bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effective Cancer Risk Communication to Prevent Disparities in the Era of Precision Medicine
Authors: Joseph G , Pasick RJ , Schillinger D , Luce J , Cheng JKY , Guerra C 
Published: March 2017

Abstract
As genetics and genomics become part of mainstream Medicine, these advances have the potential to reduce or exacerbate health disparities. Gaps in effective communication (where all parties share the same meaning) are widely recognized as a major contributor to health disparities. The purpose of this study was to examine cancer genetic counselor-patient communication, to assess its effectiveness from the patient perspective, and to pilot intervention strategies to improve it. We used multiple inductive methods, including standard ethnographic techniques to systematically observe and audio-record genetic counseling sessions, and qualitative interviews with observed patients using the audio recordings to stimulate recall and probe specific aspects of the communication. Data analyses were conducted using grounded theory. We observed 64 English-, 35 Spanish- and 25 Cantonese- speaking public hospital patients (n = 124) and 10 Genetic Counselors in 170 appointments, and interviewed 49 patients who had been offered testing. We identified a fundamental mismatch between the information provided by genetic counselors and the information desired and meaningful to patients. Several components of the communication that contributed to this mismatch and often resulted in ineffective communication included: (1) too much information; (2) complex terminology and conceptually difficult presentation of information; (3) information perceived as not relevant by the patient; (4) unintentional inhibition of patient engagement and question-asking; (5) vague discussions of screening and prevention recommendations. To address these communication barriers, we adapted from other fields of Medicine to the genetic counseling context and pilot tested evidence-based strategies for effective communication with limited literacy patients. Our findings indicate a need to transform the standard model of hereditary cancer risk communication. The increasing access of diverse populations to genetic services, high rates of limited health literacy in the US, and growing complexity of genetic information have created a perfect storm. If not directly addressed, this convergence can be expected to exacerbate health disparities in the genomic age.
Identifying Patient Smoking History for Cessation and Lung Cancer Screening through Mining Electronic Health Records
Authors: Onega T , Nutter EL , Sargent J , Doherty JA , Hassanpour S 
Published: March 2017

Abstract
Electronic health records (EHRs) contain information about tobacco use, but smoking status and history are often inadequately captured, resulting in missed opportunities for smoking cessation intervention and lung cancer screening decision-making. Informatics methods can improve ascertainment of smoking behaviors through development of a tobacco use registry from EHRs. Methods: Using structured data and free text from our local EHR, we developed two support vector machine (SVM) models to classify smoking status (never, former, current) and smoking history (never, pack-years, cigarettes per day, years smoked). We trained and tested these models on 758 clinical notes from the Epic-based EHR of the Dartmouth-Hitchcock health system; the training set had 479 notes and the test set 280. Notes were eligible if a patient was: ≥21 years old with a clinical encounter in the EHR from 1/1/15-9/1/16. We assessed the models' performance through precision (probability that retrieved element is relevant), recall (probability that relevant element is retrieved), and the F1-score (harmonic mean of precision and recall). We also tested the models on publicly available data from the National Centers for Biomedical Computing (i2b2) Results: Of the 280 test records, 22% were current smokers, 19% former, and 59% never smokers. Accuracy assessment of our models showed: precision = 68% and recall = 85% for smoking status and for smoking history; precision = 66% and recall = 94%. The F1-scores for smoking status and history were 65% and 74%, respectively. The majority of correctly classified smokers also had one or more smoking history element ascertained with our model. Of those individuals correctly classified as never smokers (n = 98) only two were misclassified as having a smoking history. When testing our models on i2b2 data, our F1-score was 92%. Review of misclassified records indicates that deep learning refinements to our current machine learning approach will improve performance measures. Conclusion: Machine learning models applied to our Epic EHR consistently identifies smoking history. Creating a tobacco use registry from the EHR is feasible and with advanced algorithms, will help target patients for cancer control efforts, such as smoking cessation and lung cancer screening.
Premenopausal Breast Cancer: Exercise and Leukocyte Telomere Length
Authors: Oakley-Girvan I , Pitteri S , Canchola A , Sellmeyer D , Palesh O , Stewart S , Hsieh C-L , Bloom J 
Published: March 2017

Abstract
Leukocyte telomere length (LTL) may function as a marker of health, the immune system and cancer survival. We evaluated whether premenopausal breast cancer survivors (PBCS) that successfully increased exercise levels also increased LTL. This study is the first to describe LTLs in a population-based sample of PBCS before and after an exercise intervention. We analyzed LTL before and after the Exercise for Bone Health Intervention, a randomized, controlled trial of 273 premenopausal women 55 years of age or younger at diagnosis that started the intervention within 2 years of receipt of initial chemotherapy. This pilot analysis included 60 women with the greatest increase in exercise from pre to post intervention. Those with longer LTLs at pre-intervention (PRE) had LTLs that grew shorter during the study, however, they still had longer LTLs at post-intervention (POST) than those who started with shorter LTLs. The group whose LTLs shortened the most during the study were those with longer LTLs and more exercise at PRE, ANOVA across four levels P = 0.030. In multivariable regression models of LTL change adjusted for age and LTL at PRE, factors that were independently associated with LTLs that became shorter were older age (P = 0.017), longer telomeres at PRE (P = 0.0004), higher levels of exercise (P = 0.013), higher income (P = 0.011), feeling down-hearted and blue (P = 0.003), higher levels of sociability (P = 0.015), more chronic medical conditions (P = 0.018), and higher levels of insulin-like grown factor-1 at POST (P = 0.003). While this is a pilot sub-study and requires additional confirmation, we postulate that women accustomed to exercising and being highly sociable pre-diagnosis may have experienced a greater impact on their lifestyles post-diagnosis resulting in a more rapid rate of LTL shortening. We hypothesize that time to return to LTL homeostasis for YBCS may be dependent upon a combination of physical health and psychosocial networks pre and post diagnosis and the immune system may be an important modifier. Further studies combining new technology to improve the capture of exercise and psychosocial well-being, and monitor levels of inflammation are needed to determine whether lifestyle interventions can be used to impact biomarkers of health in YBCS.
FDA Drug Approval: Elotuzumab in Combination with Lenalidomide and Dexamethasone for the Treatment of Relapsed or Refractory Multiple Myeloma
Authors: Gormley Nicole J. , Ko Chia-Wen , Deisseroth Albert , Nie Lei , Kaminskas Edvardas , Kormanik Natasha , Goldberg Kirsten B. , Farrell Ann T. , Pazdur Richard 
Published: March 2017

Abstract
On November 30, 2015, the FDA approved elotuzumab (Empliciti; Bristol-Myers Squibb) in combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who received one to three prior therapies. FDA approval was based primarily on the results of a phase III, randomized, open-label, multicenter trial, CA204004, which evaluated elotuzumab in combination with lenalidomide and dexamethasone (E-Ld) compared with lenalidomide and dexamethasone (Ld) alone in patients with relapsed or refractory multiple myeloma. Coprimary endpoints were progression-free survival (PFS) and overall response rate (ORR). The key secondary endpoint was overall survival, but these data were not mature at the time of clinical database cutoff. The trial demonstrated a statistically significant improvement in PFS, with an estimated HR of 0.70 for E-Ld over Ld [95% confidence interval (CI), 0.57–0.85; P = 0.0004). Estimated median PFS was 19.4 months in the E-Ld arm and 14.9 months in the Ld arm. ORR was 75.8% in the E-Ld arm compared with 65.5% in the Ld arm. Serious adverse reactions were reported in 65% of patients in the E-Ld arm compared with 57% in the Ld arm. The FDA approved elotuzumab with the following warnings and precautions: infusion reactions, infections, second primary malignancies, hepatotoxicity, and interference with the determination of complete response. Clin Cancer Res; 23(22); 6759–63. ©2017 AACR.
Distinctive expression signatures of serum microRNAs in ischaemic stroke and transient ischaemic attack patients
Authors: Wang Cheng , Song Jia-xi , Lv Qiu-shi , Pan Hao , Zhang Chun-ni , Wu Jia , Fan Chun-li , Ma Li-juan , Liu Ting , Wang Jun-jun 
Published: March 2017

SummaryCirculating microRNAs (miRNAs) have recently emerged as promising biomarkers for ischaemic stroke (IS). However, the expression patterns of specific miRNAs in transient ischaemic attack (TIA) patients have not been investigated. Their predictive values for the presence of IS and TIA and their relationships to the neurological deficit severity of IS and the subsequent stroke risk after TIA remain unclear exactly. In this study, 754 miRNAs were initially screened by the TaqMan Low Density Array (TLDA) in two pooled serum samples from 50 IS patients and 50 controls. Markedly altered miRNAs were subsequently validated by individual quantitative reverse-transcription PCR (qRT-PCR) assays first in the same cohort of TLDA and further confirmed in another larger cohort including 177 IS, 81 TIA patients and 42 controls. Consequently, TLDA screening showed that 71 miRNAs were up-regulated and 49 miRNAs were down-regulated in IS patients. QRT-PCR validation confirmed that serum levels of miR-23b-3p, miR-29b-3p, miR-181a-5p and miR-21–5p were significantly increased in IS patients. Strikingly, serum levels of miR-23b-3p, miR-29b-3p and miR-181a-5p were also significantly elevated in TIA patients. Furthermore, up-regulated miR-23b-3p, miR-29b-3p and miR-21–5p could clearly differentiate between IS and TIA patients. Logistic regression and receiver-operating characteristic curve analyses demonstrated that these altered miRNAs may function as predictive and discriminative biomarkers for IS and TIA, and their distinctive expression signatures may contribute to assessing neurological deficit severity of IS and subsequent stroke risk after TIA.Supplementary Material to this article is available online at www.thrombosis-online.com.
Identification of a functional genetic variant driving racially dimorphic platelet gene expression of the thrombin receptor regulator, PCTP
Authors: Kong Xianguo , Simon Lukas , Holinstat Michael , Shaw Chad , Bray Paul , Edelstein Leonard 
Published: March 2017

SummaryPlatelet activation in response to stimulation of the Protease Activated Receptor 4 (PAR4) receptor differs by race. One factor that contributes to this difference is the expression level of Phosphatidylcholine Transfer Protein (PCTP), a regulator of platelet PAR4 function. We have conducted an expression Quantitative Trait Locus (eQTL) analysis that identifies single nucleotide polymorphisms (SNPs) linked to the expression level of platelet genes. This analysis revealed 26 SNPs associated with the expression level of PCTP at genome-wide significance (p < 5×10–8). Using annotation from ENCODE and other public data we prioritised one of these SNPs, rs2912553, for functional testing. The allelic frequency of rs2912553 is racially-dimorphic, in concordance with the racially differential expression of PCTP. Reporter gene assays confirmed that the single nucleotide change caused by rs2912553 altered the transcriptional potency of the surrounding genomic locus. Electromobility shift assays, luciferase assays, and overexpression studies indicated a role for the megakaryocytic transcription factor GATA1. In summary, we have integrated multi-omic data to identify and functionalise an eQTL. This, along with the previously described relationship between PCTP and PAR4 function, allows us to characterise a genotype-phenotype relationship through the mechanism of gene expression.
Mortality and cancer after 12 versus 30 months dual antiplatelet therapy
Authors: Cabrera-Fuentes Hector , Lee Kwangmin , Cho Young , Park Kyungil , Park Tae , Kim Young , Yoon Sung-Cheol , Serebruany Victor , Kim Moo 
Published: March 2017

SummaryThe optimal duration and cancer risks of antiplatelet therapy following percutaneous coronary intervention (PCI) are unclear. We compared cancer and all-cause mortality after dual antiplatelet therapy (DAPT) for the combination of clopidogrel and aspirin (ASA) versus ASA alone over 18 months follow-up in event-free patients at 12 months DAPT from the Health Insurance Review and Assessment (HIRA) dataset via the Korean Outcomes Registry Evaluating Antithrombotics (KOREA). We selected PCI patients who were event free for 12 months and maintained a consistent antiplatelet regimen for 18 more months. The primary endpoints were any cancer and all-cause mortality at 30 months follow-up after PCI. From 320,351 screened post-PCI patient HIRA records, we excluded 294,413 and qualified 25,938, constituting DAPT (n=10,992) and ASA (n=14,946) groups. The Propensity Score Matching (PSM), and Inverse Probability of Treatment Weighting (IPTW) revealed no significant differences in background demographics and clinical characteristics for DAPT versus ASA patients. At 30-months post-PCI, after massive (>91 %) exclusions, cancer risk was higher for continuous DAPT [455 (4.15 %) vs 606 (4.04 %); HR=1.221; 95 %CI: 1.061–1.405; p=0.005], which remained significant by PSM (p=0.006) or IPTW (p=0.007), while all-cause mortality was similar [136 (1.24 %) vs 192 (1.28 %) HR=0.999; 95 %CI: 0.736–1.135; p=0.993]. This analysis suggests a potential mild excess cancer risk, but no mortality benefit in Korean post-PCI patients treated with DAPT for an additional 18 months beyond conventional 12 months DAPT. These data are not supporting continuing DAPT for more than one year in East Asians. Analysing cancer types and assessing potential cancer association with bleeding are warranted.
Quality of Care at Hospitals Identified as Outliers in Publicly Reported Mortality Statistics for Percutaneous Coronary Intervention
Authors: Waldo Stephen W. , McCabe James M. , Kennedy Kevin F. , Zigler Corwin M. , Pinto Duane S. , Yeh Robert W. 
Published: March 2017

Background:
Public reporting of percutaneous coronary intervention (PCI) outcomes may create disincentives for physicians to provide care for critically ill patients, particularly at institutions with worse clinical outcomes. We thus sought to evaluate the procedural management and in-hospital outcomes of patients treated for acute myocardial infarction before and after a hospital had been publicly identified as a negative outlier.

Methods:
Using state reports, we identified hospitals that were recognized as negative PCI outliers in 2 states (Massachusetts and New York) from 2002 to 2012. State hospitalization files were used to identify all patients with an acute myocardial infarction within these states. Procedural management and in-hospital outcomes were compared among patients treated at outlier hospitals before and after public report of outlier status. Patients at nonoutlier institutions were used to control for temporal trends.

Results:

Among 86 hospitals, 31 were reported as outliers for excess mortality. Outlier facilities were larger, treating more patients with acute myocardial infarction and performing more PCIs than nonoutlier hospitals (
P
<0.05 for each). Among 507 672 patients with acute myocardial infarction hospitalized at these institutions, 108 428 (21%) were treated at an outlier hospital after public report. The likelihood of PCI at outlier (relative risk [RR], 1.13; 95% confidence interval [CI], 1.12–1.15) and nonoutlier institutions (RR, 1.13; 95% CI, 1.11–1.14) increased in a similar fashion (interaction
P
=0.50) after public report of outlier status. The likelihood of in-hospital mortality decreased at outlier institutions (RR, 0.83; 95% CI, 0.81–0.85) after public report, and to a lesser degree at nonoutlier institutions (RR, 0.90; 95% CI, 0.87–0.92; interaction
P
<0.001). Among patients that underwent PCI, in-hospital mortality decreased at outlier institutions after public recognition of outlier status in comparison with prior (RR, 0.72; 9% CI, 0.66–0.79), a decline that exceeded the reduction at nonoutlier institutions (RR, 0.87; 95% CI, 0.80–0.96; interaction
P
<0.001).

Conclusions:
Large hospitals with higher clinical volume are more likely to be designated as negative outliers. The rates of percutaneous revascularization increased similarly at outlier and nonoutlier institutions after report of outlier status. After outlier designation, in-hospital mortality declined at outlier institutions to a greater extent than was observed at nonoutlier facilities.
Time in Therapeutic Range and Outcomes After Warfarin Initiation in Newly Diagnosed Atrial Fibrillation Patients With Renal Dysfunction
Authors: Szummer Karolina , Gasparini Alessandro , Eliasson Staffan , Ärnlöv Johan , Qureshi Abdul Rashid , Bárány Peter , Evans Marie , Friberg Leif , Carrero Juan Jesus 
Published: March 2017

Background
It is unknown whether renal dysfunction conveys poor anticoagulation control in warfarin‐treated patients with atrial fibrillation and whether poor anticoagulation control associates with the risk of adverse outcomes in these patients.

Methods and Results

This was an observational study from the Stockholm CREatinine Measurements (SCREAM) cohort including all newly diagnosed atrial fibrillation patients initiating treatment with warfarin (n=7738) in Stockholm, Sweden, between 2006 and 2011. Estimated glomerular filtration rate (eGFR; mL/min per 1.73 m
2
) was calculated from serum creatinine. Time‐in‐therapeutic range (TTR) was assessed from international normalized ratio (INR) measurements up to warfarin cessation, adverse event, or end of follow‐up (2 years). Adverse events considered a composite of intracranial hemorrhage, ischemic stroke, myocardial infarction, or death. During median 254 days, TTR was 83%, based on median 21 INR measurements per patient. TTR was 70% among patients with eGFR <30, around 10% lower than in those with normal renal function. During observation, adverse events occurred in 4.0% of patients, and those with TTR ≤75% were at higher adverse event risk. This was independent of patient characteristics, comorbidities, number of INR tests, days exposed to warfarin, and, notably, independent of eGFR: adjusted odds ratio (OR) 1.84 (95% CI, 1.41–2.40) for TTR 75% to 60% and adjusted OR 2.09 (1.59–2.74) for TTR <60%. No interaction was observed between eGFR and TTR in association to adverse events (
P
=0.2).

Conclusion
Severe chronic kidney disease (eGFR <30) patients with atrial fibrillation have worse INR control while on warfarin. An optimal TTR (>75%) is associated with lower risk of adverse events, independently of underlying renal function.
Individual Differences and Long-term Consequences of tDCS-augmented Cognitive Training
Authors: Katz Benjamin , Au Jacky , Buschkuehl Martin , Abagis Tessa , Zabel Chelsea , Jaeggi Susanne M. , Jonides John 
Published: March 2017

Abstract
A great deal of interest surrounds the use of transcranial direct current stimulation (tDCS) to augment cognitive training. However, effects are inconsistent across studies, and meta-analytic evidence is mixed, especially for healthy, young adults. One major source of this inconsistency is individual differences among the participants, but these differences are rarely examined in the context of combined training/stimulation studies. In addition, it is unclear how long the effects of stimulation last, even in successful interventions. Some studies make use of follow-up assessments, but very few have measured performance more than a few months after an intervention. Here, we utilized data from a previous study of tDCS and cognitive training [Au, J., Katz, B., Buschkuehl, M., Bunarjo, K., Senger, T., Zabel, C., et al. Enhancing working memory training with transcranial direct current stimulation. Journal of Cognitive Neuroscience, 28, 1419–1432, 2016] in which participants trained on a working memory task over 7 days while receiving active or sham tDCS. A new, longer-term follow-up to assess later performance was conducted, and additional participants were added so that the sham condition was better powered. We assessed baseline cognitive ability, gender, training site, and motivation level and found significant interactions between both baseline ability and motivation with condition (active or sham) in models predicting training gain. In addition, the improvements in the active condition versus sham condition appear to be stable even as long as a year after the original intervention.
The Law concerning Public Education of Gifted Students
Authors: Zirkel Perry A. , Stevens Paul L. 
Published: March 2017

It is estimated that there are as many as 2.5-3.0 million school-age children in the nation who are gifted.1 The number of such children participating in special public educational programs is approximately 1.2 million.2 Definitions of giftedness and commitments to publicly funded special programs for gifted students vary widely. Reflecting our federal structure for education, some of the legal development have arisen on the national level but the primary scene of activity relating to the law of gifted education is at the state level. This article provides a comprehensive overview of the legal activity on the federal and state levels. This increasing activity has been largely neglected in legal books and periodicals to date.