bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of unmethylated MGMT-promoter recurrent glioblastoma with cancer stem cell assay-guided chemotherapy and the impact on patients’ healthcare costs
Authors: Ranjan Tulika , Yu Alexander , Elhamdani Shaed , Howard Candace M , Lirette Seth T , Denning Krista L , Valluri Jagan , Claudio Pier Paolo 
Published: May 2023

Abstract

Background
Glioblastoma (GBM) is a lethal disease. At least in part, the recurrence of GBM is caused by cancer stem cells (CSCs), which are resistant to chemotherapy. Personalized anticancer therapy against CSCs can improve treatment outcomes. We present a prospective cohort study of 40 real-world unmethylated Methyl-guanine-methyl-transferase-promoter GBM patients treated utilizing a CSC chemotherapeutics assay-guided report (ChemoID).

Methods
Eligible patients who underwent surgical resection for recurrent GBM were included in the study. Most effective chemotherapy treatments were chosen based on the ChemoID assay report from a panel of FDA-approved chemotherapies. A retrospective chart review was conducted to determine OS, progression-free survival, and the cost of healthcare costs. The median age of our patient cohort was 53 years (24–76).

Results
Patients treated prospectively with high-response ChemoID-directed therapy, had a median overall survival (OS) of 22.4 months (12.0–38.4) with a log-rank P = .011, compared to patients who could be treated with low-response drugs who had instead an OS of 12.5 months (3.0–27.4 months). Patients with recurrent poor-prognosis GBM treated with high-response therapy had a 63% probability to survive at 12 months, compared to 27% of patients who were treated with low-response CSC drugs. We also found that patients treated with high-response drugs on average had an incremental cost-effectiveness ratio (ICER) of $48,893 per life-year saved compared to $53,109 of patients who were treated with low-response CSC drugs.

Conclusions
The results presented here suggest that the ChemoID Assay can be used to individualize chemotherapy choices to improve poor-prognosis recurrent GBM patient survival and to decrease the healthcare cost that impacts these patients.
A multi-institutional retrospective pooled outcome analysis of molecularly annotated pediatric supratentorialZFTA-fused ependymoma
Authors: Ng Chia Huan , Obrecht Denise , Wells Olivia , Zapotocky Michal , Sumerauer David , Coltin Hallie , Khuong-Quang Dong-Anh , Eisenstat David D , Kinross Kathryn M , White Christine L , Algar Elizabeth M , Luck Amanda , Witt Hendrik , Schüller Ulrich , Mynarek Martin , Pietsch Torsten , Gerber Nicolas U , Benesch Martin , Warmuth-Metz Monika , Kortmann Rolf , Bison Brigitte , Taylor Michael D , Rutkowski Stefan , Pfister Stefan M , Jones David TW , Gottardo Nicholas G , von Hoff Katja , Pajtler Kristian W , Ramaswamy Vijay , Hansford Jordan R 
Published: May 2023

AbstractBackgroundZFTA-RELA (formerly known as c11orf-RELA) fused supratentorial ependymoma (ZFTAfus ST-EPN) has been recognized as a novel entity in the 2016 WHO classification of CNS tumors and further defined in the recent 2021 edition. ZFTAfus ST-EPN was reported to portend poorer prognosis when compared to its counterpart, YAP1 ST-EPN in some previously published series. The aim of this study was to determine the treatment outcome of molecularly confirmed and conventionally treated ZFTAfus ST-EPN patients treated in multiple institutions.MethodsWe conducted a retrospective analysis of all pediatric patients with molecularly confirmed ZFTAfus ST-EPN patients treated in multiple institutions in 5 different countries (Australia, Canada, Germany, Switzerland, and Czechia). Survival outcomes were analyzed and correlated with clinical characteristics and treatment approaches.ResultsA total of 108 patients were collated from multiple institutions in 5 different countries across three continents. We found across the entire cohort that the 5- and 10-year PFS were 65% and 63%, respectively. The 5- and 10-year OS of this cohort of patients were 87% and 73%. The rates of gross total resection (GTR) were high with 84 out of 108 (77.8%) patients achieving GTR. The vast majority of patients also received post-operative radiotherapy, 98 out of 108 (90.7%). Chemotherapy did not appear to provide any survival benefit in our patient cohort.ConclusionThis is the largest study to date of contemporaneously treated molecularly confirmed ZFTAfus ST-EPN patients which identified markedly improved survival outcomes compared to previously published series. This study also re-emphasizes the importance of maximal surgical resection in achieving optimal outcomes in pediatric patients with supratentorial ependymoma.
Significance of molecular diagnostics for therapeutic decision-making in recurrent glioma
Authors: Blobner Jens , Dengler Laura , Blobner Sven , Eberle Constantin , Weller Jonathan , Teske Nico , Karschnia Philipp , Rühlmann Katharina , Heinrich Kathrin , Ziemann Frank , Greif Philipp A , Jeremias Irmela , Wuerstlein Rachel , Hasselmann Korbinian , Dorostkar Mario , Harter Patrick N , Quach Stefanie , Stoecklein Veit , Albert Nathalie L , Niyazi Maximilian , Tonn Joerg-Christian , Thon Niklas , Christoph Westphalen Benedikt , von Baumgarten Louisa 
Published: May 2023

Abstract

Background
Targeted therapies have substantially improved survival in cancer patients with malignancies outside the brain. Whether in-depth analysis for molecular alterations may also offer therapeutic avenues in primary brain tumors remains unclear. We herein present our institutional experience for glioma patients discussed in our interdisciplinary molecular tumor board (MTB) implemented at the Comprehensive Cancer Center Munich (LMU).

Methods
We retrospectively searched the database of the MTB for all recurrent glioma patients after previous therapy. Recommendations were based on next-generation sequencing results of individual patient’s tumor tissue. Clinical and molecular information, previous therapy regimens, and outcome parameters were collected.

Results
Overall, 73 consecutive recurrent glioma patients were identified. In the median, advanced molecular testing was initiated with the third tumor recurrence. The median turnaround time between initiation of molecular profiling and MTB case discussion was 48 ± 75 days (range: 32–536 days). Targetable mutations were found for 50 recurrent glioma patients (68.5%). IDH1 mutation (27/73; 37%), epidermal growth factor receptor amplification (19/73; 26%), and NF1 mutation (8/73; 11%) were the most detected alterations and a molecular-based treatment recommendation could be made for all of them. Therapeutic recommendations were implemented in 12 cases (24%) and one-third of these heavily pretreated patients experienced clinical benefit with at least disease stabilization.

Conclusions
In-depth molecular analysis of tumor tissue may guide targeted therapy also in brain tumor patients and considerable antitumor effects might be observed in selected cases. However, future studies to corroborate our results are needed.
Paediatricians’ awareness of Canadian screen time guidelines, perception of screen time use, and counselling during the COVID-19 pandemic
Authors: Amos Kiersten A , Ogilvie Jacqueline D , Ponti Michelle , Miller Michael R , Yang Fanyu , Ens Andrea R 
Published: May 2023

Abstract

Objectives
Paediatricians are essential in guiding families on screen time use as digital media becomes increasingly prevalent. While this has been highlighted through the COVID-19 pandemic there is no literature on paediatricians’ awareness of Canadian screen time guidelines, or perception of these guidelines during this time. The aim of this study was to assess pediatricians’ knowledge, attitudes, and comfort with the Canadian Paediatric Society’s (CPS) screen time guidelines, specifically during the COVID-19 pandemic.

Methods
Our survey was developed by a paediatric resident and paediatric endocrinologist, reviewed by local experts, and sent electronically to members of the CPS Community and Developmental Paediatrics sections.

Results
All 53 respondents were aware of current CPS screen time guidelines, and the majority self-reported fair to excellent knowledge of guidelines for both age groups (&lt;5 years and school-aged children/adolescents). Over 80% noticed increased screen use during the pandemic, and 98% were somewhat or very concerned about screen use and their patients’ health and well-being. Pediatricians reported concerns about associations between increased screen time with worsening behaviour, mental health concerns, obesity, and sedentary lifestyle. The greatest barrier to reducing screen time was perceived insufficient motivation or support from caregivers/families.

Conclusions
Responding Canadian paediatricians are knowledgeable and comfortable with current screen time guidelines in Canada. Despite this, there is increasing concern with health outcomes associated with screen use. These results highlight paediatricians’ important role in counselling patients and may encourage further local advocacy and public education around screen use and associated health risks in children.
BLE beacon-based floor detection for mobile robots in a multi-floor automation laboratory
Authors: Wu Haiping , Liu Hui , Roddelkopf Thomas , Thurow Kerstin 
Published: May 2023

Abstract
As an important task of multi-floor localization, floor detection has elicited great attention. Wireless infrastructures like Wi-Fi and Bluetooth Low Energy (BLE) play important roles in floor detection. However, most floor detection research tends to focus on data modelling but pays little attention to the data collection system, which is the basis of wireless infrastructure-based floor detection. In fact, the floor detection task can be greatly simplified with proper data collection system design. In this paper, a floor detection solution is developed in a multi-floor life science automation lab. A data collection system consisting of BLE beacons, a receiver node and an Internet of Things (IoT) cloud is provided. The features of the BLE beacon under different settings are evaluated in detail. A mean filter is designed to deal with the fluctuation of the received signal strength indicator data. A simple floor detection method without a training process was implemented and evaluated in more than 100 floor detection tests. The time delay and floor detection accuracy under different settings are discussed. Finally, floor detection is evaluated on the H20 multi-floor transportation robot. Two sensor nodes are installed on the robot at different heights. The floor detection performance with different installation heights is discussed. The experimental results indicate that the proposed floor detection method provides floor detection accuracy of 0.9877 to 1 with a time delay of 5 s.
Older Adults’ Perspectives on Screening for Cognitive Impairment Following Critical Illness: Pre-Implementation Qualitative Study
Authors: Keegan Alek , Strahley Ashley , Taylor Stephanie P. , Wilson Taniya M. , Shah Meehir D. , Williamson Jeff , Palakshappa Jessica A. 
Published: May 2023

OBJECTIVES:
Screening for cognitive impairment following ICU discharge is recommended but not part of routine care. We sought to understand older adults’ perspectives on screening for cognitive impairment following an ICU admission to inform the design and delivery of a cognitive screening intervention.

DESIGN:
Qualitative study using semi-structured interviews.

SUBJECTS:
Adults 60 years and older within 3 months of discharge from an ICU in an academic health system.

INTERVENTIONS:
Interviews were conducted via telephone, audio recorded and transcribed verbatim. All transcripts were coded in duplicate. Discrepancies were resolved by consensus. Codes were organized into themes and subthemes inductively.

MEASUREMENTS AND MAIN RESULTS:
We completed 22 interviews. The mean age of participants was 71 ± 6 years, 14 (63.6%) were men, 16 (72.7%) were White, and 6 (27.3%) were Black. Thematic analysis was organized around four themes: 1) receptivity to screening, 2) communication preferences, 3) information needs, and 4) provider involvement. Most participants were receptive to cognitive screening; this was influenced by trust in their providers and prior experience with cognitive screening and impairment. Participants preferred simple, direct, compassionate communication. They wanted to understand the screening procedure, the rationale for screening, and expectations for recovery. Participants desired input from their primary care provider to have their cognitive screening results placed in the context of their overall health, because they had a trusted relationship, and for convenience.

CONCLUSIONS:
Participants demonstrated limited understanding of and exposure to cognitive screening but see it as potentially beneficial following an ICU stay. Providers should use simple, straightforward language and place emphasis on expectations. Resources may be needed to assist primary care providers with capacity to provide cognitive screening and interpret results for ICU survivors. Implementation strategies can include educational materials for clinicians and patients on rationale for screening and recovery expectations.
Value of Coronary Sinus During Computed Tomography Pulmonary Angiography for Predicting Pulmonary Hypertension in Patients with Acute Pulmonary Embolism
Authors: Zhang Chuang , Xin Qian , Xu Hongling , Wang Xiangyu , Yan Zhiqiang , Sun Shengtao , Shi Xiangmin , Tian Mei 
Published: May 2023

Objective:
Computed tomography pulmonary angiography (CTPA) parameters are valuable for predicting pulmonary hypertension (PH) in patients with pulmonary embolism (PE). However, few studies have used the coronary sinus ostium area (CSOA), derived from CTPA, to detect PH. This study aimed to compare the prognostic values of the CSOA, coronary sinus ostium diameter (CSOD), and right ventricular (RV)/left ventricular (LV) ratio for PH.

Methods:
This study retrospectively analyzed 78 patients (mean age, (51.94 ± 12.33) years; 53.8% male) with acute PE confirmed by CTPA at the Sixth and Eighth Medical Centers of the People’s Liberation Army General Hospital between June 2018 and June 2020. Patients were categorized into 2 groups using a pulmonary artery systolic pressure (PASP) cut-off of 30 mmHg. CTPA parameters were compared between these groups.

Results:
Patients with PASP >30 mmHg (n = 22) had a larger CSOA, CSOD, RV diameter, RV/LV ratio, and inferior vena cava diameter compared with patients with PASP ≤30 mmHg (n = 56). The CSOA had an area under the receiver-operating characteristic curve (AUC, 0.84; 95% confidence interval (CI), 0.74–0.94; P < 0.001) similar to that of the RV/LV ratio (AUC, 0.85; 95%CI, 0.73–0.99; P < 0.001), while that of the CSOD was smaller (AUC, 0.66; 95%CI, 0.51–0.81; P < 0.05).

Conclusion:
Both CSOA and CSOD demonstrated a good ability to predict PH, while CSOA better predicted PASP >30 mmHg.
Impact of performance-based budgeting on quality outcomes in U.S. military health care facilities
Authors: Decker Kimberly L. , Schwab Stephen D. , Bazzoli Gloria J. , Chukmaitov Askar S. , Wernz Christian 
Published: May 2023

Background
Performance-based budgeting (PBB) is a variation of pay for performance that has been used in government hospitals but could be applicable to any integrated system. It works by increasing or decreasing funding based on preestablished performance thresholds, which incentivizes organizations to improve performance. In late 2006, the U.S. Army implemented a PBB program that tied hospital-level funding decisions to performance on key cost and quality-related metrics.

Purpose
The aim of this study was to estimate the impact of PBB on quality improvement in U.S. Army health care facilities.

Approach
This study used a retrospective difference-in-differences analysis of data from two Defense Health Agency data repositories. The merged data set encompassed administrative, demographic, and performance information about 428 military health care facilities. Facility-level performance data on quality indicators were compared between 187 Army PBB facilities and a comparison group of 241 non-PBB Navy and Air Force facilities before and after program implementation.

Results
The Army’s PBB programs had a positive impact on quality performance. Relative to comparison facilities, facilities that participated in PBB programs increased performance for over half of the indicators under investigation. Furthermore, performance was either sustained or continued to improve over 5 years for five of the six performance indicators examined long term.

Conclusion
Study findings indicate that PBB may be an effective policy mechanism for improving facility-level performance on quality indicators.

Practice Implications
This study adds to the extant literature on pay for performance by examining the specific case of PBB. It demonstrates that quality performance can be influenced internally through centralized budgeting processes. Though specific to military hospitals, the findings might have applicability to other public and private sector hospitals who wish to incentivize performance internally in their organizational subunits through centralized budgeting processes.
Comparison of Long-Term Outcomes of DSEK and DMEK in Fuchs Endothelial Dystrophy
Authors: Fu Lanxing , Hollick Emma J. 
Published: May 2023

Purpose:
This study aimed to compare the long-term endothelial cell loss, graft survival, and clinical outcomes in patients with Fuchs endothelial dystrophy (FED) after Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK) using a standardized surgical protocol.

Methods:
Three hundred and six consecutive DSEK and DMEK grafts of 223 patients with FED performed by 8 surgeons between January 2006 and August 2022 were analyzed. The primary outcome measures were graft survival, endothelial cell loss, and best spectacle-corrected visual acuity.

Results:
At 5 years, graft survival was 96% for both DSEK and DMEK eyes. The mean percentage of endothelial cell loss was 57.7 ± 17.1 in DSEK and 56.8 ± 15.2 in DMEK eyes (P = 0.430). The mean best spectacle-corrected visual acuity was 0.13 ± 0.14 logMAR in DSEK and 0.01 ± 0.18 logMAR in DMEK grafts (P <0.00001) at 5 years postoperatively. Rebubbling was performed in 7.8% DSEK and 2.1% DMEK grafts (P = 0.441). Cox regression identified rejection episodes (HR 6.5; 95% CI: 1.70–24.8; P = 0.0062) as a significant contributing factor for graft failure.

Conclusions:
DMEK had superior visual acuity outcomes compared with DSEK in these patients up to 5 years after surgery. At 5 years, there was no significant difference in graft survival or endothelial cell loss between DSEK and DMEK eyes with FED. We propose that our standardized technique reduces the need for rebubbling.
Association Between Fuchs Endothelial Corneal Dystrophy, Diabetes Mellitus, and Multimorbidity
Authors: Nealon Cari L. , Halladay Christopher W. , Gorman Bryan R. , Simpson Piana , Roncone David P. , Canania Rachael L. , Anthony Scott A. , Sawicki Rogers Lea R. , Leber Jenna N. , Dougherty Jacquelyn M. , Cooke Bailey Jessica N. , Crawford Dana C. , Sullivan Jack M. , Galor Anat , Wu Wen-Chih , Greenberg Paul B. ,   the Million Veteran Program, Lass Jonathan H. , Iyengar Sudha K. , Peachey Neal S. 
Published: May 2023

Purpose:The aim of this study was to assess risk for demographic variables and other health conditions that are associated with Fuchs endothelial corneal dystrophy (FECD).Methods:We developed a FECD case–control algorithm based on structured electronic health record data and confirmed accuracy by individual review of charts at 3 Veterans Affairs (VA) Medical Centers. This algorithm was applied to the Department of VA Million Veteran Program cohort from whom sex, genetic ancestry, comorbidities, diagnostic phecodes, and laboratory values were extracted. Single-variable and multiple variable logistic regression models were used to determine the association of these risk factors with FECD diagnosis.Results:Being a FECD case was associated with female sex, European genetic ancestry, and a greater number of comorbidities. Of 1417 diagnostic phecodes evaluated, 213 had a significant association with FECD, falling in both ocular and nonocular conditions, including diabetes mellitus (DM). Five of 69 laboratory values were associated with FECD, with the direction of change for 4 being consistent with DM. Insulin dependency and type 1 DM raised risk to a greater degree than type 2 DM, like other microvascular diabetic complications.Conclusions:Female sex, European ancestry, and multimorbidity increased FECD risk. Endocrine/metabolic clinic encounter codes and altered patterns of laboratory values support DM increasing FECD risk. Our results evoke a threshold model in which the FECD phenotype is intensified by DM and potentially other health conditions that alter corneal physiology. Further studies to better understand the relationship between FECD and DM are indicated and may help identify opportunities for slowing FECD progression.
Hazard Detection During Simulated Driving in Glaucoma Patients
Authors: Daga Fábio B. , Boer Erwin R. , Diniz-Filho Alberto , Elhosseiny Ahmed , Jammal Alessandro A. , Tavares Ivan M. , Medeiros Felipe A. 
Published: May 2023

Précis:
In this cross-sectional study, glaucoma patients showed slower reaction times (RTs) to hazardous situations when compared with control subjects during simulated driving. Worse RTs were associated with a greater magnitude of visual field loss.

Purpose:
The purpose of this study was to evaluate the impact of different hazardous traffic conditions on driving performance in glaucoma patients using a high-fidelity driving simulator.

Methods:
The cross-sectional study was performed with 52 glaucoma patients and 15 control subjects. A series of hazard scenarios were presented, such as pedestrians crossing the street unexpectedly or vehicles suddenly pulling into the driver’s lane. RTs in seconds (s) from first the evidence of a hazard to the time it took the driver to take the foot off the gas pedal (“Gas Off”) and the time it took to depress the brake pedal (“Brake On”) were compared between groups.

Results:
Overall, mean RTs were statistically significantly slower in glaucoma patients (3.39±3.88 s) compared with controls (2.39±1.99 s; P=0.005) for the “Brake On” task but not for the “Gas Off” task (2.74±3.42 vs. 2.13±1.91 s, respectively; P=0.120). For subjects with glaucoma, multivariable models adjusted for age, gender, race, and visual acuity demonstrated significantly slower RTs for worse values of binocular mean sensitivity for both “Gas Off” and “Brake On” tasks (1.12 and 1.14 s slower per 10 dB worse; P=0.009 and P<0.001, respectively). Subjects with glaucoma took significantly longer times to brake for smaller (low saliency) hazards compared with larger (high saliency) hazards (P=0.027).

Conclusions:
RTs in response to hazardous driving situations were slower for glaucoma patients compared with controls. Individualized assessment of driving fitness using hazardous scenarios in driving simulators could be helpful in providing an assessment of driving risk in glaucoma patients.