bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation between adiponectin level and the degree of fibrosis in patients with non-alcoholic fatty liver disease
Authors: Mohamed Manal Sabry , Youssef Tarek Mohammed , Abdullah Esraa Ebrahim , Ahmed Ahmed Elmetwally 
Published: September 2021

Abstract
Background
Non-alcoholic fatty liver disease (NAFLD) is one of the most prevalent chronic liver diseases, particularly in Egypt. It is defined as the accumulation of lipids inside the hepatocytes, in the absence of other etiologies of hepatic damage. It is frequently associated with obesity, diabetes mellitus, and metabolic syndrome. Adiponectin is an abundant adipocyte-derived protein with well-established anti-atherogenic, insulin-sensitizing, and anti-inflammatory properties. The liver is a major target organ for adiponectin especially in fatty liver diseases, and this adipocytokine has the ability to control many liver functions including metabolism, inflammation, and fibrosis. In this study, we aimed to find out the correlation between the degree of liver fibrosis in NAFLD patients and their serum adiponectin level as a future non-invasive method for the assessment of liver fibrosis to substitute liver biopsy to avoid its hazardous complication and also to study the correlation between diabetes mellitus as well as obesity and serum adiponectin level.

Results
Fifty patients were selected to participate in our study based on our inclusion criteria. They were recruited from the Internal Medicine Department, Gastroenterology Clinic in Al-Demerdash Hospital using a convenient sampling method. Diagnosis of NAFLD was confirmed by laboratory markers: aspartate aminotransferase (AST), alanine aminotransferase (ALT), lipid profile, ultrasound, and FibroScan examination. Analyzing the adiponectin levels showed that besides its significant correlation with body mass index (BMI), hypertension, diabetes mellitus, and dyslipidemia, it was significantly lower in the high-grade fibrosis group compared to the low-grade fibrosis group with a P-value of (0.000) and a cutoff value for stage 3/4 fibrosis of about 2.31 μg/ml which marked a promising hope of adiponectin being of protective value against liver fibrosis.

Conclusion
Both serum levels and hepatic adiponectin receptor expression are decreased in NAFLD. Therefore, either adiponectin itself or adiponectin-inducing agents might be of key therapeutic interest in the near future in the treatment of NAFLD.
Interdisciplinary design education: development of an elective course in architecture and engineering departments
Authors: Badawi A. M. , Abdullah M. R. 
Published: September 2021

AbstractCollaboration among disciplines is becoming a standard practice in Architecture, Engineering, and Construction (AEC) industry. However, limited studies have addressed the involvement of interdisciplinarity into architectural undergraduate curricula. The study seeks to expand the literature on this topic, namely by offering an alternative model for teaching an Interdisciplinary Design Course (IDC), mainly in architectural engineering departments, with the participation of engineering departments. The authors hypothesize that by the adoption of the IDC, architecture students would have a better understanding of the nature of AEC interdisciplinary design knowledge. The study aims to highlight the value of the IDC and to test the hypothesis. A qualitative research methodology has been adopted, including the design of an experiment and then the application of a case study comprising four instructors and 24 students from four departments in the Faculty of Engineering, Cairo University. Students’ design process, teamwork attitude, and own experiences on the IDC have been recorded using direct observation, interviews, and surveys. Data have been analyzed using descriptive statistics to identify the effectiveness and challenges of the experiment, in addition to the comparison with the traditional design studio. The results have shown the students’ satisfaction with collaboration with their peers from other disciplines, as it boosted their understanding of the integrated design process and increased their knowledge about each other’s discipline. In addition, architecture students commended the IDC much more than the traditional design studio.
Using objective clinical metrics to understand the relationship between the electronic health record and physician well-being: observational pilot study
Authors: Mosquera Matthew J. , Ward Heather Burrell , Holland Christopher , Boland Robert , Torous John 
Published: September 2021

Background
Electronic health records (EHRs) are a significant contributor to physicians’ low satisfaction, reduced engagement and increased burnout. Yet the majority of evidence around EHR and physician harms is based on self-reported screen time, which may both over- and underreport actual exposure.

Aims
The purpose of this study was to examine how objective EHR use correlates with physician well-being and to develop preliminary recommendations for well-being-based EHR interventions.

Method
Prior to the onset of COVID-19, psychiatry residents and attending physicians working in an out-patient clinic at an academic medical centre provided consent for access to EHR-usage logs and completed a well-being assessment made up of three scales: the Maslach Burnout Inventory, the Urecht Work Engagement Scale and the Professional Quality of Life Measure. Survey responses and objective EHR data were analysed with descriptive statistics.

Results
Responses were obtained from 20 psychiatry residents (total eligible residents n = 27; 74% participation) and 16 clinical faculty members (total eligible faculty n = 24; 67% participation) with an overall response rate of 71% (total eligible residents and faculty n = 51 and total residents and faculty who completed survey n = 36). Moderate correlations for multiple well-being domains emerged in analysis for all participants, especially around the time spent per note and patient visits closed the same day.

Conclusions
EHR-usage logs represent an objective tool in the evaluation and enhancement of physician well-being. Results from our pilot study suggest that metrics for note writing efficiency and closing patient visits the same day are associated with physician well-being. These metrics will be important to study in ongoing efforts involving well-being-based EHR interventions.
Comparing U.S. Preventive Services Task Force 2013 versus 2021 lung cancer screening eligibility.
Authors: Smeltzer Matthew , Liao Wei , Taylor Meghan Brooke , Fehnel Carrie , Faris Nicholas , Lane Jordan Goss , Williams Sara Cat , Akinbobola Olawale , Pacheco Alicia , Epperson Amanda , Luttrell Joy , McCoy Denise , Smith Elizabeth , Adams Kim , Ray Meredith , Robbins Todd , Wright Jeffrey , Osarogiagbon Raymond U. 
Published: September 2021

13 Background: Early detection of lung cancer provides the best opportunity for long-term survival. In 2021 US Preventive Services Task Force (USPSTF) expanded the 2013 risk-based Low-dose CT (LDCT) screening criteria, in part to reduce unintended race and gender disparities in lung cancer detection. We evaluated the impact of the updated USPSTF criteria in a cohort of patients from an incidental lung nodule program (ILNP). Methods: We implemented an ILNP in a community healthcare system in the mid-south US. Patients with lung lesions on routinely-performed radiologic studies were triaged using evidence-based guidelines. We prospectively tracked patient demographics, clinical characteristics, procedures, complications, and health outcomes. We classified all patients in the ILNP cohort based on USPSTF 2013 and 2021 screening criteria. Statistical analysis used the chi-square test. Results: The ILNP cohort included 14,642 patients from 2015-2021. This cohort was 56% female, 65% White, 29% Black, with a median age of 64 years. Overall 1,581 (10.8%) met 2013 and 2,051 (14.0%) met 2021 USPSTF criteria. 1.9% of subjects eligible by 2013 criteria were diagnosed with lung cancer compared to 2.2% by 2021 criteria. 470 additional patients met screening criteria when we expanded from USPSTF 2013 to 2021. As expected, these patients were younger and less likely to have Medicare insurance. These additional eligible patients were significantly more likely to be female (58% v 49%, p = 0.0011) or Black (28% vs. 18%, p < 0.0001) compared to those eligible by 2013 criteria. 44 of the 470 (9%) were diagnosed with cancer: 36% adenocarcinoma, 18% squamous, and 11% small cell, 11% non-lung primary, 9% non-small cell lung cancer NOS, and 15% other or unknown histology. The median tumor size was 3 cm with an interquartile range from 1.7 to 4.2 cm. The clinical stage distribution was 34% I, 4.5% II, 15.9% III, and 31.8% IV. Conclusions: In this selective community-based cohort, USPSTF 2021 criteria identified a higher percentage of subjects with lung cancer and were more inclusive of women and minorities compared to USPSTF 2013 criteria.
Biomarker testing patterns and identification of barriers to testing for homologous recombination deficiencies across four advanced-stage solid tumors in a multicommunity practice setting.
Authors: Goldfarb Scott D. , McLaurin Kimmie K. , McAneny Barbara L. , Shetty Veena , Engstrom-Melnyk Julia , Black Christopher M. 
Published: September 2021

16 Background: Opportunities have increased for diagnostic test results to affect treatment choice in tumor types with homologous recombination deficiencies. According to NCCN Guidelines, biomarker testing has the potential to identify patients eligible for targeted treatment such as PARP inhibitors. Methods: We conducted a noninterventional, mixed-methods cohort study to evaluate biomarker testing concordant with NCCN guidelines in 2018-19. Starting with an abstraction of structured and unstructured data from electronic health records, a cohort of 300 patients newly diagnosed with advanced ovarian cancer (aOC), HER2-negative metastatic breast cancer (MBC), metastatic pancreatic cancer (mPaC), and metastatic prostate cancer (mPC) was selected in reverse chronological order of diagnosis date, proportionately distributed from the NCCA (National Cancer Care Alliance, LLC) network. Outcomes included: proportion of patients who completed biomarker testing (defined as at least BRCA1/2 testing), time from diagnosis to test order, and time from test order to results. For patients that did not receive a biomarker test, the treating physicians were sent questionnaires to capture reasons for not ordering or for non-completion of biomarker testing. Results: Patients were identified at 10 practices from 8 states (CA, ME, NM, NY, OH, TX, UT, VT) in 2018 (N=86) and 2019 (N=214). The most commonly used tests were germline only (47%-66%), followed by tissue for multiple genes (18%-40%). Ovarian cancer had the highest completion of biomarker testing (Table). For HER2-negative MBC, the completion rate of BRCA testing was 85% for triple-negative disease and 55% for hormone receptor-positive disease. All questionnaires were completed (N=85); the most common reasons identified as barriers to testing were no perceived need or clinical benefit (42%), biomarker tests considered for a later date depending on patient’s response to treatment (14%), lack of a standard practice or guidance for biomarker testing at the practice (14%), and reimbursement for genetic counseling (12%). Conclusions: Biomarker workup was completed for the majority of patients. Given the first FDA approval of a PARP inhibitor was for aOC in 2014, biomarker testing rates and timing may naturally improve for more recent approvals such as mPC (2020). Evaluation of long-term trends for adherence to NCCN biomarker testing recommendations on the impact to patient outcomes is warranted. [Table: see text]
Leveraging social determinants of health to reduce hospital length of stay: A pilot quality improvement project to address inpatient cancer patients' barriers during the COVID 19 pandemic.
Authors: Kamaraju Sailaja , Atkinson Dave , Wetzel Thomas , Wright Tamiah , Charlson John A. , Cadman Jennifer , Campbell Grace , Power Steve 
Published: September 2021

233 Background: Prior reports from our institution demonstrated high rates of racial segregation, unfavorable social determinants of health (SDoH) in Milwaukee, WI, and statewide reports of inferior outcomes for cancer patients from minority communities. At the Medical College of Wisconsin's Cancer Center (Milwaukee, WI), during the first through last quarters of 2018-2019, cancer patients from the low socioeconomic status (SES) communities who were hospitalized to inpatient oncology units had an average length of stay (LOS) of 7.2 days compared to 5.6 days for high SES group. Under the auspices of the American Society of Clinical Oncology's Quality Training Program (QTP) initiative, we aimed to reduce the hospital LOS by 10% or less by May 2021 for inpatient oncology teams. Methods: A multidisciplinary team collaboration between the inpatient and outpatient providers was developed during this QI initiative. We examined LOS index data, payer types, and other diagnostic criteria for the oncology inpatient solid tumor service and two comparator services (bone marrow transplant, BMT; internal medicine). We generated workflow, a cause-and-effect diagram, and a Pareto diagram to determine the relevant factors associated with longer hospital LOS. Institution-wide implementation of the SDH screen project was launched to evaluate and address specific barriers to SDoH to expedite a safe discharge process during the pandemic. Results: Through one test of change (Plan-Do-Study-Act cycles 1, 2 &3), we identified the problem of extended LOS and patient-related barriers to discharge during this QI initiative. Compared to the baseline LOS, after the launch of the SDoH screen project, there was a 6.5% decrease in the inpatient average LOS for oncology patients (7.89 to 7.40days, p = 0.004),10.7% for BMT (15.96 days to14.26, p = 0.166), and 2.4% for Internal Medicine (4.61 to 4.50 to days, p = 0.131). There was a 10.0% decrease in LOS (8.07 to 7.26 days, p = < 0.001) for the three specialties combined. With collaboration from inpatient and outpatient providers, appropriate referrals were generated to address patient-specific SDH before discharge (i.e., transportation coordination, nutritional and physical therapy referrals, social worker assistance with food, and housing insecurities). Conclusions: In this pilot project, implementing SDoH screening-based-care delivery at the time of inpatient admission demonstrated a slight improvement in LOS for solid tumor oncology patients and provided timely referrals, opportunities to engage and explore the discharge facilities early on during the COVID 19 pandemic. With this preliminary data, we plan to continue to expand our efforts through a systemwide implementation of this SDoH survey both in the inpatient and outpatient settings to address cancer inequities.
Adoption of immune checkpoint inhibitors (ICI) for unresectable locally advanced or metastatic urothelial carcinoma (u/mUC): A retrospective assessment of community oncology practices.
Authors: Aguilar Kathleen M. , Grivas Petros , Seal Brian S. , Robert Nicholas J. , Davies Kalatu , Fleming Mark T. 
Published: September 2021

293 Background: ICI approval provided new treatment options for patients (pts) with u/mUC. We aimed to assess the adoption of ICI and describe 1L treatment patterns in the US community oncology setting. We hypothesized that most pts would receive ICI either as first- (1L) or second- line (2L) treatment given their FDA approval indications within the study period. Methods: This was a retrospective study of all study-eligible adult pts with u/mUC who initiated 1L treatment between 5/1/16 – 11/30/18 within The US Oncology Network. Data were sourced from structured and unstructured electronic health record data through 5/31/19 and assessed descriptively. Results: Among 750 eligible pts, 327 received 1L ICI (median age 74, 72.5% men, 77.1% white, 27.2% never smokers, 63.6% Eastern Cooperative Oncology Group performance status (ECOG PS] score of 0/1) and 423 1L non-ICI agents (median age 72, 74.0% men, 84.2% white, 26.0% never smokers, 60.5% ECOG PS score of 0/1). The most common treatment sequences were 1L ICI or 1L non-ICI without 2L treatment (n = 301 [40.1%] and n = 197 [26.3%], respectively), followed by 1L non-ICI and 2L ICI (n = 176, 23.5%). Platinum-based chemotherapy was the most common non-ICI therapy. Among a subset of patients randomly selected for chart review who received 1L ICI (n = 70), the most common reasons for 1L discontinuation were death (22.9%), transition to hospice (21.4%) and disease progression (11.4%). In contrast, the most common reason for 1L discontinuation among patients who received 1L non-ICI therapy selected for chart review (n = 133) were toxicity (27.8%), disease progression (22.6%) and completion of planned treatment (19.5%). Conclusions: As a retrospective observational study, limitations include lack of randomization, missing data, selection bias and unmeasured confounders. The high proportion of pts who received ICI during this period suggests enthusiasm for new therapies with less toxicity than chemotherapy. Nonetheless, the high attrition across treatment lines indicates an unmet need for tolerable and effective 1L u/mUC therapies, including switch maintenance ICI, which recently emerged as the new standard of care with level I evidence. Further investigation is needed to understand factors considered by pts and providers when determining treatment, as well as prognostic and predictive biomarkers.
Experienced quality of care and emotional functioning of patients with advanced cancer and their relatives: Results of a multicenter observational cohort study (eQuiPe).
Authors: van Roij Janneke , Raijmakers Natasja , Ham Laurien , van den Beuken-van Everdingen Marieke , van den Borne Ben , Creemers Geert-Jan , Hunting Jarno Cornelis , Kuip Evelien , van Leeuwen Lobke , Van Laarhoven Hanneke W.M. , Mandigers Caroline M. , Nieboer Peter , van der Velden Lilly-Ann , Van Zuijlen Cornelia , Gelissen John , Zijlstra Myrte , Brom Linda , Fransen Heidi , van de Poll-Franse Lonneke V ,   eQuipe Study Group
Published: September 2021

3 Background: Previous studies on experienced quality of care and quality of life have not addressed the reciprocal relation between patients and their relatives. For the first time we were able to include almost 700 couples (patient – relative) in a palliative oncological care context. This study aims to assess the experienced quality of care and emotional functioning (EF) of patients with advanced cancer and their relatives, including their reciprocal relation by using a dyadic approach. Methods: A prospective multicentre observational study among patients with advanced cancer and their relatives, recruited from 40 hospitals in the Netherlands or self-enrolled between November 2017 and January 2020 (eQuiPe study). Patients with metastatic cancer and their relatives were eligible to participate. Respondents completed a questionnaire and clinical data of the patient were obtained by linking the information to the Netherlands Cancer Registry (NCR). Logistic regression analyses were performed on baseline data of 1,103 patients and 831 relatives to assess the association between experienced quality of care and EF of patients and relatives separately and across dyads. Results: In total, 1,103 (65%) patients and 831 (71%) relatives completed the baseline questionnaire, including 699 unique patient-relative couples. Patients experienced lower levels of quality of life, including EF, and more symptoms compared to the normative population ( p<.001). Relatives reported even clinically relevantly lower EF compared to patients (69 vs. 78, p<.001) and were less satisfied with care (59 vs. 74; p<.001). Being more satisfied with care in general ( p<.05) and clarity about who their central health care professional ( p<.05) were positively associated with high EF in patients. For relatives, perceived continuity of care ( p<.01) and continuity of information for the patient ( p<.05) were positively associated with high EF. Dyadic analyses showed that EF of patients ( p<.001) and relatives ( p<.001) was positively associated with EF of the other person and perceived continuity of care by relatives was positively associated with high EF in patients ( p<.01). Conclusions: Experienced integral organisation and satisfaction with care in patients and relatives are related to their EF. The additional reciprocal relation between patients’ and their relatives’ EF and the experienced continuity of care suggests the opportunity for a family‐centered approach to optimize advanced cancer care.
Descriptive analysis of MRI functional changes occurring during reduced dose radiotherapy for myxoid liposarcomas
Authors: Kousi Evanthia , Messiou Christina , Miah Aisha , Orton Matthew , Haas Rick , Thway Khin , Hopkinson Georgina , Zaidi Shane , Smith Myles , Barquin Elizabeth , Moskovic Eleanor , Fotiadis Nicos , Strauss Dirk , Hayes Andrew , Schmidt Maria A 
Published: September 2021

Objectives:
Myxoid liposarcomas (MLS) show enhanced response to radiotherapy due to their distinctive vascular pattern and therefore could be effectively treated with lower radiation doses. This is a descriptive study to explore the use of functional MRI to identify response in a uniform cohort of MLS patients treated with reduced dose radiotherapy

Methods:
10 patients with MLS were imaged pre-, during, and post-radiotherapy receiving reduced dose radiotherapy and the response to treatment was histopathologically assessed post-radiotherapy. Apparent diffusion coefficient (ADC), T2* relaxation time, volume transfer constant (Ktrans), initial area under the gadolinium curve over 60 s (IAUGC60) and (Gd) were estimated for a central tumour volume.

Results:
All parameters showed large inter- and intrasubject variabilities. Pre-treatment (Gd), IAUGC60 and Ktrans were significantly different between responders and non-responders. Post-radiotherapy reductions from baseline were demonstrated for T2*, (Gd), IAUGC60 and Ktrans for responders. No statistically significant ADC differences were demonstrated between the two response groups. Significantly greater early tumour volume reductions were observed for responders.

Conclusions:
MLS are heterogenous lesions, characterised by a slow gradual contrast-agent uptake. Pre-treatment vascular parameters, early changes to tumour volume, vascular parameters and T2* have potential in identifying response to treatment. The delayed (Gd) is a suitable descriptive parameter, relying simply on T1 measurements. Volume changes precede changes in MLS functionality and could be used to identify early response.

Advances in knowledge:
MLS are are characterised by slow gradual contrast-agent uptake. Measurement of the delayed contrast-agent uptake (Gd) is simple to implement and able to discriminate response.