tbuckley/cabot-search huggingface dataset:
Constructing a framework for Return to Sport in elite football (PhD Academy Award)
Authors: Matt Taberner
Journal: British Journal of Sports Medicine (2020)

The primary aim of my research was to construct a conceptual framework for on-pitch rehabilitation to help guide practitioners in the Return to Sport (RTS) process following injury in elite football. I then described how the framework was used to support RTS following; a common injury (hamstring strain), a rare injury (traumatic fracture) and a severe injury (anterior cruciate ligament reconstruction (ACLR)).

Injury and re-injury are major problems in elite football.1 Inadequate rehabilitation is a risk factor for re-injury2 and football clubs strive to continually improve rehabilitation and RTS of injured players. The absence of specific frameworks to guide the on-pitch rehabilitation process was a surprising gap in the contemporary sports science literature.

I developed an approach to rehabilitation and RTS over a decade in my roles of applied sports science and rehabilitation in the English Premier League (EPL) (figure 1). I embedded this experience and key elements of the RTS process defined in the literature into a framework for on-pitch rehabilitation. My goal was to progress the athlete from a setting …
Diagnostic value of cardiopulmonary exercise test for coronary heart disease
Authors: Ning-fu Wang, Zhan-lin Zhou, Jian Xu, Guo-xing Tong, Hao Pan, Liang Zhou, Xian-hua Ye, Jian-min Yang
Journal: BMJ (2011)

Cardiopulmonary exercise test and electrocardiogram exercise test were performed in 68 patients with suspected coronary artery disease,the diagnostic value of two tests was compared with coronary angiography results as the gold standard.The results show that the sensitivity,specificity,positive predictive value and negative predictive value of electrocardiogram exercise test for coronary heart disease were 51.28％,68.97％,68.97％ and 51.28％ respectively; those for ratio of O2 pulse peak in cardiopulmonary exercise test were 51.28％,75.86％,74.07％ and 53.66％ respectively.It suggests that the results of cardiopulmonary exercise test may have the same value as electrocardiogram exercise test in diagnosis of coronary artery disease.

Key words: 
Exercise test; Coronary disease
Updated results from phase I dose-escalation study of AMG 330, a bispecific T-cell engager molecule, in patients with relapsed/refractory acute myeloid leukemia (R/R AML).
Authors: Farhad Ravandi, Roland B. Walter, Marion Subklewe, Veit Buecklein, Mojca Jongen-Lavrencic, Peter Paschka, Gert J. Ossenkoppele, Hagop M. Kantarjian, Antreas Hindoyan, Suresh K Agarwal, Tian Dai, Sophia Khaldoyanidi, Anthony Selwyn Stein
Journal: Journal of Clinical Oncology (2020)

7508 Background: In this open label phase 1 dose escalation study, safety, tolerability, pharmacokinetics, pharmacodynamics and preliminary efficacy of AMG 330 were evaluated in patients (pts) with R/R AML (NCT#02520427). Methods: AMG 330 was evaluated as a continuous IV (cIV) infusion using a 3+3 design. Response was assessed per revised IWG criteria. Each cycle (2–4 weeks duration) was followed by an infusion-free interval. Eligible pts were ≥18 y/o with &gt; 5% blasts in bone marrow and ≥1 line/s of prior therapy. Results: As of December 10, 2019, 55 pts (median age, 58.0 [18.0–80.0] years) were enrolled in 16 cohorts. AMG 330 was administered on 4 schedules (0–3 dose steps) prior to the target dose (TD, 0.5–720 µg/day). Dose steps were implemented in the dose schedule design based on the adverse event (AE) profile. Across all schedules, 55 (100%) pts reported treatment-emergent AEs (any grade). AMG 330–related AEs reported in 49/55 (89%) pts included cytokine release syndrome (CRS; 67%; ≥ grade 3 in 13%), (60%) and nausea (20%) as the most frequent AEs. CRS was reversible and occurred in a dose/schedule-dependent manner mostly within the first 24 hours of administration of triggering AMG 330 dose. The frequency and severity of CRS correlated with the dose level and leukemic burden at baseline. AMG 330 exhibited dose-dependent increase in steady state exposures over the studied dose range with clinical PK profile consistent with cIV administration. Eight of 42 evaluable pts responded: 3 complete remissions (CR; including 1 CR with negative measurable residual disease reported after data snapshot), 4 CR with incomplete hematologic recovery, and 1 morphologic leukemia free state. Seven responders who achieved CR/CRi received a TD equal or above the minimal efficacious dose of 120 μg/day. Among analyzed CR/CRi responders, 4/6 (67%) had adverse cytogenetic risk profile, 3/6 (50%) had ≥4 lines of prior therapy and all had relapsed disease. Responders had higher AMG 330 exposures and 3 responders treated with ≥600 μg/day TD remain in CR/CRi: 1 patient for &gt; 5 months after cycle 1, 1 patient bridged to hematopoietic stem cell transplant after cycle 4 and 1 patient is in cycle 3. Preliminary response assessment showed a correlation with lower tumor burden at baseline with a trend towards higher CD8+ lymphocyte count and E:T ratio. Conclusions: AMG 330 dosed up to 720 μg/day provided early evidence of acceptable safety profile, drug tolerability and anti-leukemic activity, and supports further dose escalation. Clinical trial information: NCT02520427 .
Education level and outcomes after acute myocardial infarction in China
Authors: Huo Xiqian, Khera Rohan, Zhang Lihua, Herrin Jeph, Bai Xueke, Wang Qianying, Lu Yuan, Nasir Khurram, Hu Shuang, Li Jing, Li Xi, Zheng Xin, Masoudi Frederick A, Spertus John A, Krumholz Harlan M, Jiang Lixin
Journal: BMJ (2019)

目的
中国是人口多样化、教育程度差异很大的国家，然而教育程度与我国急性心肌梗死（AMI）患者预后的相关性仍不清楚。本研究旨在探索AMI患者的教育程度与预后的相关性，以期进一步指导未来健康医疗干预的方向。


方法
研究基于China PEACE前瞻性AMI研究的数据，共纳入来自中国53家医院的3 369名连续入选的AMI患者，并根据其接受教育的程度分为高（高中、大学及研究生）、中（初中学位）、低（小学及小学以下）3个不同水平。采用生存模型分析不同教育程度与AMI后1年严重心血管病不良事件（MACE）发生率和全因病死率的关系，并校正了人口统计学和心血管危险因素等差异的影响。


结果
研究人群的中位年龄为61（52~69）岁，23.2%为女性，33.3%为高学历水平，32.4%为中等学历水平，34.3%为低学历水平。与高中、大学或研究生学历相比，小学或小学以下学历患者的1年MACE发生率更高(危害比2.41, 95%可信区间1.72~3.37)，全因病死率也显著增高(危害比3.09, 95%可信区间1.69~5.65)。在校正人口统计学及共病因素后，教育程度与1年全因病死率的关联减弱（危害比1.41, 95%可信区间0.74~2.69, P=0.30），但教育程度与AMI后1年MACE的关联仍有统计学意义，且学历低的患者的不良事件发生风险是学历高者的近1.7倍(调整危害比1.68, 95%可信区间1.18~2.41, P=0.004)。


结论
在中国AMI住院患者人群中，教育程度较低的患者在AMI发病1年内发生不良心血管事件和全因死亡的风险更高。将来对AMI患者的健康干预应根据其教育程度的不同，有针对性地完善出院后的宣教和护理，以期改善患者预后。


临床试验注册号
NCT01624909。
Effects of Bi-level positive airway pressure on the level of B-type natriuretic peptide in patients with acute left ventricular failure
Authors: Xiaoli Yuan
Journal: BMJ (2014)

A total of 122 patients with acute left ventricular failure from January 2011 to December 2013 at our hospital were recruited and divided randomly into control group (n=62) and observation group (n=60). Control group received conventional therapy and Bi-level positive airway pressure (Bi-PAP) was added along with conventional therapy for observation group. And 12 and 8 patients died in control and observation groups respectively within 24 h after treatment and there was no statistical difference. The BNP levels of the control group pre-treatment and at 1 h and 24 h post-treatment were (1 040±315), (995±245) and (570±164) ng/L. The BNP levels of observation group pre-treatment and at 1 h and 24 h post-treatment were (1 080±209), (995±245) and (490±138) ng/L. BNP of observation group at 1 h and 24 h post-treatment decreased significantly compared with that pre-treatment and control group (P<0.01). Only at 24 h post-treatment, the BNP level of control group decreased significantly compared with that pre-treatment (P<0.01).


Key words: 
Bi-level positive airway pressure; Natriuretic peptide, brain
Phase II/III trial of post-operative chemoradiotherapy comparing 3-weekly cisplatin with weekly cisplatin in high-risk patients with squamous cell carcinoma of head and neck (JCOG1008).
Authors: Naomi Kiyota, Makoto Tahara, Hirofumi Fujii, Tomoko Yamazaki, Hiroki Mitani, Shigemichi Iwae, Yasushi Fujimoto, Yusuke Onozawa, Nobuhiro Hanai, Takenori Ogawa, Hiroki Hara, Nobuya Monden, Eiji Shimura, Shujiro Minami, Takashi Fujii, Kaoru Tanaka, Takeshi Kodaira, Junki Mizusawa, Kenichi Nakamura, Ryuichi Hayashi
Journal: Journal of Clinical Oncology (2020)

6502 Background: The standard treatment for post-operative high-risk patients (pts) with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) is chemoradiotherapy with 3-weekly cisplatin (CDDP) (100 mg/m 2 , q3wk, 66 Gy/33Fr; 3-weekly CDDP+RT). However, one concern with 3-weekly CDDP+RT is insufficient CDDP compliance due to high-dose-related toxicities. Weekly CDDP+RT (40 mg/m 2 , qwk, 66 Gy/33Fr; weekly CDDP+RT) is an alternative regimen with better compliance. Here, we conducted a phase II/III trial of weekly CDDP+RT in post-operative high-risk LA-SCCHN. Methods: This is a multi-institutional randomized phase II/III trial to confirm the non-inferiority of weekly CDDP+RT (Arm B) compared with 3-weekly CDDP+RT (Arm A). The trial enrolled pts aged 20-75 years with post-operative high-risk features (microscopically positive margin and/or extranodal extension) and ECOG-PS 0-1. Pts were randomized in a 1:1 ratio to Arm A or Arm B. Primary endpoint of phase II was the proportion of treatment completion and that of phase III was overall survival (OS). A non-inferiority margin of hazard ratio (HR) was set at 1.32. Results: Between Oct 2012 and Dec 2018, 261 pts were enrolled (Arm A 132 pts, Arm B 129 pts). At the planned second interim analysis in phase III with 76/161 events, the Data and Safety Monitoring Committee recommended terminating the trial and publishing the results because the statistical boundary for OS non-inferiority had met the pre-specified stop criteria. With a median follow-up of 2.2 years in all randomized pts, 3-year OS was 59.1% in Arm A and 71.6% in Arm B with a HR of 0.69 (99.1% CI, 0.374-1.273 [ &lt; 1.32], one-sided p for non-inferiority = 0.00272 &lt; 0.00433). 3-year RFS was 53.0% in Arm A and 64.5% in Arm B with a HR of 0.71 (95% CI, 0.48-1.06). Regarding acute adverse events, neutropenia (≥ grade 3), increased creatinine (≥ grade 2), hearing impairment (≥ grade 2) and mucositis (≥ grade 2) occurred in 48.8%, 8.5%, 7.8% and 55.0% in Arm A and 35.3%, 5.7%, 2.5% and 59.0% in Arm B, respectively. For compliance, median total dose of CDDP was 280 mg/m 2 (IQR, 250-299) in Arm A and 239 mg/m 2 (IQR, 199-277) in Arm B. Total radiation dose was 66 Gy (IQR, 66-66) in both arms. Proportion of treatment completion was 93.2% in Arm A and 86.8% in Arm B. Conclusions: Weekly CDDP+RT is non-inferior to 3-weekly CDDP+RT for post-operative high-risk LA-SCCHN pts and has a favorable toxicity profile. Weekly CDDP+RT should be considered the new standard treatment option for these pts. Clinical trial information: 000009125 .
Abstract 11499: Safety or Efficacy; Or Could We Have Both? A Focused Study of Prohibited Devices in the MRI Environment
Authors: Robert W Biederman, Loretta Gevenosky, Huma Samar, Ronald Williams, June Yamrozik, Richard Lombardi, Moneal Shah, Francesco Mangini, Christopher Bonnet, Mark Doyle
Journal: Circulation (2019)

Introduction: MRI is infrequently performed on patients with conventional pacemakers/ICDs. While many studies have unequivocally documented MRI safety in pts with implanted devices, the clinical va...
Impact of preexisting cardiovascular disease (CVD) on treatments and outcomes of patients with breast or lung cancer.
Authors: Atul Batra, Shiying Kong, Rodrigo Rigo, Winson Y. Cheung
Journal: Journal of Clinical Oncology (2020)

12063 Background: Prior cardio-oncology and geriatric oncology research has mainly focused on cancer treatments and their late effects on cardiac health, but little information is known about how cardiac health may influence subsequent cancer treatments. This real-world study aimed to evaluate the associations of pre-existing CVD on treatment adherence and survival in patients with breast or lung cancer. Methods: We linked administrative data from the population-based cancer registry, electronic medical records, and billing claims in a large province (Alberta, Canada) over a 10-year time period (2006-2015). Multivariable logistic regression analyses were performed to identify associations of CVD with cancer treatments. Multivariable Cox proportional hazards models were constructed to determine the effect of CVD on overall survival (OS), while adjusting for receipt of cancer treatments. Results: We identified 46,227 patients with breast or lung cancer, of whom 77% were women and median age was 65 years. While 82% of patients with breast cancer were early stage, 50% with lung cancer had metastasis. The prevalence of pre-existing CVD was 20% where congestive heart failure was most frequent. In logistic regression, CVD was associated with lower odds of receiving appropriate chemotherapy (OR, 0.60, 95% CI, 0.56-0.65, P&lt;.0001), radiotherapy (OR, 0.76, 95% CI, 0.72-0.81, P&lt;.0001), and surgery (OR, 0.60, 95% CI, 0.54-0.66, P &lt;.0001), irrespective of tumor site (Table). The 5-year OS was lower in patients with baseline CVD as compared to those without (46% vs 58%, P&lt;0.0001). Upon adjusting for stage and treatment, CVD continued to correlate with worse OS (HR, 1.23, 95% CI, 1.19-1.26; P&lt;.0001). Conclusions: Cancer patients with prior CVD were less likely to receive standard cancer therapy. Even among those who underwent cancer treatments, worse outcomes were observed in those with CVD. Early cardio-oncology and geriatric oncology engagement may reduce treatment bias and ensure that carefully selected patients with a cardiac history are still offered appropriate cancer therapy. [Table: see text]
The effect of different dose and sites of irradiation on lymphocyte subsets in peripheral blood of patients with lung cancer.
Authors: Xiaotong Duan, Xiaoxia Zhu
Journal: Journal of Clinical Oncology (2020)

e21032 Background: To explore the effect of different radiation doses and sites on systemic immunity in patients with lung cancer by detecting the changes in the percentage of lymphocyte subsets in peripheral blood before and after radiotherapy. Methods: Peripheral blood in 48 patients with lung cancer receiving radiotherapy were collected (before, during and after radiation), and the lymphocyte subsets as follow were examined: total T cell (CD3+), CD4+T cell, CD8+T cell, CD3+CD4+/CD3+CD8+, NK cell, memory T-helper cell subpopulation (CD4+ CD45RO+), CD4+ naïve T-cell subset (CD4+CD45RA+), cytotoxic T cell (CD8+CD28+), IL-2 receptor α(CD25+), B cells (CD3-CD19+), regulatory T cells (CD4+CD25+). The results were statistically analyzed with unpaired Student's t-test using GraphPrism6 software. Results: Among non-small cell lung cancer (NSCLC) patients treated with thoracic radiation (n = 21), B cells in patients receiving 20Gy/10F (P = 0.0072), 40Gy/ 20F (P = 0.0001), 60Gy/30F (P = 0.0002) irradiation were significantly lower than that before radiotherapy. However, CD4+ naïve T-cells decreased significantly at each dose point compared with that before radiotherapy, P values were 0.0394, 0.0081 and 0.0007, respectively. NK cells after completion of 60Gy/30F irradiation were distinctly lower than those after receiving 20Gy/10F of radiotherapy (P = 0.0278), and no significant difference was found in other immune cell subsets. Patients with small cell lung cancer (n = 6) who underwent thoracic radiation showed a similar trend of changes in B cells. However, the CD4+CD45RA+ subset decreased evidently after completing radiation compared with that after 10 fractions of irradiation (P = 0.0390). The NSCLC patients (n = 4) who received radiation for bone metastases (regimen: 36Gy/12F) had evidently lower B cells (CD3-CD19+) at the end of radiotherapy than that at the start of radiotherapy (P = 0.0286). Patients with NSCLC (n = 10) who received brain radiation (regimen: 40Gy/20F for whole brain, 54-56Gy/20F for multiple brain metastases) had a significantly reduced CD4+CD45RA+ subsets after finishing radiation (20F) compared with those after 10 fraction of radiation (P = 0.0497). The changes of other subsets were not statistically significant. Conclusions: The effect of radiation in different sites and doses on peripheral blood lymphocyte subsets is not identical.It is urgent to expand the sample size to explore the law for the optimization of radiation combined with immunotherapy.Funding: 81972853, 81572279, 2016J004, LC2019ZD009, 2018CR033
风雨十年路扬帆新征程
Authors: 邵隽一
Journal: BMJ (2012)

再次感到时光如梭.在读者阅读到本期之时,恰是《中华全科医师杂志》10周岁生日,过去的10年历历在目.2002年9月,中华医学会主办并编辑出版的《中华全科医师杂志》在各界同仁厚爱和期望中创刊,这是中华医学会推动我国全科医学发展和社区卫生服务,为社区卫生服务培养高素质全科医生的具体行动,也是21世纪送给基层卫生工作者的一份厚礼。
ESR1 mutations provide novel targets for breast cancer immunotherapy.
Authors: Jonathan Goldberg, Na Qiao, Brett Gross, Funda Meric-Bernstam, Jennifer Guerriero, Ken Chen, Anne V. Philips, George Earl Peoples, Gheath Alatrash, Elizabeth A. Mittendorf
Journal: Journal of Clinical Oncology (2020)

3135 Background: Estrogen receptor (ER)-positive breast cancer is not considered immunogenic. Standard treatment is endocrine therapy to include aromatase inhibitors (AI). However, constitutively activating mutations in estrogen receptor alpha ( ESR1) emerge with treatment making tumors resistant to AI therapy. While these mutations represent a pathway of resistance, they also represent potential neoepitopes that can be targeted with immunotherapy. Here we characterize the role of ESR1 mutations as novel targets for breast cancer immunotherapy. Methods: Immunogenic epitopes derived from mutated ESR1 (i.e. D538G, Y537S and E380Q) were identified in silico using the Immune Epitope Database and by determining overlapping peptides. In vitro T2 binding assays were used to measure the affinities of these peptides to HLA class-I, specifically HLA-A*0201. Dissociation assays were employed to characterize the stability of the peptide-HLA complex. Peptide-HLA-A*0201 tetramer staining was used to determine the expansion potential of peptide-specific cytotoxic T lymphocytes (CTL) from peripheral blood of healthy females. Cytotoxicity assays were used to determine the ability of peptide-specific CTLs to lyse cells presenting mutated ESR1-derived peptides. Results: We identified 22 nonameric and decameric peptides derived from the most common ESR1 mutations; 10/22 demonstrated high affinity (i.e. IC50 &lt; 500nM) binding to HLA-A*0201. The 3 highest predicted peptides demonstrated low IC50 values (13 nM, 19.5 nM and 56.6 nM), indicating very tight binding to HLA-*0201. In vitro assays confirmed high affinity binding for 10 of the 22 in silico-predicted peptides with an average fold change of 1.52 compared to non-pulsed T2 cells, and a median dissociation half-life of 6.45 hours. Tetramer staining of peptide specific CTLs from normal donor peripheral blood mononuclear cells showed relatively high expansion frequencies, with the highest three frequencies noted for D538G (1.04%), Y537S (0.49%) and V392I (0.27%). Using 4-hour in vitro cytotoxicity assays, in comparison with non-pulsed T2 cells, there was significantly higher lysis of peptide pulsed T2 cells that were cocultured with matching peptide-specific CTL: D538G (67.1 % vs 36.9%, P &lt; 0.001), Y537S (59.5% vs 37.5%, P &lt; 0.01), and E380Q (36.3% vs 7.8%, P &lt; 0.001). Conclusions: These data confirm the immunogenicity of epitopes derived from the most common ESR1 mutations. Further investigation of these peptides as part of novel immunotherapies, to include vaccine strategies is warranted.
Hepatic arterial infusion of oxaliplatin plus raltitrexed in patients with unresectable hepatocellular carcinoma (HAIROX): A phase II, single-arm, prospective study.
Authors: Shiguang Chen
Journal: Journal of Clinical Oncology (2020)

4574 Background: Chemoembolisation and oral sorafenib are the recommended treatment for unresectable hepatocellular carcinoma (HCC); however, some patients respond poorly to these. Hepatic arterial infusion (HAI) chemotherapy may have potential benefit in these patients. We aimed to investigate the efficacy and safety of HAI of oxaliplatin plus raltitrexed in patients with unresectable HCC. Methods: In this phase II, single-arm clinical trial, we enrolled patients aged 18–70 years with unresectable HCC at the Fujian Cancer Hospital (China). We performed HAI with oxaliplatin (100 mg/m 2 for 4 hours) and raltitrexed (3 mg/m 2 for 1 hour). Treatment was repeated every 3 weeks and was discontinued either because of disease progression, unacceptable toxicity levels, or refusal of further treatment. We used Simon’s two-stage design. The primary endpoint was the objective response rate according to the Response Evaluation Criteria in Solid Tumors version 1.1. Results: Fifty-one patients were screened between January 5, 2018 and August 7, 2019. Of these, 39 patients (34 men and 5 women; median age, 53 years) were enrolled and included in the intention-to-treat population. Objective response was achieved in 18 (51.4%) of 35 patients in the per-protocol population and in 18 (46.2%) of 39 patients in the intention-to-treat population. Treatment-related grade 4 adverse events or deaths were not reported, and the observed grade 3 adverse events were elevated aspartate aminotransferase levels (5[12.8%]), elevated alanine aminotransferase levels (1 [2.6%]), leukopenia (1 [2.6%]), thrombocytopenia (1 [2.6%]), and abdominal infection (1 [2.6%]). Conclusions: HAI of oxaliplatin plus raltitrexed showed promising efficacy and acceptable toxicity levels in patients unresectable HCC, and further evaluation is warranted. Clinical trial information: ChiCTR-OOC-17014182 . [Table: see text]
Trends in the use of administrative databases in urologic oncology: 2000-2019.
Authors: Zev Leopold, Priya Dave, Adarsh Menon, Hiren V. Patel, Arnav Srivastava, Thomas L Jang, Eric A. Singer
Journal: Journal of Clinical Oncology (2020)

e17111 Background: Administrative databases (AD) provide investigators with nationally representative study populations to answer research questions using large sample sizes. Their use has significantly grown over the past 20 years, particularly in urologic oncology. We aimed to quantify the trends and incidence of AD use in published manuscripts in urologic oncology. We examined six commonly used databases: National Cancer Database (NCDB), Surveillance, Epidemiology and End Results Database (SEER), SEER-Medicare (SEER-M), Nationwide Inpatient Sample, National Surgical Quality Improvement Program, and Premier Healthcare Database. Methods: A literature review powered by PubMed and DistillerSR from 2000 to 2019 aggregated manuscripts that used the aforementioned databases to study a genitourinary malignancy. Included publications were categorized by database used, corresponding author department affiliation, organ, journal, year, and contribution - defined as temporal treatment trends, outcomes and survival, comparative effectiveness research, and cost-effectiveness. Results: There were 2265 publications across 307 journals that met the inclusion criteria. Between 2000 and 2019 the compound annual growth rate of these publications was 18.7%. SEER contributed most heavily over the study period, with a 14.6% growth rate. NCDB use grew 75.6% annually starting in 2012. Prostate cancer comprised the majority of publications (51.3%), followed by kidney (23.1%) and bladder (22.5%) cancer. Journals publishing these manuscripts had a median impact factor of 2.78 (range 0.36 - 223.68) in 2018. Urologists published 52.5% of AD manuscripts over the study period, with epidemiologists and radiation oncologists publishing 18.2% and 10.6%, respectively. Conclusions: Our results show substantial growth in the use of ADs for the study of genitourinary oncology. The increased use is likely multi-factorial and may be driven by increasing competition to secure funding, ability to answer questions previously limited by sample size, and improved quality of databases. Given the broad use of ADs, investigators and specialty societies should advocate for continued improvement in the data captured by them.