bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract PO-095: The PROState AI Cancer–Decision Support (PROSAIC-DS) pilot study: Clinical decision support technology and its role in prostate cancer MDT meetings
Authors: Santis Vishal , Enting Deborah , Patkar Vivek , Chalkidou Anastasia , Fox John , Ruta Danny , Makanjuola Jonathan K. 
Published: March 2021

Abstract
Background Multidisciplinary teams (MDT/tumour boards) were first introduced in the 1990s and have experienced little change to their methodology since. Universally used for the treatment of prostate cancer (CaP) in the UK new interventions are proposed to improve MDT efficiency and patient outcomes. Clinical practice guidelines (CPGs), designed to increase the uptake of evidence-based practice, suffer from lack of proper implementation. There is increasing evidence to suggest a gap between CPGs and actual treatment and the use of artificial intelligence an (AI) systems can help to increase the efficiency of the MDT. Methods We evaluated differences in MDT concordance with guidelines in the primary treatment of localised or locally advanced prostate cancer using the Deontics AI based custom clinical decision support software (CDSS) software. 59 paper cases were created by an expert clinician, 9 of which were excluded as they did not meet eligibility criteria. The remaining 50 cases were provided to the CDSS for evaluation. Simultaneously, two physicians assessed each patient case and provided their treatment recommendations. The results were assessed for concordance with UK, European and American guidelines, inter-rater reliability and trends in concordance based on patient variables.Results Overall clinician concordance with guidelines was 76%, while total concordance with all three guidelines was 28%. Overall concordance was highest with NICE guidelines, while total concordance was highest for NCCN guidelines. Inter-rater reliability was highest for the NCCN guidelines. Age &lt; 75 (p &lt;0.001; odds ratio [OR], 35.000), prostate volume &lt; 46.5ml (p =0.047; OR, 4.909), and a Gleason score ≠ 8 (p =0.013; OR, 12.333), were all significantly associated with increased guideline concordance in this study. Conclusions Concordance with CPGs needs to be improved in specific patient groups. This may reflect cognitive bias, cognitive overload, or conflicting guideline recommendations and evidence base. One potential solution may be the integration of CDSS technology into the MDT setting.
Citation Format: Vishal Santis, Deborah Enting, Vivek Patkar, Anastasia Chalkidou, John Fox, Danny Ruta, Jonathan K. Makanjuola. The PROState AI Cancer–Decision Support (PROSAIC-DS) pilot study: Clinical decision support technology and its role in prostate cancer MDT meetings [abstract]. In: Proceedings of the AACR Virtual Special Conference on Artificial Intelligence, Diagnosis, and Imaging; 2021 Jan 13-14. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(5_Suppl):Abstract nr PO-095.
Abstract PR-02: Machine learning models to quantify lineage plasticity and neuroendocrine differentiation in high-grade prostate cancer
Authors: Knudsen Beatrice , Garraway Isla , Gertych Arkadiusz , Lewis Michael , Ferrero Alessandro , Whitaker Ross 
Published: March 2021

Abstract
Neuroendocrine differentiation (NED) is a type of lineage plasticity that occurs in multiple cancer types either de-novo, or as a result of treatment-induced selection pressure. NED is identified by different, partially overlapping clinical, morphological and genomic features which include small cell neuroendocrine histomorphology, gene expression signatures of Rb1 loss and lethal tumor behavior. Through the eyes of pathologists, the most extreme form of NED is small cell, neuroendocrine carcinoma (SmCC), a rare cancer type that can arise in many organs. Adenocarcinomas, the most common cancer type in the adult population can harbor clinical and genomic characteristics of SmCC without recognizable morphologic features. Therefore, we determined whether machine learning algorithms can be trained to identify salient morphologic features of NED in adenocarcinoma. Using a cohort of prostate needle biopsies, we trained complementary algorithms to generate NED scores from high-grade prostate cancer regions and tested NED scores for correlation with gene expression and pathway activation from RNA sequencing of the exact same tumor regions. Using this approach as a validation strategy, we observed correlations between NED scores and pathway activation known to be increased in SmCC. In addition, we discovered novel morphologic features through functional interpretations of pathways correlated with NED scores. Finally, we used multi-variate regression analysis to demonstrate that computer generated NED scores predict the risk of lethal prostate cancer in diagnostic prostate needle biopsies. Altogether, we demonstrate the feasibility to quantify NED - lineage plasticity in regular diagnostic H&E stained pathology slides, which can be developed into an impactful, point-of-care clinical assay for the management and treatment of prostate cancer patients.
Citation Format: Beatrice Knudsen, Isla Garraway, Arkadiusz Gertych, Michael Lewis, Alessandro Ferrero, Ross Whitaker. Machine learning models to quantify lineage plasticity and neuroendocrine differentiation in high-grade prostate cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference on Artificial Intelligence, Diagnosis, and Imaging; 2021 Jan 13-14. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(5_Suppl):Abstract nr PR-02.
Fruit and Vegetable Intake and Mortality
Authors: Wang Dong D. , Li Yanping , Bhupathiraju Shilpa N. , Rosner Bernard A. , Sun Qi , Giovannucci Edward L. , Rimm Eric B. , Manson JoAnn E. , Willett Walter C. , Stampfer Meir J. , Hu Frank B. 
Published: March 2021

Background:
The optimal intake levels of fruit and vegetables for maintaining long-term health are uncertain.

Methods:
We followed 66 719 women from the Nurses’ Health Study (1984–2014) and 42 016 men from the Health Professionals Follow-up Study (1986–2014) who were free from cardiovascular disease (CVD), cancer, and diabetes at baseline. Diet was assessed using a validated semiquantitative food frequency questionnaire at baseline and updated every 2 to 4 years. We also conducted a dose-response meta-analysis, including results from our 2 cohorts and 24 other prospective cohort studies.

Results:

We documented 33 898 deaths during the follow-up. After adjustment for known and suspected confounding variables and risk factors, we observed nonlinear inverse associations of fruit and vegetable intake with total mortality and cause-specific mortality attributable to cancer, CVD, and respiratory disease (all
P
nonlinear
<0.001). Intake of ≈5 servings per day of fruit and vegetables, or 2 servings of fruit and 3 servings of vegetables, was associated with the lowest mortality, and above that level, higher intake was not associated with additional risk reduction. In comparison with the reference level (2 servings/d), daily intake of 5 servings of fruit and vegetables was associated with hazard ratios (95% CI) of 0.87 (0.85–0.90) for total mortality, 0.88 (0.83–0.94) for CVD mortality, 0.90 (0.86–0.95) for cancer mortality, and 0.65 (0.59–0.72) for respiratory disease mortality. The dose-response meta-analysis that included 145 015 deaths accrued in 1 892 885 participants yielded similar results (summary risk ratio of mortality for 5 servings/d=0.87 [95% CI, 0.85–0.88];
P
nonlinear
<0.001). Higher intakes of most subgroups of fruits and vegetables were associated with lower mortality, with the exception of starchy vegetables such as peas and corn. Intakes of fruit juices and potatoes were not associated with total and cause-specific mortality.

Conclusions:
Higher intakes of fruit and vegetables were associated with lower mortality; the risk reduction plateaued at ≈5 servings of fruit and vegetables per day. These findings support current dietary recommendations to increase intake of fruits and vegetables, but not fruit juices and potatoes.
AMOC and Climate Responses to Dust Reduction and Greening of the Sahara during the Mid-Holocene
Authors: Zhang Ming , Liu Yonggang , Zhang Jian , Wen Qin 
Published: March 2021

AbstractNorth Africa was green during the mid-Holocene [about 6000 years ago (6 ka)] and emitted much less dust to the atmosphere than in the present day. Here we use a fully coupled atmosphere–ocean general circulation model, CESM1.2.2, to test the impact of dust reduction and greening of the Sahara on the Atlantic meridional overturning circulation (AMOC) during this period. Results show that dust removal leads to a decrease of AMOC by 6.2% while greening of the Sahara with 100% shrub (100% grass) cover causes an enhancement of the AMOC by 6.1% (4.8%). The AMOC is increased by 5.3% (2.3%) when both the dust reduction and green Sahara with 100% shrub (100% grass) are considered. The AMOC changes are primarily due to the precipitation change over the west subtropical North Atlantic, from where the salinity anomaly is advected to the deep-water formation region. Global-mean surface temperature increases by 0.09° and 0.40°C (0.25°C) when global dust is removed and when North Africa and the Arabian region are covered by shrub (grass), respectively, showing a dominating effect of vegetation over dust. The comparison between modeled and reconstructed sea surface temperature is improved when the effect of vegetation is considered. The results may have implications for climate impact of future wetting over North Africa, either through global warming or through building of solar farms and wind farms.
Inverted circadian variation of arterial pressure in a geriatric patient: an indicator of autonomic dysfunction
Authors: Lieten Siddhartha , Debain Aziz , Bravenboer Bert , Mets Tony 
Published: March 2021

Abstract
Background
Orthostatic hypotension (OH) in geriatric patients frequently involves a component of autonomic failure (AF). The combination of OH with nocturnal hypertension (NHT) is indicative of AF, which is described as pure (PAF), when neurologic symptoms are absent, or as multisystem atrophy (MSA), when combined with motor disturbance (Parkinsonism or Parkinson disease).

Case presentation
An 87-year-old man presented with long-lasting OH. He frequently fell, causing several fractures, and he developed heart failure. Blood pressure (BP) registration revealed a reversal of the day-night rhythm with NHT. An 18-FDG PET brain CT scan showed cerebellar hypometabolism, indicating MSA.

Conclusions
This case demonstrates the use of continuous BP registration in geriatric patients with OH for diagnosing NHT. It illustrates the usefulness of 18-FDG PET brain CT scan to specify the nature of the AF. The case also illustrates the difficulty of managing the combination of OH and NHT.
Effect of empagliflozin on ectopic fat stores and myocardial energetics in type 2 diabetes: the EMPACEF study
Authors: Gaborit B. , Ancel P. , Abdullah A. E. , Maurice F. , Abdesselam I. , Calen A. , Soghomonian A. , Houssays M. , Varlet I. , Eisinger M. , Lasbleiz A. , Peiretti F. , Bornet C. E. , Lefur Y. , Pini L. , Rapacchi S. , Bernard M. , Resseguier N. , Darmon P. , Kober F. , Dutour A. 
Published: March 2021

Abstract
Background
Empagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that has demonstrated cardiovascular and renal protection in patients with type 2 diabetes (T2D). We hypothesized that empaglifozin (EMPA) could modulate ectopic fat stores and myocardial energetics in high-fat-high-sucrose (HFHS) diet mice and in type 2 diabetics (T2D).

Methods
C57BL/6 HFHS mice (n = 24) and T2D subjects (n = 56) were randomly assigned to 12 weeks of treatment with EMPA (30 mg/kg in mice, 10 mg/day in humans) or with placebo. A 4.7 T or 3 T MRI with 1H-MRS evaluation–myocardial fat (primary endpoint) and liver fat content (LFC)–were performed at baseline and at 12 weeks. In humans, standard cardiac MRI was coupled with myocardial energetics (PCr/ATP) measured with 31P-MRS. Subcutaneous (SAT) abdominal, visceral (VAT), epicardial and pancreatic fat were also evaluated.
The primary efficacy endpoint was the change in epicardial fat volume between EMPA and placebo from baseline to 12 weeks. Secondary endpoints were the differences in PCr/ATP ratio, myocardial, liver and pancreatic fat content, SAT and VAT between groups at 12 weeks.

Results
In mice fed HFHS, EMPA significantly improved glucose tolerance and increased blood ketone bodies (KB) and β-hydroxybutyrate levels (p < 0.05) compared to placebo. Mice fed HFHS had increased myocardial and liver fat content compared to standard diet mice. EMPA significantly attenuated liver fat content by 55%, (p < 0.001) but had no effect on myocardial fat.
In the human study, all the 56 patients had normal LV function with mean LVEF = 63.4 ± 7.9%. Compared to placebo, T2D patients treated with EMPA significantly lost weight (− 2.6 kg [− 1.2; − 3.7]) and improved their HbA1c by 0.88 ± 0.74%. Hematocrit and EPO levels were significantly increased in the EMPA group compared to placebo (p < 0.0001, p = 0.041). EMPA significantly increased glycosuria and plasma KB levels compared to placebo (p < 0.0001, p = 0.012, respectively), and significantly reduced liver fat content (− 27 ± 23 vs. − 2 ± 24%, p = 0.0005) and visceral fat (− 7.8% [− 15.3; − 5.6] vs. − 0.1% [− 1.1;6.5], p = 0.043), but had no effect on myocardial or epicardial fat. At 12 weeks, no significant change was observed in the myocardial PCr/ATP (p = 0.57 between groups).

Conclusions
EMPA effectively reduced liver fat in mice and humans without changing epicardial, myocardial fat or myocardial energetics, rebutting the thrifty substrate hypothesis for cardiovascular protection of SGLT2 inhibitors.
Trial registration NCT, NCT03118336. Registered 18 April 2017, https://clinicaltrials.gov/ct2/show/NCT03118336
High expression of CDCA7 predicts poor prognosis for clear cell renal cell carcinoma and explores its associations with immunity
Authors: Liu Shouyong , Wang Yi , Miao Chenkui , Xing Qianwei , Wang Zengjun 
Published: March 2021

Abstract
Background
Cell division cycle-associated 7 (CDCA7), as a member of the cell division cycle associated family, was reported to be aberrantly expressed in both solid tumors and hematological tumors, suggesting its essential role in promoting tumorigenesis. Hence, we aimed to explore its comprehensive roles of overall survival (OS) in clear cell renal cell carcinoma (ccRCC) and emphasize its associations with immunity.

Methods
The RNA sequencing data and corresponding clinical information were downloaded from The Cancer Genome Atlas (TCGA) database. Gene set enrichment analysis (GSEA) was adopted to explore CDCA7 associated signaling pathways. Univariate and multivariate Cox regression analyses were carried out to assess independent prognostic factors. Furthermore, roles of CDCA7 in human immunity were also investigated.

Results
Our results suggested that CDCA7 was overexpressed in ccRCC and its elevated expression was related to shorter OS (P < 0.01). Univariate and multivariate Cox regression analyses identified CDCA7 as an independent prognostic factor (both P < 0.05). The prognostic nomogram integrating CDCA7 expression level and clinicopathologic variables was constructed to predict 1-, 3- and 5-year OS. GSEA indicated that high CDCA7 expression was related to the apoptosis pathway, cell cycle pathway, JAK-STAT pathway, NOD like receptor pathway, P53 pathway, T cell receptor pathway and toll like receptor pathway, etc. Moreover, CDCA7 was significantly related to microsatellite instability (MSI, P < 0.001) and tumor mutational burden (TMB, P < 0.001). As for immunity, CDCA7 was remarkably associated with immune infiltration, tumor microenvironment, immune checkpoint molecules and immune pathways.

Conclusions
CDCA7 could serve as an independent prognostic factor for ccRCC and it was closely related to MSI, TMB, and immunity.
Culturally competent communication in Indigenous disability assessment: a qualitative study
Authors: Ferdinand Angeline , Massey Libby , Cullen Jennifer , Temple Jeromey , Meiselbach Kristy , Paradies Yin , Baynam Gareth , Savarirayan Ravi , Kelaher Margaret 
Published: March 2021

Abstract
Background
Indigenous people tend to exhibit a higher burden of disability than their non-Indigenous counterparts, and are often underserved by disability services. Engaging appropriately with Indigenous communities, families and individuals in the initial stages of disability assessment and planning is crucial in order to build trust and understanding of disability service models and ensure that Indigenous people receive support that is tailored to their needs and cultural realities. This article aims to identify key elements of culturally competent communication in Indigenous disability assessment and planning, and provide recommendations for strengthening capacity in this area.

Methods
This qualitative research was designed to involve Aboriginal and Torres Strait Islander people at all stages and to reflect the views of Aboriginal and Torres Strait Islander researchers, people and families affected by disability and the community-controlled health sector. Semi-structured individual interviews were undertaken with staff implementing the National Disability Insurance Scheme (NDIS) (n = 4), NDIS participants (n = 24), disability support providers and organisational partners (n = 19) and Community Connectors (n = 8) in Queensland and the Northern Territory of Australia. Key themes derived from thematic analysis included appropriate and adequate engagement of individuals with disability and their families, the role of trusted relationships, and culturally safe and appropriate communication during planning meetings.

Results
Overall, the research findings highlight that a low level of cultural competence in the initial stages of the disability assessment and planning process exacerbated participant confusion and distrust towards assessment staff and the NDIS. Given difficulties in communication, participant understanding of the NDIS was generally limited. The necessity of culturally safe and appropriate use of interpreters was stressed, as was the role of trusted individuals, including existing service providers, Community Connectors and family members in providing a solid base for participant understanding of the NDIS.

Conclusions
Cultural competence in disability assessment and planning can be strengthened through multi-level engagement with the Aboriginal community-controlled sector and community leaders. Implementing mechanisms to enable the involvement of families, trusted service providers and Community Connectors can support a more meaningful understanding of individuals’ needs within their cultural context and in relation to their cultural roles.
“Include me if you can”—reasons for low enrollment of pediatric patients in a psychopharmacological trial
Authors: Niemeyer Larissa , Mechler Konstantin , Buitelaar Jan , Durston Sarah , Gooskens Bram , Oranje Bob , Banaschewski Tobias , Dittmann Ralf W. , Häge Alexander 
Published: March 2021

Abstract
Background
Low recruitment in clinical trials is a common and costly problem which undermines medical research. This study aimed to investigate the challenges faced in recruiting children and adolescents with obsessive-compulsive disorder and autism spectrum disorder for a randomized, double-blind, placebo-controlled clinical trial and to analyze reasons for non-participation. The trial was part of the EU FP7 project TACTICS (Translational Adolescent and Childhood Therapeutic Interventions in Compulsive Syndromes).

Methods
Demographic data on pre-screening patients were collected systematically, including documented reasons for non-participation. Findings were grouped according to content, and descriptive statistical analyses of the data were performed.

Results
In total, n = 173 patients were pre-screened for potential participation in the clinical trial. Of these, only five (2.9%) were eventually enrolled. The main reasons for non-inclusion were as follows: failure to meet all inclusion criteria/meeting one or more of the exclusion criteria (n = 73; 42.2%), no interest in the trial or trials in general (n = 40; 23.1%), and not wanting changes to current therapy/medication (n = 14; 8.1%).

Conclusions
The findings from this study add valuable information to the existing knowledge on reasons for low clinical trial recruitment rates in pediatric psychiatric populations. Low enrollment and high exclusion rates raise the question of whether such selective study populations are representative of clinical patient cohorts. Consequently, the generalizability of the results of such trials may be limited. The present findings will be useful in the development of improved recruitment strategies and may guide future research in establishing the measurement of representativeness to ensure enhanced external validity in psychopharmacological clinical trials in pediatric populations.

Trial registration
EudraCT 2014-003080-38. Registered on 14 July 2014.
Asymmetric Returns and the Economic Content of Accruals and Investment
Authors: Del Viva Luca , Kothari S. P. , Lambertides Neophytos , Trigeorgis Lenos 
Published: March 2021

This study contributes to our understanding of what accruals capture and how they relate to the distribution of future returns. It examines the past and future growth components of accruals and shows that, whereas past growth is negatively associated with idiosyncratic skewness, future growth is positively associated with it. In addition, although both past and future growth are negatively associated with future returns, the association is more pronounced for past growth when volatility is lower, but for future growth when volatility is higher. The study also shows that the association between the future growth component and future returns reverses in the long run, whereas the association between past growth and future returns does not. This paper was accepted by Shivaram Rajgopal, accounting.
Theatre ventilation
Authors: Theodorou C , Simpson GS , Walsh CJ 
Published: March 2021

Introduction Owing to the COVID-19 pandemic, there has been significant disruption to all surgical specialties. In the UK, units have cancelled elective surgery and a decrease in aerosol generating procedures (AGPs) was favoured. Centres around the world advocate the use of negative pressure environments for AGPs in reducing the spread of infectious airborne particles. We present an overview of operating theatre ventilation systems and the respective evidence with relation to surgical site infection (SSI) and airborne pathogen transmission in light of COVID-19. Methods A literature search was conducted using the PubMed, Cochrane Library and MEDLINE databases. Search terms included “COVID-19”, “theatre ventilation”, “laminar”, “turbulent” and “negative pressure”. Findings Evidence for laminar flow ventilation in reducing the rate of SSI in orthopaedic surgery is widely documented. There is little evidence to support its use in general surgery. Following previous viral outbreaks, some centres have introduced negative pressure ventilation in an attempt to decrease exposure of airborne pathogens to staff and surrounding areas. This has again been suggested during the COVID-19 pandemic. A limited number of studies show some positive results for the use of negative pressure ventilation systems and reduction in spread of pathogens; however, cost, accessibility and duration of conversion remain an unexplored issue. Overall, there is insufficient evidence to advocate large scale conversion at this time. Nevertheless, it may be useful for each centre to have its own negative pressure room available for AGPs and high risk patients.