bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beyond the pain: Decoding opioid use in advanced cancer ED visits.
Authors: Nortey Joel , Lynch Andrew , Lyon Liisa , Ramalingam Nirmala D. , Liu Raymond 
Published: June 2024

e24034 Background: Patients with advanced cancer often turn to the emergency department (ED) for pain treatment, impacting their quality of life and escalating healthcare costs. A crucial step in reducing avoidable ED visits is to identify the characteristics of this patient group and explore potential intervention points. This study aims to characterize the use of narcotics in the ED among patients with advanced cancer. Methods: This retrospective cross-sectional study involved adults aged 18 and older diagnosed with Stage IV solid cancers who passed away within one year of diagnosis (excluding those who died within 30 days). Participants had at least one ED visit within that year at one of 21 cancer centers within Kaiser Permanente Northern California from 2018 to 2020. Demographics, clinical variables, frequencies, and trends in ED visits were collected and compared based on opioid utilization. Pain management details for those receiving opioids during ED visits were also recorded. Results: The study encompassed 2,554 patients with 6,406 ED visits in their final year of life. Sixty-one percent of these patients received opioids during their ED visits, with a median of three visits per patient. In 56% of visits, patients had filled an opioid prescription within the last 30 days. Morphine (39%) and hydromorphone (29%) were the most commonly administered opioids, primarily intravenously (66%). The prevalent cancer subtypes receiving opioids during ED visits were breast, head and neck, and upper GI. Among patients in treatment with chemo, radiation, or both, 65% received opioids during ED visits, a higher rate compared to the 55% of patients not in treatment. For treated patients, chemotherapy was associated with increased ED visits requiring opioid pain management. Median survival did not differ significantly between those who received opioids during ED visits (130 days) and those who did not (123 days). Conclusions: This study emphasizes the dynamic pain needs of this patient population throughout their final year, leading them to seek pain management from the ED when their pain exceeds their home regimen. Factors influencing these needs include cancer subtype and current treatment status, particularly chemotherapy. Further studies are essential to understanding the variations in pain needs over the final year, enabling providers to better recognize and address changes in patients' pain requirements outside the ED.
Correlation between Palliative Performance Scale results and observed survival among Mexican patients with advanced cancer.
Authors: Cruz-Zermeño Mayte , Covarrubias-Gómez Alfredo , Lagunas-Medina Alex , Esparza-Orozco María Fernanda , Esparza-Orozco Raúl Emiliano , Ramos-Lopez Wendy Alicia , Soto Pérez de Celis Enrique , Chavarri Guerra Yanin 
Published: June 2024

e24040 Background: Cancer is a common cause of death among Hispanics. Estimating patient survival is critical in cancer care since it allows better shared decision-making and avoids use of futile therapy. Palliative Performance Scale (PPS) has been widely used for survival prediction among patients with cancer. However, its performance has not been validated across populations in Latin America, which could have different outcomes. The aim of this study was to analyze the correlation between PPS score and observed survival among patients with advanced cancer to facilitate physician and patient decision-making near the end of life. Methods: We conducted a retrospective observational analysis of patients with advanced cancer included in “ Te Acompañamos” cohort, a multidisciplinary patient navigator-led supportive care program in a single center in Mexico City. We used descriptive statistics to analyze clinico-demographic variables, PPS score, observed survival in days (from recruitment to death). Pearson correlation coefficients were used for correlating observed survival in days and predicted survival using PPS. U de Mann Whitney was used for comparing survival days between PPS groups. Results: We analyzed 246 patients with advanced cancer included in “Te Acompañamos” who died between August 2017-January 2024. Among these patients, 143 (58%) were women. Mean age was 64 years (SD 13). 153 patients (62%) had gastrointestinal (GI), 43 (17%) gynecologic, 19 (7%) genitourinary, 5 (2%) lung, 5 (2%) thyroid, and 21 (8%) other solid malignancies. Pancreatic cancer was the most common cancer (n = 60, 24%). Patients with GI cancer more frequently reported pain (59%) and had an average PPS of 67.7%. Mean survival was 233 days (SD 247) and mean predicted survival in days according to PPS was 68 days (SD 20). Correlation between observed survival days and PPS-predicted survival was low (R = 0.29). Patients with PPS < 50% had mean survival of 74.6 days while patients with PPS > 50% of 243.2 days (p < 0.05). Patients aged < 60 years with GI tumors had a higher PPS score, while older patients had a lower score (74.6% vs 65%; p < 0.05). No other significant differences were found in other subgroups. Conclusions: Our results show weak correlation between observed and predicted survival in days using PPS. However, lower PPS was associated with decreased survival. Among patients with GI cancers we observed that older patients had the lowest PPS scores. This study emphasizes the need to develop and validate more precise tools for survival prediction across patient populations, including minorities such as the Hispanics. Our study suggests that strategies to diagnose and alleviate pain promptly in patients with advanced cancer near the end of life are urgently required.
Relationship between hope and quality of life in patients with advanced cancer in Uruguay: An observational analysis.
Authors: Camejo Natalia , Amarillo Dahiana , Nantes Florencia , Castillo Cecilia , Krygier Gabriel David 
Published: June 2024

e24055 Background: International research suggests a beneficial effect of hope on quality of life in advanced-stage cancer patients. Specific evidence for Latin America and Uruguay is limited, highlighting the need to explore this relationship for regional clinical strategies. Objective: To evaluate the correlation between hope and quality of life in Uruguayan patients with advanced cancer. Methods: This observational, analytical-descriptive, and cross-sectional study used the Herth Hope Index (HHI) and the Functional Assessment of Cancer Therapy - General (FACT-G) Quality of Life questionnaire. It included 59 patients aged 18 or older, diagnosed with advanced, non-curable cancer. Results: There was a positive but non-significant correlation between HHI and FACT-G scores (Pearson coefficient of 0.05). Hope significantly correlated with support from oncology services (p = 0.044), family support (p = 0.003), and spiritual beliefs (p = 0.029). Factors like bone metastases, diagnostic delay, and being accompanied at consultations significantly impacted quality of life (p = 0.041, p = 0.035, p = 0.012). Conclusions: The study observed a positive association between hope and quality of life, but the lack of statistical significance indicates the need for more research. Clinically, results highlight the importance of comprehensive care addressing spiritual and emotional needs, in addition to medical treatment. It also underscores the potential impact of supportive services on patient well-being. Future research should include larger sample sizes and consider longitudinal designs to better understand hope's effects over time in advanced cancer patients.
A qualitative analysis of religious coping and participation in patients with head and neck cancer.
Authors: Osazuwa-Peters Nosayaba , Lee Jeehye Rose , Kotelanski Maia , Ballew Leslie , Ortiz Colton , Garcia Madeline , Bennion Alexandra , Jean Barton Sarah , Monroe Kimberly , Lee Walter T. , Bodd Monica Himaani 
Published: June 2024

e24093 Background: Head and neck cancer (HNC) and its treatment sequelae result in substantial disfigurement, depression, and isolation. Though up to 7 out of 10 cancer patients lean on prayer or other forms of spirituality for support, little is known about the significance of prayer and religious communities for patients with HNC. There is also a dearth of literature on the role of clergy as spiritual support for patients with HNC. In this qualitative study, we explore religious coping and barriers to community engagement both from a patient and clergy perspective. Methods: We purposively sampled ten patients with HNC from a single, comprehensive cancer center and twelve clergy for interviews. Patients were selected from a larger study of religious engagement and symptomatic distress. Clergy were recruited from a network of churches near the cancer center. Both patients and clergy completed semi-structured interviews, which were then transcribed and analyzed by descriptive content analysis. Results: Four main themes emerged from patient interviews: 1) HNC-related physical symptoms (dysphagia, stoma, impaired speech) hindered relationship-building with others and structured religious groups. 2) Most patients used positive religious coping, citing frequent prayer to God for strength during treatment and peace regardless of disease outcome. Few patients used negative religious coping, describing feelings of doubt and abandonment by God. 3) Patients predominantly found spiritual (prayer) and practical comfort (encouragement, phone calls) outside of religious communities through family, physicians, and support groups. 4) Barriers to religious community involvement included physical disability, satisfaction with individual spirituality, and religious community politics. Among clergy, barriers to patient engagement in religious communities included: lack of health literacy to understand patient needs, resource limitations, insufficient hospital emphasis on holistic health, and little awareness of opportunities for aid apart from psychosocial support. Overall, most clergy and patients believed faith to be an integral part of coping with head and neck cancer. Conclusions: Though patients with HNC experienced some isolation due to physical symptoms, many found spiritual support through private practices of prayer or individual relationships. Patient and clergy views on barriers to religious community involvement diverged; many patients felt satisfied with personal practices, and clergy felt distanced from patients. While future research should focus on clinical elicitation of religious coping strategies, our patients suggest the successful adaptation of such strategies to private contexts when faced with physically debilitating cancer diagnoses.
Prescription drug, healthcare utilization, and lost earnings cost of behavioral interventions for fear of cancer recurrence in breast cancer survivors.
Authors: Yeh Paul , Park Jae Man , Miller Kathy , Lairson David R. , Johns Shelley A. 
Published: June 2024

e24095 Background: Breast cancer survivors experience distress due to the fear of cancer recurrence. Acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) can treat the fear of cancer recurrence. However, no study has applied economic evaluation methods to estimate ACT and CBT behavioral intervention costs for breast cancer survivors. Methods: 384 adult stage I-IIIA breast cancer survivors with fear of cancer recurrence were randomly assigned to either the ACT (n = 128), CBT (n = 128), or enhanced usual care (EUC, n = 128) groups. Through micro-costing, we assessed the societal perspective cost of behavioral interventions using 2022 dollars. Per-capita drug costs, healthcare utilization, and lost productivity were calculated using participant survey data. Drug costs were estimated using Micromedex’s Red Book wholesale unit price. The 2022 Medicare Physician Fee Schedule for Indiana estimated healthcare utilization costs from outpatient, inpatient, and emergency visits. Lost productivity costs included work loss, productivity loss, and unpaid work loss, valued by Indiana's mean hourly wage. We assessed the cost differences between baseline (T1) and after the 6-week intervention period (T2). We evaluated between-group differences with Bonferroni's tests for each pairwise group comparison and within-group differences with a paired t-test at a p-value of < 0.05. Results: The mean total per-capita cost change from T1 to T2 in the ACT, CBT, and EUC groups was -$563, -$1622, and -$981, respectively (Table 1). This cost reduction stemmed from drug and healthcare utilization. There was no significant between-group difference in total cost at T1 or T2 and no significant between-group or within-group cost change from T1 to T2. Conclusions: Our cost estimates will be updated at 6 and 12 months of intervention and combined with changes in quality of life and mental health metrics to assess the cost-effectiveness of ACT and CBT for fear of breast cancer recurrence. Clinical trial information: NCT05364450 . [Table: see text]
Impact of semaglutide and tirzepatide administration on weight in women with stage I-III breast cancer.
Authors: Fischbach Neal A. , Zhou Bin , Deng Yanhong , Parsons Kayla , Shelton Amy , Lustberg Maryam B. 
Published: June 2024

e24140 Background: Weight gain and obesity are significant problems for women receiving adjuvant therapy for breast cancer and obesity is associated with adverse breast cancer outcomes. In addition, obesity is associated with negative impact on overall physical and mental health. The GLP-1 agonists, semaglutide (S) and tirzepatide (T), are effective in achieving weight loss and have been associated with decreased incidence of diabetes, stroke and overall mortality in the non-diabetic as well as diabetic populations. There are limited data on the efficacy and safety of GLP1 agonists in women with breast cancer. Methods: We performed a retrospective analysis of the association of S and T use with weight loss in patients with stage I-III breast cancer diagnosed and treated at the Yale Cancer Center/Yale New Haven Health Network between 2017 and 2022. After institutional review board approval, a database including 7149 patients including 92,989 office visits was constructed. Maximal weight loss after S/T prescription as well as mean weight loss were calculated. S and T treated patient’s stage distribution and rates of recurrence were compared to untreated patients. For patients without metastatic disease, repeated measures regression analysis was utilized to evaluate changes in weight and BMI. Results: Of the 5430 evaluable patients with non-metastatic disease, 70 (1.3%) were prescribed S or T. Mean age was 58 (41-78). 74% received endocrine therapy. Mean pretreatment weight was 95.8 kg and BMI was 35.9 kg/m2. Mean weight loss for S/T treated patients was 3.03 kg (3.9-2.13, p < .0001) corresponding to reduction in BMI of 1.1 kg/m2 (0.7-1.5 p < .0001). We also calculated maximal weight loss after S/T prescription. Mean maximal weight loss was 8.89 kg (6.71-10.98 P < .0001) corresponding to a mean maximal reduction in BMI of 3.2 kg/m2 (2.3-4.2 P < .0001). Rates of local, locoregional, and distant breast cancer recurrence were 1.5%, 0%, 1.5% in the S/T treated patients and 1.3%, 4.7% and 3.3% in the untreated patients. None of these differences were statistically significant. Conclusions: In this retrospective analysis, GLP-1 agonist are associated with clinically meaningful weight loss in overweight and obese women with early breast cancer. Recurrence risk did not appear to be preliminarily impacted by treatment. Additional research is needed on long term safety as well as weight loss maintenance with these drugs in breast cancer survivors.
Phase III Randomized, Placebo-Controlled Trial of Endocrine Therapy ± 1 Year of Everolimus in Patients With High-Risk, Hormone Receptor–Positive, Early-Stage Breast Cancer
Authors: Chavez-MacGregor Mariana , Miao Jieling , Pusztai Lajos , Goetz Matthew P. , Rastogi Priya , Ganz Patricia A. , Mamounas Eleftherios P. , Paik Soonmyung , Bandos Hanna , Razaq Wajeeha , O'Dea Anne , Kaklamani Virginia , Silber Andrea L.M. , Flaum Lisa E. , Andreopoulou Eleni , Wendt Albert G. , Carney Jennifer F. , Sharma Priyanka , Gralow Julie R. , Lew Danika L. , Barlow William E. , Hortobagyi Gabriel N. 
Published: June 2024

PURPOSE
Phosphatidylinositol 3-kinase/AKT-serine threonine kinase/mammalian target of rapamycin (mTOR) pathway abnormalities contribute to endocrine resistance. Everolimus, an mTOR inhibitor, improved progression-free survival in hormone receptor–positive metastatic breast cancer (BC) when combined with endocrine therapy (ET). In this phase III randomized, placebo-controlled trial, we assessed the efficacy of everolimus + ET as adjuvant therapy in high-risk, hormone receptor–positive, human epidermal growth factor receptor 2–negative BC after adjuvant/neoadjuvant chemotherapy.

METHODS
Patients were randomly assigned 1:1 to physician's choice ET and 1 year of everolimus (10 mg orally once daily) or placebo stratified by risk group. The primary end point was invasive disease-free survival (IDFS) evaluated by a stratified log-rank test with the hazard ratio (HR) estimated by Cox regression. Subset analyses included preplanned evaluation by risk group and exploratory analyses by menopausal status and age. Secondary end points included overall survival (OS) and safety. Everolimus did not improve IDFS/OS when added to ET in patients with early-stage high-risk, hormone receptor–positive BC.

RESULTS

One thousand and nine hundred thirty-nine patients were randomly assigned with 1,792 eligible for analysis. Overall, no benefit of everolimus was seen for IDFS (HR, 0.94 [95% CI, 0.77 to 1.14]) or OS (HR, 0.97 [95% CI, 0.75 to 1.26]). The assumption of proportional hazards was not met suggesting significant variability in the HR over time since the start of treatment. In an unplanned subgroup analysis among postmenopausal patients (N = 1,221), no difference in IDFS (HR, 1.08 [95% CI, 0.86 to 1.36]) or OS (HR, 1.19 [95% CI, 0.89 to 1.60]) was seen. In premenopausal patients (N = 571), everolimus improved both IDFS (HR, 0.64 [95% CI, 0.44 to 0.94]) and OS (HR, 0.49 [95% CI, 0.28 to 0.86]). Treatment completion rates were lower in the everolimus arm compared with placebo (48%
v
73%) with higher grade 3 and 4 adverse events (35%
v
7%).

CONCLUSION
One year of adjuvant everolimus + ET did not improve overall outcomes. Subset analysis suggests mTOR inhibition as a possible target for patients who remain premenopausal after chemotherapy.
De novo TANGLED1 recruitment from the phragmoplast to aberrant cell plate fusion sites in maize
Authors: Uyehara Aimee N. , Diep Beatrice N. , Allsman Lindy A. , Gayer Sarah G. , Martinez Stephanie E. , Kim Janice J. , Agarwal Shreya , Rasmussen Carolyn G. 
Published: June 2024

ABSTRACT
Division plane positioning is crucial for proper growth and development in many organisms. In plants, the division plane is established before mitosis, by accumulation of a cytoskeletal structure called the preprophase band (PPB). The PPB is thought to be essential for recruitment of division site-localized proteins, which remain at the division site after the PPB disassembles. Here, we show that the division site-localized protein TANGLED1 (TAN1) is recruited independently of the PPB to the cell cortex by the plant cytokinetic machinery, the phragmoplast, from experiments using both the PPB-defective mutant discordia1 (dcd1) and chemical treatments that disrupt the phragmoplast in maize. TAN1 recruitment to de novo sites on the cortex is partially dependent on intact actin filaments and the myosin XI motor protein OPAQUE1 (O1). These data imply a yet unknown role for TAN1 and possibly other division site-localized proteins during the last stages of cell division when the phragmoplast touches the cell cortex to complete cytokinesis.
CLINICAL AND RADIOLOGICAL OUTCOMES OF REVISION TOTAL ANKLE ARTHROPLASTY USING THE INBONE II PROSTHESIS
Authors: Jamjoom B. , Siddiqui B. , Salem H. , Raglan M. , Dhar S. 
Published: June 2024

BackgroundThe literature on the outcome of revision total ankle arthroplasty (TAA) remains limited. We aim to report the clinical and radiological outcomes of revision TAA at a high-volume centre in the UK.MethodsRetrospective review of 28 patients that underwent 29 revision TAA procedures using INBONE II prosthesis. Demographic, radiological, and patient reported outcome measures data were analysed.ResultsThe mean (range) duration from primary TAA to revision was 87.5 (16–223) months. The main indication for the revision was aseptic loosening of the primary TAA (82.8%). Additional procedures were required in 75.9% of patients. At mean (range) follow-up of 40 (24- 60) months, the infection, re-operation, and implant survival rates were 6.9%, 6.9% and 96.5% respectively. A significant postoperative improvement in the component alignment radiographic measures was observed. Osteolysis, subsidence, loosening and heterotopic ossification rates were comparable to other reports and did not influence the clinical outcome. A significant improvement was observed in the MOXFQ (all domains) and the EQ-5D (three domains) at 24 months postoperatively.ConclusionsRevision TAA using INBONE II was associated with good short-term survival and improvement in the postoperative scores at 2 years. Maintenance of the postoperatively improved alignment was documented at follow up. The relatively high survival rate in this series supports the notion that revision TAA is a satisfactory option for failed primary TAA.
Photonic device programmability in support of autonomous optical networks
Authors: Casellas Ramon , Nadal Laia , Martinez Ricardo , Vilalta Ricard , Muñoz Raul , Svaluto Moreolo Michela 
Published: June 2024

The emergence and consolidation of increasingly programmable optical devices such as transceivers, amplifiers, multiplexers, or ROADMs—which allow their remote configuration and control by adopting software-defined networking principles such as model-driven development—is enabling the evolution toward gradually more autonomous networks. Such networks leverage device programmability and are able to adapt and react to traffic and network condition changes, e.g., changing modes of operation or reconfiguring the network state, paving the way for the increased adoption of AI/ML models in support of enhanced network operation. In this paper, after a short review of some key elements in the control and orchestration systems of optical networks in support of autonomous networking, we present in detail a proof-of-concept validation of autonomous, closed-loop dynamic adaptation of transceiver operational modes. This includes (i) the design and development of an SDN agent of a multi-band sliceable bandwidth variable transceiver, based on extended OpenConfig terminal device data models; (ii) an SDN controller that performs discovery and management of transceivers’ operational modes and maps to transport API (TAPI) profiles enabling efficient physical layer impairment-aware path computation; (iii) a dedicated externalized path computation element/digital twin that performs adaptation recommendations; and (iv) an MQTT-based telemetry platform for publisher/subscriber based state synchronization between the control plane functional entities to avoid systematic polling.