui Pengfei , Li Rongbo , Zhang Yan , Tan Chunting , Garg Ankur , Verheyden Jamie M. , Sun Xin 
Published: November 2019

ABSTRACT
The respiratory lineage initiates from the specification of NKX2-1+ progenitor cells that ultimately give rise to a vast gas-exchange surface area. How the size of the progenitor pool is determined and whether this directly impacts final lung size remains poorly understood. Here, we show that epithelium-specific inactivation of Mdm2, which encodes an E3 ubiquitin ligase, led to lethality at birth with a striking reduction of lung size to a single vestigial lobe. Intriguingly, this lobe was patterned and contained all the appropriate epithelial cell types. The reduction of size can be traced to the progenitor stage, when p53, a principal MDM2 protein degradation target, was transiently upregulated. This was followed by a brief increase of apoptosis. Inactivation of the p53 gene in the Mdm2 mutant background effectively reversed the lung size phenotype, allowing survival at birth. Together, these findings demonstrate that p53 protein turnover by MDM2 is essential for the survival of respiratory progenitors. Unlike in the liver, in which genetic reduction of progenitors triggered compensation, in the lung, respiratory progenitor number is a key determinant factor for final lung size.
Metabolic Effects of Three Different Activity Bouts during Sitting in Inactive Adults
Authors: MA SHENG-XIA , ZHU ZHENG , ZHANG LIN , LIU XIAO-MEI , LIN YAN-YU , CAO ZHEN-BO 
Published: November 2019

ABSTRACT

Purpose
This study aimed to determine whether interrupting prolonged sitting with three different walking-bout schedules improves glycemic metabolism relative to continuous prolonged sitting in sedentary adults.

Methods
In a randomized, crossover trial, 16 inactive healthy adults (7 men, 24 ± 3 yr old) completed four 26-h laboratory sessions, including 22.5 h in an energy expenditure (EE)-testing calorimeter chamber. The four 9-h intervention periods were as follows: 9-h uninterrupted sitting (SIT), 30-min sitting/3-min brisk (60% V˙O2max) treadmill walk (WALK3), 45-min sitting/5-min (WALK5), or 60-min sitting/8-min (WALK8). Coprimary outcomes included the difference in the mean interstitial glucose concentration, total area under the curve (tAUC), and incremental area under the curve (iAUC) for the entire 26 and 9 h (intervention period) during three activity-bout conditions compared with SIT.

Results
Compared with SIT, the 26-h mean glucose concentration was attenuated in WALK8 (Δmean −0.22 mmol·L−1 [95% confidence interval = −0.43 to −0.001], P = 0.048) without adjustment for EE and attenuated in WALK3 (Δ−0.47 mmol·L−1 [−0.75 to −0.10]), WALK5 (Δ−0.47 mmol·L−1 [−0.83 to −0.10]), and WALK8 (Δ−0.53 mmol·L−1 [−0.92 to −0.13]) after adjustment for EE (all P < 0.01). The 26-h tAUC was reduced in WALK3 (Δ−11.18 mmol·L−1 per 26 h [−20.07 to −2.29]), WALK5 (2.12.67 mmol·L−1 per 26 h [−22.54 to −2.79]), and WALK8 (Δ−13.85 mmol·L−1 per 26 h [−24.60 to −3.10]) (all P < 0.01), as well as the iAUC (all P < 0.05), only after adjustment for EE. The 9-h mean glucose concentration, tAUC, and iAUC decreased in the three activity-break conditions regardless of EE adjustment (all P < 0.05).

Conclusions
All three walking-bout conditions improved glycemic metabolism compared with SIT, independent of EE, in inactive, healthy adults.
Ad Networks and Consumer Tracking
Authors: D’Annunzio Anna , Russo Antonio 
Published: November 2019

We study the role of ad networks in the online advertising market. Our baseline model considers two publishers that can outsource the sale of their ad inventories to an ad network, in a market where consumers and advertisers multi-home. The ad network increases total advertising revenue by tracking consumers across outlets and reduces competition between publishers by centralizing the sale of ads. Consequently, outsourcing to the ad network benefits the publishers, but may penalize the advertisers. We show that the ad network’s ability to track consumers may either expand or reduce the provision of ads, depending on consumers’ preferences for the publishers and how advertisers use tracking information. Specifically, tracking is more likely to expand (respectively, reduce) the provision of ads when consumers’ preferences for the publishers are positively (respectively, negatively) correlated. Tracking is also more likely to expand (respectively, reduce) the provision of ads when advertisers use tracking information to cap the frequency of impressions (respectively, target specific consumers). Furthermore, we study the implications of consumers’ choice to block tracking. Generally, blocking negatively impacts the advertising industry by making ad allocation less effective. Blocking also entails an externality on consumers, which is negative when tracking reduces the provision of ads. Given these conditions, regulatory restrictions on tracking may reduce consumer surplus as well as advertising revenue. These findings contrast with the presumption that regulation should make it easier for consumers to avoid tracking. We propose further extensions, including competing ad networks, more than two publishers, and networks that do not sell ads, but only tracking information to the advertisers. This paper was accepted by Juanjuan Zhang, marketing.
PEMANASAN GLOBAL, EKSPLOITASI SUMBERDAYA PERIKANAN, DAN PENCEMARAN PESISIR SEBAGAI PENYEBAB UTAMA PERUBAHAN EKOLOGI LAUT DI INDONESIA
Authors: . Hadiyanto 
Published: November 2019

GLOBAL WARMING, OVERFISHING, AND COASTAL POLLUTION AS MAJOR CAUSES OF MARINE ECOLOGICAL CHANGES IN INDONESIA. Changes in marine ecology are normal, because the earth is dynamic, and are getting worse and faster since human are involved in their processes, indicating the Anthropocene Era begins. Consequently, three parameters to measure the quality of the earth for living, i.e. climate changes, rate of biodiversity loss, and nitrogen cycles, have been over the maximum thresholds. In general, changes in marine ecology are caused by phenomena that are occuring in global scale (e.g. increasing of CO emission, global warming, and ocean acidification), regional scale (e.g. overfishing, and changes in oceagraphical processes, rain and storm), and local scale (e.g. eutrophication, sedimentation, pollution, biological invasions, herbivory, and diseases). Result of reviews shows that major causes of changes in marine ecology in Indonesia may be global warming, overfishing, and coastal pollution. As a result, species richness, abundance, distribution, and community structure of marine ecosystems in Indonesia change significantly.