tbuckley/cabot-search huggingface dataset:
Beneficial involvement of gynecologic oncologist in Medicare ovarian cancer patient's standard of care treatment receipt and survival.
Authors: Sun Hee Rim, Shawn Hirsch, Thomas B. Richards, Cheryll C. Thomas, Lauren Westervelt, Wendy R. Brewster, Sherri L. Stewart
Journal: Journal of Clinical Oncology (2015)

e17661 Background: We examined quality care (defined by surgical and chemotherapeutic standard of care (SOC) treatment) receipt among women with ovarian cancer who received surgery as the initial treatment procedure from a gynecologic oncologists (GO) vs non-GO. Additionally, we examined if this translated into improved survival. Methods: The Surveillance, Epidemiology, and End Result (SEER)-Medicare dataset was used to identify 11,688 women diagnosed with ovarian cancer between 1992-2006. The analysis was restricted to Medicare recipients with a surgical procedure code before any chemotherapy (n = 6,714). Multivariate logistic regression was used to determine the odds that a woman 1) had a GO perform the initial surgery and 2) received minimum surgical and chemotherapeutic standards of care. Cox Proportional Hazard Modeling was used to estimate the relative risk of mortality among ovarian cancer patients by treatment received and by physician specialty, after adjusting for other variables. Results: Among patients with initial surgical treatment, 33.6% received surgery from a GO. Sixty-six percent received surgical SOC, which was more often performed by a GO than non-GO. Risk of mortality was greater among those who did not receive surgical SOC as compared to those who did [hazard ratio 1.44 (95%CI: 1.34-1.55), p < 0.01]. Risk of mortality was greater among women seen by non-GOs than GOs (for surgical treatment), older compared to younger adults, black compared to white women, and those with more compared to fewer comorbidities. Conclusions: This study provides additional evidence for a survival advantage associated with receiving standard of care surgical and overall treatment by a GO. Differences in treatment and survival among those not receiving the SOC, including the elderly and black women, continue to persist.
Providers’ inability to estimate health literacy among African American (AA) patients (pts) with early prostate cancer (PCa).
Authors: William Martin-Doyle, Kerry L. Kilbridge, Susan Regan, Christopher Paul Filson, Quoc-Dien Trinh, Sierra Williams, Viraj A. Master
Journal: Journal of Clinical Oncology (2019)

77 Background: Providers’ estimates of a pt’s health literacy are important for communication and shared decision making among men with early PCa. We explored differences between providers’ estimates of health literacy and measured health literacy among AA pts in a prospective cohort study at Grady Memorial Hospital and the Atlanta Veterans Administration Hospital. Methods: Providers (n=18) estimated the health literacy of 124 newly diagnosed, early-stage, AA PCa pts after discussions with each pt regarding his PCa treatment options, categorized as ≤Grade (Gr) 3; Gr 4-6; Gr 7-8; and High school. At a subsequent visit, prior to choosing his cancer treatment, each pt’s health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), using the same categories. Domains of numeracy, comprehension of common PCa terms, and anatomic knowledge were assessed using published methods. Concordance between estimated and actual health literacy was evaluated via Cohen’s Kappa coefficient (1.00 = perfect agreement). Results: Despite their discussions with the pts, providers consistently overestimated pts’ health literacy. Agreement between provider estimates and pts’ measured values was consistently low (32.0%-37.6%). These rates were approximately what would be expected by chance. Among the 75 patients with the lowest levels of health literacy, agreement was even lower (12.3%-35.6%). In this group 26.7% of provider assessments were off by ≥2 REALM categories. Conclusions: Healthcare providers are surprisingly ineffective at estimating the health literacy of their pts with early stage PCa. This poor accuracy may diminish providers’ ability to communicate successfully with pts and engage in shared decision making, especially among pts with poor health literacy. [Table: see text]
Biochemical and imaging surveillance for Li-Fraumeni syndrome: The “Toronto Protocol” at 11 years.
Authors: Anita Villani, Ari Shore, Jonathan Wasserman, Harriet Druker, Bailey Gallinger, Ana Novokmet, Uri Tabori, Jonathan L. Finlay, Joshua David Schiffman, David Malkin
Journal: Journal of Clinical Oncology (2015)

e12546 Background: Carriers of a germline TP53 mutation have a substantial lifetime risk of developing cancer. We sought to update our evaluation of a comprehensive surveillance protocol for individuals with Li-Fraumeni syndrome. Methods: A clinical surveillance protocol, utilizing frequent biochemical and imaging studies, was introduced at three tertiary care centres on January 1, 2004 for TP53 mutation carriers. We conducted a prospective observational study of individuals in 20 families who either chose to undergo surveillance or who declined surveillance. The primary outcome measure was detection of new cancers. Results: As of January 1, 2015, 46 TP53 mutation carriers were identified. Thirty-one individuals have undergone surveillance over an average period of 65 months (range 4-150 months), and 20 asymptomatic tumors have been detected in 10 patients. Two additional cancers were diagnosed between assessments. Twelve incidental findings were documented, most of which led to additional imaging and 2 of which led to a biopsy. Among the 22 patients who declined surveillance, 21 symptomatic tumors were diagnosed in 19 patients. Seven of the 19 patients not on surveillance who developed cancer are alive, compared to 8 of the 10 patients on surveillance who developed cancer. Individuals demonstrated nearly 100% compliance with the surveillance protocol. Conclusions: We demonstrate the sustained feasibility and utility of a surveillance protocol for the early detection of neoplasms in individuals with germline TP53 mutations.
Abstract P381: Sedentary Behavior and All-Cause Mortality: A Review ofSystematic Reviews With Meta-Analyses
Authors: Andrew L Mills, Jessica Lee, Trent Sever, Christina M Shay
Journal: Circulation (2019)

Introduction: Growing evidence suggests that higher levels of sedentary behavior (SB) are associated with higher risk of death. Multiple systematic reviews with meta-analyses (SRMA) have been published on this topic and synthesis of these results would have great utility in facilitating knowledge uptake. Purpose: The purpose of this project is to synthesize existing SRMAs in order to examine associations between SB and all-cause mortality. Methods: A systematic literature review was conducted by querying multiple electronic databases and hand-searching references. Inclusion criteria were SMRAs that reported associations in adults (18+ years old); examined SB as an exposure; included all-cause mortality as an outcome; and where sufficient results were available. Eligibility assessment and data extraction were done in duplicate by two independent reviewers. Discrepancies were solved by consensus. Descriptive characteristics, point estimates, confidence intervals and I 2 were extracted from eligible studies. Results: A total of 676 records were initially identified. After exclusions based on title, abstract, and full-text assessments, 5 eligible meta-analyses were identified, which included results based on 3,575,480 adults. Among the 5 meta-analyses, the studies per meta-analysis ranged from 3 to 12 and sitting time and television viewing time were the types of sedentary behaviors assessed. Effect sizes (OR, RR, HR) in the identified reports ranged from 0.96 to 1.59 (Figure 1). Conclusions: This systematic review of meta-analyses indicates a consistent dose-response of effect sizes between level of SB and all-cause mortality. This emphasizes the importance of targeting SB as a way of improving CV and overall health.
Sequential versus sandwich chemotherapy and radiation for the treatment of advanced endometrial cancer.
Authors: Emma Longley Barber, Tom Basson, Paola A. Gehrig, Victoria Lin Bae-Jump, Stephanie B. Wheeler, Kenneth H Kim
Journal: Journal of Clinical Oncology (2015)

e16513 Background: Combination chemotherapy and radiation is standard treatment for advanced stage endometrial cancer and can be given in a sequential or a sandwich fashion. Series have shown a survival benefit to sandwich therapy, but this may come at the expense of increased toxicity. Our objective was to evaluate differences in toxicity and survival between patients who received sandwich and sequential therapy. Methods: Women with stage III-IV endometrial cancer treated with sequential or sandwich therapy between 2005-2012 were included. Sandwich therapy was defined as chemotherapy/radiation/chemotherapy and sequential therapy was chemotherapy/radiation. Toxicities were defined per CTCAEv4.0. Treatment delay was a greater than 2 week delay. Primary outcomes were overall survival (OS), progression free survival (PFS), treatment delay, and toxicity. Chi square and student's t-test were used to determine associations. Kaplan Meier method was used to estimate survival. Results: We identified 105 patients. Median age was 64 (30-88), median BMI was 30 (18-54) and 26.7% were of non-Caucasian race. Histology was 57.1% endometrioid, 15.2% serous, 6.7% carcinosarcoma, 3.8% clear cell, and 17.2% mixed/other; and 93.3% of patients had stage III disease. Sandwich therapy was given to 75.6% and sequential to 24.4%. Nineteen percent experienced a treatment delay, 41% experienced a grade 3 or 4 toxicity, and 23.8% were hospitalized. PFS at 3 years was 61.6% and OS was 70.7%. Treatment delay, hospitalization, and grade 3 or 4 toxicity were not associated with recurrence or death at 3 years. Sandwich therapy patients did not experience more treatment delays (20.0% v 16.0% p = 0.66), grade 3 or 4 toxicities (43.8% v 32.0% p = 0.30), or hospitalizations (26.2% v 16.0% p = 0.29). Mean treatment duration did not differ between sandwich and sequential patients (194±33.3 v 194±43.4 days p = 0.92). There was also no difference in PFS (65.8 v 61.2 months p = 0.93) or OS (70.2 v 63.5 months p = 0.79). Conclusions: We found no significant difference between sandwich and sequential therapy with regard to toxicity, treatment delay, PFS or OS. However, we did observe a trend towards improved survival and increased toxicity with sandwich therapy.
Abstract P004: Activity-Aware Medication Prompting and Bluetooth Pillbox Usability and Acceptability With Adults
Authors: Jessica C Ardo, Diana Guijarro, Hassan G Ghasemzadeh, Lorraine S Evangelista
Journal: Circulation (2019)

Purpose/Aims: To examine usability (e.g., efficiency, learnability) and acceptability (e.g., user experience, perceived control) of the activity-aware medication prompting application and pillbox in a sample of adults at risk of CVD. Background: Medication adherence has been identified as one potentially modifiable factor that contributes to increased morbidity and remains a great challenge for many adults at risk of CVD due to decreased knowledge of medication self-management. Novel strategies have been proposed to improve medication adherence. However, medication adherence outcomes have primarily been tracked using self-report and therefore success with these interventions varies widely. It is important to measure and take into account end users’ perceptions of usability and acceptability of these technologies as they are being developed. Methods: A software algorithm was developed and tested in adults at risk of CVD (N=12) to recognize daily behavior contexts using machine learning combined with automated activity discovery. Participants were given the pillbox device to use for 8 weeks, from which medication adherence rates were monitored. Usability and acceptability of the platform were assessed at study completion using a Usability Survey and open-ended questions. Results: Participants (33.3 % male; mean age 55.00, ±10.57) reported moderate to high levels of usefulness and acceptability (see Table). Participants claimed that the platform and pillbox devices were useful, user-friendly and easy to learn and understand, but did not feel that it helped them understand their illness, influence a change in health habits or impact their feelings of control. Implications: This study highlights the importance of seeking end-user feedback in the development of intelligent technologies. Participants’ perceptions of usability and acceptability are warranted to ensure that these applications will achieve their intended aim of improving medication adherence and ultimately human health and health care delivery.
Abstract P346: High Stress Reasons for Immigration May Increase Risk for Diabetes: The Africans in America Study
Authors: Regine Mugeni, Margrethe F Horlyck - Romanovsky, Jessica Y Aduwo, Sara M Briker, Thomas Hormenu, Stephanie T Chung, Lilian S Mabundo, Christopher W Dubose, David Berrigan, Anne E Sumner
Journal: Circulation (2019)

Background: Scant data exists on whether reason for immigration (work, asylum/refugee, study, family reunification and lottery) affects physiologic stress experienced by Africans living in America. It is also uncertain if high stress measured by allostatic load score (ALS), translates into risk for diseases such as diabetes. Goals: Working with self-identified healthy African-born blacks enrolled in the Africans in America study (n=147, men 66% (97/147), age 42±10y (mean±SD), BMI 27.6±4.3 kg/m 2 ), we (a) determined whether ALS varies by reason for immigration; (b) examined the relationship of ALS to risk factors for diabetes including insulin resistance and visceral adipose tissue (VAT) volume. Methods: A priori it was decided immigration reasons above the median ALS would be defined as high stress and below the median, low stress. ALS was calculated using 10 variables from 3 domains: cardiac (SBP, DBP, pulse, cholesterol, HDL, homocysteine), metabolic (BMI, A1C, albumin) and immunological (hsCRP). One point was assigned if a variable was determined high-risk range and 0 if not. According to the distribution of the variables in the cohort, high-risk was defined by being in the highest quartile for each variable, except for albumin and HDL, which required the lowest quartile. Diabetes was diagnosed by OGTT, insulin resistance by Matsuda Index and VAT by abdominal CT scan. Results: Three reasons for immigration were identified as high stress: work, asylum/refugee and study (Fig). Low stress reasons were: family and lottery (Fig). Mean ALS for high and low stress reasons for immigration were: 2.8±0.2 vs 1.8±0.2, P &lt;0.01. (Fig). DM was diagnosed in 7% (10/147) of participants, but 90% (9/10) of the immigrants with DM had high stress reasons for living in America. ALS was positively correlated with fasting glucose, 2h glucose, insulin resistance and VAT (all P &lt;0.01). Conclusion: High stress reasons for immigration were work, asylum/refugee and study. They may be associated with adverse physiologic consequences including diabetes.
a Phase I California Cancer Consortium Study of the Combination of Rituximab and Ipilimumab in Patients with Relapsed/Refractory CD20+ B-Cell Lymphoma; Efficacy, Safety and Immune Correlative Analysis
Authors: Joseph Tuscano, Susan Groshen, Denice Tsao-Wei, Emanual Maverakis, Paul R. Kaesberg, Tanya Siddiqi, Leslie Popplewell, Sikander Ailawadhi, Myo Htut, Robert W. Chen, Mark Kirschbaum, Mark T. Schroeder, Brian A Jonas, Ted Wun, Neil Palmisiano, David F. Claxton, Edward Newman
Journal: Blood (2017)
Quantity and Quality Reconstitution of NKG2A+ NK Cells Are Associated with Graft-Versus-Host Disease after Allogeneic Hematopoietic Cell Transplantation
Authors: Lijuan Hu, Xiang-Yu Zhao, Xingxing Yu, Meng Lv, Ting-Ting Han, Wei Han, Xiao-Jun Huang
Journal: Blood (2018)
Dichotomous sized-based clinical staging of localized renal masses affects management but not clinical outcomes.
Authors: Lael Suzanne Reinstatler, Kristian D. Stensland
Journal: Journal of Clinical Oncology (2019)

670 Background: Clinical staging of localized renal masses is assigned according to radiographic tumor diameter cut-offs, with T1 masses defined as 7 cm or less and T2 greater than 7cm. However, it is unknown if tumors with infinitesimal size differences exhibit oncologic behavior to warrant different surgical management. Arbitrarily dichotomizing otherwise similar tumors to different stage groups may inappropriately influence the management of renal tumors and affect patient outcomes. We evaluated differences in management and outcomes in otherwise similarly sized tumors among patients that differ only in clinical T stage. Methods: Data from the National Cancer Center Database was extracted on all patients with a diagnosis of stage T1 or T2 clear cell renal cell carcinoma (RCC). Analyses were limited to tumors on the cusp of T1/T2 staging to include: 69 mm, 70 mm, and 71 mm. Clinical data were compared and Kaplan-Meier and Cox proportional hazards survival modeling were performed. Results: A total of 2815 patients were included. There were 1882 stage T1 and 933 stage T2 tumors; there were no differences in demographics or comorbidity scores. Of 171 tumors reported to be 69 mm, 132 (77.2%) were staged as T1. Of 2339 70 mm tumors, 1686 (72%) were staged as T1. Of 305 71 mm tumors, 64 (21%) were staged as T1. For management, 11.7% of T1 masses were treated with partial nephrectomy vs 7.3% of T2 masses and 75.8% of T1 masses were treated with radical nephrectomy vs 80.7% of T2 masses (p&lt;0.001). T2 masses were more likely to have lymph node dissection than T1 masses (15.1% vs 9.9%, p&lt;0.001), but pathologic N and M staging was similar. On survival analyses, there was no difference in survival between T1 and T2 masses. Conclusions: In this analysis, tumors of similar size but different clinical stage exhibited similar survival, yet were managed differently according to assigned clinical T stage. Patients with large T1 or small T2 masses may be managed inappropriately if the treatment is based on dichotomized clinical staging alone. When possible, risk calculation using precise parameters such as tumor size as part of a prediction model is preferable to dichotomized rules of thumb when determining optimal treatment courses.
Reductionist thinking and animal models in neuropsychiatric research
Authors: Nicole M. Baran
Journal: Behavioral and Brain Sciences (2019)

Abstract Reductionist thinking in neuroscience is manifest in the widespread use of animal models of neuropsychiatric disorders. Broader investigations of diverse behaviors in non-model organisms and longer-term study of the mechanisms of plasticity will yield fundamental insights into the neurobiological, developmental, genetic, and environmental factors contributing to the “massively multifactorial system networks” which go awry in mental disorders.
Агрегационная способность тромбоцитов у пациентов с гипертонической болезнью в сочетании с неалкогольной жировой болезнью печени на фоне ожирения
Authors: N.M. Bazhenova
Journal: GASTROENTEROLOGY (2019)

Актуальность. Активация тромбоцитов и их агрегации являются важнейшими процессами в патофизиологии ишемической болезни сердца. Зависимость смертности от сердечно-сосудистой заболеваемости может усугубляться присутствием других сопутствующих сердечно-сосудистых факторов риска, в том числе гипертонической болезнью (ГБ), ожирением, неалкогольной жировой болезнью печени (НАЖБП). Цель работы: изучить наличие тромбофилических изменений крови у пациентов с гипертонической болезнью и сопутствующим ожирением и неалкогольной жировой болезнью печени путем определения агрегационной способности тромбоцитов. Материалы и методы. Обследован 91 пациент. Средний возраст — (57,9 ± 9,4) года. Выделено три группы пациентов: I — 36 больных ГБ II стадии с сопутствующей НАЖБП, II — 28 пациентов с НАЖБП без ГБ, III группа — 27 пациентов с ГБ II стадии без сопутствующей НАЖБП. Результаты. Выявлено достоверное увеличение степени спонтанной агрегации у пациентов во всех группах по сравнению с группой контроля: у пациентов с ГБ II ст. — в 3 раза (p &lt; 0,05), у пациентов с НАЖБП — в 4,2 раза (p &lt; 0,001), у пациентов с НАЖБП + ГБ II ст. — в 7 раз (p &lt; 0,01). Степень АДФ-индуцированной агрегации тромбоцитов достоверно возрастала во всех группах пациентов: в группе ГБ II ст. увеличивалась на 116 % (p &lt; 0,05), в группе НАЖБП + ГБ II ст. — на 93 % (р &lt; 0,001), при самостоятельной НАЖБП — на 71,7 % (p &lt; 0,05). Степень агрегации, индуцированной арахидоновой кислотой, достоверно снижалась на 8,3 % (p &lt; 0,05) в группе пациентов с НАЖБП + ГБ II ст. Выводы. При гипертонической болезни наблюдалось увеличение функциональной активности тромбоцитов, выраженность которой значительно возрастала при присоединении НАЖБП. У пациентов с изолированной НАЖБП также наблюдалось статистически значимое усиление спонтанной агрегации тромбоцитов, что позволяет рассматривать НАЖБП как один из факторов риска тромбофилических изменений первичного звена гемостаза.
Abstract 42: Diabetes Metabolomics Score and Risk of Progression from Gestational Diabetes to Type 2 Diabetes
Authors: Deirdre K Tobias, Olga Demler, Clary Clish, Liming Liang, JoAnn E Manson, Cuilin Zhang, Frank B Hu
Journal: Circulation (2017)

Background: A number of individual metabolites have been identified for their relationship with type 2 diabetes (T2D) risk. We sought to evaluate a pattern of T2D metabolites to estimate the collective impact of these markers on elevating the risk of progression to T2D among high risk women with a history of gestational diabetes mellitus (GDM). Methods: We conducted a prospective nested case-control study among women with a history of GDM in the Nurses’ Health Study II longitudinal cohort. Three panels of plasma metabolites were assayed via liquid chromatography tandem mass spectroscopy among 175 T2D cases and 175 controls, matched for age and fasting status at blood draw in 1997-1999. Incident type 2 diabetes cases occurred a median of 7 years after blood collection (range 1-15 years). Based on the published literature, we identified 38 metabolites associated with T2D and available among our measured panels, including branched-chain and other amino acids, lipids, and others. Metabolite levels were log-transformed and standardized. We derived a T2D MET SCORE, summing across the points corresponding to individuals’ assigned quintile level for each of the 38 metabolites. We estimated the odds ratios (OR) and 95% confidence intervals (CI) for the association of the T2D MET SCORE with incident T2D risk using multivariable conditional logistic regression models, adjusted for age, fasting status, body mass index (BMI), physical activity, and other established T2D risk factors. Results: Cases and controls were on average 43 years at blood draw with a mean of BMI 28.6 kg/m 2 . In the model adjusted for age and fasting status, the T2D MET SCORE was significantly associated with a step-wise increase in T2D risk across quartiles (Q1: [reference]; Q2: OR=2.5 CI=1.2, 5.6; Q3: OR=7.0 CI=3.2, 15.2; Q4: OR=10.9 CI=4.7, 24.9). Adjusting for BMI and other risk factors attenuated the relationship, although the score remained significantly associated with T2D risk (Q4 vs. Q1: OR=7.2 CI=2.5, 20.3). The T2D MET SCORE was associated with T2D risk among both obese and non-obese women (p for interaction=0.4). A BCAA sub-score (3 metabolites) and a lipid sub-score (16 metabolites) were also positively associated with T2D risk (BCAA Q4 vs. Q1: OR=3.5 CI=1.4, 8.8; lipids Q4 vs. Q1: OR=3.6 CI=1.4, 9.1). Conclusions: A pattern of high-risk circulating metabolites is significantly associated with progression from GDM to type 2 diabetes later in life.