tbuckley/cabot-search huggingface dataset:
Abstract 17751: Low Appendicular Skeletal Muscle Mass is Associated With High Coronary Plaque Complexity in Patients With ST-segment Elevation Myocardial Infarction
Authors: Ryosuke Satou, Eiichi Akiyama, Hiroyuki Suzuki, Chika Kawashima, Yasushi Matsuzawa, Masaaki Konishi, Katsutaka Hashiba, Nobuhiko Maejima, Noriaki Iwahashi, Kengo Tsukahara, Kiyoshi Hibi, Masami Kosuge, Toshiaki Ebina, Shinichi Sumita, Satoshi Umemura, Kazuo Kimura
Journal: Circulation (2015)

Introduction: Loss of skeletal muscle mass is associated with diabetes, insulin resistance, inflammation, and generalized atherosclerosis. The angiographic complexity of coronary artery disease can predict outcomes in patients undergoing percutaneous coronary intervention. However, the relationship between skeletal muscle mass and ST-segment elevation myocardial infarction (STEMI) remains undetermined. Hypothesis: We assessed the hypothesis that low appendicular skeletal muscle mass index (ASMI) is associated with high coronary plaque complexity in patients with STEMI. Methods: We enrolled consecutive 112 patients with STEMI (age 64±12, male 87.5%) in this study. Appendicular skeletal muscle mass was estimated from dual-energy X-ray absorptiometry (DXA) scan before discharge and ASMI was defined as appendicular skeletal muscle mass divided by height squared (kg/m 2 ). ASMI was dichotomized according to the Asia Working Group for Sarcopenia criteria, which determined low (&lt;7.0 kg/m 2 for men and &lt;5.4 kg/m 2 for women by DXA) and normal ASMI. And we graded the coronary plaque complexity by using the Synergy between Percutaneous Coronary Intervention with Taxus and Coronary Surgery (SYNTAX) score at the initial coronary angiography. Result: ASMI correlated positively with body mass index (r=0.80, P&lt;0.001), as well as negatively with age (r=-0.63, P&lt;0.001), SYNTAX score (r=-0.28, P=0.003), Killip classification (r=-0.22, P=0.019), and B-type natriuretic peptide levels on admission (r=-0.27, P=0.014). The prevalence of low ASMI patients was 41% (n=46). Low ASMI patients had higher SYNTAX score (19.0±8.3 versus 13.7±7.7, P=0.001) compared with normal ASMI patients. Multivariate logistic regression analysis including age, gender and various classical risk factors demonstrated that ASMI significantly and independently correlated with moderate-severe coronary plaque complexity (SYNTAX score&gt;22, n=22) in STEMI patients (odds ratio per 1: 0.55, 95%-confidence interval: 0.35-0.87, P=0.01). Conclusion: Low ASMI is significantly associated with high coronary plaque complexity in patients with STEMI, suggesting that skeletal muscle mass could play a crucial role in the pathogenesis of atherosclerosis in patients with STEMI.
Bioinformatics Commons: The Cornerstone of Life and Health Sciences
Authors: Zhang Zhang, Yu Xue, Fangqing Zhao
Journal: Genomics Proteomics & Bioinformatics (2018)

Bioinformatics, an interdisciplinary field that combines biology, mathematics, computer science, medicine, and health science, to integrate, analyze, and interpret biological data, is now becoming increasingly data-intensive.To dig out the treasure from big data powered by high-throughput sequencing technologies, it is highly dependent on Bioinformatics Commons that involves a variety of fundamental resources, including databases, web servers, algorithms, methods, software tools, ontologies, and standards.To be short, Bioinformatics Commons has become the cornerstone of life and health sciences, facilitating and accelerating the translation of big data into big discoveries.Over years, a number of resources in Bioinformatics Commons have been developed and publicly released, with the aim to ease users to explore the relationship between genotype and phenotype and improve our understanding of genetic basis for human diseases.Hence, it is pivotal to raise the general awareness of the significance of Bioinformatics Commons in knowledge discovery.Toward this end, as a consequence, we
Pilot study of iPad-based patient-reported outcomes at the MGH Cancer Center.
Authors: Aparna Raj Parikh, Margaret Soriano, Ephraim P. Hochberg, Courtney McLeish, Inga Tolin Lennes, Elizabeth Souza, Therese Marie Mulvey
Journal: Journal of Clinical Oncology (2018)

190 Background: Patient reported outcomes (PROs) have been shown to improve outcomes in cancer patients in clinical trials and have also been shown to improve the patient experience, provide real-time access to patient reported symptoms and are increasingly used across disciplines. Given the importance of PROs, at the MGH Cancer Center, we implemented a pilot using iPADs to capture patient reported outcomes for patients receiving IV chemotherapy in the breast and lymphoma clinics as well all IV chemotherapy patients at one of the MGH satellite clinics where patients across all disease groups are seen. Methods: 12 measures from the PRO-CTCAE were selected to be applicable to all cancer patients. Working with the technology team and EPIC team at MGH the selected PROs were loaded into iPADs and are automatically assigned to patients receiving IV chemotherapy. Staff and clinicians were trained in the breast, lymphoma and satellite clinic. Patient who were receiving IV chemotherapy were assigned iPADs at check in. Patients completed the questionnaire and in real-time, the data was available in the EPIC chart. The objectives of the pilot were to assess the feasibility of collecting iPAD based PROs at the MGH Cancer Center. Results: In the 4-month pilot, there were 2,304 visit types that were eligible to receive an iPAD for PRO collection, 79% (N = 1,1816) patients were assigned an iPAD. Of the 1,816 patients assigned an iPAD, 65% (N = 1,173) patients completed the PROs, 4% (N = 36) partially completed the PROs. In terms of completion at the main disease specialty clinic vs the satellite, completion rates were higher at the satellite (77% vs 44%). During one week, we asked the front desk to record why patients did not complete the PROs-93 patients were assessed, 45% of patient refused the iPAD, in 28% of these patients the staff did not capture the reason and 22% were not given an iPAD. Conclusions: This pilot demonstrates the feasibility of collecting PROs in an oncology clinic for patients receiving IV chemotherapy. We plan to continue to improve the assignment of PROs to eligible patients, educate staff, providers and patients on the important of PROs and plan to expand to all the clinics at MGH Cancer Center and satellite centers.
Abstract 18207: The Efficacy of Transplantation of Human Ips Cell Derived Cardiac Tissue for Dilated Cardiomyopathy Hamster Model
Authors: Shinya Takimoto, Hidetoshi Masumoto, Kenji Minakata, Yasuhiko Tabata, Jun K Yamashita
Journal: Circulation (2016)

Introduction: Cardiovascular disease remains a major cause of death despite advances in medical technology. Induced pluripotent stem cells (iPSCs) are a potential resource of cardiac regenerative t...
Impact of a comprehensive copay assistance and drug recovery system in a community cancer center.
Authors: Robert D. Siegel, Theresa Standifer, Terra Spann, Michael Borron, Richard Slough, Dionne Pringle, Bonnie Helms, Kristina Stoeppler-Biege
Journal: Journal of Clinical Oncology (2018)

121 Background: The cost of oncology drugs has escalated rapidly while rollbacks in health care coverage and the emergence of high deductible and limited policies have made these drugs unaffordable for many. Many pharmaceutical companies offer drug replacement for those uninsured or for whom coverage is inadequate. Previously Bon Secours St. Francis Cancer Center (BSSFCC) had contracted with a third-party to recover replacement drug from these pharmaceutical programs. In 2017, we opted to suspend that third-party contract and take the process internally. Methods: BSSFCC is located in Greenville, SC. Nearly1500 new cases of cancer were diagnosed in 2016, of which, 3.5% are uninsured. We hired 2.5 FTE's to manage our drug recovery program. After clearance with legal and compliance officers, limited power of attorney was obtained to pursue these efforts on the patients’ behalf. Patients who had no drug coverage, inadequate coverage, or off-label denials were identified at the time of chemotherapy education, pre-authorization, or by after-the-fact processing of claims. Our efforts at drug recovery are noted below. Results: We recovered drug for 71 patients during fiscal 2017. The total cost of those recovered drugs was $3.25 million. This compared with $389,000 recovered by our third-party vendor (pre-commission) in FY 2016. $842,000 of drug replacement were for off-label use in insured patients, while $587,000 represented use in the uninsured. The remainder represented replacement drug for those with inadequate drug coverage and an ipilimumab replacement program for adjuvant therapy for melanoma. Conclusions: Embedding a process within a community cancer center to manage drug recovery for the un- and underinsured proved to have a substantial return on investment. The drug expenses which had to be written off were decreased substantially but most importantly, our ability to replace drug with some reliability allowed many of our patients to receive effective therapy that otherwise would have been cost prohibitive. Although the ability to recover drugs in this fashion is both helpful and appreciated, our program does nothing to rein in the unsustainable rise in the cost of cancer care.
A data driven approach to immunotherapy toxicity management.
Authors: Sadiqa Mahmood, Eli Schwamm, Kenneth L. Kehl, Brett Glotzbecker, Robert Andrews, Prabhsimranjot Singh, Belen Fraile, Shobana Muthulingam, Andrew J. Wagner, Joseph O. Jacobson, Nicole R. LeBoeuf, Osama E. Rahma
Journal: Journal of Clinical Oncology (2018)

326 Background: The immune checkpoint inhibitors (ICIs) confer a risk of unique inflammatory immune-related adverse events (irAEs), which are highly distinct from the adverse events historically observed with cytotoxic therapy. To develop a strategy for easier identification and mitigation of irAEs, we sought to understand the frequency of ED visits and hospitalizations in 90 days following ICI start by implementing a rapid learning system (RLS). Methods: We convened an Immunotherapy Toxicities Management Committee with representatives from the Center for Immuno-Oncology, Quality and Patient Safety, and Informatics to draft a series of recommendations for the development of an irAE rapid learning system. The Committee requested an audit of all irAEs between June 2015 and April 2018 by drug, event type (clinical diagnosis), outcomes (including ED visits, hospitalization with length of stay, and death), and time-frame (days since beginning ICI course). An automated pipeline was created to merge structured data from the Electronic Health Record (Epic) and billing system (EPSi). This data was used to design a tool which consisted of an automated dashboard to monitor patient and enable interventions. Results: Over the course of 3 years, a total of 2,020 unique patients receiving ICIs were seen. 918 were treated with Pembrolizumab (45.4%), 768 with Nivolumab (38.0%), 234 with Atezolizumab (11.6%), 111 with Nivolumab &amp; Ipilmumab (5.6%), 68 with Ipilimumab (3.4%), 9 with Durvalumab (0.4%), and 9 with Avelumab (0.4%). ED visits and hospitalization rates over 90 days were similar among the three most prescribed therapies, ranging from 332 unique patient events in the Pembrolizumab Cohort (36.1%) to 96 unique patient events in the Atezolizumab cohort (41.0%). Conclusions: The dashboard is effective tool to build a RLS for irAEs. The immediate output of this tool is using natural language processing (NLP) to distinguish between irAEs related ED visits and hospitalizations or regular disease progression, and measure the impact of interventions including (a) developing standardized algorithms for monitoring for irAEs, (b) designing an educational program for providers, and (c) developing an inpatient and outpatient immunotherapy toxicity management service.
Standardized approach to incident management across a radiation oncology network.
Authors: Seth D Frey, Mary Frances McAleer, Gary Walker, Rachel Bissonnett Natter, Timothy Edwards, Albert Koong, Joseph M. Herman, Bruce D. Minsky, Mohamed K Khan, Anthony E. Dragun, Michael R Olson, Molly Gabel, Robin Bierman, Lehendrick Turner, Manolo Llorente, Icaro Thiago de Carvalho, Ugur Selek, Stephen M. Hahn, Deborah A. Kuban
Journal: Journal of Clinical Oncology (2018)

235 Background: Quality and safety reporting is one of the most important aspects of creating a culture of safety. As part of a multidisciplinary Cancer Network, the Radiation Oncology Division at the lead institution devised an electronic incident reporting system that was implemented at the Network partners to define, standardize, quantify, and trend incidents in the radiation oncology treatment and care process. The purpose of this study is to assess robustness of the system, initial trends seen, and potential to improve quality and safety of the Network practice. Methods: Beginning in January 2017, the incident reporting system at the lead institution was configured to provide inclusion of 13 partnering radiation oncology facilities. Over one year, the organizations were on-boarded and trained on the use of the application. Descriptive analyses of the data from the use of this new reporting system were used in this study. Results: From January 1, 2017 to April 30 2018, a total of 832 incident reports were submitted by 13 different facilities. The average number of days from event submission to resolution was reduced to 10.25 days, compared with up to 60 days before implementation of the new central reporting system. The change in reporting rate was variable across the partner sites following implementation of the new system. The most frequent event types reported included ineffective communication (13%), planning-related problems (5%), incomplete or missing simulation orders (5%), and scheduling error or conflict (4%). Conclusions: Implementation of a centralized reporting system across a network of partner sites has greatly improved the overall reporting process, with reduced event resolution time and increased capability of tracking and trending incidents. By standardizing incident reporting across institutions, there are multiple opportunities to augment a strong culture of safety.
Abstract 16673: Framingham Risk Trajectories Predict Left Ventricular Dyssynchrony as a Measure of Subclinical Myocardial Dysfunction: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Ravi Sharma, Satoru Kishi, Bharath Ambale-Venkatesh, Laura Colangelo, Jared Reis, Donald Lloyd-Jones, Cora Lewis, Stephen Sidney, David Jacobs, Kiang Liu, Samuel Gidding, João A Lima
Journal: Circulation (2014)

Background: Left ventricular (LV) dyssynchrony is a measure of myocardial dysfunction in heart failure patients. However, its significance as a marker of incipient myocardial dysfunction in response to cumulative risk burden among asymptomatic individuals is not known. Our objective was to evaluate the extent of LV dyssynchrony in relationship to longitudinal changes in cardiovascular risk in otherwise healthy middle age individuals. Methods &amp; Results: We defined five distinct Framingham risk score (FRS, D’Agostino Circulation 2008) (excluding age) trajectories in the CARDIA cohort (n=4634) to estimate the pattern of cumulative cardiovascular risk exposure over 25 year. Standard deviation of time to peak systolic circumferential strain (SD-TPS) among 6 mid-ventricular segments using 2-dimensional speckle-tracking echocardiography determined the extent of LV dyssynchrony in 2718 participant (54.3% women). Using multivariate linear regression after adjustment for demographics and LV ejection fraction, we found that among women in comparison to the low-stablegroup (reference trajectory), increased burden of cardiovascular risk was associated with progressively higher values of SD-TPS; B-coefficients were 3.50msec (95%CI, 0.23 - 6.77, p=0.04) for the moderate-stable, 7.32msec (2.56 - 12.09, p=0.003) for the elevated-stable, 8.79msec (3.49 - 14.10, p=0.001) for the moderate-increasing, and 9.54msec (0.09 - 18.99, p=0.048) for the elevated-increasing groups. There was attenuation of parameter estimates after further adjustment for cumulative body-mass-index (BMI) with loss of statistical significance. These associations were not statistically significant in men. Conclusions: Women had higher values of subclinical LV dyssynchrony in response to incremental cumulative cardiovascular risk burden over 25 years. Such relationships were absent in men. Cumulative BMI was the strongest predictor of LV dyssynchrony.
Analyzing pathways data to reduce unwarranted variation, understand practice patterns, and update pathways.
Authors: Julia Cooper Hall, Joanna M. Hamilton, David Michael Jackman, Carole Kathleen Tremonti, Teresa L. Greenberg, Victoria Hayne, Leah A. Stein, Joseph O. Jacobson
Journal: Journal of Clinical Oncology (2018)

300 Background: A clinical pathways program requires regular updates to pathways content, real-time decision support, and data collection and analysis of decisions made. A goal of Dana-Farber Pathways (DFP) is to analyze data to reduce unwarranted variation and inform granular, warranted variation. Methods: Each of our 31 medical oncology pathways is created and updated by DF experts (clinicians and scientists). DFP is implemented through a web-based portal that provides real-time decision support. DFP captures on- and off- pathway treatment decisions and reasons for off-pathway decisions; this is shared with each disease group monthly. For each interval review meeting we assess on-pathway rates and decisions for each node in the pathway. Low on-pathway rates prompt discussion about possible action, including provider education or pathway modification. Results: In 2017, 7,460 total treatment decisions were collected through DFP; 78% were on-pathway. We have clinical reasoning for 90% of the off-pathway decisions. Off-pathway analysis has been used in several important ways: 1. Catalyzing change: we detected early adoption of immunotherapy in small cell lung cancer and discussed the relevant data. The pathway was updated to adopt this class of treatment. 2. Understanding unexpected events: we identified a recent etoposide shortage and discussed alternate recommendations. They were added to the pathway in case of future shortages. 3. Provider education: we detected a consistently low on-pathway rate in one location, mostly driven by a specific provider. This provided a mechanism to discuss practice patterns and provide targeted education. Conclusions: Off-pathway analysis provides insight into user variation, fosters and supports peer coaching, and supports the creation of dynamic, up-to-date pathways.[Table: see text]
Abstract 14546: Aortic Stiffness and Its Relationship to Exercise and Ventricular Volumes After Surgical Reconstruction in Single Ventricle Patients Using Real Time Exercise Cardiac Magnetic Resonance
Authors: Mark A Fogel, Esther Kim, Marc Keller, Matthew Harris, Kevin Whitehead, phillip Trusty, Mike Tree, Alan Wei, Ajit Yoganathan
Journal: Circulation (2016)

Introduction: Aortic reconstruction (recon) in single ventricle (SV) pts create a stiff large vessel which may adversely impact SV afterload & exercise performance. Hypothesis: SV pts with recon demonstrate evidence of increased afterload & aortic stiffness correlates with exercise performance. Methods: SV pts after Fontan were studied with real time exercise CMR & metabolic exercise stress test. Aortic pulse wave velocity (PWV) & distensibility (Dis) of the descending aorta at the level of the diaphragm (DAo) were recorded. Significance was P<0.05. Results: 18 pts who underwent recon & 30 did not (age median [range] 17.4 [12-42] and 17.0 [12.7-25.6] yrs respectively, P=0.33). PWV was greater in recon than in non-recon (median [range] 4.4 [2.3-9.8] vs 3.6 [2.6-6.3] m/s respectively, P=0.006). Significant inverse correlations in recon were found between PWV and end-diastolic, end-systolic and stroke volumes both at rest and at exercise, presumably because of increased afterload (table). Significant inverse...
Peripheral PDGFRα+gp38+ mesenchymal cells support the differentiation of fetal liver–derived ILC2
Authors: Satoshi Koga, Katsuto Hozumi, Ken-ichi Hirano, Masaki Yazawa, Tommy Terooatea, Aki Minoda, Takashi Nagasawa, Shigeo Koyasu, Kazuyo Moro
Journal: The Journal of Experimental Medicine (2018)

Group 2 innate lymphoid cells (ILC2s) are derived from common lymphoid progenitors (CLPs) via several specific precursors, and the transcription factors essential for ILC2 differentiation have been extensively studied. However, the external factors regulating commitment to the ILC lineage as well as the sites and stromal cells that constitute the optimal microenvironment for ILC2-specific differentiation are not fully defined. In this study, we demonstrate that three key external factors, the concentration of interleukin 7 (IL-7) and strength and duration of Notch signaling, coordinately determine the fate of CLP toward the T, B, or ILC lineage. Additionally, we identified three stages of ILC2 in the fetal mesentery that require STAT5 signals for maturation: ILC progenitors, CCR9+ ILC2 progenitors, and KLRG1- immature ILC2. We further demonstrate that ILC2 development is supported by mesenteric platelet-derived growth factor receptor α (PDGFRα)+ glycoprotein 38 (gp38)+ mesenchymal cells. Collectively, our results suggest that early differentiation of ILC2 occurs in the fetal liver via IL-7 and Notch signaling, whereas final differentiation occurs in the periphery with the aid of PDGFRα+gp38+ cells.
Labour conference 2018: party pledges investment in general practice, public health, and cancer transport costs
Authors: Adrian O’Dowd
Journal: BMJ (2018)

The Labour Party would give more funding to general practice, public health, and paid transport for young patients with cancer, the shadow health secretary has pledged.

In a keynote speech at the party’s annual conference in Liverpool on 26 September, Jon Ashworth said that eight years of “Tory austerity” had seen waiting lists grow, bed numbers fall, services disappear, and hospitals forced to sell land.

“Eight years of austerity sees hospitals crumbling, equipment breaking down,” he said. “Austerity has meant we are so short of midwives that last year half of maternity units shut their doors at some point to women in the throes of labour. …