bluuebunny/crossref_metadata_2025_split huggingface dataset:
Value of a multidisciplinary geriatric oncology committee on patient care in a community-based, academic cancer center.
Authors: Singh Gurbani , Morant Lena , Bedra McKenzie , Emel Jennifer , Harris Kelly , Markan Yudhishtra , deBorja Christopher , Tong Monica , Downs Patrice , Boutros Cherif 
Published: May 2024

e13771 Background: The heterogeneity in health and functional ability among older patients makes the management of cancer a unique challenge. The Geriatric Oncology Program at the University of Maryland Baltimore Washington Medical Center (BWMC) was created to optimize cancer management and recommendations for older patients. This study aimed to assess the benefits of the implementation of such a program at a community- based academic cancer center. Materials and Methods: We retrospectively analyzed patients aged ≥80 years presenting to the Geriatric Oncology Program between January 2017 and July 2022. A multidisciplinary team of specialists collectively reviewed each patient using geriatric-specific domains and stratified each patient into one of three management groups- Group 1: those deemed fit to receive standard oncologic care (SOC); Group 2: those recommended to receive optimization services prior to reassessment for SOC; and Group 3: those deemed to be best suited for supportive care and/ or hospice care. ANOVA, chi-square, and Kaplan-Meier analyses were used to assess patient outcomes. Results: Among 233 patients included, 76 (32.6%) received SOC (Group 1), 43 (18.5%) were optimized (Group 2), and 114 (49.0%) received supportive care or hospice referral (Group 3). There was no significant difference in sex, race, or age among all three groups. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) score was implemented in 2019 (n=90). Patients receiving supportive/ hospice care only had an average score of 5.8, while the averages for those in the optimization and SOC groups were 4.6 and 4.1, respectively (p=< .001). SOC patients had the longest average survival of 2.71 years compared to the optimization (2.30 years) and supportive care groups (0.93 years) (p= <0.001). 69.8% of optimized patients were deemed fit for SOC upon re-evaluation following optimization services. For all patients that underwent surgical interventions, post- operatively, 23 patients (85%) were discharged home and 4 (15%) were discharged to a rehab facility. The average survival after surgery for all patients was 3.16 years, while patients who were optimized prior to surgery had an average survival after surgery of 3.21 years. Conclusions: The present study demonstrates the need for specialized consideration of the heterogeneity that cancer diagnoses present in older individuals. The Geriatric Oncology Program at BWMC is able to maximize treatment outcomes for geriatric patients through the provision of SOC therapies and optimization services, while also minimizing unnecessary interventions on an individual patient-centric level.
Breast cancer outcomes and treatment toxicity in geriatric patients compared to other patients at the Cancer Disease Hospital in Zambia.
Authors: Chitula Mwando Fidelia , Kizub Darya Aleksandrovna , Mwaba Catherine Kasongo , Msadabwe Susan Citonje , Mwala Kabisa 
Published: May 2024

e13773 Background: Breast cancer is the second most common cancer in women in Zambia and the most common cancer in older women. Management of geriatric cancer patients can be challenging due to physiological changes and multiple comorbidities. Methods: Data was extracted from the CDH electronic database of breast cancer patients for November 2005 - November 2022. Geriatric patients were defined as those 65 years old or older. Data was analyzed using descriptive statistics. Clinical-pathologic characteristics and outcomes for geriatric (GP) and younger patients were compared using the Chi Squared Test/Fisher’s exact test for discrete and Student’s T-test for continuous variables. All p-values were two-sided. Results: Of 1981 patients, 493 (24.9%) were geriatric. 374 (18.9%) had Stage I/II cancer, 607 (30.6%) Stage III, 579 (29.2%) de novo Stage IV, with no differences between geriatric and younger patients. 441 (22.2%) had hormone receptor-positive (HR+) disease, 115 (5.8%) had HER2+ by IHC, 195 (9.3%) were triple-negative, 52 (2.6%) HR+HER2+. Geriatric patients were more likely to have invasive lobular carcinoma (4.6% v. 2.4%), less likely to have grade 3 (42.0% v 50.6%) or HER2+ (11.6% v 19.3%) cancer. 1889 (94.8%) received systemic treatment, 1188 (60.0%) surgery, and 844(42.6%) radiation (RT), with no differences in geriatric and younger patients. Geriatric patients were less likely to receive palliative RT (9.6% v 15.7%), to receive a lower total RT dose and had similar rates of RT dermatitis as younger patients. Geriatric patients were less likely to be treated with doxorubicin, docetaxel and more likely with methotrexate. After median follow-up of 1.1 years (st. dev 2.6), 301(15.2%) were alive without disease, 826 (41.7%) alive with cancer, 203 (10.2%) died from cancer, with no difference in local, distal recurrence, or survival for geriatric patients. Geriatric patients were less likely to be in good physical condition (33.9% v 39.4%) and more likely to have a worse ECOG (1.0% v 0.4% for ECOG 4, 4.1% v 2.4% for ECOG 3, 14.0% v 10.9% for ECOG 2, 73.4% v 75.8% for ECOG 1, 7.4% v 10.4% for ECOG 0). Geriatric patients had a lower number of total treatment toxicities (OR 0.95, 95% CI 0.91-0.98) and were less likely to have leukopenia (OR 0.89, 95% CI 0.83-0.94) and neutropenia (OR 0.88, 95% CI 0.82-0.95). (for similar outcomes p-value > 0.05; all where differences are noted p-value < 0.05). Conclusions: GPs were similar to other patients in terms of cancer stage and outcomes and had less aggressive disease. GPs had worse functional status, received less toxic chemotherapy, were less likely to receive surgery and RT. GPs had either a similar amount or less treatment toxicity compared to other patients. Results are limited by short follow-up of about 1.5 years. Results are limited by incomplete non-hematologic toxicity data.
Efficacy and safety of DOACs versus LMWH for elderly patients with active cancer: A meta-analysis.
Authors: Marinho Alice , Caldeira de Freitas Maria Carolina , Coelho Itaya Gabriela , Da Costa Larissa Maria , Lambert Fossen Eduardo , Celso Davi Said Gonçalves , Ferro Andre , Dias Yasmin , Vissotto Eduardo de Figueiredo , De Souza Mariana 
Published: May 2024

e13776 Background: Anticoagulant treatment in patients with cancer aims to reduce the high risk of thromboembolism. Direct oral anticoagulants (DOACs) and low-molecular-weight heparin (LMWH) are currently approved for the treatment of cancer-related thrombosis. However, there is limited data comparing the efficacy and safety of these two antithrombotic therapies among elderly patients with cancer. Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were systematically searched for studies comparing DOACs with LMWH in cancer patients with newly diagnosed venous thromboembolism (VTE) or pulmonary embolism (PE). Both solid tumors and hematologic malignancies were included. Outcomes of interest were recurrent VTE and major bleeding. Odds ratio (OR) with 95% confidence intervals (CI) were pooled with a random-effects model. Statistical analysis was performed with Review Manager 5.4.1. Heterogeneity was assessed using the I2 statistic and chi-squared test. Results: Four studies, three randomized controlled trials (RCTs) and one observational, were included. A total of 3,266 patients older than 65 years who underwent anticoagulation with DOACs (35%) or LMWH (65%) were incorporated in the analysis. There was no statistically significant difference between anticoagulation therapies for recurrent VTE (OR, 0.68; 95% CI, 0.41-1.11; p = 0.13; I² = 56%; Table) or major bleeding (OR, 1.18; 95% CI, 0.61-2.25; p = 0.08; I² = 60%; Table). Conclusions: Our findings suggest no statistically significant differences in recurrent VTE or major bleeding between DOACs and LMWH in elderly oncologic patients with newly diagnosed VTE or PE. Given the practical challenges of using LMWH, DOACs may be considered an alternative anticoagulation strategy for these patients. [Table: see text]
Abemaciclib dose escalation to maintain intensity (ADE-MI).
Authors: Prescott Kevin , Gadi VK , Danciu Oana Cristina , Hoskins Kent , Ibraheem Abiola Falilat , Owens Jovonne , Chen Zhengjia 
Published: May 2024

TPS618 Background: Abemaciclib is a an oral CDK4/6 inhibitor that is FDA-approved as adjuvant therapy for certain patients with early-stage HR+HER2- breast cancer in combination with endocrine therapy. The major toxicity of abemaciclib is diarrhea, which often occurs within the first 6-8 days of treatment initiation. Across several registrational trials, roughly 25% of patients with diarrhea from abemaciclib treatment required dose interruptions with roughly 20% required dose reductions. Because diarrhea happens early in the treatment course, one concern is this might dissuade people from continuing on or being fully adherent to adjuvant therapy. Incorporating strategies to minimize diarrhea may improve adherence and permit more patients to stay on the target recommended dose of 150mg BID for the full 2 years of adjuvant therapy. Our trial-in-progress evaluates dose escalation to address diarrhea as a cause of dose interruptions, reductions, and discontinuations, a strategy that has worked with other therapeutic agents. Specifically, our study tests the hypothesis that gradual up-titration of abemaciclib dose over a course of 4 weeks will decrease the rate of grade 3 or worse diarrhea. Methods: This is a post-marketing, single arm, phase IV trial for patients with high-risk early-stage HR+HER2- breast cancer who are eligible for treatment with adjuvant abemaciclib in combination with endocrine therapy. Fifty (50) subjects will be enrolled. Patients will gradually up-titrate the dose of abemaciclib over the course of 4 weeks before reaching the FDA recommended dose of 150mg BID (Table). The primary objective of this study is to increase the proportion of patients on the FDA recommended dose of abemaciclib at 3 months of treatment. At the significance level of 0.05, a minimum of 43 patients will achieve a power of at least 80% to detect the improvement (80% vs the historical control of 60%), using a two sized exact binomial test. Additional objectives are determining the number of days with greater than grade 1 diarrhea in the first month of treatment, determining rates of grade 3 or greater diarrhea, determining DFS and OS, and to assess patient reported outcomes regarding adverse events. The trial opened to enrollment on 12/21/2023. The first patient on the study was enrolled 1/25/2024. Clinical trial information: NCT06169371 . [Table: see text]
The Hero of This Novel Is a Tree: Biocentric Narrative Strategies in Contemporary Eco-fiction
Authors: Archer Kirby 
Published: May 2024

Abstract
This article considers the novel's possibilities for depicting and responding to the climate crisis by analyzing Richard Powers's efforts to write a biocentric perspective in The Overstory (2018). In biocentric narratives, humans, typically the focal point of the novel, are decentered in favor of perspectives that attempt to encompass more of the living world. Efforts to evade narrative anthropocentrism, which are often encouraged by ecocritics, may not offer an effective frame through which to articulate the climate crisis. The article defends narrative anthropocentrism against the charge that it is unambiguously problematic and challenges the claim that it is potentially avoidable through the adoption of a theoretically biocentric narrative perspective. Rather, strategic awareness of narrative anthropocentrism can help novelists foster visions of strong connections to our environments and inspire reader engagement with environmental concerns. Powers's effort to move beyond anthropocentrism, which is motivated by positive intentions to impact reader interest in environmental issues, is stymied by the inevitability of the human perspectives and interests that attend the construction of any narrative. The article concludes that some instances of anthropocentrism in novels like The Overstory, in which Powers cannot altogether supplant anthropocentrism with a biocentric perspective, are more constructive and positive vis-à-vis nonhuman nature and the environment than others, such as Powers's portrayal of reverence for nonhuman nature. If reverence reveals the attachment of human values and emotions to nonhuman entities, it suggests how anthropocentrism might be harnessed for the benefit of the wider environment.
In Default of Providence: Tragedy and Tess of the d'Urbervilles
Authors: Rolland Anick S. 
Published: May 2024

Abstract
Reconsidering Thomas Hardy's Tess of the d'Urbervilles: A Pure Woman in view of newly discovered textual discrepancies between editions and critical scholarship, this essay makes a necessary intervention in the reading tradition of the rape-fall-punishment triad by shifting the central event of the novel to the murder as it relates to aspects of the novel's religious framework. It argues that Tess's actions are contingent on a critical phrase, “a shining light,” that has been suppressed through the novel's complicated publication history and reconnects sections of the plot to restore the significance of tragedy in the novel without explaining that tragedy through her violation. By recovering the religious significance of conversion in the text as crucial to a structure of extralegal justice on which the events of the novel hinge, the essay argues that Tess's crime, rather than serving as mere irony, is motivated by faith and an understanding of justice that illuminates the problem of the uncanny God of the nineteenth century, present through absence. As the salvation plot is brought back into relevance with the marriage plot, the concept of Tess's love as a powerful force that should be able to overcome all is reduced to a failed attempt at epistemic reform. Through her failure, the novel raises questions about the possibilities of radical world-making that have historically been overlooked by Hardy's critics.
Association Between Radiological Severity of Lumbar Spinal Stenosis and Spinopelvic Parameters in Adult Patients With Achondroplasia
Authors: Cai Husule , Omara Chady , Vleggeert-Lankamp Carmen L. A. 
Published: May 2024

BACKGROUND AND OBJECTIVES:
Adults with achondroplasia are more vulnerable to suffer from neurogenic claudication because of a congenital narrow spinal canal, which makes them susceptible to lumbar spinal stenosis (LSS). The study aims to investigate the correlations between sagittal alignment parameters and the degree of LSS in patients with achondroplasia with LSS.

METHODS:
The radiological data of adult achondroplasts presented to the neurosurgical clinic of our medical center from 2019 to 2022 were collected. Lumbar stenosis was graded using the Schizas scale, and the dural sac cross-sectional area (DSCA) was measured. The angles defining the spinopelvic parameters comprising lumbar lordosis, thoracolumbar kyphosis, sagittal vertical axis, pelvic tilt, sacral slope, and pelvic incidence were measured. Spearman or Pearson correlation was used to investigate the association between sagittal misalignment and LSS.

RESULTS:
A total of 34 achondroplastics were enrolled, with a median age of 44.3 ± 15.5 years, ranging from 18.6 to 78.5 years. Larger thoracolumbar kyphosis was associated with more severe stenosis according to the Schizas scale of the L12 lumbar level (r = 0.44, P = .020, 95% CI [0.08, 0.70]). Larger sagittal vertical axis correlated with a smaller DSCA at L23 (r = −0.53, P = .036, 95% CI [−0.81, −0.04]) and L45 (r = −0.66, P = .004, 95% CI [−0.87, −0.26]). Larger pelvic tilt was demonstrated to be associated with a smaller DSCA of the L34 lumbar level (r = −0.42, P = .027, 95% CI [−0.68, −0.05]) and the L45 lumbar level (r = −0.47, P = .011, 95% CI [−0.71, −0.12]).

CONCLUSION:
The upper LSS may be attributed to an increased kyphosis of the thoracolumbar spine. On the contrary, the lower LSS seemed to be correlated with a more backward tilt of the pelvis.
Racial Disparities in Breast Cancer Genetic Testing May be Mitigated by Counseling
Authors: Siegel Julie B. , Bertolino Melanie , Mukherjee Rupak , Meeder Kiersten , Hughes Kevin S. , Abbott Andrea M. 
Published: May 2024

Abstract
Background
Currently, racial disparities exist in access to genetic testing. Recent developments have helped narrow the gap in accessibility. The purpose of this study was to determine whether racial disparities in genetic consultation attendance and completion of genetic testing persist, and, if so, factors that contribute to under-utilization of these resources.

Methods
A single-institution retrospective review of breast patients referred for genetic counseling between 2017 and 2019 was performed. Univariate and multivariate logistic regression evaluated factors associated with genetic counseling attendance and genetic testing.

Results
A total of 596 patients were referred for genetic counseling: 433 (72.7%) white; 138 (23.2%) black; and 25 (4.2%) other or unknown. In multivariate analysis, black patients, patients without breast cancer family history, and patients without a current cancer diagnosis, classified as high risk, were significantly less likely to attend their genetics appointment (p = 0.010, p = 0.007, p = 0.005, respectively). Age, insurance type, distance from facility, and need for chemotherapy did not significantly impact consult completion rate. Of the patients who completed a genetic consult, 84.4% (n = 248) had genetic testing and 17.7% (n = 44) had a pathogenic variant. For patients who attended counseling, there were no significant factors that were predictive with receipt of genetic testing.

Conclusions
In this study, there was a significant association between race and attending genetic counseling. Once counseled, most patients went on to receive genetic testing, and racial disparities in testing disappeared, emphasizing the value of providing additional education about the importance and purpose of genetic testing.
Vitamin A - potential anticancer weapon
Authors: Popławska Natalia Aleksandra , Śliz Justyna , Skorupska Marta , Czeczotka Magdalena Joanna , Woźniak Krzysztof 
Published: May 2024

Introduction:
Vitamin A, one of the most popular vitamins that people usually associate with eye health or beautiful skin, also has many other functions and uses. Recently many scientists conducted studies to determine if vitamin A could be a new weapon against cancers.
Aim of the study:
The aim of the study was to discuss recent findings regarding the impact of Vitamin A and other retinoids on potential applications in anticancer therapy.
Materials and methods:
This review of studies is based on scientific articles available in PubMed and Google Scholar databases. The names of the cancers were juxtaposed with term "Vitamin A" and with term "Retinoids" to gather data regarding the effect of retinoids on cancer treatment and prevention.
Results:
After analyzing the gathered publications, it is possible to conclude that retinoids can have a positive impact on cancer treatment. Some of them can induce apoptosis of cancer cells and others can reduce their proliferation. Moreover, retinoids can also play an important role in preventing cancers, such as ovarian, breast, cervical, or skin cancer. The role of retinoids in the prevention of prostate cancer remains unclear due to conflicting research results.
Conclusion:
The studies have shown promising results which indicate a need for further research into anticancer mechanisms of retinoids. Specifically, more research is needed to explore the positive impact of retinoid use in treating cancer diseases. The significant potential of retinoids may make it possible to include them in clinical practice and develop an effective therapeutic strategy for cancer treatment based on them.
can school become a non-adultist institution?
Authors: Liebel Manfred , Meade Philip 
Published: May 2024

To answer the question of whether school can become a non-adultist institution, this article examines the unequal adult–child (teacher–pupil) power relations that characterize school under the framework of bourgeois-capitalist society and that are upheld by certain functions, methods, norms and knowledge standards. Under the influence of the anti-authoritarian youth protest movements from the 1960s onwards, overt power in school (e.g. by means of corporal punishment) has been criticized and, in most countries, abolished. However, power imbalances between teachers and pupils have not disappeared, but rather developed towards a more subtle, covert power, e.g. by framing certain expectations. The hierarchical top-down and one-way learning principles of school institutions are mostly left uncontested. This article does not content itself with simply stating that schools repeatedly reproduce adultism under these societal conditions, but also discusses possible strategies and interventions that could shift unequal power relations and ultimately overturn them. It looks at various concepts and alternative forms of education critical of adultism that have emerged since the beginning of the 20th century both within and outside the state school system. It further explores the contradictions that should be expected to arise in their implementation within the framework of existing educational institutions. Particular attention is paid to the respective possibilities for action on the part of teachers and pupils. We offer a decisive challenge to teachers to rethink how they deal with their power, which is always derived and fragile, and how they can contribute to pupils empowering themselves and significantly influence learning and decision-making processes at school.
Tecnologias em saúde da hanseníase no âmbito da Atenção Primária à Saúde: revisão de escopo
Authors: Martins Rosa Maria Grangeiro , Alves Dailon de Araujo , Alves Sabrina Alaide Amorim , Silva Karine Nascimento da , Torres Raimundo Augusto Martins , Martins Francisca Juliana Grangeiro , Pereira Maria Lúcia Duarte 
Published: May 2024

Objetivo: mapear as tecnologias em saúde para manejo no cuidado à pessoa com hanseníase na Atenção Primária à Saúde. Método: revisão de escopo baseada na metodologia do JBI, em seis bases de dados, seguindo a checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Foram incluídos estudos publicados em qualquer idioma, com diferentes abordagens metodológicas. Resultados: os 14 estudos incluídos na revisão mostram que a aplicabilidade de tecnologias para o manejo do cuidado a pessoa com hanseníase na Atenção Primária à Saúde, possibilitam a confirmação de diagnóstico, acompanhamento, monitoramento e prevenção de incapacidades. Conclusão: nota-se que tecnologia em saúde se apresentam como ferramentas que auxiliam no processo de cuidado na assistência a pessoas com hanseníase, a fim de permitir aos profissionais de saúde conhecimento sobre a doença, proporcionando qualidade na sua prática de saúde.