tbuckley/cabot-search huggingface dataset:
Abstract P101: Neighborhood Walkability and Risk of Hypertension
Authors: Alana Jones, Natalie Colabianchi, Virginia Howard, George Howard, Ryan Irvin, Ninad Chaudhary, Suzanne E Judd
Journal: Circulation (2019)

Introduction: Over the past decade, studies on associations between built environments and health outcomes have exponentially increased, particularly regarding walkability. Some studies have shown associations between walkability and lower blood pressure, as well as other cardiometabolic risk factors. Objective: The purpose of this study was to investigate associations between objectively measured neighborhood walkability and incidence of hypertension in older adults in a national cohort study in the United States. Methods: Neighborhood walkability was measured by Walk Score, and scores were generated for participants in the Reasons for Geographical and Racial Differences in Stroke Study (REGARDS, n=30,172). Descriptive statistics were reported by the categories of Walk Score: Car-Dependent, Somewhat Walkable, Very Walkable, and Walker’s Paradise. Associations between walkability and blood pressure were tested both cross-sectionally and longitudinally. Covariates included age, race, sex, geographical region, income, education, health behaviors (i.e., smoking, alcohol use, exercise), and cardiovascular comorbidities (i.e., dyslipidemia, diabetes). Linear models tested associations between Walk Score and systolic and diastolic blood pressure. Logistic regression models tested associations between Walk Score and incident, prevalent, and treated hypertension. Results: In adjusted analyses, Walk Score category was not associated with incident hypertension in the entire cohort. However, among white participants, a higher Walk Score category was associated with a lower odds of incident hypertension. In secondary analyses, higher Walk Score category was associated with lower odds of treated hypertension (OR 0.87, 95% CI 0.78-0.97, p=0.03). Higher Walk Score was linearly associated with higher diastolic blood pressure cross-sectionally in black participants but not among the entire cohort (P-interaction=0.02). Conclusions: We found limited evidence that higher walkability was an important contributor to hypertension. Further studies are needed to understand the associations between walkability and cardiovascular health outcomes. A better understanding of the relationship between residential features and hypertension could potentially help redefine intervention strategies for cardiovascular disease risk reduction.
A comparison of pathologic and intermediate term oncologic outcomes following open and robotic radical cystectomy.
Authors: Janet Baack Kukreja, Roger Li, Mohamed Seif, Xuemei Wang, Ashish M. Kamat, Colin P.N. Dinney, Louis L. Pisters, Neema Navai
Journal: Journal of Clinical Oncology (2019)

440 Background: Conflicting data regarding the oncologic efficacy of robotic surgery has led to concerns for possible inferiority. Despite recent prospective results from the RAZOR trial demonstrating non-inferior progression free survival, results from another prospective randomized trial from Memorial Sloan Kettering suggests a possible difference in the pattern of recurrences. We examined our experience with both open (ORC) and robotic radical cystectomy (RRC) with the objective of establishing recurrence patterns and pathologic comparisons at a high volume tertiary referral center. Methods: We performed a retrospective cohort study at a high volume academic tertiary referral center for patients who underwent radical cystectomy (RC) for bladder cancer from 2005 to 2017. The surgical choice of RRC or ORC is based on provider preference. A multivariable analysis was carried out to determine factors predictive of recurrence free survival (RFS) and overall survival after RC. Analysis was done with SAS 9.4. Results: 1813 patients were identified, 10% underwent RRC and no difference in recurrence patterns were found compared to ORC. There was no difference in the severity of pathology distribution between the two cohorts. There was no difference in positive surgical margin status, 2.4% in ORC and 1.1% in RRC. Peritoneal carcinomatosis was seen in 1.1% of ORC and 0.5% in RRC. Shorter RFS was associated with younger age (HR 1.04, 95%CI 1.03-1.05, p&lt;0.001), neoadjuvant chemotherapy (HR1.55 95%CI 1.32-1.82, p&lt;0.001), higher pathologic stage (stage T4 HR 4.38, 95%CI 3.17-6.06, p&lt;0.001), positive lymph nodes at RC (HR 1.82 95%CI 1.53-2.17, p&lt;0.001) and positive surgical margins (HR 1.50 95%CI 1.19-1.89, p&lt;0.001). At a median follow up of 60 months neither progression free or overall survival for ORC compared to RRC was significantly different. Conclusions: The data from this study supports continued use of RRC as a safe oncologic procedure with similar outcomes to ORC.
Causes of stillbirths among women from South Africa: a prospective, observational study
Authors: Shabir A Madhi, Carmen Briner, Salome Maswime, Simpiwe Mose, Philiswa Mlandu, Richard Chawana, Jeannette Wadula, Yasmin Adam, Alane Izu, Clare L Cutland
Journal: The Lancet Global Health (2019)

About 2·6 million third-trimester stillbirths occur annually worldwide, mostly in low-income and middle-income countries, where the causes of these deaths are rarely investigated.We did a prospective, hospital-based, observational study in Soweto, South Africa, to investigate the causes of stillbirths in fetuses of at least 22 weeks' gestational age or with a birthweight of at least 500 g. Maternal clinical information was abstracted from medical records. Investigations included placental macroscopic and histopathological examination and fetal blood culture (including screening for pathogenic bacteria associated with stillbirth). Cases missing one or more of these investigations were considered to have incomplete samples and were excluded from the analysis of cause of stillbirth. Causes of stillbirths were assessed by individual case reviews by at least two obstetricians, and classified with a modified Stillbirth Collaborative Research Network classification system.Between Oct 9, 2014, and Nov 8, 2015, we enrolled 354 stillbirths (born to 350 women). Among the women with available data, 133 (38%) of 350 had hypertension, median age was 27 years (IQR 23-33), 51 (18%) of 291 were obese, six (2%) of 344 had syphilis, and 94 (27%) of 350 had HIV. 63 (18%) of 341 fetuses showed intrauterine growth restriction. Of 298 cases (born to 294 mothers) with complete samples, the most common causes of stillbirth were maternal medical conditions (64 [21%] cases; among them 56 [19%] with hypertensive disorders and six [2%] with diabetes), placental or fetal infections (58 [19%]; 47 [16%] with fetal invasive bacterial infection), pathological placental conditions (57 [19%]; among them 27 [9%] with fetal membrane and placental inflammation and 26 [9%] with circulatory abnormalities), and clinical obstetric complications (54 [18%]; 45 [15%] with placental abruption). Six (2%) stillbirths were attributed to fetal, genetic, or structural abnormalities. In 55 (18%) cases, no cause of death was identified. The most common bacteria to which stillbirths due to fetal invasive infections were attributed were group B streptococcus (15 [5%] cases), E coli (12 [4%]), E faecalis (six [2%]), and S aureus (five [2%]).Targeted investigation of stillbirths (even without fetal autopsy) can ascertain a cause of stillbirth in most cases. Further studies using such investigations are needed to inform the prioritisation of interventions to reduce stillbirths globally.Novartis and GlaxoSmithKline.
Individual and group-delivered hypnotherapy in irritable bowel syndrome: a randomised controlled trial
Authors: Carla E. Flik, Ir. W. Laan, N. P. A. Zuithoff, Yanda R. van Rood, André J P M Smout, Bas L A M Weusten, Peter Whorwell, Wit Nj de
Journal: The Lancet. Gastroenterology & hepatology (2018)
Abstract P373: Estimation of Atherosclerotic Cardiovascular Disease Risk in Veterans
Authors: Luc Djousse, Jason L Vassy, David R Gagnon, Bing Lu, Yuk-Lam Ho, Lauren Costa, J. M Gaziano, Kelly Cho, Peter W Wilson
Journal: Circulation (2019)

There are concerns that 2013 ACC/AHA ASCVD pooled risk prediction models are not accurate predictors in contemporary American patient populations, and that these models do not take into account the highly prevalent use of statin therapy or the effects of statins on vascular disease prevention. Using validated phenotyping algorithms, we evaluated the accuracy of the pooled risk model for the development of Hard ASCVD in 1.42 million Veterans (4.3% women, 16.6% black) with mean age 60 years (range 40-79 years) at baseline VA outpatient clinic evaluations in 2002-2004. There were 93,250 Hard ASCVD events over a mean of 8.4 years of follow up. We estimated Hard ASCVD risk using traditional variables (age, sex, race, total cholesterol, HDL cholesterol, diabetes mellitus, systolic blood pressure, blood pressure treatment, and smoking history) employed in the 2013 ACC/ACC ASCVD risk report. Three analytic approaches were undertaken, using 1) published 2013 ACC/AHA prediction equations, 2) 2013 ACC/AHA variables to fit VA-specific Cox regression models for white men, black men, white women, and black women, and 3) model 2 plus baseline statin use. The Harrell’s c-statistics for the models are shown in the table along with the hazard ratios for statins from model 3. Traditional predictor variables were generally statistically significant in all models, and model 1 over predicted absolute risk of Hard ASCVD in VA by approximately 6%, and statin use was associated with up to an 18% reduction in ASCVD risk. In conclusion, these results demonstrate that the pooled ASCVD prediction model performs relatively well in the VA setting, as shown by relatively good c-statistics. The 2013 ACC/AHA over predicted ASCVD risk and statin therapy at baseline was an important determinant of outcomes.
Abstract MP19: Socioeconomic Status and Incident Heart Failure Among Individuals with Diabetes, Obesity and Metabolic Syndrome: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Amira O Collison, Lena M Mathews, Lucia Kwak, Priya Palta, Kunihiro Matsushita, April P Carson, Deidra C Crews, Sherita H Golden, Priya Vart, Lisa A Cooper, Josef Coresh, Gerardo Heiss, Chiadi E Ndumele
Journal: Circulation (2019)

Background: Diabetes, obesity and metabolic syndrome (MS) are strong risk factors for incident heart failure (HF). Lower socioeconomic status (SES) is also linked to increased HF risk. Given the importance of lifestyle, self-management, and access to care in managing diabetes, MS and obesity, SES may confer greater risk among individuals with these conditions. Hypothesis: We hypothesized that lower SES is associated with greater risk for incident HF among individuals with diabetes, MS or obesity than among those without these conditions. Methods: We studied 12,938 ARIC participants (mean age: 53 years, 26% black, 56% female) from the baseline visit (1987-1989) without CVD and with BMI ≥18.5 kg/m 2 . Income, education, and area deprivation index were evaluated as single measures of SES and in a combined SES score (high, medium, low). We constructed Cox regression models to estimate hazard ratios (HRs) for HF associated with SES (through 12/31/16), stratified by diabetes, MS, and obesity status, separately, and with tests for interactions of SES with diabetes, MS or obesity. Results: There were 2,551 HF events over a median 27 years of follow-up. The lowest education level was more strongly associated with HF risk in the presence of diabetes (HR 3.17, 95% CI: 1.95-5.14), than in the absence of diabetes (HR 1.56, 95% CI: 1.31-1.86; p interaction &lt;0.01)(Table). Significant interactions were also observed for diabetes and MS with most other SES measures, including the combined SES score. The combination of lowest education and diabetes was associated with an HR of 3.95 (3.21-4.87) for HF compared to the combination of highest education and no diabetes. There were no significant interactions between obesity and SES measures. Conclusion: Low SES is associated with elevated HF risk, particularly among individuals with diabetes and MS. There is urgent need to understand the underlying mechanisms for this association, which may inform tailored interventions to address the marked HF risk in those with both low SES and diabetes or MS.
High Rate of Sustained Minimal Residual Disease Negativity Predicts Prolonged Survival for the Overall Patient Population in the Phase 2 KRd Plus Autologous Stem Cell Transplantation MMRC Trial
Authors: Andrzej J. Jakubowiak, Noopur Raje, Ravi Vij, Donna Reece, Jesus G. Berdeja, Leonor Stephens, Kathryn M. Tinari, Cara A. Rosenbaum, Jagoda K. Jasielec, Paul G Richardson, Sandeep Gurbuxani, Jennifer Nam, Erica Severson, Amanda McIver, Brittany Wolfe, Sarah Major, Shaun Rosebeck, Andrew Stefka, David Johnson, Dominik Dytfeld, Kent Griffith, Agata Turowski, Tyler Hycner, Todd M. Zimmerman
Journal: Blood (2017)
Trends and Factors Associated With Physician Burnout at a Multispecialty Academic Faculty Practice Organization
Authors: Marcela G. del Carmen, John Herman, Sandhya Rao, Michael K. Hidrue, David Ting, Sara R. Lehrhoff, Sarah Lenz, James Heffernan, Timothy G. Ferris
Journal: JAMA Network Open (2019)

Physician burnout is common, and prevalence may differ throughout a clinician's career. Burnout has negative consequences for physician wellness, patient care, and the health care system. Identifying factors associated with burnout is critical in designing and implementing initiatives to reduce burnout.To measure trends and identify factors associated with physician burnout.Survey study conducted from May 16 to June 15, 2014, and again from May 16 to June 15, 2017, measuring rates of physician burnout in a large academic medical practice. Factors associated with burnout out were evaluated. In 2014, 1774 of 1850 eligible physicians (95.9%) completed the survey. In 2017, 1882 of 2031 (92.7%) completed the survey.Medical specialty, demographic characteristics, years in practice, and reported rates of burnout.Burnout rates measured at 2 points and risk factors associated with burnout.Respondents included 1027 men (57.9%) and 747 women (42.1%) in 2014 and 962 men (51.1%) and 759 women (40.3%) in 2017. The mean (SD) number of years since training completion was 15.3 (11.3) in the 2014 survey data and 15.1 (11.3) in the 2017 data. Burnout increased from 40.6% to 45.6% between the 2 points. The increased rate was associated with an increase in exhaustion (from 52.9% in 2014 to 57.7% in 2017; difference, 4.8%; 95% CI, 1.6%-8.0%; P = .004) and cynicism (from 44.8% in 2014 to 51.1% in 2017; difference, 6.3%; 95% CI, 3.1%-9.6%; P < .001). Compared with midcareer physicians (11-20 years since training), early-career physicians (≤10 years since training) were more susceptible to burnout (odds ratio, 1.36; 95% CI, 1.05-1.77), while physicians in their late career (>30 years since training) were less vulnerable (odds ratio, 0.59; 95% CI, 0.40-0.88).Efforts to alleviate physician burnout and administrative burden require a combination of a shared commitment from physicians and organizations and central and locally implemented programs. Continued research is necessary to establish the most effective initiatives to decrease physician burnout at the individual and organizational level.
Pulmonary hypertension associated with left heart disease: efforts to improve the meaning of haemodynamic phenotypes
Authors: Christian Gerges, Mario Gerges, Irene M. Lang
Journal: European Respiratory Journal (2019)

<b>Haemodynamic estimates of pulmonary vascular disease are a major requirement for the understanding and management of patients with pulmonary hypertension due to left heart disease</b>http://ow.ly/ABsl30nuXX2
Genetic testing patterns for homologous recombination repair (HRR) alterations in patients with metastatic prostate cancer (mPC): An assessment at the University of Rochester (UR).
Authors: Kerry Schaffer, Kaitlin Kyi, Carol Lustig, Deepak M. Sahasrabudhe, Michelle Shayne, Andrea M Baran, Chunkit Fung
Journal: Journal of Clinical Oncology (2019)

322 Background: Germline and somatic HRR alterations are present in 12% and 20% of patients with mPC, respectively, and can have treatment implications. NCCN guidelines recommend offering genetic testing for patients with mPC. This study examines genetic testing patterns in patients with mPC at UR. Methods: We conducted a retrospective study of all patients (n = 240) with mPC who saw medical oncology at UR from 10/1/2017 to 4/1/2018. We abstracted the following data from medical records: patient demographics, mPC characteristics, types of genetic testing, and clinically significant (CS) HRR alterations as defined by Myriad, Ambry, and Foundation One. To compare characteristics of patients who had genetic testing to those who did not, we used non-parametric Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables. Results: The median age at mPC diagnosis was 71 years (range: 42-93 years), 86.3% were white, and 35% had mPC at initial diagnosis. 64 patients (26.7%) were offered genetic testing and 40 patients (16.7%) completed germline (n = 12), somatic (n = 21), or both germline and somatic genetic testing (n = 7). Median time from diagnosis of mPC to germline and somatic genetic testing were 9 months and 35 months, respectively. Among the 24 patients who were offered, but did not have testing, the reasons were: patients’ refusal (n = 10), death/hospice care (n = 7), insurance issue (n = 3), patient’s preference to have somatic testing at disease progression (n = 3), and missed genetic counseling visit (n = 1). Compared to patients who did not have genetic testing, those who had testing were younger at the time of mPC diagnosis (63.5 vs 73.0 years; p &lt; 0.0001). CS HRR alterations were identified in 8 of 40 patients tested (20%): somatic HRR alterations include BRCA2 (n = 2), ATM (n = 1), CDK 12 (n = 1), and C HEK2 (n = 1); germline HRR alterations include BRCA2 (n = 2) and CHEK2 (n = 1). Conclusions: We report that approximately one-fourth of patients with mPC at UR had genetic testing offered, with a 20% prevalence of HRR alterations in those tested. Future research should develop strategies to address barriers to genetic testing.
Dual-Sensitized T-Cells Responding to EBV Blcl and Either CMVpp65 or WT-1 Peptide Pools Have Distinct or Shared HLA Restrictions That May Depend on the Presenting HLA Alleles
Authors: Ekaterina Doubrovina, Aisha N. Hasan, Susan Prockop, Karim Baroudy, Richard O'Reilly
Journal: Blood (2018)
Disparities in survival outcomes in African Americans in renal cell carcinoma: Impact of oncological versus nononcological factors.
Authors: Margaret Frances Meagher, Aaron Bradshaw, David Anyakora, Dattatraya H Patil, Kazutaka Saito, Brittney Cotta, Yosuke Yasuda, Ahmed Eldefrawy, Stephen Ryan, Ryan Nasseri, Juliana Alksne, Fang Wan, Yasuhisa Fujii, Viraj A. Master, Ithaar Derweesh
Journal: Journal of Clinical Oncology (2019)

595 Background: African-Americans have increased incidences of renal cortical tumor subtypes of lower oncological potential in the setting of lower risk disease when compared to other ethno-racial groups. However, survival outcomes are similar. We investigated the impact of African-American race on overall survival, oncological outcomes, functional outcomes, and non-cancer mortality. Methods: Multi-institutional retrospective analysis of patients who underwent partial or radical nephrectomy between 1998-2018. Primary outcome was overall survival (OS). Secondary outcomes included non-cancer mortality (NCM), recurrence free survival (RFS), and estimated glomerular filtration rate (eGFR) decline. Multivariable logistic regression (MVA) were used to elucidate predictive factors for OS, NCM, and RFS, and eGFR &lt;45 and &lt;30 ml/min/1.73m2. Results: 3,088 patients were divided into African American (AA, n=353) and Non-African American (NAA, n=2735) sub-groups. No difference was noted between groups with respect to mean tumor size (p=0.211) or metastases presence (p=0.846). African-American race was an independent risk factor for functional decline to eGFR&lt;45 (OR 4.43, p&lt;0.001) and eGFR&lt;30 (OR 5.15, p&lt;0.001). MVA for worsened NCM demonstrated African-American race (OR=1.72, p=0.042), increasing age (OR=1.03, p=0.001), radical nephrectomy (OR=2.98, p&lt;0.001), and increasing tumor size (OR=1.26, p&lt;0.001) to be independent risk factors. MVA for worsened OS included increasing age (OR=1.04, p&lt;0.001), tumor size (OR=1.182, p&lt;0.001), clear cell histology (OR=1.62, p&lt;0.001), high tumor grade (OR=2.12, p&lt;0.001), and post-operative eGFR &lt;45 (OR=2.12, p&lt;0.001). MVA for worsening RFS demonstrated high tumor grade (OR=2.38, p&lt;0.001) and increasing clinical tumor size (OR=1.152, p&lt;0.001) to be independent factors. Conclusions: African Americans undergoing renal surgery for RCC appear to have similar OS and RFS, but poorer NCM than non-African American patients. The cause of these disparities is multi-faceted and likely associated with functional decline. Nephron-sparing management should be considered in African-Americans presenting with renal cortical tumors.
Genomic findings in adenocarcinoma of the urinary bladder.
Authors: Oleg Shapiro, Leszek Kotula, Timothy Byler, Joseph Jacob, Brian Michael Alexander, Laurie M. Gay, Sherri Z. Millis, Julia Andrea Elvin, Jon Chung, Jo-Anne Vergilio, Shakti Ramkissoon, Eric Allan Severson, Jonathan Keith Killian, Siraj Mahamed Ali, Alexa Betzig Schrock, Vincent A. Miller, Gustavo de La Roza, Jeffrey S. Ross, Gennady Bratslavsky, Nick Liu
Journal: Journal of Clinical Oncology (2019)

132 Background: Prostatic ductal carcinoma (PDC) is an uncommon centrally located prostate with a characteristic tubulopapillary histology. PDC shares some biomarker features with the more common prostatic acinar carcinoma (PAC) including PSA expression. Methods: In this comparative comprehensive genomic profiling (CGP) study, FFPE samples from 61 clinically advanced PDC and 4,132 PAC were profiled for all classes of genomic alterations (GA). Tumor mutational burden (TMB) was determined on 1.1 Mbp of sequenced DNA and microsatellite instability (MSI) was determined on 114 loci. Results: The age, frequency of genomic alterations (GA) per tumor and TP53 GA of PDA and PAC were similar (Table). TMPRSS2:ERG fusions and AR GA were more often identified in PAC than PDC whereas PTEN GA were more common in PDC than PAC. Targetable GA were identified at similar frequencies in both groups focused on BRCA2 (PARP inhibitors), BRAF (BRAF/MEK inhibitors) and PIK3CA (MTOR inhibitors). ATM GA (PARP inhibitors) were more common in PAC than PDC. CDK12 GA potentially associated with immunotherapy (IO) benefit were similar in PDA and PAC as were the frequencies of MSI-High status, median TMB and high TMB levels. Conclusions: The pathologic features of PDC and PAC have been classically maintained as representative of 2 different tumor types with potentially contrasting histogenesis. In the current CGP-based study, PDA and PAC did not display significant differences in genomic signatures. CGP may reveal biomarkers that could direct patients to targeted (PARP, MTOR and BRAF/MEK inhibitors) or immunotherapies ( CDK12 GA, MSI-High or high TMB status) in both PDA and PAC. [Table: see text]