bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rates of procedures among those with incidentally detected pulmonary nodules: A real-world data assessment.
Authors: Thompson Jeffrey C. , DaCosta Byfield Stacey , Hansen Pamela , Tucker Jamie , Vachani Anil 
Published: September 2022

405 Background: With the increased utilization of chest computed tomography, incidental pulmonary nodules (PN) are frequently encountered in clinical practice. While several professional guidelines exist on PN management, limited evidence exists regarding the evaluation of PN in clinical practice. We examined the incidence of lung cancer (LC) and utilization of invasive procedures in patients with PNs using real-world data. Methods: We conducted a retrospective cohort study using longitudinal, real-world data with de-identified administrative claims and electronic health records (EHR). The cohort included adults (>18 years) with evidence of newly diagnosed PN (ICD9 793.11, 793.19; ICD10 R91.1*, R91.8*) from 1/2014 to 12/2020 in claims (the first claim identified was considered the index date) and ≥1 lung nodule measurement in the EHR with a note date +/- 30 days from the index date. Continuous enrollment in a commercial or Medicare Advantage plan for 12 months pre- and 12 months post-index was required. Exposure categories were created based on lung nodule size; < 6mm, 6-8mm, > 8mm-15mm, > 15-30mm. During the 12-month follow-up, we identified a diagnosis of invasive lung cancer (≥1 claims for ICD9 162.xx; ICD10 C34.xx) or carcinoma in situ of the lung (ICD9 231.xx; ICD10 D02.xx). Rates of repeat imaging, biopsy, and surgery were examined among patients with (LC cohort) and without lung cancer (benign PN cohort) during the 12-month follow-up period. Results: Among 4,304 patients with a nodule measurement, 4.7% (n = 201) were diagnosed with LC during the follow-up period; 2.1%, 4.2%, 8.2%, and 28.3% among those with lung nodules < 6mm, 6-8mm, > 8-15mm, and > 15-30mm, respectively. As expected, the proportion of patients receiving procedures during the follow-up period was significantly higher in patients with LC compared to those with benign PNs (p < 0.01), regardless of lung nodule size (see column percentages in Table). However, the majority (53%) of all procedures were performed in the benign PN cohort. Among all patients that underwent a procedure during the study period, 63% of bronchoscopy, 49% of TTNB, and 38% of thoracic surgery occurred in patients with benign PNs (see row percentages in Table). Conclusions: Although several professional guidelines exist for the management of incidental PN, there continues to be wide variation in the management of PNs with invasive procedures frequently performed in patients ultimately identified to have benign disease. Methods to improve risk stratification of pulmonary nodules would be of significant clinical utility.[Table: see text]
Real-world treatment patterns among men with metastatic castration-resistant prostate cancer (mCRPC) in the U.S. Medicare population.
Authors: Freedland Stephen J. , Davis Matthew , Epstein Andrew J. , Arondekar Bhakti , Ivanova Jasmina I. 
Published: September 2022

406 Background: Multiple life-prolonging therapies have been approved for mCRPC, for example novel hormonal therapies (NHT; abiraterone [abi], enzalutamide [enza]), docetaxel (doc), cabazitaxel, sipuleucel-T, and radium-223. This study describes real-world treatment patterns with life-prolonging therapies and sequencing among men with mCRPC in the US Medicare population. Methods: Men newly diagnosed with mCRPC were identified in Medicare fee-for-service claims during 1/1/2014–6/30/2019. Adult men were required to have a diagnosis of prostate cancer, metastasis diagnosis, castration-resistance using a published claims-based algorithm, and continuous insurance coverage for ≥1 year before and ≥6 months after index mCRPC diagnosis unless patients died. Treatment patterns of life-prolonging therapies after mCRPC diagnosis and sequencing were described. Results: Among 14,780 men with mCRPC, median age was 75 years, 10% used NHT in the year prior to mCRPC, and 3% had prior taxane therapy. Median follow-up after mCRPC diagnosis was 17 months. 22% of men received no life-prolonging therapy after mCRPC diagnosis, 78% received ≥1 line of therapy with life-prolonging treatment after mCRPC diagnosis, 42% had ≥2, and 20% had ≥3. The most common first-line (1L) therapies were abi (36%), enza (28%), and doc (16%). The most common second-line (2L) therapies were enza (33%), abi (28%), and doc (15%). The most common third-line (3L) therapies were doc (24%), enza (19%), and abi (17%). Median time from start of 1L to next line of therapy or end of follow-up was 13.7 months, 10.9 months from the start of 2L, and 8.9 months from the start of 3L. The most common 1L to 2L treatment sequences among men with ≥2 lines were NHT followed by a different NHT (33%), chemotherapy followed by NHT (14%), and NHT followed by chemotherapy (13%). There were 5,630 men with ≥2 lines of therapy and ≥1 NHT, of whom 53% had ≥2 NHTs. Conclusions: Substantial proportions of men with mCRPC did not receive a life-prolonging therapy or had only 1L therapy after mCRPC diagnosis, with a 50% fall-off rate after each line of therapy. NHTs were the most common 1L and 2L therapies, and NHT followed by a different NHT was the most common treatment sequence. Further research is needed to understand how treatment patterns change as NHTs and doc are used earlier in the disease continuum and new therapies are introduced and ultimately to identify optimal treatment sequencing.
Clinical surveillance and PSA outcomes among patients with non-metastatic castration resistant prostate cancer (nmCRPC) treated with a next-generation androgen receptor inhibitor (ARI) in urology clinics with or without in-office dispensing (IOD).
Authors: Burbage Sabree , Waters Dexter , Rossi Carmine , Kinkead Frederic , Pilon Dominic , Muser Erik , Ellis Lorie 
Published: September 2022

410 Background: As use of oral therapies in prostate cancer treatment increases, IOD of oral medication has become more common. The objective of this study was to describe clinical surveillance practices and PSA outcomes in nmCRPC patients (pts) treated in clinics with or without IOD. Methods: nmCRPC pts with ≥1 ARI prescription (Rx) were identified in data from 95 US urology practices between 2018-2021. Pts were categorized into 3 groups: (1) Treated in IOD clinic and received ARI onsite within 14 days of Rx (IOD+), (2) Treated in IOD clinic but no onsite ARI receipt within 14 days of Rx (IOD-), and (3) Treated in a clinic without IOD (non-IOD). Descriptive analyses were conducted on pt characteristics, PSA and imaging data. PSA response, reported using Kaplan-Meier rates, was defined as ≥50% reduction in post-index (PI; index date = 14 days after 1st ARI Rx) PSA compared to baseline PSA (measured within 13 weeks before 1st ARI prescription). PSA progression was defined as ≥25% increase in PI PSA above baseline PSA. Results: 3,300 nmCRPC pts were identified (N = 615 IOD+; 2,474 IOD-; 211 non-IOD). Baseline characteristics differed for race, use of bone resorption agents and 1st generation anti-androgens, and PSA doubling time (PSADT; table). By 6 months PI, PSA screening was observed in similar proportions of pts in IOD and non-IOD, while PSA response was observed in a higher proportion of IOD+ (80%) than IOD- (64%) or non-IOD (63%). PSA progression was observed in fewer IOD+ pts (10%) than IOD- (16%) or non-IOD (17%). PI imaging was conducted in similar proportions of pts in IOD and non-IOD clinics; however, non-IOD performed more imaging per pt and time to imaging was shorter than in IOD+ clinics. Conclusions: Differences were noted in patient characteristics and prior medication use in ARI-treated patients within IOD and non-IOD clinics. IOD+ was observed to have higher rates of PSA response, fewer patients with PSA progression, and use fewer imaging tests after ARI initiation than non-IOD or IOD-. Additional studies controlling for differences in baseline characteristics and examining longer term outcomes are needed to understand how IOD services impact quality of patient care.[Table: see text]
Identifying sources of burnout among clinicians at a cancer center: A qualitative analysis.
Authors: Nguyen Oliver , Alishahi Amir , Moore Colin Evan , Perkins Randa , Bickel Young Jennifer , Heimbeck Dorte , Turner Kea 
Published: September 2022

429 Background: Clinician burnout leads to increased job turnover and workforce shortages, and reduced patient satisfaction and quality of care. Despite its importance, there has been limited study of burnout among the cancer care workforce including sources of burnout. This information can be used to inform intervention design for use in the cancer care setting specifically. To address this gap, we analyzed open-ended responses to a well-being survey administered to clinicians (physicians and advanced practice providers) at a Cancer Center. Methods: In February 2022, we electronically administered the American Medical Association’s clinician well-being survey to all practicing clinicians at a National Cancer Institute-designated Comprehensive Cancer Center in Florida. Of 700 clinicians, 405 (58%) responded. Of the respondents, 259 (64.0%) answered the free-text question “Tell us more about your stressors and what we can do to minimize them.” We used in-vivo coding to develop qualitative themes across responses. If a given response incorporated multiple themes, we coded the response under all pertinent themes. Results: A majority (76/259) of respondents commented on staffing issues, such as their clinics being understaffed or the quality of current staff. Another frequent theme (64/259) was the electronic health records (EHR) system, such as lack of integration between modules, inbox fatigue, alert fatigue, and inefficient documentation review processes. Respondents also reported scheduling issues as a pain point (56/259), such as having schedules that do not reflect actual clinical practice, being overbooked, and scheduling errors. Documentation burden was also highlighted as an issue across respondents (34/259). Documentation was considered tedious and some respondents reported a mismatch between available documentation tools in the EHR and actual documentation needs. Less common themes reported across respondents included design issues of facility space (e.g., no dedicated workspace to complete work without interruptions) and insufficient time to complete administrative, research, and documentation requirements. Conclusions: Our findings suggest that interventions that optimize staffing models, EHR processes (e.g., documentation), and scheduling practices may reduce burnout for a considerable number of cancer care clinicians.
Implementation of EHR medication-adherence screening tool in breast cancer clinic.
Authors: Desanti de Oliveira Beatriz , DeStephano David , Beauchemin Melissa Parsons , Law Cynthia , Howard Kristina ` , Wright Jason Dennis , Kronish Ian , Hershman Dawn L. , Accordino Melissa Kate 
Published: September 2022

438 Background: Nonadherence to prescribed medications occurs frequently in patient with breast cancer (BC) and can affect BC outcomes as well as outcomes for comorbid conditions. We implemented a process to screen for medication adherence in the electronic health record (EHR) in an urban outpatient BC clinic. Methods: Plan-Do-Study-Act (PDSA) methodology was used to implement a screening process for medication adherence for all patients seen in the outpatient breast oncology clinic. At check-in (via the patient portal or clinic based kiosks), patients were asked to complete an EHR adherence screener. Two PDSA cycles were completed. During cycle one (2/16/22-5/17/22), patients were asked if they received ≥1 prescribed medication; if yes they were asked to complete the questionnaire (y/n); if yes a 3-item questionnaire was used to screen for adherence to all medications over the prior 7 days. Adherence was defined as 3 of 3 responses “none of the time” to “I have missed my medicine;” “I have skipped a dose of my medicine;” and “I did not take a dose of my medicine.” During cycle two (5/17/22-6/5/22) the screener was simplified. Patients were no longer asked to complete the survey; and the survey was modified to 1-item “I did not take a dose of my medicine”, adherence was defined as response of “none of the time”. We evaluated response rate and self-reported non-adherence rate. Results: During PDSA cycle 1 (2/16/22-5/17/22), 2840 visits occurred and 722 (25%) responses were received; 80% noted prescription of ≥1 medication, 38% agreed to complete the survey; and 87% reported adherence to all prescribed medications while 13% reported non-adherence. During PDSA cycle 2 (5/17/22-6/5/22), 512 visits occurred and 172 (33%) responses were received. Of those, 73% reported prescription of ≥1 medication; of those 66%-reported adherence to all prescribed medications, 21% reported non-adherence, and 17% preferred not to answer. Conclusions: This EHR screener is a simple and scalable tool to rapidly screen for medication adherence. Up to a quarter of patients who completed screening reported non-adherence. Further tools are needed to assess adherence among patients who lack access to the patient portal or clinic kiosk, or are uncomfortable checking in with these mechanisms. Future interventions are necessary to further screen potentially non-adherent patients and for interventions to improve adherence once vulnerable patients are identified.
Evaluating clinician emotion regulation during a serious illness conversation in oncology using multimodal assessment: A pilot study.
Authors: Wasp Garrett Thomas , Kaur Satveer , Andersen Eric , Vergo Maxwell Thomas , Chelen Julia , Tosteson Tor , Barr Paul J. , Barnato Amber E 
Published: September 2022

439 Background: Clinician emotion regulation (ER), self and the patient’s, likely moderates successful prognostic discussions with patients, yet challenges around its evaluation limit its investigation. We performed a pilot study to develop and assess an experimental framework that uses multimodal assessment (self-report, observer, and biometric data) to measure clinician ER during a simulated, serious illness conversation (SIC). Methods: We developed our experimental framework in four steps: 1) drafted a patient case and assessment framework; 2) refined the data collection strategy using a multidisciplinary research team; 3) trained our actor; and 4) iteratively piloted the case to optimize data collection. For the assessment, we conducted a cross-sectional, case series pilot study with physicians trained in SIC to assess its feasibility and acceptability, defined a priori as an enrollment rate >60% of approached clinicians, > 90% completion rate of survey items, < 20% missing data from wearable heart rate variability (HRV) sensors. To characterize clinician ER strategies, we analyzed the visit dialogue, physician interviews performed while watching the visit back, and physician SIC documentation generated post visit. We used a hybrid approach of inductive and deductive coding and theme development based on preexisting ER theory. Results: The development phase yielded two major modifications: 1) abandoned use of AppleWatch since it did not provide continuous HRV measurement; and 2) used telehealth with video given context of COVID-19 pandemic. We approached 12 physicians and 11 enrolled, of which 5 were female and 10 white, 5 were medical oncologists, and 6 specialty palliative care physicians. All participants completed all study survey items. The results of our three HRV sensors were as follows: Empatica E4 and Polar H10 met our pre-specified HRV collection in all 11 resting tasks and SIC encounters, and the Scoche R24 the benchmark in 7/11 resting tasks and 4/11 of simulated encounters. Preliminary qualitative analysis suggests investigators can characterize clinician use of intrapersonal and interpersonal ER strategies. Conclusions: The use of multimodal assessment of clinician ER in a simulated, telehealth SIC visit was acceptable and feasible.
Genetic Dissection of Primary Aldosteronism in a Patient With MEN1 and Ipsilateral Adrenocortical Carcinoma and Adenoma
Authors: Parisien-La Salle Stéfanie , Corbeil Gilles , El-Haffaf Zaki , Duranceau Caroline , Latour Mathieu , Karakiewicz Pierre I , Lacroix André , Bourdeau Isabelle 
Published: September 2022

Abstract

Background
Adrenal tumors are found in up to 40% of patients with multiple endocrine neoplasia type 1 (MEN1). However, adrenocortical carcinomas (ACC) and primary aldosteronism (PA) are rare in MEN1.

Case
A 48-year-old woman known to have primary hyperparathyroidism and hypertension with hypokalemia was referred for a right complex 8-cm adrenal mass with a 38.1 SUVmax uptake on 18F-FDG PET/CT. PA was confirmed by saline suppression test (aldosterone 1948 pmol/L-1675 pmol/L; normal range [N]: &lt;165 post saline infusion) and suppressed renin levels (&lt;5 ng/L; N: 5-20). Catecholamines, androgens, 24-hour urinary cortisol, and pituitary panel were normal. A right open adrenalectomy revealed a concomitant 4-cm oncocytic ACC and a 2.3-cm adrenocortical adenoma. Immunohistochemistry showed high expression of aldosterone synthase protein in the adenoma but not in the ACC, supporting excess aldosterone production by the adenoma.

Genetic analysis
After genetic counseling, the patient underwent genetic analysis of leucocyte and tumoral DNA. Sequencing of MEN1 revealed a heterozygous germline pathogenic variant in MEN1 (c.1556delC, p.Pro519Leufs*40). The wild-type MEN1 allele was lost in the tumoral DNA of both the resected adenoma and carcinoma. Sequencing analysis of driver genes in PA revealed a somatic pathogenic variant in exon 2 of the KCNJ5 gene (c.451G&gt;A, p.Gly151Arg) only in the aldosteronoma.

Conclusion
To our knowledge, we describe the first case of adrenal collision tumors in a patient carrying a germline pathogenic variant of the MEN1 gene associated with MEN1 loss of heterozygosity in both oncocytic ACC and adenoma and a somatic KCNJ5 pathogenic variant leading to aldosterone-producing adenoma. This case gives new insights on adrenal tumorigenesis in MEN1 patients.
Stendhal’s Definition of Beauty, in and as Philosophy
Authors: Weintraub Alex 
Published: September 2022

Abstract
In On the Genealogy of Morals (1887), Friedrich Nietzsche misquotes Stendhal’s definition of beauty. Beauty is not, as the German philosopher claims, “a promise of happiness” (72). Rather, Stendhal proposes in a footnote to his book De l’amour (1822)—in a chapter entitled “La Beauté détrônée par l’amour”—that “la beauté n’est que la promesse du bonheur” (40). Nevertheless, Nietzsche’s misquotation of Stendhal and his subsequent interpretation of the French author’s aesthetics have held sway in later philosophy, such that Stendhal is regularly recruited to endorse views about beauty quite dissimilar from his own. This article approaches Stendhal as a philosopher in order to develop a clearer sense of what the author really meant by characterizing beauty as “only a promise of happiness.” Through close readings of De l’amour and Rome, Naples, et Florence, it is proposed that Stendhal’s restrictive only allows for and even recommends so-called mere judgments of beauty, or the experience of beauty as a completed pleasure in reflective contemplation, as opposed to the Nietzschean reading of Stendhal, which would define judgments of beauty as forepleasures to future satisfactions. More importantly, this article aims to recover what Stendhal still has to teach present-day philosophers and critics about judgments of taste.
Should Shipwrecks Be Sweet?
Authors: Truglio Maria Rosa 
Published: September 2022

Abstract
Demand for books about current events in Italy has yielded scores of children’s books in the past three decades that treat the topic of immigration. The goals of eliciting empathy in children and explaining to them complex historical and contemporary events can be challenged by the perceived need to shield children from traumatizing scenes. This essay examines four recent children’s books published in Italy that dramatize immigration from Africa. Authors Maria Attanasio, Erminia Dell’Oro, Dino Ticli, and Francesco D’Adamo allude to canonical Western literature (such as Pinocchio and Cuore) as a way to sweeten these often bitterly disquieting narratives for their young readers. This essay probes the potentials and limits of intertextuality and ultimately argues that several texts go beyond leveraging the image of capsized ships in the Mediterranean, an image that has become a media fetish, to engage readers in ways that facilitate both empathy and critical self-reflection.
Electric Love Therapy
Authors: Modern John Lardas 
Published: September 2022

AbstractIn the early 1970s, as the industrial economy crumbled around Detroit and its suburbs, Dr. H. C. Tien, an independent electroconvulsive therapist who ran the Michigan Institute of Psychosynthesis in Lansing, MI, advocated a “cybernetic” approach to family psychiatry. In Tien’s practice, one can learn how the liberatory kernel of religion and the truth of sexual difference—key components of moral treatment in nineteenth-century asylum reform—became amplified by emerging paradigms of neural nets and information processing. In Tien’s practice—what he called Electric Love Therapy—electric shock treatment became a technology of conversion and, more precisely, of sexual differentiation and spiritual cultivation. Tien’s is a disturbing example of how the regulation of sexuality and gender as private matters serves as resource and spur to secular demands to proprietize religion as an interior matter.
A Managerial Fast Break
Authors: Black Cameron 
Published: September 2022

Abstract
In the mid- to late twentieth century, the field of professional sports underwent drastic cultural and economic change. No sports association was impacted as much as the National Basketball Association, which grew monumentally from 1975 to 1990. This article argues that the NBA’s growth stemmed from new collective bargaining agreements put in place during the 1980s to implement a workplace culture that fit within the broader conservative backlash during the decade. The NBA implemented punishments for drug-based and conduct-based offenses for its players and established a salary cap to regain control over players’ remuneration. This not only raised revenue but assimilated its growing population of African American players to traditional workplace norms that simultaneously attempted to counter racist stereotypes about their “natural” talents and legitimized ideas that Black players needed to be carefully managed.
Crossing Black Waters
Authors: Rumore Micheal A. 
Published: September 2022

Abstract
The burgeoning field of Indian Ocean studies has emerged as a repository of universalist political aspirations, often inspired by the Non-Aligned imagination of the Third World era. In particular, the notion of Indian Ocean “cosmopolitanism,” as both an object of desire and critique, looms large in the field as a figure of decolonial solidarities outside the epistemological confines of modern coloniality. This essay contends that the racial politics of Indian Ocean cosmopolitanism, itself an inheritance of the Afro-Asian hierarchies of mid-century Third Worldism, deserves more attention. It also explores the Afro-Asian antinomies of Indian Ocean studies as a reflection of broader critical ambivalences about questions of colonial humanism and anticolonial liberation.