tbuckley/cabot-search huggingface dataset:
Trends in resource utilization and costs during implementation of a lay navigation program.
Authors: Gabrielle Betty Rocque, Maria Pisu, Bradford E. Jackson, Elizabeth Ann Kvale, Aras Acemgil, Richard A. Taylor, Wendy Demark-Wahnefried, Kelly Kenzik, Yufeng Li, Michelle Martin, Nedra Lisovicz, Karen Meneses, Mona Fouad, Edward E. Partridge
Journal: Journal of Clinical Oncology (2015)

6502 Background: Lay navigators provide support to patients from diagnosis through survivorship or end of life. We hypothesized that integrating lay navigators into the care team would lead to reduced healthcare utilization and cost. Methods: Medicare claims data were obtained for patients ≥ 65 years old diagnosed with cancer in 2008-2014 within the UAB Health System Cancer Community Network (UAB CCN) (12 cancer centers in AL, MS, TN, GA, FL) to identify the percentage with ≥ 1 ER visit, hospitalization, ICU admission, or hospice admission. Analysis period runs from 1/1/2012 to 6/30/14. The first patient was enrolled in the navigation program in March 2013, and ~30% of patients were navigated by June 2014. Costs for Medicare were assessed, excluding prescription drugs. We used general linear models to evaluate changes in both health care utilization and cost from the pre- (1/1/12-2/28/13) to the post- implementation period (3/1/13-6/30/14). Results: We observed decreases after implementation from 13.4% to 11% for hospitalizations (18% decrease, p < 0.01), 8.0% to 7.1% for ER visits (12% decrease, p < 0.01), 2.9% to 2.5% for ICU admissions (14% decrease, p = 0.04) and an increase of 3.9% to 4.3% for hospice (9.2% increase p = 0.37). Costs decreased about $158 per quarter per beneficiary over the analysis period. A significant pre-post decrease of $952 per beneficiary (p < 0.01) lead to an estimated total reduction in Medicare costs of $18,406,920 for the 19,335 beneficiaries in the UAB CCN for the five quarters post-implementation. Conclusions: Thislay health navigator program may increase hospice use and reduce health care use and costs. Further analysis of its direct impact is warranted. The project described was supported by Grant Number 1C1CMS331023 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this abstract are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.
Building capacity for geospatial cancer research in Uganda: a feasibility study
Authors: Kirsten Beyer, Robert Lukande, Simon Kasasa, Danielle Savino, Kavanya Gray, Sarah Nambooze, Phoebe Amulen, Laura Cassidy, Nazarius Tumwesigye, Harriet Babikako, Ronald Anguzu, Tifany Frazer, Tonny Oyana, Henry Wabinga
Journal: The Lancet Global Health (2019)

BackgroundThere is a growing epidemic of cancer and other non-communicable diseases in sub-Saharan Africa. Targeted, specific, cost-effective strategies are needed to manage the growing burden of cancer. In high-resource settings, geospatial analysis has transformed cancer control through geographic targeting of interventions and policies. A similar approach could improve cancer control in sub-Saharan Africa; however, georeferenced cancer data and increased geospatial research capacity are needed. Here, we aimed to assess the feasibility of geocoding and mapping small-area cancer data from a cancer registry in Uganda.MethodsWe established a partnership including the Makerere University Department of Pathology, School of Public Health and College of Computing and Information Sciences, the Kampala Cancer Registry, Uganda, and the Medical College of Wisconsin, USA. The overarching goal of our multidisciplinary and multi-institutional partnership is to increase geospatial cancer research capacity at Makerere University to enhance the prioritisation and targeting of limited cancer prevention and control resources in Uganda.FindingsTwo medical students from the Medical College of Wisconsin, mentored by faculty at their own institution and Makerere University, worked in Kampala with registry staff to identify, enter, and quality-check geographic codes of residence for approximately 1522 cervical cancer records from 2005 to 2014. Information about district (n=1520, 99·9%) and subcounty (n=1486, 97·6%) was available for the vast majority of cases, and the parish was identifiable for a large proportion of cases (n=1242, n=81·6%), with increasing availability in more recent years. A seed grant is supporting ongoing capacity building at the Kampala Cancer Registry, including the purchase of new computing hardware and software and the implementation of a revised geographic data collection protocol to support future geospatial analysis of Kampala Cancer Registry data.InterpretationIt is feasible to geocode cancer registry records in Kampala, Uganda, and to create cancer incidence maps to identify areas with higher than expected cancer burdens. This capacity building partnership is a catalyst for improving targeted prevention and control efforts to reduce the burden of cancer in Uganda.FundingDr Elaine Kohler Summer Academy of Global Health Research, Class of 2001 Scott Sprtel Summer Research Training Fellowship, Medical College of Wisconsin Office of Global Health Research Seed Project Funding for Faculty.
Abstract P060: Sedentary Behavior is Directly Associated With Higher Prevalence of Chronic Kidney Disease in Older Adults: The Framingham Heart Study
Authors: Joowon Lee, Vanessa Xanthakis, Ramachandran S Vasan
Journal: Circulation (2019)

Introduction: Self-reported physical inactivity and sitting time have been associated with a greater prevalence of chronic kidney disease (CKD) in middle-aged populations. However, data are limited regarding the association of objectively-assessed physical activity and sedentary behavior with prevalence of CKD among older adults. Hypothesis: We hypothesized that higher physical activity and less sedentary time will individually and conjointly be associated with a lower prevalence of CKD in older adults. Methods: We evaluated 1,318 Framingham Offspring cohort participants (mean age 69.3 years, 53.9% women) with accelerometry-derived physical activity data (wear time ≥ 10 hours/day for at least 4 days) at examination 9 (2011-2014). CKD was defined as an eGFR &lt; 60 ml/min/1.73 2 and/or urine albumin-to-creatinine ratio (UACR) ≥ 25/35 micrograms/mg (men/women) at examination 9. Multivariable logistic regression models were used to relate physical activity and sedentary time with the prevalence of CKD adjusting for covariates (Table). In sensitivity analysis to mitigate reverse causality, we excluded participants with more advanced CKD (eGFR&lt;30 ml/min/1.73 2 ). Results: Men spent more time in moderate to vigorous physical activity (MVPA) (mean 21.7 min/day) and less time in sedentary time (mean, 660.7±76.9 min/day), compared to women (mean MVPA, 15.6 min/day; mean sedentary time, 675.8±70.5 min/day). Overall, 279 participants had prevalent CKD (20.8%; 127 women). Higher sedentary time was associated with a higher prevalence of CKD after adjusting for risk factors and MVPA in sensitivity analysis, the association remained significant. MVPA was inversely associated with CKD prevalence in minimally-adjusted models only. Conclusions: Our cross-sectional observations on a sample of older adults are consistent with the notion that reduction of sedentary time in the elderly may have salutary effects on kidney function. Additional studies of multiethnic cohorts are warranted to confirm our observations.
Abstract P154: Healthy Lifestyle and Risk of Incident Heart Failure With Preserved and Reduced Ejection Fraction in Postmenopausal Women: The Women’s Health Initiative Study
Authors: Corinna A Noel, Michael J LaMonte, Deborah Pearlman, Matthew Allison, Aladdin H Shadyab, Bernhard Haring, Lisa Warsinger Martin, Hailey Banack, Deepika Laddu, Patricia K Nguyen, JoAnn E Manson, Charles B Eaton
Journal: Circulation (2019)

Background: Heart failure (HF) is a growing health concern in the United States. Lifestyle risk factors including diet, physical activity, cigarette smoking, and body mass index (BMI), have been shown to be independently and jointly associated with incident heart failure. However, these associations have not been evaluated for HF subtypes, HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF). Objective: To assess the combined associations of diet, physical activity, cigarette smoking, and BMI with risk of HFpEF and HFrEF subtypes. Methods: 39,893 postmenopausal women aged 50-79, without self-reported HF at baseline, were included in this analysis. A lifestyle score was created following a similar method previously used in WHI, defining the following healthy criteria: high diet quality (Alternate Healthy Eating Index quintile 4 or 5), being physically active (more than 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise or equivalent combination), not a current cigarette smoker, and BMI between 18.5 and 25 kg/m 2 . Women received 1 point for each healthy criterion that was met, and points were summed to obtain the healthy lifestyle score, ranging in value from 0 (least healthy) to 4 (most healthy). Trained adjudicators determined cases of incident heart failure through 2018, defining HFpEF as EF≥45% and HFrEF as EF&lt;45%. Results: Over a mean follow-up of 14.5 years, 2426 HF incident hospitalized cases were documented and confirmed, classifying 1345 cases as HFpEF and 685 cases as HFrEF. Healthy lifestyle was strongly associated with a decreased risk of both HFpEF and HFrEF (Table). Conclusion: Findings suggest that a healthy lifestyle may be associated with decreased risk of HF subtypes among postmenopausal women. Results from this research provide a better understanding of the role of modifiable lifestyle factors in each of the HF subtypes, allowing for the development of more targeted primary and secondary prevention strategies specific to HFpEF and HFrEF.
Abstract P017: Biomarkers Representing Aging-Related Biological Pathways Are Associated With All-Cause Mortality: The Framingham Study
Authors: Cecilia Castro-Diehl, Rachel Q Ehrbar, Ramachandran S. Vasan, Vanessa Xanthakis
Journal: Circulation (2019)

Background: Chronological aging is the result of different biological processes and molecular mechanisms that, if identified, may increase our ability to mitigate aging-related decline in body functions. We hypothesized that aging-related biomarkers reflecting multiple biological pathways are associated with all-cause mortality. Methods and Results: We related leukocyte telomere length (LTL) expressed by terminal restriction fragment (TRF) length, urinary concentrations of creatinine-corrected isoprostanes, circulating concentrations of insulin-like growth factor (IGF)-1, and asymmetrical dimethylarginine (ADMA) in up to 2314 Framingham Offspring Study participants attending routine examination cycles (mean age 58 yrs, 55% women) to all-cause mortality using Cox proportional hazards regression models. Biomarkers were modeled individually and in combination, adjusting for age, sex, body mass index, systolic blood pressure, diabetes, smoking status, hypertension medication, total cholesterol/HDL. We created also a biomarker score as a composite of biomarkers associated with mortality risk. Kaplan Meier curves were created ( Figure ) to graphically present the survival time as a function of tertiles of the biomarker score. There were 593 deaths (274 women) during a median follow-up of 20 years. TRF and IGF-1 values were inversely related to all-cause mortality (multivariable-adjusted hazard ratios [HR] per SD increase, 0.86, 95% confidence interval [CI], 0.75-0.998 and 0.89, 95% CI 0.81-0.97 for TRF and IGF-1, respectively). Isoprostanes and ADMA values were positively related to all-cause mortality (multivariable-adjusted HR per SD increase, 1.17, 95% CI, 1.11-1.23, and 1.09, 95% CI, 1.01-1.18, respectively). Conclusion: In our prospective community-based study, aging-related biomarkers were associated with all-cause mortality, supporting the concept that molecular pathways represented by these biomarkers may reflect the processing of aging in the community.
Abstract P405: Racial Disparities in Ischemic and Hemorrhagic Post-stroke Mortality in United States Veterans
Authors: Laura Tarko, Yuk-Lam Ho, Lauren Costa, David R Gagnon, Serkalem Demissie, Sudha Seshadri, Luc Djousse, Kelly Cho, Peter W Wilson, Hugo J Aparicio
Journal: Circulation (2019)

Introduction: Blacks and Hispanics have been shown to have higher stroke mortality than non-Hispanic whites. However, this may be due to higher incidence of strokes in blacks and Hispanics. Fewer studies have investigated health disparities in post-stroke mortality stratified by stroke type. We studied risk of mortality by race/ethnicity after either incident acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) in a national sample of patients from the Veteran’s Health Administration (VHA). Methods: We included patients with a first occurrence of an inpatient AIS or ICH in a VHA hospital between 2002-2007. We categorized patients as non-Hispanic white, non-Hispanic black, or Hispanic. Veterans with any prior stroke-related code were excluded. For each of AIS and ICH, we constructed a piecewise multivariate survival model for post event all-cause mortality. We separated follow-up intervals into &lt;30 day, 30-90 day, 90 day-1 year, and &gt;1 year post admission. Results: We identified 36,569 patients with an incident stroke in 2002-2007 (91% AIS, 9% ICH). The proportion of white, black, and Hispanic patients with AIS was 68%, 26%, and 6% respectively; and in ICH was 63%, 27%, and 10%. Compared to whites, blacks had better survival for AIS in the first 30 days, while Hispanics tended to have better survival in the 30-90 day and &gt;1 year intervals. With ICH, blacks had higher mortality in the first 30 days. (Table 1) Conclusion: Blacks experience better 30-day survival after AIS compared to whites, but worse 30-day survival after ICH. This may be driven by higher prevalence of hypertension in blacks leading to small vessel occlusion, which is associated with lower mortality, or poorer control of blood pressure in the setting of ICH, which is associated with higher mortality. Hispanic patients may have better long-term survival after stroke compared to whites, a ‘Hispanic paradox’ that has been shown in other studies. Stroke events should be stratified by ischemic and hemorrhagic type when evaluating for racial disparities in outcomes.
The Odyssee Study: Prevention of Dysbiosis Complications with Autologous Fecal Microbiota Transfer (FMT) in Acute Myeloid Leukemia (AML) Patients Undergoing Intensive Treatment: Results of a Prospective Multicenter Trial
Authors: Mohamad Mohty, Florent Malard, Anne Vekhoff, Simona Lapusan, Francoise Isnard, Evelyne D'Incan, Jerome Rey, Colombe Saillard, Xavier Thomas, Sophie Ducastelle-Lepretre, Etienne Paubelle, Marie Virginie Larcher, Clément Rocher, Christian Recher, Suzanne Tavitian, Francoise Huguet, Anne-Sophie Michallet, Lila Gilis, Pierre Peterlin, Patrice Chevallier, Stephanie Nguyen-Quoc, Emilie Plantamura, Lilia Boucinha, Cyrielle Gasc, Mauricette Michallet, Joel Doré, Ollivier Legrand
Journal: Blood (2018)
Propensity score matched comparison of stereotactic body radiation therapy versus intensity-modulated radiation therapy for the treatment of localized prostate cancer.
Authors: Caspian Oliai, Matthew Bernetich, Luther W. Brady, Jun Yang, Steven Arrigo, John Lamond, Michael Good, Michael Mooreville, Bruce Garber, Rachelle Marie Lanciano
Journal: Journal of Clinical Oncology (2015)

e16023 Background: Stereotactic body radiation therapy (SBRT) is an attractive option for the primary treatment of localized prostate cancer due to favorable treatment duration and cost. Recent analysis has shown SBRT to be over $7,000 cheaper than the standard of care, intensity-modulated radiation therapy (IMRT), and on average is 6 to 7 weeks shorter in duration. We compare SBRT to IMRT in terms of non-inferiority. Methods: Two hundred and sixty-three patients were analyzed. Patients had localized prostate adenocarcinoma, ranging from very low- to high-risk disease. We retrospectively compare consecutive patients treated with SBRT with consecutive patients treated with conventionally fractionated IMRT at a separate site within the same hospital-based department. Most common dose scheme for SBRT is 36.25 Gy in 5 fractions, and IMRT 75.6 Gy in 42 fractions. To minimize selection bias, we perform two separate propensity score analyses. We use 1:1 propensity score matching with caliper, differing by the inclusion of risk group, and several other patient and tumor factors. Results: As a result of matching, treatment groups became similar, absolute standard bias reduced to ≤ 0.19 for both matching analyses. For the first analysis (not accounting for risk group), five-year Kaplan Meier (KM) survival was 90.8% and 88.1% in the SBRT and IMRT treatment groups, respectively (p = 0.7260); while freedom from biochemical failure (FFBF) was 88.7% and 95.5%, respectively (p = 0.1720). For the second analysis (which accounts for risk group), five-year KM survival was 96.7% and 87.1% in the SBRT and IMRT treatment groups, respectively (p = 0.3025); while FFBF was 89.7% and 90.3%, respectively (p = 0.6446). Toxicity did not exceed grade 3. Highest genitourinary toxicity at most recent follow-up was grade 2, present in 12% and 14% of IMRT and SBRT patients, respectively. Conclusions: Our data support the hypothesis that SBRT is non-inferior to IMRT. Given the lower cost and convenience for patients, SBRT could be considered an appropriate treatment alternative for localized prostate cancer.
Abstract MP13: Plasma Homocysteine is Causally Associated With Ischemic Stroke in a Han Chinese Population: A Mendelian Randomization Study
Authors: Zhengbao Zhu, Tanika N. Kelly, Yonghong Zhang, Changwei Li, Aili Wang, Tan Xu, Xiao Sun, Mengyao Shi, Xiaoqing Bu, Jing Chen, Jiang He
Journal: Circulation (2019)

Introduction: Observational studies identified plasma homocysteine as a risk factor for ischemic stroke, but randomized controlled trials of folate supplementation reported inconsistent findings. The methylenetetrahydrofolate reductase ( MTHFR) gene encodes an enzyme critical for homocysteine metabolism and can serve as an unconfounded proxy for plasma homocysteine levels. Hypothesis: We assessed the hypothesis that there was a causal association between plasma homocysteine and risk of ischemic stroke by Mendelian randomization method. Methods: We examined the association between the MTHFR gene and ischemic stroke among 11,753 Chinese participants. The discovery stage included 999 ischemic stroke cases and 1,001 controls with no history of atherosclerotic disease. The MTHFR gene was sequenced using the SOLiD 4hq platform. Variants with minor allele count &gt;10 were each tested for association with stroke using logistic regression models. Interactions between significant variants and alcohol drinking on stroke were also tested. Aggregate analysis of rare variants (minor allele count &lt;20) used the sequence kernel association test. Variants achieving P&lt;1х10 -4 were tested for replication among 4,724 ischemic stroke cases and 5,029 controls from the China Stroke Project. Results: An association between MTHFR rs1801133, a missense variant known to reduce enzyme activity and increase plasma homocysteine level, and ischemic stroke was identified in discovery, replication and joint analyses (P=2.10х10 -8 , 2.65х10 -11 , and 6.93х10 -17 , respectively). Each copy of the rs1801133 risk allele conferred respective odds ratios (95% confidence interval) of 1.44 (1.27, 1.64), 1.21 (1.15, 1.28), and 1.25 (1.18, 1.31). This variant also interacted with alcohol intake on stroke risk (P for interaction=7.82х10 -9 , 1.86х10 -10 , and 1.46х10 -18 , respectively). Odds ratios (95% confidence interval) of stroke associated with the risk allele were 1.66 (1.40, 1.96), 1.26 (1.18, 1.36), and 1.32 (1.23, 1.40) in non-drinkers and 1.17 (0.92, 1.49), 1.12 (1.01, 1.23), and 1.12 (1.03, 1.23) among alcohol drinkers in discovery, replication and joint analyses, respectively. No additional variants were identified. Conclusions: In conclusion, this is the first large scale genomic study to implicate the etiologic relevance of plasma homocysteine in ischemic stroke. An attenuating effect of alcohol intake on this relation was also observed.
CD47 Blockade and Cowpea Mosaic Virus Nanoparticle In Situ Vaccination Triggers Phagocytosis and Tumor Killing
Authors: Chao Wang, Nicole F. Steinmetz
Journal: Advanced Healthcare Materials (2019)

Contemporary immunotherapies, e.g., those that target the CTLA-4 and PD-1/PD-L1 axis, act on T cells to reinstate their antitumor activity. An alternative, and possibly more powerful approach is to target and reprogram the innate immune system within the tumor microenvironment. To this end, blockade of CD47 has been demonstrated as an attractive approach. Blockade of CD47 inhibits antiphagocytic signals therefore inducing macrophage phagocytosis of cancer cells. CD47 blockade also primes antitumor T-cell responses by either activating antigen-presenting cells or inhibiting interactions between CD47 on cancer cells and the matricellular protein thrombospondin-1 on T cells. Here, a combination immunotherapy is identified using cowpea mosaic virus (CPMV) in situ vaccination and CD47-blocking antibodies. The CPMV in situ vaccine synergizes with CD47 blockade, because CPMV in situ vaccination activates the innate immune system, leading to recruitment and activation of phagocytes. Therefore, the combination therapy targets monocytes and boosts their ability of cancer cell phagocytosis, in turn priming the adaptive immune system leading to a potent antitumor immune response. This work presents a novel strategy to promote macrophage activity to kill tumor cells, and hold promise to enhance T cells targeted immunotherapies by inducing both innate and adaptive arms of immune system.