bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying factors underlying increased emergency care needs of Black patients with pancreas cancer.
Authors: John Kristen M , Louis Tanya C. , Saluja Deepak , King Daniel 
Published: May 2024

e13749 Background: In a retrospective study, we observed that African American/Black patients are 2.8x more likely to have recurrent ED visits than non-Black patients. These findings motivated this prospective study using a standardized questionnaire to better understand the factors leading to ED visits among Black patients. Methods: A study of Black patients with pancreas cancer who had at least 1 ED visit in a 5 month period in 2022-2023 was conducted. Computational identification of health system encounters by patients with pancreas cancer was performed using ICD10 C25* as a cohort identifier. The cohort was filtered by encounter type for ED and self-reported race for Black. Weekly, an African American oncology nurse practitioner called these patients to administer a questionnaire regarding social determinants of health and discuss reasons underlying the ED visit. Three attempts were made to contact each patient. Demographic and clinical features were obtained from the electronic health record. Results: During this 5-month period, 31 patients meeting criteria were identified; among these 31 who had at least 1 ED visit, 45% had ≥2 ED visits and 13% had ≥5 ED visits. The cohort was 68% female with mean age of 70.3 and median household income of $92,608. 74% had non-metastatic disease and 35% were on chemotherapy at the time of visit. 52% of patients had Medicare, 35% had commercial insurance, 10% had Medicaid, and 3% were uninsured. We reached 55% patients, of whom 71% agreed to participate. Notably, 83% endorsed high school as their highest level of education, 25% were immigrants to the United States, and 17% experienced financial barriers to care (Table). 33% had been seen at our institution’s pancreas cancer multidisciplinary clinic. Two recurrent themes noted during discussions with these patients were that that those with multiple ED visits were nearing end-of-life and/or had caretakers or family members in the medical field. Conclusions: We identified female gender, education level, immigrant status, and financial barriers to care as themes associated with ED visit burden in Black patients with pancreas cancer. Having caretakers in the medical field, who may have witnessed the consequences of healthcare disparities, may also contribute to higher rates of ED use. We hope to use these data to inform interventions to address these disparities. [Table: see text]
Investigating perioperative interventions to enhance surgical outcomes for older adults with cancer: A systematic review.
Authors: Sorensen Luke , Lam Anh B. , Moore Vanessa Ann , Bouvette Max Joseph , Diaz Adolfo , Wismann Andrea , Nipp Ryan David 
Published: May 2024

e13765 Background: Older adults with cancer have unique needs, particularly in perioperative settings, which likely influence surgical outcomes in the geriatric oncology population. Little work has sought to describe available literature investigating perioperative interventions to enhance surgical outcomes for these individuals. We conducted a systematic review to describe the literature on perioperative interventions in older adults with cancer undergoing surgery. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search using the Ovid MEDLINE, CINAHL, and Embase databases, searching for literature published from 1/2010-10/2023 (search terms used relevant terminology for geriatric oncology in the perioperative setting). We included randomized controlled trials that enrolled adults >60 years old with cancer, excluding studies on pharmacologic or procedural interventions. Results: We identified 1,036 studies and 922 abstracts through our initial search. Title and abstract review resulted in 20 manuscripts. After full-text review, 9 were removed as their study design, patient population, or intervention did not align with inclusion criteria. Our final review included 11 studies (90.9% [10/11] were conducted outside of the US and 45.6% [5/11] were published within the past 2 years). Patients’ age ranged from 60-95 and median number of patients per study was 147 (range: 44-690). Studies were primarily on patients with colorectal cancer (81.8% [9/11]), with all involving non-emergent elective surgeries. Most studies (63.6% [7/11]) evaluated exercise interventions, and the remaining assessed geriatric assessment-guided interventions (18.2% [2/11]), nutrition optimization (9.1% [1/11]), or patient empowerment (9.1% [1/11]). Primary outcomes were as follows: postoperative complications (36.4% [4/11]), feasibility of exercise programs (27.3% [3/11]), quality of life (18.2% [2/11]), delirium incidence (9.1% [1/11]), or hospital length of stay (9.1% [1/11]). All studies had postoperative complications as a primary or secondary outcome. Overall, 54.5% (6/11) found a positive primary outcome including: postoperative complications (18.2% [2/11]), implementation of exercise program (18.2% [2/11]), quality of life (9.1% [1/11]), or nutrition (9.1% [1/11]). Conclusions: In this review, we found 11 studies focused on perioperative interventions in older adults with cancer undergoing surgery. Notably, interventions involved exercise, geriatric assessment-guided care, nutrition optimization, and patient empowerment. Although most studies met their primary endpoint, we found heterogeneity in intervention modality and outcome assessment, thus demonstrating further work is required to address the unique perioperative needs of the geriatric oncology population.
Effect of age on delivering chemotherapy to older adults with advanced pancreatic adenocarcinoma.
Authors: Tannous Toufic , Panjrolia Ekta , Resendes Natasha M. , Islam Raiyan , Hammel Iriana M. 
Published: May 2024

e13767 Background: Age is one of the most important risk factors for developing pancreatic adenocarcinoma (PDAC), 65% of the newly diagnosed cancer cases occur in individuals above 65 years of age (yo). The only potential cure for PDAC includes surgical resection, however, the majority of patients (70%) present with locally advanced/unresectable or metastatic PDAC (APDAC). Many oncologists remain hesitant to administer treatment to older adults for fear of perceived increased chemotoxicity risk and the thought of treatment intolerability. Methods: This retrospective cohort study included patients who were diagnosed and treated for APDAC within the Veterans Integrated Services Network (VISN) 8 which includes Veterans Affairs medical facilities in Florida, southern Georgia, Puerto Rico, and the U.S. Virgin Islands. Demographic data such as age, sex, race, ethnicity and treatment data such as chemotherapy and palliative care use were pulled from the VA Cancer Registry, available from Corporate Data Warehouse Data. We conducted a detailed chart review in the VA electronic health record to confirm stage and the eastern cooperative oncology group (ECOG) status at the time of diagnosis. Statistical analyses were conducted using GraphPad Prism 10.1.2 software. Analyses consisted of t-test for normally distributed continuous variables, chi-squared test for categorical variables and the Mann Whitney U test for the ECOG score of both groups. Results: Ninety-nine patients with APDAC above the of age 65 were identified from the period of June 1, 2017 till July 31, 2021. 46 received chemotherapy (C group) and 53 patients did not receive chemotherapy (NC group), characteristics (Table). The mean age for those in the C group were 72 years old (yo) vs 76 yo from the NC group with a P value of 0.0017 which was statistically significant. Looking at the age subgroups, the majority of the patients that received C, were of the 65-74 age subgroup (71%). The median ECOG for the NC group was 2 and that for C was 1 group. 39% of the C group received palliative care as opposed to 32% of the NC group with a P value of 0.532. Conclusions: Despite an acceptable ECOG range between 1 and 2, Age played an important factor in determining who received chemotherapy in APDAC. Studies other than ECOG are needed to help oncologists determine the fitness of APDAC patients and minimize hesitancy to deliver treatment. The involvement of palliative care in patients with APDAC was suboptimal and a push for more involvement of palliative care is needed. [Table: see text]
Implementing a mutidisciplinary approach for older adults with cancer: Challenges and achievements in a geriatric oncology program in Sao Paulo, Brazil.
Authors: Pontes Luciola De Barros , da Silva Jennifer Kamila , Santos Juliana duarte , Proença Regiane , Buesa Nadia Haidar , Dutra Adriana Fatima , Borges Fabiola Alves de Santana , Gomes Maria Livia Leite de Abreu , Neto Raquel de Sousa , da Conceição Bianca Vasconcellos , Porro Carolina Ferraioli , França Jadna Helena dos Santos , Ferreira Nivalda Gonçalves , de Oliveira Carla Jussaria , Criminazzo Thassio Pastre , Mendes Leonardo Daniel , Freire Jakline Maria , da Silva Amanda Costa Rosa , Nascimento Evelyn Aparecida 
Published: May 2024

e13769 Background: Treating an older adult with cancer is complex and requires multidisciplinary effort. Multiple studies demonstrate the benefits of timely integration of Geriatric Oncology (GO) with routine oncologic care. Despite this growing body of evidence, there are very few cancer centers around the world that have a dedicated GO program, notably in low- and middle- income countries (LMIC). The objective of this abstract is to describe the first year of the GO program in a private oncology center in São Paulo, Brazil. Methods: As an effort of oncologists, geriatricians and nurses, the team built a consultative model with a nurse performing the G8 triage score to every cancer patient aged ≥ 70 years. For those with a G8 less than 14 points, a comprehensive geriatric assessment (CGA) was performed. The results of the CGA were than provided as a report to the treating physician and all the members of the multidisciplinary team, so that a geriatric assessment (GA) driven intervention could be planned. The patients were then followed for 3, 6, and 12 months to detect falls, emergency rooms visits, hospitalizations, and death. Results: From January 2023 to January 2024, 110 patients with a median age of 79 were evaluated, with 57% having a G8 less than 14. 70 patients we submitted to a CGA. The majority of the tumors were gastrointestinal (30%), lung (20%) and genito-urinary (17%). Regarding the GA domains: 70% of the patients had a possible or probable cognitive impairment by the 10-point cognitive screener; 53% mild psychological distress by PHQ-4 Screening Tool; 47% showed important reduction in hand grip strength scale calling the attention to sarcopenia; 48% were found to be at nutritional risk and 42% were classified as malnourished at the mini-nutritional assessment; polypharmacy was detected in 67% of the patients. Despite these findings, 78% of the patients we classified as ECOG 0 or 1. After GA driven interventions, at 3 and 6 months follow up, 88% of the patients remained with no falls, with a mild rate of hospitalizations (40%) and a low rate of treatment discontinuation (15%). By the end of 6 month follow up, 24% of the patients have died. Conclusions: Geriatric conditions such as functional impairment are common and frequently unrecognized or inadequately addressed in older adults with cancer. Identifying geriatric conditions by performing a GA can help the health team to manage these conditions and provide better oncology care.
A phase II trial comparing dalpiciclib in combination with letrozole versus standard chemotherapy as neoadjuvant therapy in patients with high-risk HR- positive HER-2 negative breast cancer: DARLING-02.
Authors: Zhang Lina , Geng Cuizhi , Liu Yueping , Han Jianjun , Han Meng , Huang Ruixue , Li Xianqiao , Luo Ruizhen , Li Yuntao , Ma Jie , Qi Huaihua , Wang Zunyi , Wang Xiaochun , Yang Chao , Yang Jingqiang , Yang Lixian , Yu Jingjing , Zhang Yingzhou , Zhang Zhisheng , Zhou Xinping 
Published: May 2024

TPS626 Background: Dalpiciclib is a CDK4/6 inhibitor that has shown promising efficacy and safety when in combination with endocrine in the treatment of advanced HR+ HER2- breast cancer. Building on preliminary findings from our previous study (Geng, 2023SABCS PO2-02-05), we aim to evaluate the efficacy and safety of dalpiciclib combined with letrozole versus standard chemotherapy as neoadjuvant treatment in patients with high-risk early breast cancer (EBC). Methods: This is a prospective, multicenter, randomized phase II non-inferiority trial. Main eligibility criteria include: female patients ≥18 years, ECOG performance status of 0-1, histologically confirmed invasive breast cancer, clinical stage T1c-T2, cN1–2 or T3-4, cN0-2, ER≥50%, HER2-negative, and Ki67 ≤ 20%. Participants are randomized 1:1 to receive either 24-week experimental intervention (oral dalpiciclib 150mg once daily for 3 weeks on, 1 week off and oral letrozole 2.5 mg/day) or 24-week standard intervention (intravenous epirubicin 100 mg/m² and intravenous cyclophosphamide 500 mg/m² on day 1 for three 3-week cycles, followed by intravenous docetaxel 100 mg/m2 on day 1 for three 3-week cycles). The primary endpoint is the objective response rate (ORR) assessed by RECIST v1.1. Secondary endpoints include patient-reported outcomes (EORTC QLQ-C30, EORTC QLQ-BR23), residual cancer burden 0–I rate, preoperative endocrine prognostic index score 0 rate, pathological complete response rate , 2-year invasive disease-free survival rate, and safety. Exploratory endpoints include biomarker analysis. The hypothesis is that the experimental group will not be inferior to control group. Assuming an ORR of 70% for both groups, a sample size of 65 patients per group is required to achieve 80% power to detect a non-inferiority margin of up to 20% at a two-sided significance level of 5%. A total of 130 patients are needed (65 per group). Considering a dropout rate of 10% per group, the total sample size is approximately 144 patients. The trial was registered at ClinicalTrials.gov (NCT06107673) and is actively recruiting. Clinical trial information: NCT06107673 .
Reading (in) Graham Greene's The Ministry of Fear (1943)
Authors: Ludtke Laura Elizabeth 
Published: May 2024

Abstract
This essay offers a transgeneric reading of Graham Greene's 1943 novel The Ministry of Fear, first tracing the emergence of spy fiction from invasion fiction at the end of the nineteenth century and then establishing William Le Queux's influence on the culture of espionage in Britain as well as in British spy fiction. Following on from this genealogy of genre, it interrogates the novel's protagonist's claim that “[t]he world has been remade by William Le Queux” in the context of the dual histories of espionage in Britain and the spy in British fiction, while attending to the novel's own reception of those histories. Focusing on the significance of the novel's intertextual and paratextual evidence in an interpretation of the novel's unconventional narrative strategies, the essay examines hybrid modes of reading the novel, as well as reading in the novel as a way of parsing its entangled narrative modes, levels, and discourses. Greene encourages transgeneric reading as a possible resolution to the epistemological uncertainty readers experience at the novel's close due to its troubling of genre expectations, its allusiveness, and, ultimately, its eschewal of narrative closure. At the same time, the essay proposes that, in attending in spy fiction to what is read and how it is read, we might better appreciate the challenges presented by the rehabilitation of a genre that also requires disentangling the many hierarchies of modernist cultural production.
Digital mentoring on expressing breast milk for working mothers
Authors: Sarimin Dorce Sisfiani , Pasambo Yourisna , Desyani Ni Luh Jayanthi 
Published: May 2024

Background/Aims Working mothers may find it difficult to maintain exclusive breastfeeding; this challenge can be addressed through expressing breast milk. However, barriers to expressing breast milk include perceived insufficient milk supply and a lack of knowledge on pumping, storing and giving breast milk to babies. This study's aim was to identify the effectiveness of expressed breast milk assistance, through the ASIPku mobile application, among working mothers in North Sulawesi, Indonesia. Methods This quasi-experimental study involved 100 participants (intervention: n=50, control: n=50), selected using cluster randomised trials. Questionnaires were used to assess exclusive breastfeeding and use of the app in the intervention group. Chi-squared tests were used for data analysis. Results Assistance using mobile applications had a significant effect on exclusive breastfeeding among working mothers in North Sulawesi (P<0.001). Conclusions Digital mentoring was effective in improving the rate of exclusive breastfeeding. By providing information on expressing breast milk, these apps can be used to support women and make exclusive breastfeeding more accessible to working mothers.
The role of germline BRCA1 & BRCA2 mutations in familial pancreatic cancer: A systematic review and meta-analysis
Authors: Limijadi Edward Kurnia Setiawan , Muniroh Muflihatul , Prajoko Yan Wisnu , Tjandra Kevin Christian , Respati Danendra Rakha Putra 
Published: May 2024

Background
Familial Pancreatic Cancer (FPC) presents a notable risk, with 3–10% of pancreatic adenocarcinoma cases having a family history. Studies link FPC to syndromes like HBOC, suggesting BRCA1/BRCA2 mutations play a role. BRCA gene functions in DNA repair impact FPC management, influencing sensitivity to therapies like PARP inhibitors. Identifying mutations not only aids FPC treatment but also reveals broader cancer risks. However, challenges persist in selectively applying genetic testing due to cost constraints. This Systematic Review focuses on BRCA1/BRCA2 significance in FPC, diagnostic criteria, prognostic value, and limitations.

Method
Original articles published from 2013 to January 2023 were sourced from databases such as Scopus, PubMed, ProQuest, and ScienceDirect. Inclusion criteria comprised observational cohort or diagnostic studies related to the role of BRCA1/2 mutation in correlation to familial pancreatic cancer (FPC), while article reviews, narrative reviews, and non-relevant content were excluded. The assessment of bias used ROBINS-I, and the results were organized using PICOS criteria in a Google spreadsheet table. The systematic review adhered to the PRISMA 2020 checklist.

Result
We analyzed 9 diagnostic studies encompassing 1325 families and 4267 patients from Italy, USA, and Poland. Despite the limitation of limited homogenous PICO studies, our findings effectively present evidence. BRCA1/2 demonstrates benefits in detecting first-degree relatives FPC involvement with 2.26–10 times higher risk. These mutation findings also play an important role since with the BRCA1/2 targeted therapy, Poly-ADP Ribose Polymerase inhibitors (PARP) may give better outcomes of FPC treatment. Analysis of BRCA1 and BRCA2 administration’s impact on odds ratio (OR) based on six and five studies respectively. BRCA1 exhibited non-significant effects (OR = 1.26, P = 0.51), while BRCA2 showed significance (OR = 1.68, P = 0.04). No heterogeneity observed, indicating consistent results. Further research on BRCA1 is warranted.

Conclusion
Detecting the BRCA1/2 mutation gene offers numerous advantages, particularly in its correlation with FPC. For diagnostic and prognostic purposes, testing is strongly recommended for first-degree relatives, who face a significantly higher risk (2.26–10 times) of being affected. Additionally, FPC patients with identified BRCA1/2 mutations exhibit a more favorable prognosis compared to the non-mutated population. This is attributed to the availability of targeted BRCA1/2 therapy, which maximizes treatment outcomes.
The effect of forward postural lean on running economy, kinematics, and muscle activation
Authors: Carson Nina M. , Aslan Daniel H. , Ortega Justus D. 
Published: May 2024

Background
Running economy, commonly defined as the metabolic energy demand for a given submaximal running speed, is strongly associated with distance running performance. It is commonly believed among running coaches and runners that running with increased forward postural lean either from the ankle or waist improves running economy. However, recent biomechanical research suggests using a large forward postural lean during running may impair running economy due to increased demand on the leg muscles.

Purpose
This study tests the effect of altering forward postural lean and lean strategy on running economy, kinematics, and muscle activity.

Methods
16 healthy young adult runners (23±5 years, 8M/8F) ran on a motorized treadmill at 3.58m/s using three postural lean angles [upright, moderate lean (50% of maximal lean angle), and maximal lean] and two strategies (lean from ankle and lean from waist [trunk lean]). Metabolic energy consumption, leg kinematics, and muscle activation data were recorded for all trials.

Results
Regardless of lean strategy, running with an increased forward postural lean (up to 8±2 degrees) increased metabolic cost (worsened economy) by 8% (p < .001), increased hip flexion (p < .001), and increased gluteus maximus (p = .016) and biceps femoris (p = .02) muscle activation during the stance phase. This relation between running economy and postural lean angle was similar between the ankle and trunk lean strategies (p = .743).

Conclusion
Running with a large forward postural lean reduced running economy and increased reliance on less efficient extensor leg muscles. In contrast, running with a more upright or moderate forward postural lean may be more energetically optimal, and lead to improved running performance.