bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer services in Sri Lanka: current status and future directions
Authors: Jayarajah Umesh , Abeygunasekera Anuruddha M. 
Published: June 2021

AbstractBackgroundThe burden of cancer in Sri Lanka is on the rise. The overall incidence of cancer in Sri Lanka has doubled over the past 25 years with a parallel rise in cancer-related mortality. Cancer has become the second commonest cause of hospital mortality in Sri Lanka. In this review, we aim to provide an overview of the current status and future direction of cancer care in Sri Lanka.Main bodyIn Sri Lanka, cancer services are predominantly provided by the state sector free of charge to the general public. With the establishment of national cancer policy on cancer prevention and control, there has been a commendable improvement in the cancer services provided island-wide. An increasing number of breast, oropharyngeal, thyroid, oesophageal, colorectal, lung, and gastric cancers are being diagnosed and treated annually. Primary prevention measures include restrictions in tobacco and HPV vaccination. Screening programs for selected cancers such as breast, oral and cervical cancers are delivered. Medical oncology units with facilities for systemic therapy and adequately supported by surgical, pathology, and radiology departments have been established in each district general hospital island-wide. Although the current progress is commendable, future changes are necessary to overcome the current limitations and to cater the ever increasing burden of cancer. Measures are necessary to enhance the coverage of Sri Lanka Cancer Registry. Timely high-quality research and audits are essential. Community participation in planning strategies for cancer prevention and treatment is minimal. Community-based palliative care facilities and radiation and other systemic therapy should be made available in all provinces. A culture of multi-disciplinary care with proper referral pathways would help to improve the current setting.ConclusionIn conclusion, Sri Lanka has a reasonably balanced and continuously expanding program for prevention, screening, and treatment of cancers. Emphasis on preventive strategies related to reducing tobacco smoking, chewing betel, and obesity, making cancers a notifiable disease, involving the community in planning cancer care and prevention strategies, conducting research to evaluate cost-effectiveness of existing treatment and increasing radiotherapy facilities would further improve the cancer services in Sri Lanka.
Teratoma in the hepatoduodenal ligament: a case report
Authors: Nandan Ruchira , Dhua Anjan , Tyagi Sidharth , Jain Vishesh , Agarwala Sandeep , Bhatnagar Veereshwar 
Published: June 2021

Abstract
Background
Teratoma of the hepatoduodenal ligament is a rare entity. Only 17 cases of hepatoduodenal ligament teratoma exist in the literature.

Case presentation
A girl with antenatally detected intraabdominal lesion was brought to us at the age of 3 years for the prime concern of progressive abdominal distension. Evaluation showed that the mass was a teratoma arising likely from the hepatoduodenal ligament. During the excision, there was an inadvertent pin-point perforation of the common bile duct. Primary repair of the common bile duct was performed. The child had an uneventful recovery.

Conclusions
The significance of anticipating complications and taking adequate measures while dissecting the porta has been emphasized in this kind of rare location of a teratoma.
Effect of an antiracism intervention on disparities in time to lung cancer surgery.
Authors: Stein Jacob Newton , Cykert Samuel , Yongue Christina , Eng Eugenia , Wood Isabella Kathryn , Charlot Marjory 
Published: June 2021

101 Background: Racial disparities are well described in the management of early-stage lung cancer, with Black patients less likely to receive potentially curative surgery than non-Hispanic Whites. A multi-site pragmatic trial entitled Accountability for Cancer Care through Undoing Racism and Equity (ACCURE), designed in collaboration with community partners, eliminated racial disparities in lung cancer surgery through a multi-component intervention. The study involved real-time electronic health record (EHR) monitoring to identify patients not receiving recommended care, a nurse navigator who reviewed and addressed EHR alerts daily, and race-specific feedback provided to clinical teams. Timeliness of cancer care is an important quality metric. Delays can lead to disease progression, upstaging, and worse survival, and Black patients are more likely to experience longer wait times to lung cancer surgery. Yet interventions to reduce racial disparities in timely delivery of lung cancer surgery have not been well studied. We evaluated the effect of ACCURE on timely receipt of lung cancer surgery. Methods: We analyzed data of a retrospective cohort at five cancer centers gathered prior to the ACCURE intervention and compared results with prospective data collected during the intervention. We calculated mean time from clinical suspicion of lung cancer to surgery and evaluated the proportion of patients who received surgery within 60 days stratified by race. We performed a t-test to compare mean days to surgery and chi2 for the delivery of surgery within 60 days. Results: 1320 patients underwent surgery in the retrospective arm, 160 were Black. 254 patients received surgery in the intervention arm, 85 were Black. Results are summarized in Table. Mean time to surgery in the retrospective cohort was 41.8 days, compared with 25.5 days in the intervention cohort (p<0.01). In the retrospective cohort, 68.8% of Black patients received surgery within 60 days versus 78.9% of White patients (p<0.01). In the intervention, the difference between Blacks and Whites with respect to surgery within 60 days was no longer significant (89.41% of Black patients vs 94.67% of White patients, p=0.12). Conclusions: Racial disparities exist in the delivery of timely lung cancer surgery. The ACCURE intervention improved time to surgery and timeliness of surgery for Black and White patients with early-stage lung cancer. A combination of real-time EHR monitoring, nurse navigation, and race-based feedback markedly reduced racial disparities in timely lung cancer care. [Table: see text]
Artificial intelligence (AI)–powered pathologic response (PathR) assessment of resection specimens after neoadjuvant atezolizumab in patients with non-small cell lung cancer: Results from the LCMC3 study.
Authors: Dacic Sanja , Travis William D. , Giltnane Jennifer Margaret , Abel John , Kos Filip , Hilz Stephanie , Hennek Stephanie , Fujimoto Junya , Sholl Lynette M. , Khalil Farah , Ritter Jon , D'Apuzzo Massimo , Lee Jay M. , Rusch Valerie W. , Carbone David Paul , Nicholas Alan , Johnson Ann , Schulze Katja , Kris Mark G. , Wistuba Ignacio Ivan 
Published: June 2021

106 Background: PathR is an efficacy endpoint in Phase II and III neoadjuvant trials and is proposed as a surrogate for disease-free survival (DFS) and overall survival. Machine learning (ML)–based, automated approaches standardize quantification of areas of tumor bed and residual viable tumor. Here we show that automation may provide a scalable alternative to or complementary tool for manual assessment. Methods: We determined inter-reader variability for PathR among pathologists in the LCMC3 (NCT02927301) study and developed an AI-powered digital PathR assessment tool in line with manual consensus recommendations. Study cases were reviewed for PathR by a local site pathologist and 3 central expert pathologists (n = 127). When determined manually, major PathR (MPR) was defined as ≤10% viable tumor averaged per case. ML models were trained and validated by the PathAI research platform using digitized H&E-stained tumor sections. The digital PathR model predicted percent viable tumor for each case as the sum of the cancer epithelium area from each slide divided by the sum of tumor bed area for each slide. DFS (clinical cutoff: Oct 23, 2020) was reported for patients with manual and digital PathR assessment (n = 135). For digital MPR, we used a prevalence-matched cutoff that maintained the same proportion of patients as manual MPR. Results: Inter-reader agreement among 1 local and 3 central pathologists for manual PathR was good (n = 127; ICC = 0.87; 95% CI: 0.84-0.90). Agreement was 91% (κ = 0.82) on manual MPR and 98% (κ = 0.88) on pathologic complete response (pCR). 6 patients had unanimous pCR. Digital and manual PathR were strongly correlated (n = 135, Pearson r = 0.78) and digital PathR demonstrated an outstanding predictability for manual MPR (AUROC = 0.975). The range was 0%-60% for digital PathR and 0%-100% for manual PathR with a regression line slope < 1.0 (m = 0.303) indicating systematic differences between the methods, consistent with digital PathR using a high-resolution segmentation of cancer epithelium from stroma across each slide. Longer DFS was observed for MPR yes vs no with both digital and manual assessment (Table). Conclusions: This analysis showed good inter-reader agreement for manual and strong correlation of AI-powered digital and manual PathR. Comparable DFS rates for manual MPR and digital MPR are encouraging in the preliminary data. These data support further studies of digital PathR as a standardized and scalable tool to determine PathR. Clinical trial information: NCT02927301. [Table: see text]
Utility of the 70-gene MammaPrint assay for prediction of benefit from extended letrozole therapy (ELT) in the NRG Oncology/NSABP B-42 trial.
Authors: Rastogi Priya , Bandos Hanna , Lucas Peter C. , van 't Veer Laura , Wei Jia-Perng Jennifer , Geyer Charles E. , Fehrenbacher Louis , Graham Mark , Chia Stephen K. L. , Brufsky Adam , Walshe Janice Maria , Soori Gamini S. , Dakhil Shaker R. , Paik Soonmyung , Swain Sandra M. , Menicucci Andrea , Wang Shiyu , Audeh M. William , Wolmark Norman , Mamounas Eleftherios P. 
Published: June 2021

502 Background: The 70-gene MammaPrint (MP) assay predicts risk of distant recurrence (DR) in hormone-receptor positive early-stage breast cancer and classifies cancers as Low Risk or High Risk. NSABP B-42 evaluated ELT in patients (pts) who had completed 5 yrs of adjuvant endocrine therapy (tx). The primary objective was to determine the utility of MP to identify pts enrolled in NSABP B-42 who are likely to benefit from ELT. Methods: A total of 1,866 pts from B-42 had available MP results. Primary endpoint is DR. Secondary endpoints are disease-free survival (DFS) and breast cancer-free interval (BCFI). For the primary analysis, pts were classified as High Risk (MP-H) (MP score ≤0.000) or Low Risk (MP-L) (MP score > 0.000). Exploratory analyses were performed for MP-L subcategories: MP Ultralow Risk (MP-UL) (MP score > 0.355) and MP-L but not MP-UL (MP-LNUL) (MP score > 0.000, ≤0.355). Likelihood ratio test based on stratified Cox proportional hazards (PH) model was used for treatment by risk group interaction. Stratified log-rank test was used to compare treatment groups. Hazard ratios and 95% CI were computed based on the stratified Cox PH model. Results: Among 1,866 pts, 706 (38%) were MP-H and 1,160 (62%) were MP-L. Of the MP-L, 252 (22%) were MP-UL. There were no significant differences in the distribution of patient and tumor characteristics between the MP group and the rest of the B-42 cohort, except for HER2 status. ELT effect was more pronounced in the MP cohort than in the overall B-42 population. For DR, there was statistically significant ELT benefit in MP-L (HR = 0.43, 95% CI 0.25-0.74, p = 0.002), but not MP-H (HR = 0.65, 0.34-1.24, p = 0.19) (interaction p = 0.38). For DFS, there was statistically significant ELT benefit in MP-L, but not MP-H (interaction p = 0.015). Similar findings were observed for BCFI (interaction p = 0.006). Within subcategories of MP-L, there was statistically significant ELT benefit in MP-LNUL, but not in MP-UL for all three endpoints, however the power in MP-UL was limited due to low number of pts (Table). Clinical trial information: 00382070. Conclusions: Statistically significant ELT benefit was observed for MP-L, but not MP-H. The treatment by risk group interaction was not statistically significant for DR, but it was for DFS and BCFI. The benefit appears to be stronger in MP-LNUL than in MP-UL. NCT: 00382070. Support: U10CA180868, -180822, U24CA196067; Novartis; Agendia.[Table: see text]
Comparison of the Spectral Features of the Frontal Electroencephalogram in Patients Receiving Xenon and Sevoflurane General Anesthesia
Authors: McGuigan Steven , Evered Lisbeth , Silbert Brendan , Scott David A. , Cormack John R. , Devapalasundaram Abarna , Liley David T. J. 
Published: June 2021

BACKGROUND:
Depth-of-anesthesia monitoring is often utilized for patients receiving xenon anesthesia. Processed electroencephalogram (EEG) depth-of-anesthesia monitoring relies to a significant extent on frequency domain analysis of the frontal EEG, and there is evidence that the spectral features observed under anesthesia vary significantly between anesthetic agents. The spectral features of the EEG during xenon anesthesia for a surgical procedure have not previously been described.

METHODS:
Twenty-four participants scheduled for general anesthesia for lithotripsy were randomized to receive either xenon anesthesia or sevoflurane anesthesia. Frontal EEG recordings were obtained from each participant via the Brain Anesthesia Response Monitor (BARM). Twenty-two EEG recordings were suitable for analysis: 11 in participants who received sevoflurane and 11 in participants who received xenon. Spectrograms for the duration of the anesthetic episode were produced for each participant. Group-level spectral analysis was calculated for two 30-second EEG epochs: one recorded at awake baseline and the other during maintenance anesthesia. A linear mixed-effects model was utilized to compare the changes in 5 frequency bands from baseline to maintenance between the 2 groups.

RESULTS:
The spectrograms of sevoflurane participants illustrate an increase in frontal delta (0.5–4 Hz), theta (4–8 Hz), and alpha (8–13 Hz) band power during maintenance anesthesia. In contrast, spectrograms of the xenon participants did not illustrate an increase in alpha power. The results of the linear mixed-effects model indicate that both agents were associated with a significant increase in delta power from baseline to maintenance. There was no significant difference in the magnitude of this increase observed between the agents. In contrast, sevoflurane anesthesia was associated with significantly greater absolute power in the theta, alpha, and beta (13–30 Hz) bands when compared to xenon. In terms of relative power, xenon was associated with a significant increase in delta power compared to sevoflurane, while sevoflurane was associated with greater increases in relative theta, alpha, and beta power.

CONCLUSIONS:
Both xenon anesthesia and sevoflurane anesthesia were associated with significant increases in delta power. Sevoflurane anesthesia was also associated with increases in theta, alpha, and beta power, while xenon anesthesia was associated with greater consolidation of power in the delta band. Xenon anesthesia and sevoflurane anesthesia are associated with distinct spectral features. These findings suggest that appropriate depth-of-anesthesia monitoring may require the development of agent-specific spectral measures of unconsciousness.
"Διδακτήρια άθλια, ρυπαρά και ετοιμόρροπα, δυσώδη και σκοτεινά...": Η υγιεινή κατάσταση των σχολικών κτηρίων στα τέλη του 19ου αιώνα μέσα από τα θεσμικά κείμενα της εποχής
Authors: Κανταράκη Σοφία 
Published: June 2021

Σκοπός της παρούσας μελέτης είναι η αποτύπωση της εικόνας των ελληνικών διδακτηρίων μέσα από θεσμικά κείμενα. Το τελευταίο τέταρτο του 19ου αι. παρατηρείται έντονα ένα επιστημονικό και νομοθετικό ενδιαφέρον για τη βελτίωση των συνθηκών της σχολικής φοίτησης στην ελληνική επικράτεια, γεγονός που πρόβαλε σταδιακά και την ανάγκη θεσμοθέτησης της σχολικής υγιεινής. Το πεδίο αυτό, έστω και καθυστερημένα για την ελληνική εκπαιδευτική πραγματικότητα, σηματοδοτεί τη μετάβαση σε ένα πλαίσιο αναγκαίων θεσμικών διενεργειών, συμπληρωματικών των νέων οικονομικών μετασχηματισμών και κοινωνικο-πολιτισμικών αλλαγών που «πυροδοτούνται» από τη δεκαετία του 1870 και μετά. Διαφαίνεται ότι η συμπόρευση της παιδαγωγικής και ιατρικής επιστήμης, αλλά και λόγοι κοινωνικής ισορροπίας, καθιστούν πλέον επιτακτική την ανάγκη εποπτείας της υγείας των μαθητών αλλά και του σχολικού περιβάλλοντος. Άμεσα συνυφασμένο αναδύεται το θέμα των διδακτηρίων και της ποιοτικής τους καταλληλότητας, ως κεντρικός άξονας γύρω από τον οποίο περιελίσσονται δυσλειτουργικά στοιχεία, αντιβαίνοντα τον σκοπό της εκπαίδευσης. Τα ευρήματα της έρευνας, μέσω της ποιοτικής ανίχνευσης θεσμικών τεκμηρίων, βεβαιώνουν και επιβεβαιώνουν τις ανησυχίες του εκπαιδευτικού κόσμου για την υποβαθμισμένη σχολική υγιεινή, τις ελλείψεις, και την εν γένει αθλιότητα των διδακτηρίων στα τέλη του 19ου αιώνα.
Interactive SARS-CoV-2 mutation timemaps
Authors: Warren René L. , Birol Inanc 
Published: June 2021

As the year 2020 came to a close, several new strains have been reported of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the agent responsible for the coronavirus disease 2019 (COVID-19) pandemic that has afflicted us all this past year. However, it is difficult to comprehend the scale, in sequence space, geographical location and time, at which SARS-CoV-2 mutates and evolves in its human hosts. To get an appreciation for the rapid evolution of the coronavirus, we built interactive scalable vector graphics maps that show daily nucleotide variations in genomes from the six most populated continents compared to that of the initial, ground-zero SARS-CoV-2 isolate sequenced at the beginning of the pandemic. Availability: The tool used to perform the reported mutation analysis results, ntEdit, is available from GitHub. Genome mutation reports are available for download from BCGSC. Mutation time maps are available from https://bcgsc.github.io/SARS2/.
Estimating the duration of seropositivity of human seasonal coronaviruses using seroprevalence studies
Authors: Rees Eleanor M. , Waterlow Naomi R. ,   Centre for the Mathematical Modelling of Infectious Diseases COVID-19 Working Group, Lowe Rachel , Kucharski Adam J. 
Published: June 2021

Background: The duration of immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still uncertain, but it is of key clinical and epidemiological importance. Seasonal human coronaviruses (HCoV) have been circulating for longer and, therefore, may offer insights into the long-term dynamics of reinfection for such viruses. Methods: Combining historical seroprevalence data from five studies covering the four circulating HCoVs with an age-structured reverse catalytic model, we estimated the likely duration of seropositivity following seroconversion. Results: We estimated that antibody persistence lasted between 0.9 (95% Credible interval: 0.6 - 1.6) and 3.8 (95% CrI: 2.0 - 7.4) years. Furthermore, we found the force of infection in older children and adults (those over 8.5 [95% CrI: 7.5 - 9.9] years) to be higher compared with young children in the majority of studies. Conclusions: These estimates of endemic HCoV dynamics could provide an indication of the future long-term infection and reinfection patterns of SARS-CoV-2.
Socioeconomic position and mental health during the COVID-19 pandemic: a cross-sectional analysis of the CovidLife study
Authors: Pierre Miranda , Keller Markéta , Altschul Drew , Fawns-Ritchie Chloe , Hartley Louise , Nangle Clifford , Edwards Rachel , Dawson Rebecca , Campbell Archie , Flaig Robin , Porteous David J. 
Published: June 2021

Background: The coronavirus disease 2019 (COVID-19) pandemic has been linked to an increase in mental health problems. This study examined their association with socioeconomic position (SEP), as well as potential confounding and mediating factors. Methods: We analysed data from the CovidLife study (N=14,387; 66.4% female; mean [SD] age, 57.4 [13.9] years). Data were collected in an online survey of UK adults (aged 18 years or over) between 17 April and 7 June 2020. SEP measures included area deprivation (the Scottish Index of Multiple Deprivation [SIMD]), education level, household income, and employment status. Mental health was measured using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7) scale. Worry indices were derived using principal component analysis. Logistic regression was used to estimate the associations between SEP and mental health. Results: Low SEP was associated with increased odds of depression and anxiety (odds ratio [OR] range 1.18-2.69). These associations remained significant after adjusting for age, sex, relationship status, and psychiatric history. Multivariable adjustment for medical worry and isolation during the pandemic had the largest attenuating effects (ranges 18-60% and 4-46%, respectively) on mental health outcomes. When adding further adjustment for the remaining SEP markers and all potential confounding and mediating factors, depression was associated with high area deprivation and low education level and income, whilst anxiety was only associated with low education level. No dose-response relationship was observed. Conclusions: SEP was inversely associated with mental health, which was mostly explained by medical worry and isolation during the COVID-19 pandemic. Mental health interventions might target these factors to prevent widening inequalities in mental health. Future studies should use longitudinal data to investigate the association.