bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and validation of a deep learning–based cardiovascular disease risk prediction model for long-term breast cancer survivors.
Authors: Oh Sinae , Shim Jae Yong 
Published: June 2024

12023 Background: Previous efforts in predicting cardiotoxicity risk among patients with breast cancer have mostly focused on preventing and monitoring of cardiovascular complications during cancer therapy. We aimed to develop prediction models for the risk of chronic cardiovascular complications in breast cancer survivors during long-term follow-up. Methods: We used the Korean National Health Insurance Service databases between 2005 and 2021, including 5,131 5-year female breast cancer survivors diagnosed in 2006. The study cohort was randomized on a 4:1 ratio into the derivation and validation cohort. The primary outcome was the occurrence of major adverse cardiovascular events (MACEs), a composite of acute myocardial infarction, congestive heart failure, and stroke, at any time before the final follow-up at 10 years. We used the Cox proportional hazards model (CoxPH) with the least absolute shrinkage and selection operator penalty to determine the order of clinical factors based on their absolute coefficient value. We developed a deep learning survival model (DeepSurv) and compared its performance with traditional models such as CoxPH and random survival forest (RSF) using the same dataset. Model performance was assessed by discrimination and calibration. Results: During the 48054.1 person-years of follow-up, 325 (6.3%) patients developed MACE. We identified 18 relevant clinical factors without zero coefficients, including age, hypertension, atrial fibrillation, stroke, diabetes mellitus, myocardial infarction, household income, congestive heart failure, hemoglobin level, systolic blood pressure, peripheral arterial occlusive disease, chronic kidney disease, aromatase inhibitor use, alcohol consumption, cigarette smoking, tamoxifen use, radiotherapy, and total cholesterol level. The CoxPH, RSF, and DeepSurv model yielded time-dependent concordance index values of 0.713, 0.721, and 0.729, respectively, in the validation cohort. all models demonstrated good integrated Brier scores of 0.031 or less. Conclusions: We developed and validated a deep learning survival model that predict MACEs in individual 5-year breast cancer survivors, incorporating both conventional and breast cancer treatment-related cardiovascular risk factors, and demonstrated good calibration and discrimination. These models can assist breast cancer survivors and clinicians in optimally selecting risk-reducing strategies based on individual MACEs risk.
The impact of glucagon-like peptide 1 agonists on anthracycline or human epidermal growth factor receptor 2 inhibitor-associated cardiotoxicity in patients with breast cancer and diabetes mellitus.
Authors: Chiang Cho Han , Chang Yu-Cheng , Tang Zhiting , See Xin Ya , Chi Kuan-Yu , Chang Yu , Chiang Cho Hung , Ghamari Azin , Curtis Lauren Mary , Neilan Tomas G. 
Published: June 2024

12026 Background: Anthracyclines or human epidermal growth factor receptor 2 (HER-2) inhibitors are associated with the potential for major adverse cardiovascular outcomes (MACE) among patients with breast cancer. Diabetes mellitus (DM) further increases the risk of MACE. Glucagon-like peptide 1 agonists (GLP1a) have been shown to improve MACE in the non-cancer population; however, there are no data testing whether GLP1a reduce the risk for MACE associated with anthracyclines or HER-2 inhibitors. Therefore, we hypothesized that GLP1a may decrease the risk for MACE among patients with breast cancer and DM receiving anthracycline or HER-2 inhibitors. Methods: We performed a retrospective, propensity score-matched cohort study using the TriNetX Analytics Network database, which contains de-identified data from over 120 participating healthcare institutions. We included adult breast cancer patients with type 2 DM who were treated with an anthracycline or HER-2 inhibitor therapy. We matched patients receiving a GLP1a with patients receiving non-GLP1a second-line diabetes medication based on the following variables: age, sex, pre-existing cardiac disease, the use of radiation, metastatic disease, cancer therapy, underlying comorbidities, and use of cardiovascular and diabetes medications. The primary outcome of interest, MACE, was defined as a composite of heart failure, myocardial infarction, and atrial fibrillation/flutter. Secondary outcomes included a composite of heart failure hospitalization and incident heart failure. Safety outcomes included all-cause mortality within 5 years of therapy initiation. Results: We matched 724 patients receiving a GLP1a treatment with patients receiving non-GLP1a treatment. The median age was 60 years for both cohorts. The prevalence of hypertension (81%), metastatic disease (61%), and radiation therapy (42%) was similar between cohorts, as was the use of anthracyclines and HER-2 inhibitors. In Cox proportional hazard analyses, the group receiving GLP1a treatment was associated with a lower risk of MACE (Hazard ratio (HR), 0.59 [95% CI: 0.41-0.86]), and heart failure hospitalization (HR, 0.56 [95% CI: 0.37-0.83]), and all-cause mortality (HR, 0.67 [95% CI: 0.48-0.93]) compared with non-GLP1a. Conclusions: GLP1a were associated with a reduction in major adverse cardiovascular events, incident heart failure and heart failure hospitalization, and all-cause mortality among anthracycline or HER-2 inhibitor-treated patients with breast cancer and DM. [Table: see text]
Experience of young patients with cancer discussing cannabis with their providers.
Authors: Baral Amrit , Diggs Bria-Necole A. , Marrakchi El Fellah Ranya , Hernandez Ortega Nicolas , Islam Jessica Yasmine , Camacho-Rivera Marlene , Penedo Frank J. , Vidot Denise Christina 
Published: June 2024

12061 Background: Although cannabis use among cancer patients to manage cancer treatment-related symptoms continues to grow, little is known about patterns in patient-provider communication regarding cannabis use. We examined demographic differences in cannabis communication among cancer patients and providers at a National Cancer Institute designated cancer center. Methods: We used data of 495 cancer patients via an anonymous electronic survey administered at the University of Miami via REDCap. Participants with consent to contact notations in their electronic medical record were recruited via phone calls and personalized messages in their MyUCHART portal. Self-reported responses on patients' disclosure of cannabis use to healthcare providers and their comfort on discussing cannabis with cancer doctors were analyzed. Age was categorized as: 20-39y, 40-59y and ≥60y. Chi-squared/Fisher’s exact tests and logistic regression analyses were conducted adjusting for age, sex, and ethnicity. Results: The sample was 51.8% male, 39.4% Hispanic, and mean age was 45.9y (SD=15.1) (41.1% were between 20-39y); 43.8% were undergoing treatment and 35.4% were in follow-up/finished treatment. Almost half (45.5%) reported current (past 30-days) cannabis use. Younger (20-39y) patients had higher prevalence of not disclosing cannabis use than older (>60y) patients (36.8% vs 23.9% p<0.01). There were no sex or ethnicity statistical differences. Majority (67.7%) of current cannabis users reported comfort discussing cannabis use with their provider. However, among individuals aged 20-39y, 40.8% reported feeling uncomfortable discussing cannabis with their cancer doctor. In the 40-59y age group, 21.0% expressed discomfort, while only 5.6% of those over 60 years reported similar unease. After adjusting for age, sex, and ethnicity, newly diagnosed cancer patients had lower odds (aOR:0.41, 95% CI:0.17-0.99) of feeling comfortable discussing cannabis use compared to those in follow-up/finished treatment group. Conclusions: Age was a significant factor in disclosing cannabis use to healthcare providers, with disparities noted by age group. These insights highlight the importance of considering age-related factors and treatment status when addressing cannabis use discussions within the oncology setting.
Accuracy of medical oncology prognosis for patients with metastatic cancer evaluated for enrollment onto an ongoing randomized clinical trial.
Authors: McClelland Shearwood 
Published: June 2024

12063 Background: For patients with metastatic cancer, a key aspect of interdisciplinary care has involved the overall prognosis provided by Medical Oncology, which often dictates the intensity and direction of further care while impacting all other disciplines, most prominently Radiation Oncology, Surgical Oncology and Palliative Medicine. Despite the millions of patients for whom such prognoses have been ascribed, the success rate of Medical Oncology prognosis has been sparsely described. This study represents prospective evaluation of Medical Oncology prognosis accuracy for patients having been considered for enrollment onto an ongoing Phase 2 randomized controlled oncology trial. Methods: The ongoing Spine Patient Optimal Radiosurgery Treatment for Symptomatic MEtastatic Neoplasms (SPORTSMEN) clinical trial (clinicaltrials.gov number NCT05617716) is a Phase 2 randomized clinical trial examining optimal radiation therapy treatment of symptomatic spinal metastases with a primary endpoint of pain freedom at 3 months post-treatment. A key eligibility criteria for trial enrollment is overall prognosis exceeding 3 months, typically provided by Medical Oncology. During the first year of trial enrollment, Medical Oncology prognosis for patients considered for SPORTSMEN inclusion was prospectively assessed for accuracy. Results: From January 2023 through December 2023, a total of 27 patients with documented Medical Oncology prognosis were considered for SPORTSMEN enrollment. Medical Oncology administered a prognosis exceeding three months in 26 patients, and less than three months in one patient. Of patients with a prognosis exceeding three months, 12 (46%) succumbed to death or hospice care prior to three months; the patient ascribed a prognosis of less than three months did not survive to exceed this threshold. The Medical Oncology prognosis overall was proven correct for 15 of 27 patients (56%). Medical Oncologist prognostic accuracy was 13/19 (68.4%) for outpatients, and 2/8 (25%) for inpatients; this difference was statistically significant (p=0.0381). Conclusions: In patients with symptomatic metastatic spine disease, the estimated prognosis provided by Medical Oncology is often optimistic, as nearly half of patients assigned a prognosis of greater than three months failed to reach this threshold before experiencing death or hospice. These findings indicate that providers considering enrolling patients on clinical trials should expect a prognosis overestimation rate exceeding 40%. Consequently, a more heuristic approach to assessing patient prognosis may be necessary to avoid unwarranted prognostic optimism, particularly for inpatients. Such an approach could potentially provide a more compassionate and cost-effective management of these patients’ remaining lifespan thereby optimizing quality-of-life.
Sociodemographic characteristics associated with reading online health education materials among patients with cancer.
Authors: White Melissa Christina , Bhardwaj Arun , Christman Amanda , Osazuwa-Peters Nosayaba 
Published: June 2024

12111 Background: Health literacy is an important aspect of navigating cancer care. There are over 18 million cancer survivors currently in the United States, and the number is expected to continue increasing. As new therapeutic options emerge for cancer patients, it is important that patients are able to read and understand literature from their clinical encounters regarding their treatment options and prognosis. Very little real-world data exists describing cancer patients’ reading of cancer information. We aimed to identify baseline characteristics associated with reading online health education materials among patients during active cancer care. Methods: We used retrospective data from Navigating Cancer for individuals ≥18 years, with confirmed cases of cancer between 2017 and 2023. We performed an unadjusted comparison of baseline characteristics between patients who read at least one article versus those who did not read, using chi-square test. Multivariable logistic regression estimated associations between patients’ sociodemographic characteristics and online health education material reading status (read vs. not read). Results: Among 2,903 eligible patients with cancer included in the study, approximately 65% ( n= 1890) read the online health educational materials. On average, females dominated both reading status categories (femaleread=70%; femalenot_read=70.98%). However, on average patients in the “not read” category differed with a relatively higher proportion of younger adults (≤40read=14.81% vs. ≤40not_read=20.04%) and lower rates of graduate education (graduateread=27.2% vs. graduatenot_read=19.74%). In the fully-adjusted model, age group was associated with reading status, with a 31% lower odds for patients with cancer ≤ 40 years (aOR = 0.69, 95% CI 0.55-0.87; P=0.001), and a 38% lower odds for older patients 80+ years (aOR = 0.62, 95% CI 0.42-0.93; P=0.022) relative to patients 40-60 years. Also, education was a significant predictor, with a 36% reduced odds for patients with a high school diploma or less (aOR=0.64, 95% CI 0.53-0.76; P<0.001), but 26% higher odds for graduates (aOR = 1.26, 95% Ci 1.03-1.55; P=0.022), relative to patients with some college education. Similarly, White patients relative to Non-White patients with cancer (aOR = 1.27, 95% CI 1.08-1.49; P=0.004) showed 27% increased odds of reading online educational materials. Conclusions: This study showed an association between age, race, educational status and odds of reading online cancer health education among cancer survivors. Given the focus on patient-centered cancer care and equity in physician-patient cancer communication, it is important that clinical providers recognize factors associated with reading of cancer education materials in their patient population.
Risks of Iodine Excess
Authors: Sohn Seo Young , Inoue Kosuke , Rhee Connie M , Leung Angela M 
Published: June 2024

Abstract
Iodine is a micronutrient that is required for thyroid hormone synthesis. The iodide cycle in thyroid hormone synthesis consists of a series of transport, oxidation, organification, and binding/coupling steps in thyroid follicular cells. Common sources of iodine include the consumption of an iodine-rich diet or iodine-fortified foods, the administration of amiodarone, iodine-containing supplements, or iodinated contrast media, and other miscellaneous sources. Methods to assess population iodine status include the measurement of urinary iodine concentrations, blood thyroglobulin levels, prevalence of elevated neonatal thyrotropin levels, and thyroid volume. Although excessive iodine intake or exposure is generally well tolerated, an acute iodine load may result in thyroid dysfunction (hypothyroidism or hyperthyroidism) in certain susceptible individuals due to the failure to escape from the Wolff–Chaikoff effect and to the Jod–Basedow phenomenon, respectively. In this review, we discuss the associations between excessive iodine intake or exposure, with particular focus on iodinated contrast media as a common source of excess iodine in health care settings, and risks of incident thyroid dysfunction. We also summarize the risks of iodine excess in vulnerable populations and review current guidelines regarding the screening and monitoring of iodinated contrast–induced thyroid dysfunction. Finally, we discuss the long-term potential nonthyroidal health risks associated with iodine excess and suggest the need for more data to define safe upper limits for iodine intake, particularly in high-risk populations.
Capacity Allocation and Scheduling in Two-Stage Service Systems with Multiclass Customers
Authors: Zhong Zhiheng , Cao Ping , Huang Junfei , Zhou Sean X. 
Published: June 2024

Problem definition: This paper considers a tandem queueing system in which stage 1 has one station serving multiple classes of arriving customers with different service requirements and related delay costs, and stage 2 has multiple parallel stations, with each station providing one type of service. Each station has many statistically identical servers. The objective is to design a joint capacity allocation between stages/stations and scheduling rule of different classes of customers to minimize the system’s long-run average cost. Methodology/results: Using fluid approximation, we convert the stochastic problem into a fluid optimization problem and develop a solution procedure. Based on the solution to the fluid optimization problem, we propose a simple and easy-to-implement capacity allocation and scheduling policy and establish its asymptotic optimality for the stochastic system. The policy has an explicit index-based scheduling rule that is independent of the arrival rates, and resource allocation is determined by the priority orders established between the classes and stations. We conduct numerical experiments to validate the accuracy of the fluid approximation and demonstrate the effectiveness of our proposed policy. Managerial implications: Tandem queueing systems are ubiquitous. Our results provide useful guidelines for the allocation of limited resources and the scheduling of customer service in those systems. Our proposed policy can improve the system’s operational efficiency and customers’ service quality. Funding: Z. Zhong’s research is partially supported by the Fundamental Research Funds for the Central Universities [Grant 2023ZYGXZR074] and the Hunan Provincial Natural Science Foundation of China [Grant 2022JJ40109]. P. Cao’s research is partially supported by the National Natural Science Foundation of China [Grant 72122019]. J. Huang’s research is partially supported by the Hong Kong Research Grants Council General Research Fund [CUHK-14501621] and the National Natural Science Foundation of China [Grant 72222023]. S. X. Zhou’s research is partially supported by the Hong Kong Research Grants Council General Research Fund [CUHK-14500921], the National Natural Science Foundation of China [Grant 72394395], and the Asian Institute of Supply Chains and Logistics. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2023.0266 .
MediYoga compared to physiotherapy treatment as usual for patients with stress-related symptoms in primary care rehabilitation: A randomized controlled trial
Authors: Bellfjord Madeleine , Grimby-Ekman Anna , Larsson Maria E. H. 
Published: June 2024

Objective
The purpose of this study was to compare the effect of MediYoga as a group treatment to conventional treatment provided by a physiotherapist for people with perceived stress-related symptoms.

Design
Randomized controlled trial.

Settings
Primary care rehabilitation, Gothenburg Sweden.

Subjects
Fifty-five patients with stress-related symptoms were invited to participate. Nine patients declined, and a total of 46 patients aged 26–70 years (mean 47), 44 women and two men were randomized, 23 to the MediYoga group and 23 to the physiotherapy treatment as usual group.

Interventions
The MediYoga group performed MediYoga for one hour a week during an 8-week period. The control group received physiotherapy treatment as usual.

Main measures
Data were mainly collected by self-reported questionnaires. For primary outcome the Swedish version of the Perceived Stress Scale (PSS) was used. Secondary outcomes were the Hospital Anxiety and Depression Scale (HADS), EuroQol–5D (EQ-5D) and EuroQol–Visual Analog Scale (EQ-VAS). Thoracic excursion was the only physical measurement. Mixed effect model was used for analyse.

Results
For the primary outcome PSS, there was a close to statistically significant group effect over time advantaging MediYoga over physiotherapy (P = 0.06). For secondary outcomes, the group effect over time was statistically significant in HADS anxiety (P = 0.01) and EQ-VAS (P = 0.03). There was a group trend over time advantaging MediYoga in HADS depression (P = 0.08).

Conclusion
Despite a large dropout in both groups, MediYoga can be recommended as a treatment option for people suffering from stress-related symptoms.

Trial registration
Registered in: ClinicalTrials.gov NCT02907138
Exposure to anti- and pro-smoking messages among adults in China: Results from the Global Adult Tobacco Survey, 2018
Authors: Pei Di , Popova Lucy , Chowdhury Pranesh , Shi Jing , Njie Gibril 
Published: June 2024

Significance
For decades, tobacco advertisements and promotions have been common in mass media and public places in China. In 2015, China amended the Advertising Law to prohibit the distribution of tobacco advertising, while also initiating waves of tobacco control media campaigns. This study investigates the associations between exposure to anti- and pro-smoking messages, smoking status, and people’s smoking-related beliefs and willingness to support tobacco control policies.

Methods
A secondary data analysis was performed with the 2018 Global Adult Tobacco Survey of 19,376 adults aged ≥15 years in China. Anti- and pro-smoking message exposures were measured as the sum of sources (media or places) where respondents have seen the messages. Multivariable logistic regression analyses were conducted to examine the relationships among smoking status, message exposure, and the outcome variables (health harm beliefs, support for increasing tax on cigarettes, support for using part of the increased tax on tobacco control) controlling for smoking status and demographic differences.

Results
Overall, 63.3% of the respondents reported being exposed to anti-smoking messages from at least 1 source, while 18.1% were exposed to pro-smoking messages from at least 1 source. Adults who currently, formerly, and never smoked differed in their beliefs about smoking and willingness to support tobacco control policies. Greater reported exposure to anti-smoking messages was positively associated with belief that smoking is harmful, support for increased cigarette tax, and support for using increased tax revenue for tobacco control measures. Meanwhile, greater reported exposure to pro-smoking messages was negatively related to willingness to support cigarette tax increases.

Conclusions
While national and local tobacco control campaigns in China have reached a large proportion of the adult population, there is still room for improvement. China might consider expanding anti-tobacco campaigns, as reported exposure to these messages is associated with increased public awareness of the health hazards of smoking and support for increasing cigarette taxes.