tbuckley/cabot-search huggingface dataset:
Family and Friend Perceptions of Quality of End-of-Life Care in Medicare Advantage vs Traditional Medicare
Authors: Claire K. Ankuda, Amy S. Kelley, R. Sean Morrison, Vicki A. Freedman, Joan M. Teno
Journal: JAMA Network Open (2020)

Medicare Advantage (MA) insures an increasing proportion of Medicare beneficiaries, but evidence is lacking on patient or family perceptions of the quality of end-of-life care in MA vs traditional Medicare.To determine if there is a difference in quality of care reported by family and friends of individuals who died while insured by MA vs traditional Medicare at the end of life.This cross-sectional study used the 2011 to 2017 Medicare-linked National Health and Aging Trends Study to conduct population-based survey research representing 8 668 829 Medicare enrollees. Included individuals were 2119 enrollees who died when aged 65 years or older, with quality of care reported by a family member or close friend familiar with the individual's last month of life. Analysis was conducted in July 2020.MA enrollment at the time of death or before hospice enrollment.Perception of end-of-life care was measured with 9 validated items, with the primary outcome variable being overall care rated not excellent. We conducted a propensity score-weighted multivariable model to examine the association of each item with MA vs traditional Medicare enrollment. The propensity score and multivariable model included covariates capturing demographic and socioeconomic factors, function and health, and relationship of the respondent to the individual who died. The sample was then stratified by hospice enrollment and setting of care in the last month.Of 2119 people in the sample, 670 individuals were enrolled in MA at the time of death or prior to hospice (32.7%) and 1449 were enrolled in traditional Medicare (67.3%). In survey-weighted percentages, 53.6% (95% CI, 51.0% to 56.1%) were women and 43.4% (95% CI, 41.5% to 45.3%) were older than 85 years at the time of death. In the adjusted model, family and friends of individuals in MA were more likely to report that care was not excellent (odds ratio, 1.28; 95% CI, 1.01 to 1.61; P = .04) and that they were not kept informed (odds ratio, 1.48; 95% CI, 1.06 to 2.05; P = .02). For those in nursing homes, there was an estimated probability of 57.2% of respondents reporting that care was not excellent for individuals with traditional Medicare, compared with 77.9% of respondents for individuals with MA (marginal increase for those in MA, 0.21; 95% CI, 0.08 to 0.32; P = .001).In this cross-sectional study of people who died while enrolled in Medicare, friends and family of those in MA reported lower-quality end-of-life care compared with friends and family of those enrolled in traditional Medicare. These findings suggest that, given the rapid growth of MA, Medicare should take steps to ensure that MA plans are held accountable for quality of care at the end of life.
Cell Encapsulation: Enhanced In Vivo Vascularization of 3D‐Printed Cell Encapsulation Device Using Platelet‐Rich Plasma and Mesenchymal Stem Cells (Adv. Healthcare Mater. 19/2020)
Authors: Jesus Paez‐Mayorga, Simone Capuani, Marco Farina, Maria Luisa Lotito, Jean A. Niles, Hector F. Salazar, Jessica Rhudy, Lucas Esnaola, Corrine Ying Xuan Chua, Francesca Taraballi, Bruna Corradetti, Kathryn A. Shelton, Pramod N. Nehete, Joan E. Nichols, Alessandro Grattoni
Journal: Advanced Healthcare Materials (2020)

In article number 2000670 by Alessandro Grattoni and co-workers, vascularization of a subcutaneously implantable cell encapsulation platform is enhanced via enrichment with plateletrich plasma (PRP) and mesenchymal stem cells (MSCs) in rats and non-human primates. Timepoint vascularity assessment demonstrates enrichment with PRP and MSCs increases blood vessel density and maturity inside the encapsulation devices, unveiling an optimal window for cell transplantation. Interspecies reproducibility points toward translatability of the technology.
Financial burdens of insured adolescent and young adult cancer patients: A need for crowdfunding platforms, fundraisers, financial grants, and cost conversations with their cancer care team.
Authors: Karely Mann, Austin R. Waters, Perla L. Vaca Lopez, Nicole Ray, Tomoko Tsukamoto, Heydon K. Kaddas, Echo L. Warner, Douglas Beaty Fair, Mark Andrew Lewis, Giselle K. Perez, Elyse R. Park, Anne C. Kirchhoff
Journal: Journal of Clinical Oncology (2020)

83 Background: Cancer patients in the United States often experience distress surrounding out of pocket costs from treatment. Adolescents and young adults (AYA) are more likely to be underinsured, skip care due to cost, go into debt, and file for bankruptcy after a cancer diagnosis than patients diagnosed at older ages. We conducted semi-structured interviews with AYA cancer patients and survivors to evaluate their experiences with health insurance, cancer costs and use of crowdfunding. Methods: Eligible participants were ages 18-39, diagnosed with cancer, and currently insured. Recruitment occurred largely through patient navigators at two large cancer centers from October 2019 to March 2020. Data was collected via individual semi-structured telephone interviews, which were analyzed for content. Questions were asked pertaining to crowdfunding platforms, fundraisers, satisfaction with current health insurance policy, and cost conversations with their cancer care team. Interviews were analyzed applying two rounds of thematic content analysis. Summary statistics were calculated for demographics. Results: Twenty-four interviews were completed, with more than half of participants being female (58%), most participants being Non-Hispanic White (79%), mean age at 26.5, and currently receiving cancer treatment (79%). Three themes emerged about AYAs’ experience with treatment costs and health insurance: 1) Even with insurance, cancer care was unexpectedly expensive and burdensome on financial wellbeing; 2) Conversations about cost with cancer care teams were brief and rare and 3) Crowdfunding platforms, fundraisers or financial grants were often used as financial safety nets, and did not cover all out of pocket costs. More than half of participants expressed interest in having cost conversations with their oncologist, nurse or social worker. All participants expressed a need for education on managing cancer costs and a particular interest in educational information on appeals and out of pocket costs. Conclusions: AYAs with cancer report unexpected costs and are interested in discussing this with their cancer care team. AYAs often receive money from fundraisers, financial grants or crowdfunding platforms to assist with the expenses of treatment. Discussions between cancer care teams and AYA patients about health insurance policies and cost saving mechanisms may help reduce out of pocket costs and reliance on external financial mechanisms.
Interferon Beta-1b and Lopinavir–Ritonavir for Middle East Respiratory Syndrome
Authors: Yaseen M. Arabi, Ayed Y. Asiri, Abdullah M. Assiri, Hanan H. Balkhy, Ali Al Bshabshe, Majed Al Jeraisy, Yasser Mandourah, Mohamed H.A. Azzam, Abdulhadi M. Bin Eshaq, Sameera Al Johani, Shmeylan Al Harbi, Hani A.A. Jokhdar, Ahmad M. Deeb, Ziad A. Memish, Jesna Jose, Sameeh Ghazal, Sarah Al Faraj, Ghaleb A. Al Mekhlafi, Nisreen M. Sherbeeni, Fatehi E. Elzein, Fahad Al-Hameed, Asim Al Saedi, Naif K. Alharbi, Robert A. Fowler, Frederick G. Hayden, Abdulaziz Al-Dawood, Mohamed Abdelzaher, Wail Bajhmom, Badriah M. AlMutairi, Mohamed A. Hussein, Adel Alothman
Journal: New England Journal of Medicine (2020)

BackgroundWhether combined treatment with recombinant interferon beta-1b and lopinavir–ritonavir reduces mortality among patients hospitalized with Middle East respiratory syndrome (MERS) is unclear.MethodsWe conducted a randomized, adaptive, double-blind, placebo-controlled trial that enrolled patients at nine sites in Saudi Arabia. Hospitalized adults with laboratory-confirmed MERS were randomly assigned to receive recombinant interferon beta-1b plus lopinavir–ritonavir (intervention) or placebo for 14 days. The primary outcome was 90-day all-cause mortality, with a one-sided P-value threshold of 0.025. Prespecified subgroup analyses and safety analyses were conducted. Because of the pandemic of coronavirus disease 2019, the data and safety monitoring board requested an unplanned interim analysis and subsequently recommended the termination of enrollment and the reporting of the results.ResultsA total of 95 patients were enrolled; 43 patients were assigned to the intervention group and 52 to the placebo group. A total of 12 patients (28%) in the intervention group and 23 (44%) in the placebo group died by day 90. The analysis of the primary outcome, with accounting for the adaptive design, yielded a risk difference of −19 percentage points (upper boundary of the 97.5% confidence interval [CI], −3; one-sided P=0.024). In a prespecified subgroup analysis, treatment within 7 days after symptom onset led to lower 90-day mortality than use of placebo (relative risk, 0.19; 95% CI, 0.05 to 0.75), whereas later treatment did not. Serious adverse events occurred in 4 patients (9%) in the intervention group and in 10 (19%) in the placebo group.ConclusionsA combination of recombinant interferon beta-1b and lopinavir–ritonavir led to lower mortality than placebo among patients who had been hospitalized with laboratory-confirmed MERS. The effect was greatest when treatment was started within 7 days after symptom onset. (Funded by the King Abdullah International Medical Research Center; MIRACLE ClinicalTrials.gov number, NCT02845843.)
SAT0043 Ankylosing spondylitis and cardiac diseases
Authors: FM Santos, A Alves, C Catarino, L Bento, C Cotrim, M Carrageta, JC Silva
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> Ankylosing Spondylitis (AS) and other spondyloarthropathies (SPA), are associated with certain cardiologic problems. <h3>Objectives</h3> To identify coexisting AS and SPA in selected cardiac patients (pts) and to investigate the cardiac status of pts with an established diagnosis of AS. <h3>Methods</h3> An observational study involving two pt. groups was undertaken: Group 1 were young and middle-aged patients (&lt;50 years at time of diagnosis), followed in the cardiology department for aortic valve disease and/or with a permanent pacemaker implanted. All pts were interviewed and examined. A pelvic X-ray and blood analysis for HLA B27 was performed. Group 2 were pts with an established diagnosis of AS and no clinical evidence of cardiovascular disease. A full history, clinical examination, 24-h Holter and doppler echocardiography were performed. Cardiac abnormalities were related to clinical features of AS. <h3>Results</h3> Group 1: 14 pts with either an aortic valve replacement (AVR), aortic valve pathology and/or a permanent pacemaker were studied. 12 men and 2 women, with a mean age of 40 years (range 22–53) were observed. 9 pts had an AVR, 2 had aortic valva (AV) stenosis and 5 had a permanent pacemaker implamted. 2 of the pts had both an AVR and a permanent pacemaker. 1 of these pts was definitely diagnosed with AS and 2 pts were diagnosed as undifferentiated SPA. Group 2: 9 men and 8 women, with an average age of 43 years (min 23 and max 61) were included. Disease duration varied from 1 to 20 years with a mean of 8. Four (24%) pts had echocardiographic evidence of aortic valve thickening and regurgitation. Two pts also had left atrial dilatation. Holter exams were performed in 15 of the 17 pts. No significant conduction abnormalities or arrhythmias were apparent. The 4 pts with echocardiographic changes were older (&gt;50 years in 3 cases) or had a high Basmi index. <h3>Conclusion</h3> Young pts with AV disease or conduction disorders should be screened for AS. Regular cardiac monitoring of AS pts may help prevent the long term cardiac complications associated with this condition.
Fibroblast-Derived IL33 Facilitates Breast Cancer Metastasis by Modifying the Immune Microenvironment and Driving Type 2 Immunity
Authors: Ophir Shani, Tatiana Vorobyov, Lea Monteran, Dor Lavie, Noam Cohen, Yael Raz, Galia Tsarfaty, Camila Avivi, Iris Barshack, Neta Erez
Journal: Cancer Research (2020)

Lungs are one of the main sites of breast cancer metastasis. The metastatic microenvironment is essential to facilitate growth of disseminated tumor cells. Cancer-associated fibroblasts (CAF) are prominent players in the microenvironment of breast cancer. However, their role in the formation of a permissive metastatic niche is unresolved. Here we show that IL33 is upregulated in metastases-associated fibroblasts in mouse models of spontaneous breast cancer metastasis and in patients with breast cancer with lung metastasis. Upregulation of IL33 instigated type 2 inflammation in the metastatic microenvironment and mediated recruitment of eosinophils, neutrophils, and inflammatory monocytes to lung metastases. Importantly, targeting of IL33 in vivo resulted in inhibition of lung metastasis and significant attenuation of immune cell recruitment and type 2 immunity. These findings demonstrate a key function of IL33 in facilitating lung metastatic relapse by modulating the immune microenvironment. Our study shows a novel interaction axis between CAF and immune cells and reveals the central role of CAF in establishing a hospitable inflammatory niche in lung metastasis. SIGNIFICANCE: This study elucidates a novel role for fibroblast-derived IL33 in facilitating breast cancer lung metastasis by modifying the immune microenvironment at the metastatic niche toward type 2 inflammation.
Exploring the three domains of financial hardship experienced by ovarian cancer patients.
Authors: Margaret Irene Liang, Janice Leahgrace Simons, Ivan I. Herbey, Jaclyn Wall, Lindsay Rucker, Nataliya V. Ivankova, Warner King Huh, Maria Pisu
Journal: Journal of Clinical Oncology (2020)

71 Background: We sought to obtain ovarian cancer patients’ perspective on the 3 domains of financial hardship (psychological response, material conditions, and coping behaviors). Methods: We recruited ovarian cancer patients on systemic therapy who screened positive for financial distress using Comprehensive Score for Financial Toxicity (COST) &lt;26. Two interviewers conducted 45-minute interviews about patients’ experiences dealing with the costs of care. Interviews were recorded, transcribed, and coded by 3 analysts using inductive thematic analysis to identify common themes. Results: 22 patients completed interviews with 18 available for analysis. Median age was 57 years old, 36% were black, and participants had a median COST of 12 (range 0-23). We identified themes within each domain (Table). Conclusions: Ovarian cancer patients predominantly experienced financial hardship through psychological response and negative impact on their material conditions. These require increased provider awareness and targeted interventions. Patients did not report negative health-related coping behaviors as they prioritized their health care over immediate cost concerns. [Table: see text]
Gut microbiome stability and resilience: elucidating the response to perturbations in order to modulate gut health
Authors: Marina Fassarella, Ellen E Blaak, John Penders, Arjen Nauta, Hauke Smidt, Erwin G Zoetendal
Journal: Gut (2020)

The human gut microbiome is a complex ecosystem, densely colonised by thousands of microbial species. It varies among individuals and depends on host genotype and environmental factors, such as diet and antibiotics. In this review, we focus on stability and resilience as essential ecological characteristics of the gut microbiome and its relevance for human health. Microbial diversity, metabolic flexibility, functional redundancy, microbe–microbe and host–microbe interactions seem to be critical for maintaining resilience. The equilibrium of the gut ecosystem can be disrupted by perturbations, such as antibiotic therapy, causing significant decreases in functional richness and microbial diversity as well as impacting metabolic health. As a consequence, unbalanced states or even unhealthy stable states can develop, potentially leading to or supporting diseases. Accordingly, strategies have been developed to manipulate the gut microbiome in order to prevent or revert unhealthy states caused by perturbations, including faecal microbiota transplantation, supplementation with probiotics or non-digestible carbohydrates, and more extensive dietary modifications. Nevertheless, an increasing number of studies has evidenced interindividual variability in extent and direction of response to diet and perturbations, which has been attributed to the unique characteristics of each individual’s microbiome. From a clinical, translational perspective, the ability to improve resilience of the gut microbial ecosystem prior to perturbations, or to restore its equilibrium afterwards, would offer significant benefits. To be effective, this therapeutic approach will likely need a personalised or subgroup-based understanding of individual genetics, diet, gut microbiome and other environmental factors that might be involved.
Eye clinic attendance at the olympic and paralympic games Rio 2016 and its correlation to the WHO indicators on eye health
Authors: Arthur Gustavo Fernandes, Andrew Bastawrous, Nívea Nunes Ferraz, Benjamin Hennig, Vagner Loduca Lima, Rodrigo Galvao Viana, Mauro Campos, João Marcello Furtado
Journal: British Journal of Sports Medicine (2020)

To evaluate athletes' frequency of attendance at the eye clinic during the Olympic and Paralympic Games Rio 2016 and to correlate it to WHO core indicators on progress in ophthalmology care in a country.
Author Correction: Deep learning for automated sleep staging using instantaneous heart rate
Authors: Niranjan Sridhar, Ali Shoeb, Philip Stephens, Alaa Kharbouch, David Ben Shimol, Joshua Burkart, Atiyeh Ghoreyshi, Lance Myers
Journal: npj Digital Medicine (2020)

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Concurrent visual and acoustic tracking of passive and active delivery of nanobubbles to tumors
Authors: Carly Pellow, Eric C. Abenojar, Agata A. Exner, Gang Zheng, David E. Goertz
Journal: Theranostics (2020)

Background: There has been growing interest in nanobubbles for their potential to extend bubble-mediated ultrasound approaches beyond that of their larger microbubble counterparts. In particular, the smaller scale of nanobubbles may enable them to access the tumor extravascular compartment for imaging and therapy in closer proximity to cancer cells. Compelling preliminary demonstrations of the imaging and therapeutic abilities of nanobubbles have thus emerged, with emphasis on their ability to extravasate. However, studies to date rely on indirect histologic evidence that cannot confirm whether the structures remain intact beyond the vasculature - leaving their extravascular potential largely untapped. Methods: Nanobubble acoustic scattering was assessed using a recently reported ultra-stable formulation at low concentration (106 mL-1) and frequency (1 MHz), over a range of pressures (100-1500 kPa) in a channel phantom. The pressure-dependent response was utilized as a basis for in vivo experiments where ultrasound transmitters and receivers were integrated into a window chamber for simultaneous intravital multiphoton microscopy and acoustic monitoring in tumor-affected microcirculation. Microscopy and acoustic data were utilized to assess passive and active delivery of nanobubbles and determine whether they remained intact beyond the vasculature. Results: Nanobubbles exhibit pressure-dependent nonlinear acoustic scattering. Nanobubbles are also found to have prolonged acoustic vascular pharmacokinetics, and passively extravasate intact into tumors. Ultrasound stimulation of nanobubbles is shown to actively enhance the delivery of both intact nanobubbles and shell material, increasing their spatial bioavailability deeper into the extravascular space. A range of acute vascular effects were also observed. Conclusion: This study presents the first direct evidence that nanobubbles passively and actively extravasate intact in tumor tissue, and is the first to directly capture acute vascular events from ultrasound-stimulation of nanobubbles. The insights gained here demonstrate an important step towards unlocking the potential of nanobubbles and extending ultrasound-based applications.
Engineering the Microbiome to Prevent Adverse Events: Challenges and Opportunities
Authors: Saad Khan, Ruth Hauptman, Libusha Kelly
Journal: The Annual Review of Pharmacology and Toxicology (2020)

In the past decade of microbiome research, we have learned about numerous adverse interactions between the microbiome and medical interventions such as drugs, radiation, and surgery. What if we could alter our microbiomes to prevent these events? In this review, we discuss potential routes to mitigate microbiome adverse events, including applications from the emerging field of microbiome engineering. We highlight cases where the microbiome acts directly on a treatment, such as via differential drug metabolism, and cases where a treatment directly harms the microbiome, such as in radiation therapy. Understanding and preventing microbiome adverse events is a difficult challenge that will require a data-driven approach involving causal statistics, multiomics techniques, and a personalized means of mitigating adverse events. We propose research considerations to encourage productive work in preventing microbiome adverse events, and we highlight the many challenges and opportunities that await.
Achieving Equitable Care for People With Disabilities
Authors: Janelle S. Nassim, Alice J. Watson, Jennifer K. Tan
Journal: JAMA Dermatology (2020)

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Covid-19: This time it’s personal for GPs
Authors: Rebecca Coombes
Journal: BMJ (2020)

Covid-19: This time it's personal for GPs Rebecca Coombes head of news and viewsIn general practice, waiting rooms are quiet, there are fewer locums, and, for now at least, the Care Quality Commission's inspectors aren't calling.But BMJ articles have captured the seismic effect of covid-19 on the delivery of primary care: the tensions, challenges, and emerging lessons.As health services brace for the effects of escalating covid-19 cases, it's clear this time around that management of patients needs to be different.