tbuckley/cabot-search huggingface dataset:
The impact of insurance and race on non-small cell lung cancer outcomes.
Authors: Devalkumar Rajyaguru, Mijung Park, Omar Awais, Michal Tadeusz Krauze
Journal: Journal of Clinical Oncology (2015)

e17606 Background: Over the last decade, there have been major advances in the prevention, early detection, and treatment of cancer. However, these advances have not been experienced equally by all segments of the population. For some Americans, lack of health insurance or inadequate health insurance is a major barrier to receipt of health care services, resulting in disparities in outcomes of non-small cell lung cancer (NSCLC). We elected to examine the impact of insurance status and race on the outcomes of NSCLC in a diverse population treated at a single academic medical center. Methods: We performed retrospective review of 300 patients aged between 18 and 65 with a diagnosis of NSCLC and seen at the University of Pittsburgh Medical Center, Mercy Hospital from 2009 to 2013. Using Kaplan- Meier methods and Cox regression, we examined the relationship between insurance status and overall survival while controlling for confounders that consisted of additional socio-demographics and other tumor and treatment-related characteristics. Results: 125 patients were eligible for analysis. Fifty- two percent of patients had private insurance, 20% had Medicare, and 28% had Medicaid. Kaplan- Meier analysis revealed that in metastatic NSCLC, patients with Medicare/Medicaid coverage had inferior median overall survival (OS) compared with privately insured patients ( Medicare = 7.4 vs Medicaid = 9.1 vs Private = 12.5 months; p = 0.009). In an adjusted Cox regression, patients with stage IV NSCLC were most likely to die as a result of their disease if they had Medicare (hazard ratio [HR], 2.60; 95% CI, 1.23 to 5.50; p = 0.012) or Medicaid compared with private insurance. Females with metastatic NSCLC had better median OS compared with males(11.5 vs. 6.4 months; p = 0.03). Private insurance holder had higher rate of enrollment in clinical trials (6%) than Medicare (0%), Medicaid (0%). Race was not a predictor of survival in our cohort. Conclusions: Within a single medical center, located in a medically underserved area, Medicare/Medicaid status, a surrogate for socio-economic and functional status, was an independent predictor of inferior overall survival in patients with metastatic NSCLC. The diffrences within the metastatic NSCLC group are subject of ongoing research.
Abstract P097: Sociodemographic Differences in the Dietary Quality of Food Purchases Among Participants in the Nationally-Representative Food Acquisition and Purchase Study (FoodAPS)
Authors: Maya Vadiveloo, Haley Parker, Filippa Juul, Niyati Parekh
Journal: Circulation (2019)

Background: Self-reported dietary data may not accurately represent usual dietary intake. Grocery purchase records provide an objective measure of diet, but little research has explored whether the diet quality of grocery purchases reflects individual-level diet quality and whether it differentiates between groups with known differences in dietary quality. This study evaluated whether there are sociodemographic differences in the dietary quality of grocery purchases akin to those observed in existing individual-level national data. Hypothesis: The diet quality of grocery purchases will reflect trends observed with individual-level diet quality. Methods: Grocery purchasing data from 3,961 households in the nationally-representative Food Acquisition and Purchase Study (FoodAPS) were used. Dietary data was collected using hand scanners over 7-days, and demographic data was self-reported. The Healthy Eating Index (HEI) 2015 was used to determine grocery purchase quality, and multivariable-adjusted regression with Tukey adjustment or planned contrasts were used to determine whether HEI-15 scores differed according to food insecurity, Supplemental Nutrition Assistance Program (SNAP) participation, obesity within a household, race/ethnicity, and interactions between these variables. FoodAPS sample weights and Taylor series linearization method for variance estimation accounted for the complex sample design. Results: Primary respondents were, on average, 50.6 years, non-Hispanic White (70.3%), female (70.2%) and had attended some college (57.8%). The mean HEI-15 score was 54.7; 14.0% of households were food insecure and 12.7% received SNAP benefits. HEI-15 scores differed across all sociodemographic predictors (p&lt;0.05). Additionally, interactions (p&lt;0.1) were detected between SNAP participation and (1) food insecurity and (2) obesity within the household as well as race/ethnicity and obesity within the household. Food secure, non-SNAP households had higher HEI-15 scores than food insecure, SNAP participating households (53.9±0.5 vs. 50.3±0.7, p=0.007) in models adjusted for age, income, smoking, and education. Similarly, non-SNAP households without obesity present had significantly higher HEI-15 scores than all other households. Obesity presence within a household was associated with lower HEI-15 scores in non-Hispanic White (50.8±0.5 vs. 52.5±0.7, p=0.046), and Black households (48.8±1.5 vs. 53.1±1.4, p=0.018), but not Hispanic households (54.4±1.0 vs. 52.2±1.2, p=0.21). Conclusions: Disparities in the diet quality of grocery purchases reflect individual-level trends and vary based on sociodemographic factors. This analysis highlights the interrelationships between SNAP, food insecurity, race/ethnicity, and obesity within a household, demonstrating how the co-occurrence of risk factors may modify associations with diet quality.
Pan-Myeloid Leukemia Analysis: Machine Learning-Based Approach to Predict Phenotype and Clinical Outcomes Using Mutation Data
Authors: Kiyomi Morita, Feng Wang, Hideki Makishima, Yuanqing Yan, Tetsuichi Yoshizato, Kenichi Yoshida, Bartlomiej P. Przychodzen, Keyur Patel, Carlos E. Bueso-Ramos, Curtis Gumbs, Latasha Little, Samantha Tippen, Jianhua Zhang, Xingzhi Song, Tapan M. Kadia, Naval G. Daver, Naveen Pemmaraju, Courtney D. DiNardo, Farhad Ravandi, Srdan Verstovsek, Elias J. Jabbour, Jorge E. Cortes, Hagop M. Kantarjian, Guillermo Garcia-Manero, Jaroslaw P. Maciejewski, Seishi Ogawa, P Andrew Futreal, Koichi Takahashi
Journal: Blood (2018)
Public health education in a tribal college setting: description of a BSc programme at Navajo Nation Tribal College, New Mexico, USA
Authors: Kathryn Hartzell, Mark Bauer
Journal: The Lancet Global Health (2019)

BackgroundModels of academic public and global health programmes that are culturally situated and that provide training to meet the needs of communities affected by health disparities can provide inspiration for the development of such programmes throughout the world. In the USA, for example, more American Indian health professionals and researchers are needed to develop culturally relevant health education. Native Nations should exercise their sovereignty by designing programmes and passing policy to achieve health equity while recognising the role that culture plays in our understanding of health. Here, we describe a programme at Diné College (Navajo Nation Tribal College) that aims to build and institutionalise the social and institutional infrastructure needed to enhance the Navajo Nation's professional public health capacity by training Navajo students, practitioners, and researchers.MethodsPublic health faculty at Diné College have developed a BSc degree that meets the specific health needs of the Navajo Nation. The programme is grounded in the Diné educational philosophy, Są'áh Naagháí Bik'eh Hózhóo (SNBH). SNBH provides a philosophy for healthy living through balance with the universe and protection from life's deficiencies. SNBH is composed of four equal and interdependent components: thinking, planning, living, and assurance. In addition, the BSc in Public Health programme is guided by core competencies that reflect both Western public health practice and traditional Diné ideas about health, healing, and the research process. Through a culturally-informed curriculum, this programme aims to produce Diné scholars who are uniquely qualified to conduct health research and to practise public health in their communities.FindingsWe evaluated the project through tracking student enrolment, completed courses, and student experiences; we also documented factors associated with academic success and application of learned skill sets. Students report that the indigenous focus of the programme reinforces their commitment to a career in health or public health service and research. The new BSc in Public Health programme had 60 enrolled majors in 2018. Students have completed up to 100 credit hours of coursework, and a student advisory committee has reported self-confidence in their progress towards public health competencies.InterpretationAcademic programmes that use a culturally-situated curriculum to successfully target aspiring global health practitioners from rural communities with health disparities can serve as models to increase the diversity of global health researchers and the global health workforce.FundingNavajo NARCH Partnership National Institutes' of Health National Institute of General Medical Sciences (NIH-NIGMS), S06GM123550. Diné College Title III Funding.
Perioperative DD-MVAC as a safe and efficacious treatment for MIBC: Results of a retrospective community center study with clinical correlates of toxicity and response.
Authors: Nicole Brenner, Sukesh Manthri, Xuefei Jia, Bruno R. Bastos
Journal: Journal of Clinical Oncology (2015)

e15540 Background: Despite reassuring data showing efficacy of Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (DD-MVAC), community oncologists traditionally choose Gemcitabine and Cisplatin (GC) for treatment of Muscle-Invasive Bladder Cancer (MIBC). This retrospective study assessed 2-year overall survival (OS) and 2-year progression-free survival (PFS) in patients at our institution with MIBC (Stage T2-T3) treated with peri-operative DD-MVAC (every 14 days for goal of 4 cycles, some received 3 cycles due to toxicity) and radical cystectomy (robotic-assisted (RARC) or open (ORC)). Secondary endpoints included complete pathologic response (CPR). Methods: Fifteen patients with MIBC on peri-operative DD-MVAC at our institution were included and an IRB-approved chart-review was performed. The Kaplan-Meier method was used to summarize OS and PFS, which were both measured from the start of treatment. The log rank test was used to compare outcomes between patient groups. Results: The mean age was 63.3+/-9.1 years and 80% were male. 21.4% of patients had T2N0, 35.7% had T3N0, and 42.9% had T2/3N+. 4 patients progressed and died during follow up, 1 of who had micro-papillary histology. OS within the 2-year follow-up was 72.7% +/- 13% and 2-year PFS was 61.3% +/- 15% with no associations with stage, lymph nodes, age, gender, or anemia. Of note, patients with chemotherapy-induced mucositis (4 patients, 26.7%) had a significantly higher risk of disease progression (p = 0.048) and a slightly higher risk of death (p = 0.065). Anemia was the only adverse event in > 50% of patients, both drug-related (66.7%) and postoperative (71.4%). Six patients (40.0%) required early cessation of DD-MVAC (3 cycles) due to drug toxicities, which showed no association with OS (p = 0.76) or PFS (p = 0.82). CPR was identified in 5 (33.3%) patients with down-staging in 5 patients (41.7%). Conclusions: DD-MVAC is a safe and efficacious treatment for MIBC in the community setting. Mucositis may serve as a clinical prognosticator for disease progression and overall survival.
Is there a correlation between Gleason score and maximum standardized uptake value in locally advanced prostate cancer patients?
Authors: Onal Cem, Nese Torun, Ozan Cem Guler, Mehmet Reyhan, Berna Akkus Yildrim, Ali Fuat Yapar
Journal: Journal of Clinical Oncology (2019)

68 Background: The aim was to assess the intensity of 68 Ga-PSMA uptake in the primary tumour in patients locally advanced prostate cancer treated with definitive radiotherapy. Also correlation between the maximum standardized uptake value (SUV max ) of primary tumour and the Gleason score (GS) or prostate-specific antigen (PSA) level was assessed. Methods: The data of 201 biopsy-proven prostated cancer patients were retrospectively analysed. Median age of entire cohort was 68 years (range; 45 – 85 years). PET/CT images were analysed visually and semiquantitatively by measuring the SUV max . The SUV max of the primary tumour was assessed in relation to both PSA level and GS. Results: Median age of entire cohort was 68 years (ranged 45 – 85 years). Median PSA value at diagnosis was 20.3 ng/mL (ranged 2.1 – 301.0 ng/mL). Forty-two patients (23.9%) was in intermediate risk group, and 159 patients (79.1%) had high risk disease. Seventy two patients (36.8%) had regional lymph node metastasis. Median SUV max of primary tumor and metastatic lymph nodes were 13.0 (ranged 1.3 - 84.3) and 12.6 (ranged 3.6 – 64.5), respectively. Patients with GS 7 or lower had significantly lower SUV max compared to patients with GS &gt; 7 (12.1±8.4 vs. 20.9±16.4; p &lt; 0.001). However, there was no significant difference in SUV max of tumors with GS of 3+4 and 4+3 (14.8±8.6 vs. 16.3±12.7; p = 0.6). Patients with PSA ≥10.0 ng/mL exhibited significantly higher uptake than those with PSA levels &lt; 10.0 ng/mL (12.1±8.4 vs. 20.9±16.4; p &lt; 0.001). SUV max of intermediate risk patients was significantly lower than that of high risk patients (12.7±11.1 vs. 19.8±16.8; p = 0.01). In 72 patients with lymph node metastasis SUV max was significantly higher compared to 129 patients without lymph node metastasis (24.9±21.3 vs. 14.7±10.6; p &lt; 0.001). Conclusions: Tumours with GS 7 or lower, patients with PSAvalues ≤10 ng/mL, intermediate risk patients and patients without regional lymph node metastasis showed significantly lower 68 Ga-PSMA uptake. 68 Ga-PSMA-PET/CT should be preferentially applied for primary staging of prostate cancer in patients with GS &gt; 7, PSA levels ≥10 ng/ml, high risk patients and patients with regional lymph node metastasis.
OUTCOMES OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH INFLUENZA &amp; OTHER VIRAL RESPIRATORY INFECTIONS
Authors: Pimprapa Vejpongsa, Danai Kitkungvan, Mohammad Madjid, Konstantinos Charitakis, H. Vernon Anderson, Salman Arain, Prakash Balan, Richard Smalling, Abhijeet Dhoble
Journal: Journal of the American College of Cardiology (2019)
Rupture of the Aortic Valve
Authors: James J. Leonard, W. Proctor Harvey, Charles A. Hufnagel
Journal: New England Journal of Medicine (1955)

RUPTURE of the aortic valve may occur as a result of trauma,1 2 3 4 strain,1 , 5 or bacterial infection.6 , 7 The valves are usually the site of some predisposing factors such as rheumatic valvulitis, syphilitic infection,6 atheromatous changes1 , 6 and congenital anomalies.4 , 8 Nevertheless, in a considerable number of cases, the valve, as seen at post-mortem examination, is otherwise normal.1 2 3 4 The feature common to free aortic insufficiency resulting from rupture, whether traumatic or infectious in origin, is the grave and usually hopeless prognosis.Bright and Beck,9 in 1935, reviewed the general subject of traumatic heart disease with a view of possibly salvaging some cases, and their . . .
NICE proposes lower threshold for treating high blood pressure
Authors: Harriet Pike
Journal: BMJ (2019)

Thousands more people could be eligible for drugs to lower blood pressure under draft clinical guidelines published by the UK National Institute for Health and Care Excellence on 8 March 2019.1

The new recommendations reduce the threshold for risk of cardiovascular disease (CVD) at which blood pressure lowering treatment should be considered. The draft guideline suggests that treatment be offered to patients under the age of 80 years with a diagnosis of stage 1 hypertension if they have a 10 year CVD risk of 10% or more. This is in contrast to the 20% risk threshold used in previous NICE guidelines.2

The change could result in as many as 450 000 more men and 270 000 more women in England with high blood pressure being eligible for treatment. But NICE said that many of these patients were likely to be already being treated because of variation in how …
Management of Pediatric Gastroesophageal Reflux Disease
Authors: Elaine Barfield, Michelle W. Parker
Journal: JAMA Pediatrics (2019)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Pediatrics journal
Design, Formulation, and Evaluation of Novel Dissolving Microarray Patches Containing Rilpivirine for Intravaginal Delivery
Authors: Maelíosa T. C. Mc Crudden, Eneko Larrañeta, Annie Clark, Courtney Jarrahian, Annie Rein‐Weston, Benjamin Creelman, Yolanda Moyo, Sophie Lachau‐Durand, Nico Niemeijer, Peter Williams, Helen O. McCarthy, Darin Zehrung, Ryan F. Donnelly
Journal: Advanced Healthcare Materials (2019)

Antiretroviral (ARV) drugs have, for many years, been studied and administered in the prevention and treatment of human immunodeficiency virus (HIV). Intramuscular (IM) injection of long acting (LA) ARVs are in clinical development, but injectable formulations require regular access to healthcare facilities and disposal facilities for sharps. The development of a discrete, self-administered, and self-disabling vehicle to deliver ARVs could obviate these issues. This study describes the formulation, mechanical characterization, and in vivo evaluation of dissolving microarray patches (MAPs) containing a LA nanosuspension of the ARV, rilpivirine (RPV, RPV LA), for vaginal delivery. This is the first study to apply MAPs into vaginal tissue. The RPV LA MAPs penetrate ex vivo skin and a synthetic vaginal skin model and withstand the effects of potential dragging motion across synthetic vaginal epithelium. In in vivo studies, the mean plasma concentration of RPV in rats at the 56 day endpoint (116.5 ng mL-1 ) is comparable to that achieved in the IM control cohort (118.9 ng mL-1 ). RPV is detected systemically, in lymph and vaginal tissue, indicating the potential to deliver RPV LA to primary sites of viral challenge and replication. This innovative research has future potential for patients and healthcare workers, particularly in low-resource settings.
Prostate cancer-related quality of life and risk for anxiety and depression.
Authors: Shauna McManus, Julie Olson, Melissa F. Miller, Kelly Clark, Kevin Stein
Journal: Journal of Clinical Oncology (2019)

41 Background: Due to side effects of invasive treatments, prostate cancer (PC) patients face long-term quality of life (QoL) concerns and enduring psychosocial distress. We explored how QoL is linked to distress among a national sample of men with PC. Methods: 214 men with PC enrolled in the Cancer Support Community’s Cancer Experience Registry. Participants provided demographic/clinical background and completed the Prostate Cancer-Related QoL Scales, covering 6 QoL domains ( urinary control, sexual intimacy, sexual confidence, masculine self-esteem, cancer control, and treatment regret). Psychosocial distress was captured by CancerSupportSource, a 25-item tool with 2-item depression and anxiety screening subscales. Scores ≥3 indicate risk for clinically significant depression or anxiety respectively, and signal need for referral and further assessment. We examined bivariate correlations between demographic/clinical background, QoL, and prevalence of ‘risk for clinically significant anxiety and depression’, and used logistic regression to calculate odds of anxiety and depression risk by QoL, adjusting for demographic/clinical variables. Results: Participants were 93% White; mean ( SD) age=64 (12) years; mean ( SD) years since diagnosis=4.3 (4.9); 25% had metastatic disease. 54% underwent radiation; 55% surgery. 40% were at risk for clinically significant anxiety; 35% depression. Poorer QoL scores for sexual intimacy, sexual confidence, masculine self-esteem, cancer control, and treatment regret were bivariately associated with anxiety ( p&lt;.05) and depression ( p&lt;.001) risk. In logistic regression, poorer perceived cancer control predicted anxiety risk (R 2 =.44; OR=0.97; p&lt;.01). Lower masculine self-esteem predicted depression risk (R 2 =.68; OR=0.88; p&lt;.05). Conclusions: Questioning treatment efficacy and worrying about disease progression (i.e., lower perceived cancer control) predicts greater likelihood of anxiety risk. Lower masculine self-esteem predicts odds of depression risk. These findings elucidate the ways that PC patients’ perceptions of advancing disease and diminishing masculinity are linked to distress, thus identifying areas for psycho-educational and supportive interventions.
The molecular hallmarks and clinical consequences of tumor hypoxia in prostate cancer.
Authors: Bhandari Vinayak, Lydia Liu, Shadrielle Espirritu, Emilie Lalonde, Takafumi Yamaguchi, Lawrence Heisler, Julie Livingstone, Vincent Huang, Yu-Jia Shiah, Veronica Sabelnykova, Fouad Yousif, Michael Fraser, Melvin Chua, Theodorus Van Der Kwast, Stanley K. Liu, Paul Christopher Boutros, Robert G. Bristow
Journal: Journal of Clinical Oncology (2019)

81 Background: Localised prostate cancers are classified into risk-groups using clinical measurements like grade and stage to inform treatment decisions. However, these groupings are imprecise: ~30% of intermediate-risk patients suffer relapse of their disease despite precision image-guided radiotherapy or radical prostatectomy. One reason for this variability in response to treatment is the underlying cellular and molecular heterogeneity of tumours. Prostate tumour cells exist within a microenvironment characterized by gradients of oxygen levels and prostate tumours with low levels of oxygen (hypoxia) have poor clinical outcomes. Methods: Hypoxia was measured using multiple mRNA-based signatures. We examined 548 patients with localised prostate cancer and statistically assessed the association of hypoxia with copy-number alterations (CNAs), single-nucleotide variants (SNVs), genomic rearrangements, focal genomic events ( i.e. kataegis, chromothripsis), telomere length, clinical indices ( i.e. grade, stage) and subclonal architecture. Results: Elevated hypoxia was associated with allelic loss of PTEN, higher rates of chromothripsis and intraductal and cribriform carcinoma (IDC-CA). To translate these findings into a biomarker for prostate cancer precision medicine, we integrated tumour microenvironmental data with genomic and pathological information to stratify patients into distinct prognostic groups. Patients with localized prostate cancer that have polyclonal tumours with elevated hypoxia, allelic loss of PTEN and IDC-CA were at the highest risk of rapid biochemical failure (P = 3.48 x10 -3 , Logrank test) and metastasis (P = 4.61 x 10 -3 , Logrank test), even after controlling for T-category, Gleason score and pre-treatment PSA. Conclusions: These data suggest that the aggressiveness of prostate cancers is driven by the interplay of the tumour microenvironment, tumour evolutionary trajectories and its genomic mutational profile.