bluuebunny/crossref_metadata_2025_split huggingface dataset:
The influence of yoga and cognitive behavioral therapy on mediational relationships between insomnia and cancer-related fatigue: A URCC NCORP RCT in 550 cancer survivors.
Authors: Lin Po-Ju , Altman Brian James , Dunne Richard Francis , Mattick Lindsey Jean , Chakrabarti Alisha , Samuel Stephen Rajan , Gada Umang , Culakova Eva , Jaslowski Anthony John , Kuzma Charles S. , Mustian Karen Michelle 
Published: June 2024

12015 Background: Cancer-related fatigue (CRF) often co-occurs with insomnia and both are incapacitating adverse toxicities of cancer and its treatment which may persist months and years after the completion of treatment. Yoga and Cognitive Behavioral Therapy for Insomnia (CBT-I) are promising behavioral approaches for improving CRF and insomnia among cancer survivors. However, the influence of changes in insomnia resulting from participating in yoga or CBT-I on the subsequent changes in CRF is not fully understood. Methods: We conducted mediation analyses on data collected from a multicenter phase III RCT among cancer survivors who were randomized to receive 1) Yoga for Cancer Survivors (YOCAS, 75-min./session, 2x/wk. for 4 wks.), 2) CBT-I (90-min./session, 1x/wk. for 8 wks.), or 3) a behavioral placebo (ASCO recommended Survivorship Education, 75-min/session, 2x/wk. for 4 wks.). Brief Fatigue Inventory and Insomnia Severity Index were used to assess CRF and insomnia, respectively, at pre-, mid-, and post-intervention. Causal mediation analyses were conducted to estimate the influence of changes in insomnia at mid-intervention resulting from participating in YOCAS, CBT-I, or behavioral placebo on subsequent changes in CRF at post-intervention. Results: 550 survivors (93% female; mean age 57 years; 75% were breast cancer survivors) completed baseline and post-intervention assessments. YOCAS, compared to placebo, significantly improved CRF and insomnia at mid-intervention (CRF: -0.38±0.16, p = 0.01; Insomnia: -1.15±0.35, p < 0.01) and post-intervention (CRF: -0.35±0.17, p = 0.03; Insomnia: -1.43±0.41, p < 0.01). Among YOCAS participants, improvement in insomnia at mid-intervention significantly influenced the subsequent reduction in CRF (-0.14±0.06, p = 0.01) and accounted for 37% (95% CI: 0% - 78%) of the total reduction in CRF at post-intervention. CBT-I, compared to placebo, also significantly improved CRF and insomnia at mid- (CRF: -0.32±0.18, p = 0.06; Insomnia: -2.64±0.40, p < 0.01) and post-intervention (CRF: -0.59±0.18, p < 0.01; Insomnia: -4.95±0.46, p < 0.01). Among CBT-I participants, the improvement in insomnia at mid-intervention significantly influenced the subsequent reduction in CRF (-0.40±0.09, p < 0.01) and accounted for 60% (95% CI: 21% - 99%) of the total reduction in CRF at post-intervention. Conclusions: Both YOCAS and CBT-I effectively improve CRF and insomnia among survivors. 37%-60% of the reduction in CRF resulting from participating in YOCAS or CBT-I is due to improvement in insomnia. Clinicians should consider prescribing YOCAS yoga or CBT-I for survivors who experience CRF and insomnia. Clinical trial information: NCT02613364 .
Patient reported symptoms after cancer diagnosis and the risk of short- and long-term severe mental health events among adolescents and young adults (AYA): A population-based study.
Authors: Gupta Sumit , Li Qing , Sutradhar Rinku , Coburn Natalie G. 
Published: June 2024

12019 Background: AYA with cancer are a vulnerable sub-population at risk of adverse mental health outcomes during and after cancer treatment. Tools to identify AYA at highest risk are required to guide screening and interventions. In a population-based cohort of AYA with cancer, we determined whether self-reported symptoms were associated with subsequent short- and long-term severe mental health events (SMHE). Methods: All Ontario, Canada AYA diagnosed with cancer aged 15-29 between 2010-2018 were identified and linked to healthcare databases, including one capturing self-reported Edmonton Symptom Assessment System (ESAS) scores at cancer-related visits. Scores for depression, anxiety, and poor well-being were categorized as not measured, mild (0-3), moderate (4-6), or severe (7-9). SMHE were defined as emergency room visits or hospitalizations for mental health reasons. First, we used Cox proportional hazard models to determine the association of ESAS scores (time-varying variable) with subsequent SMHE. Second, among 5-year survivors, we determined the association of maximum ESAS score within the first year of diagnosis with long-term SMHE (i.e. starting at 5 years from cancer diagnosis). All analyses were adjusted for patient and disease variables, including mental healthcare use prior to cancer diagnosis. Results: 5,435 AYA met inclusion criteria. Median age at cancer diagnosis was 25 years [interquartile range 22-27]. Hematologic cancers were most common (1,748; 32.2%). Symptom severity was associated with subsequent SMHE risk. For example, AYA reporting severe anxiety were at more than three-fold higher risk of SMHE compared to those reporting mild anxiety [adjusted hazard ratio (aHR) 3.6, 95th confidence interval (CI) 1.9-6.7; p < 0.001]. Similar risk was seen among AYA reporting severe vs. mild depression (aHR 3.5, 1.7-7.3; p < 0.001). Among 3,518 (64.7%) 5-year survivors, symptom severity also predicted long-term SMHE. For example, starting at 5 years post cancer diagnosis, the subsequent 3-year cumulative incidence of a SMHE among those who reported severe depression at any time during the first year post cancer diagnosis was 10.5% (95CI 6.9-15.9) compared to 2.4% (95CI 1.7-3.3) among those who only reported mild depression (aHR 3.0, 95CI 1.8-4.9; p < 0.0001). Similar results were seen pertaining to severe anxiety and severe impact on well-being. AYA endorsing severe anxiety represented 13.1% of the cohort but accounted for 25.8% of AYA experiencing SMHEs during the first three years of survivorship. Conclusions: Systematic symptom screening in the first year after cancer diagnosis identifies a proportion of AYA at high risk of both short and long-term SMHE who may benefit from targeted screening and interventions. Future work will determine whether interventions during cancer treatment mitigate this risk.
The predictive role of mammographic breast calcifications in cardiovascular disease among women undergoing breast cancer screening: Insights from a retrospective database analysis of breast cancer screening.
Authors: Akbar Usman Ali , Rizwan Umer , Hussain Rida , Umer Ahmed Muaaz , Dwiggins Andrea , Hussain Sabir , Cheshire Michael 
Published: June 2024

12022 Background: Cancer screenings, particularly mammography, are crucial in early detection and management of breast cancer, the most common cancer among women worldwide. Despite advances, disparities persist in cancer outcomes and cardiovascular health, highlighting the need for an integrative approach to care. Methods: We conducted a retrospective cohort analysis of 22,118 female patients over 40 years of age diagnosed with breast arterial calcification (BAC) on mammography using the TriNetX database. Each patient with BAC was matched to a control based on age, lab values, socioeconomic class, and co-morbidities. None had ASCVD events before screening. Outcomes included acute myocardial infarction, heart failure, cardiomyopathy, and thromboembolic events. Results: Comparing cohorts with and without BAC, we found no significant difference in all-cause mortality (OR: 1.003, P=0.960). However, BAC was associated with increased risks of acute myocardial infarction (OR: 1.281, P=0.003), heart failure (OR: 1.106, P=0.021), cardiomyopathy (OR: 1.437, P<0.001), and DVT/PE (OR: 1.178, P=0.006), particularly DVT (OR: 1.243, P=0.003). Ischemic stroke, CVD, and other cardiovascular conditions showed no significant risk differences, highlighting BAC's predictive value for specific cardiovascular outcomes (Table). Conclusions: Our findings affirm BAC on mammography as a significant predictor of specific cardiovascular conditions, such as acute myocardial infarction and heart failure, highlighting its utility in cardiovascular risk stratification.[Table: see text]
End-of-life care preferences in patients with gallbladder cancer: Shifting patterns and disparities over two decades.
Authors: Jatwani Karan , Sukaina Mahnoor , Khosla Atulya Aman , Batra Nitya , Mishra Rahul , Ganiyani Mohammad Arfat , Kumar Madhan Srinivasan , Singh Rohit , Ahmed Shahid Sattar 
Published: June 2024

12036 Background: Gallbladder cancer (GBC) is an aggressive malignancy with a combined survival rate of 20%. Some studies have reported less than 10 percent utilization of palliative care services in this population. Place of Death (PoD) is an important determinant of patient and caregiver preference and cost of caregiving at the end of life (EOL). We evaluate trends in PoD for patients with GBC in the U.S. from 2003 to 2020 based on the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Methods: We analyzed data using the CDC WONDER database from January 01, 2003, to December 31, 2020. The data for deaths due to GBC was pooled using the International Classification of Diseases-10th revision code as C23, including all Gallbladder Cancers. The inclusion criteria included patients aged > 18. PoD was defined as deaths at home or hospice versus medical facilities. Annual percentage change (APC), average annual percentage change (AAPC), and joint point analysis were done using the Joinpoint Regression Program, Version 5.0.2. Results: The analysis demonstrated a total of 37,576 deaths from GBC. Fifty-eight percent of deaths (21,805) were at home or hospice; AAPC: 3.23%, CI 1.4 to 5.0 (p = 0.0002). A significantly increasing trend of dying at medical facilities was seen amongst African Americans (AA); AAPC: 1.06%, CI 0.02 to 2.10, (p = 0.04), while Whites had a significant increase in the utilization of home or hospice-based care; AAPC: 2.7%, CI 2.1 to 3.2; p < 0.0001). On age stratification, there was a significant decline in using medical facilities as PoD for the > 65 yrs cohort; AAPC: -2.65% CI -3.1 to -2.1 (p < 0.0001). In contrast, the middle age group (45-64 yrs) had a trend towards decline, which was not significant in the usage of medical facilities as PoD with AAPC: -0.42% CI -1.24 to -0.4 (p = 0.29). Conclusions: To our knowledge, this is the first study providing valuable insights into the evolving PoD preferences among GBC patients in the U.S. The racial disparities highlight the need for targeted interventions and culturally sensitive end-of-life care for different demographic groups. The age-related trends underscore the importance of tailoring end-of-life care strategies to specific age cohorts. The findings emphasize the importance of policies promoting and supporting home and hospice-based care for GBC patients. Targeted efforts are warranted to address disparities in PoD preferences among racial and age groups.
When pain management meets harm reduction: Patients with cancer navigate the opioid crisis—2016 to 2020 National Inpatient Sample analysis.
Authors: Kharel Himal , Kharel Zeni , Bhandari Samikchhya Keshary , Pokhrel Nishan Babu , Shah Purva , Sanjeevi Aditya , Rao Aniket , Orakzai Abdullah Ahmad , Eltaher Basant , Jain Tripti , Jamshed Saad 
Published: June 2024

12071 Background: The opioid crisis is a growing public health concern in the United States. In this retrospective study, we aim to look at the trends and predictors of opioid overdose-related mortality in cancer patients. Methods: A retrospective analysis of the National Inpatient Sample database (NIS) from 2016 to 2020 was conducted using International Classification of Diseases-10(ICD-10) codes to identify hospitalizations related to opioid overdose. The 2016-2020 mark was chosen because 2016 is the first NIS year with full implementation of ICD-10 code and there is absence of data after 2020. STATA version SE18.0 was used for statistical analysis. We used multivariate regression analysis to calculate the effects of various demographic and non-demographic variables including age, sex, Charlson Comorbidity Index(CCI), race, median household income, type of insurance, hospital bed size, hospital region, chronic lung disease, neuromuscular disease, and alcohol use disorder on opioid overdose-related mortality. Results: There were 6980 hospitalizations with opioid overdose in cancer patients. Mean age was 62.3 years and 49.9% were females. 97.9% of patients had high CCI. The trend of opioid overdose-related mortality in cancer patients is shown in the table. Unlike increasing opioid overdose related mortality in the general population (which, per CDC, increased by 62.44% from 2016 to 2020), we found that opioid-related admissions and mortality in cancer patients are stable over five years. Significant predictors of mortality (p-value <0.05) included male sex, African-American race, lower-median household income, and chronic lung disease with the odds ratio 1.64, 2.62, 2.13, and 1.69 respectively. Conclusions: The ongoing opioid crisis has led to tighter regulations regarding opioid prescriptions, subsequently creating increasing obstacles for cancer patients to access opioids. This analysis indicates that hospitalizations and deaths related to opioids in cancer patients have remained relatively stable, in contrast to the general population. Therefore, it is crucial to establish distinct regulations for cancer patients compared to the general population to ensure appropriate access to opioids for effective pain management. In addition, this study identified key predictors of mortality from opioid overdose in cancer patients, highlighting the complex interplay of socio-economic factors in medical care. The limitations of this study include multivariate model’s inability to account for all variables, coding errors, and an increased risk of bias due to the retrospective nature of the data. [Table: see text]
Cushing Syndrome Is Associated With a Higher Risk of Cancer—A Nationwide Cohort Study
Authors: Wu Wan-Chen , Wu Jia-Ling , Huang Tien-Shang , Li Chung-Yi , Li Hung-Yuan 
Published: June 2024

Abstract

Context
Patients with Cushing syndrome (CS) have higher risk of obesity and diabetes, which are important risk factors of cancers. However, if patients with CS have a higher incidence of cancer remains unknown.

Objective
To investigate whether endogenous CS is associated with increased cancer incidence.

Methods
A nationwide cohort study analyzing data retrieved from Taiwan's National Health Insurance program in 2006-2017. Between 2006 and 2017, 1278 patients with newly diagnosed endogenous CS were identified. Among them, 1246 patients without a history of malignancy were enrolled in this study. The age- and sex-standardized incidence rate of all-cause cancer and age-, sex-, and calendar year–standardized incidence ratio (SIR) of cancer in association with endogenous CS.

Results
The age- and sex-standardized incidences of CS decreased from 4.84 to 3.77 per million person-years between 2006 and 2017. The age at diagnosis of CS was 45.3 ± 14.8 years, and 80.0% of the patients were female. Cushing disease and adrenal CS accounted for 35.4% and 64.6% of patients with CS, respectively. The incidence rate of cancer in patients with CS was 7.77 (95% CI 5.84-10.14) per 1000 person-years, with a SIR of 2.08 (95% CI 1.54-2.75). The 3 most common cancer types were liver (27.7%), kidney (16.7%), and lung (13.0%).

Conclusion
Patients with endogenous CS have a higher incidence of cancer.
Incidence and Characteristics of Cerebral Infarction After Microsurgical Clipping of Unruptured Anterior Circulation Cerebral Aneurysms: Diffusion-Weighted Imaging-Based Analysis of 600 Patients
Authors: Han Hyun Jin , Chung Kyu Seon , Kim Solbi , Kim Jung-Jae , Park Keun Young , Kim Yong Bae 
Published: June 2024

BACKGROUND AND OBJECTIVES:
Postclipping cerebral infarction (PCI) remains a major concern after treatment for unruptured intracranial aneurysms (UIAs). However, studies of microsurgical clipping based on diffusion-weighted imaging are limited. We aimed to present the incidence, risk factors, and types of PCI and its radiological and clinical characteristics.

METHODS:
This was a retrospective single-center study in which patients were scheduled to undergo microsurgical clipping for anterior circulation UIAs. The overall incidence and risk factors were calculated. Based on the operation and relevant artery, we categorized PCI on diffusion-weighted imaging into 4 types and presented their radiological and clinical characteristics.

RESULTS:
We reviewed the radiological and clinical data of 605 patients. The overall incidence of PCI was 16.7% (101/605), of which asymptomatic infarction was 14.9% (90/605) and symptomatic infarction was 1.8% (11/605). Hypertension (adjusted odds ratio [aOR], 2.258; 95% confidence interval [CI]: 1.330-3.833), temporary clipping (aOR, 1.690; 95% CI: 1.034-2.760), multiple aneurysm locations (aOR, 1.832; 95% CI: 1.084-3.095), and aneurysm dome size (aOR, 1.094; 95% CI: 1.006-1.190) were independent risk factors for PCI. Type II (perianeurysmal perforator) infarction was the most common type of PCI (48.6%) and the most common cause of symptomatic infarction (72.7%). Types II and III (distal embolic) infarctions correlated with atherosclerotic changes in the aneurysm wall and temporary clipping (62.4% and 70.6%, respectively). The type IV (unrelated) infarction group had a higher incidence of systemic atherosclerosis (55%).

CONCLUSION:
Microsurgical clipping is a safe and viable option for the treatment of anterior circulation UIAs. However, modification of the surgical technique, preoperative radiological assessment, and patient selection are required to reduce the incidence of PCI.
Feasibility of Endovascular Deep Brain Stimulation of Anterior Nucleus of the Thalamus for Refractory Epilepsy
Authors: Kashyap Varun , Ashby Mark , Stanslaski Scott , Nguyen Kevin , Hageman Kristin , Chang Yao-Chuan , Khalessi Alexander A. 
Published: June 2024

BACKGROUND AND OBJECTIVES:
Deep brain stimulation (DBS) has developed into an effective therapy for several disease states including treatment-resistant Parkinson disease and medically intractable essential tremor, as well as segmental, generalized and cervical dystonia, and obsessive-compulsive disorder (OCD). Dystonia and OCD are approved with Humanitarian Device Exemption. In addition, DBS is also approved for the treatment of epilepsy in the anterior nucleus of the thalamus. Although overall considered an effective treatment for Parkinson disease and epilepsy, a number of specific factors determine the treatment success for DBS including careful patient selection, effective postoperative programming of DBS devices and accurate electrode placement. Furthermore, invasiveness of the procedure is a rate limiter for patient adoption. It is desired to explore a less invasive way to deliver DBS therapy.

METHODS:
Here, we report for the first time the direct comparison of endovascular and parenchymal DBS in a triplicate ovine model using the anterior nucleus of the thalamus as the parenchymal target for refractory epilepsy.

RESULTS:
Triplicate ovine studies show comparable sensing resolution and stimulation performance of endovascular DBS with parenchymal DBS.

CONCLUSION:
The results from this feasibility study opens up a new frontier for minimally invasive DBS therapy.
Disparities Associated with Decision to Undergo Oncologic Surgery: A Prospective Mixed-Methods Analysis
Authors: Van Haren Robert M. , Kovacic Melinda Butsch , Delman Aaron M. , Pratt Catherine G. , Griffith Azante , Arbili Lana , Harvey Krysten , Kohli Eshika , Pai Ahna , Topalian Alique , Rai Shesh N. , Shah Shimul A. , Kues John 
Published: June 2024

Abstract
Background
Underrepresented minority patients with surgical malignancies experience disparities in outcomes. The impact of provider-based factors, including communication, trust, and cultural competency, on outcomes is not well understood. This study examines modifiable provider-based barriers to care experienced by patients with surgical malignancies.

Methods
A parallel, prospective, mixed-methods study enrolled patients with lung or gastrointestinal malignancies undergoing surgical consultation. Surveys assessed patients’ social needs and patient-physician relationship. Semi-structured interviews ascertained patient experiences and were iteratively analyzed, identifying key themes.

Results
The cohort included 24 patients (age 62 years; 63% White and 38% Black/African American). The most common cancers were lung (n = 18, 75%) and gastroesophageal (n = 3, 13%). Survey results indicated that food insecurity (n = 5, 21%), lack of reliable transportation (n = 4, 17%), and housing instability (n = 2, 8%) were common. Lack of trust in their physician (n = 3, 13%) and their physician’s treatment recommendation (n = 3, 13%) were identified. Patients reported a lack of empathy (n = 3, 13%), lack of cultural competence (n = 3, 13%), and inadequate communication (n = 2, 8%) from physicians. Qualitative analysis identified five major themes regarding the decision to undergo surgery: communication, trust, health literacy, patient fears, and decision-making strategies. Five patients (21%) declined the recommended surgery and were more likely Black (100% vs. 21%), lower income (100% vs. 16%), and reported poor patient-physician relationship (40% vs. 5%; all p < 0.05).

Conclusions
Factors associated with declining recommended cancer surgery were underrepresented minority race and poor patient-physician relationships. Interventions are needed to improve these barriers to care and racial disparities.
Resolving Tensions Between Heterogeneous Investors in a Startup
Authors: Chen Shiqi , Lambrecht Bart M. 
Published: June 2024

Legal scholars highlight the tensions that exist between different classes of shareholders in startups. We model a startup owned by undiversified investors with heterogeneous capital contributions and risk preferences. A social planner runs the firm on behalf of all investors. We compare investors’ expected utility with a hypothetical first-best decentralized benchmark. The startup’s optimal investment policy is procyclical and a time-varying weighted average of shareholders’ optimal investment policies. The optimal contracts issued to investors are tailor-made, interdependent, and include equity claims resembling preferred stock with heterogeneous payout caps, leading to a complex capitalization table as more investors join the startup. This paper was accepted by Will Cong, finance. Funding: This work was supported by the Cambridge Endowment for Research in Finance and Keynes Fellowship. Supplemental Material: The online appendices and data files are available at https://doi.org/10.1287/mnsc.2022.01724 .
Management of chronic kidney disease associated pruritus: it's time to ask ‘do you itch?’
Authors: Burton James O , Parker Kathrine 
Published: June 2024

Prescribing information and adverse event reporting for Kapruvia®▾ (difelikefalin) can be found at the end of this article ((UK-DFK-2400065) April 2024) Itchy skin is a common symptom for people with advanced chronic kidney disease (CKD), and it has a significant impact on outcomes of treatment. Due to a combination of patient and healthcare related factors, it remains under-reported, under-diagnosed and inadequately treated. Recently, the landscape for treatment has changed. Although the pathogenesis of CKD-associated pruritus (CKD-aP) is complex and multifactorial, the role of the endogenous opioid pathway is now much better understood. Difelikefalin is a peripherally acting kappa opioid receptor agonist indicated for the treatment of moderate-to-severe pruritus associated with chronic kidney disease in adult patients on in-centre haemodialysis with a favourable safety profile; it does not produce typical opioid side-effects and is the first approved therapy for CKD-aP in Europe. People on dialysis should be asked ‘do you itch?’, and evidence-based management pathways should be used to treat this debilitating symptom much more effectively.