tbuckley/cabot-search huggingface dataset:
Alcohol Use and Abusive or Neglectful Behaviors Among Family Caregivers of Patients With Dementia
Authors: Jessica Andrea Hernandez Chilatra, Wesley Browning, Mustafa Yildiz, Maria Yefimova, Christopher D. Maxwell, Tami Sullivan, Carolyn E. Z. Pickering
Journal: JAMA Network Open (2025)

Importance The increasing prevalence of dementia presents challenges for family caregivers. Understanding how alcohol use among caregivers relates to abusive and neglectful behaviors (ANBs) toward care recipients with dementia may inform interventions to improve the well-being of both. Objective To explore alcohol use patterns among family caregivers of relatives with dementia and investigate whether hazardous drinking and drinking on a given day are independently associated with increased odds of ANBs toward care recipients. Design, Setting, and Participants This microlongitudinal cohort study included a baseline survey and 21 days of daily diary surveys among a convenience sample of family caregivers aged 18 years or older who coresided with and provided unpaid care to a community-dwelling relative with dementia across the US. Enrollment was from October 2019 to February 2023. Exposures Hazardous drinking at baseline, identified by the Alcohol Use Disorder Identification Test–Consumption screening tool, and daily alcohol consumption recorded in daily diary surveys. Main Outcomes and Measures Daily reports assessed engagement in physically aggressive, psychologically aggressive, and/or neglectful behaviors toward care recipients, categorized as binary outcomes. A generalized linear mixed model examined associations between caregivers’ baseline hazardous drinking status and daily alcohol use and odds of ANBs. Results Of 453 family caregivers (394 of 451 [87.4%] female; mean [SD] age, 51.6 [14.0] years), 82 (18.1%) screened positive for hazardous drinking. Over the 21-day period, 38 (8.4%) consumed alcohol at least once and 341 (75.3%) engaged in abusive or neglectful behavior at least once. Baseline hazardous drinking was associated with higher odds of engaging in neglectful behaviors (odds ratio [OR], 2.89; 95% CI, 1.74-4.80; P &amp;amp;lt; .001) and psychologically aggressive behaviors (OR, 2.32; 95% CI, 1.28-4.19; P = .006). Any alcohol use on a given day was associated with greater odds of physically aggressive (OR, 2.32; 95% CI, 1.10-4.88; P = .03) and neglectful (OR, 1.66; 95% CI, 1.31-2.10; P &amp;amp;lt; .001) behaviors on the same day. No statistically significant interaction between baseline hazardous drinking and daily alcohol use was observed. Conclusions and Relevance In this microlongitudinal cohort study of family caregivers of relatives with dementia, hazardous drinking and daily alcohol consumption were significantly and independently associated with increased odds of ANBs, highlighting the need for personalized interventions that address caregiving complexities and alcohol use patterns.
Nonconcurrent Control Use in FDA Approval of High-Risk Medical Devices
Authors: Maryam Mooghali, Sanket S. Dhruva, Hollin R.L. Hakimian, Vinay K. Rathi, Kushal T. Kadakia, Joseph S. Ross
Journal: JAMA Network Open (2025)

Importance The US Food and Drug Administration (FDA) may consider historical controls, objective performance criteria, or performance goals as alternatives to concurrent control groups in clinical studies evaluating safety and/or effectiveness of high-risk medical devices. However, nonconcurrent control use has limitations. Objective To examine frequency, justification, and clinically relevant details for use of nonconcurrent controls in pivotal studies supporting FDA approval of high-risk medical devices. Design, Setting, and Participants Cross-sectional study from 2019 through 2023 of original high-risk therapeutic medical device approvals in the US. Main Outcomes and Measures Frequency, justification, and clinically relevant details for use of historical controls, objective performance criteria, and performance goals and whether they had been established by the FDA. Results From 2019 to 2023, the FDA approved 101 original high-risk therapeutic medical devices, of which 13 (12.9%) were not approved on the basis of any pivotal study. Among the remaining 88 approvals, 33 (37.5%) were based on pivotal studies that used concurrent controls for all analyses, 3 (3.4%) on single-group studies without the use of nonconcurrent controls, and 52 (59.1%) were based on at least 1 analysis using historical controls, objective performance criteria, or performance goals for primary safety and/or effectiveness end points. These 52 premarket approvals included 79 primary safety or effectiveness analyses using nonconcurrent controls: 9 historical controls (11.4%), 7 objective performance criteria (8.9%), and 63 performance goals (79.7%). Overall, 3 analyses (3.8%) provided justification for use of nonconcurrent controls. Clinically relevant details were provided for 19 analyses (24.1%) with respect to historical data publication dates and for 10 (12.7%) with respect to comparison of patient characteristics between pivotal studies and nonconcurrent controls. Four of 7 objective performance criteria (57.1%) and 0 of 63 performance goals had been established by the FDA. Conclusions and Relevance This cross-sectional study of high-risk therapeutic medical device approvals by the FDA over the past 5 years found that most approvals were based on analyses using nonconcurrent controls with limited justification and clinically relevant details, potentially creating uncertainty for patients, clinicians, and payers regarding the evidence establishing device safety and effectiveness.
Breast Cancer Stage Among Ukrainian Refugees in Poland
Authors: Jakub Skórniak, Lukasz Rabalski, Bartłomiej Szynglarewicz, Bartosz Dołęga-Kozierowski, Piotr Kasprzak, Marcin Ziętek, Adam Maciejczyk, Edyta Pawlak, Martyna Krejmer-Rabalska, Katarzyna Skuza, Rafał Matkowski
Journal: JAMA Network Open (2025)

Importance Millions of Ukrainians displaced by war have sought refuge in Poland, posing challenges for cancer care. Determining whether these refugees present with more-advanced breast cancer is crucial for guiding resource allocation. Objective To evaluate the associations between Ukrainian refugee status and clinical presentation of breast cancer compared with Ukrainian permanent residents in Poland and the general Polish population. Design, Setting, and Participants This retrospective cohort study was conducted between February 2021 and February 2024 at a single tertiary oncology center (Lower Silesian Oncology, Pulmonology, and Hematology Centre, Wrocław, Poland) and included adult women with a diagnosis of stage 0 to IV breast cancer, regardless of treatment intent. Participants were categorized as Ukrainian permanent residents (UPRs), Ukrainian war refugees (UWRs), or general Polish population (GPP). Exposures War refugee status (UWR) vs permanent residence (UPR) vs general Polish population (GPP) and a diagnosis of breast cancer. Main Outcomes and Measures Primary outcomes were clinical stage (0-IV) at diagnosis, tumor grade (G1-G3), and age at presentation. Stage distributions and odds ratios (ORs) were evaluated using weighted logistic regression, adjusting for age and time period (before the war, first war year, and second war year). Results Of 3259 patients, 44 were in the UWR group (mean [SD] age, 52.9 [13.5] years), 72 were in the UPR group (mean [SD] age, 49.9 [11.4] years), and 3143 were in the GPP group (mean [SD] age, 59.5 [12.6] years). Stage III to IV disease occurred in 19 patients (43.2%) in the UWR group vs 849 patients (27.0%) in the GPP group. Adjusted analysis showed that refugees had a 2.00-fold increased odds (95% CI, 1.06-3.76; P = .03) of stage III to IV disease and 2.42-fold increased odds (95% CI, 1.29-4.55; P = .006) of grade 3 tumors. Conclusions and Relevance In this retrospective cohort study, war refugee status was associated with a higher prevalence of aggressive tumor grades and more-advanced stage disease at diagnosis. Although aggressive breast cancer subtypes are more common in younger women, the disproportionate burden of advanced disease in this cohort highlights the impact of health care access barriers and delayed presentation. These findings underscore the need for tailored strategies, such as accessible screening and early diagnostic interventions, to improve outcomes among Ukrainian refugees in Poland.
Patterns in Symptoms Preceding Acute Care in Patients With Cancer
Authors: Chichi Chang, Jie Jane Chen, Jean Feng, Isabel Friesner, Somya Mohindra, Lauren Boreta, Michael W. Rabow, Steve E. Braunstein, Ryzen Benson, Julian C. Hong
Journal: JAMA Network Open (2025)

Importance Patients with cancer frequently experience unplanned acute care with emergency department visits and hospitalization due to disease or treatment complications, which impacts outcomes, quality of life, and health care costs. There remains a knowledge gap in understanding patterns of symptoms that precede acute care events. Natural language processing (NLP) may enable greater understanding of the symptoms and identify differences across patient and cancer characteristics. Objective To characterize symptoms preceding acute care in patients with cancer and quantify differences in symptom documentation across sociodemographic and cancer histologic subgroups. Design, Setting, and Participants A cohort study in a single tertiary-care institution, including all acute care (emergency department and hospitalization) encounters for patients aged 18 years or older with a primary cancer diagnosis identified between January 1, 2013, and December 31, 2023. Main Outcomes and Measures Natural language processing was used to identify routine clinical documentation to characterize symptoms documented in the 30 days preceding acute care. Logistic regression analyses was used to examine the possible association between sex, age, race and ethnicity, insurance coverage, cancer histologic characteristics, and reported symptoms. Results Overall, 28 708 patients with cancer had 70 606 acute care visits with 854 830 associated preceding documented symptoms. Median age was 61 (IQR, 48-70) years. Men (37 861 encounters [53.62%]) and patients of White race (39 989 encounters [56.64%]) accounted for most acute care encounters. Pain (7.54% of documented symptoms), nausea (6.74%), and vomiting (5.79%) were the most frequently documented symptoms. Acute care encounters with patients who were female (adjusted odds ratio [AOR], 1.14; 95% CI, 1.10-1.18; P &amp;amp;lt; .001), Asian (AOR, 1.22; 1.17-1.28; P &amp;amp;lt; .001), Black (AOR, 1.17; 95% CI, 1.10-1.25; P &amp;amp;lt; .001), American Indian or Alaska Native (AOR, 1.21; 95% CI, 1.01-1.44; P = .04), or Medicaid-insured (AOR, 1.10; 95% CI, 1.05-1.14; P &amp;amp;lt; .001) were associated with a high documented symptom burden (&amp;amp;gt;10 unique symptoms) preceding acute care visits. Patients aged 65 years or older (AOR, 0.96; 95% CI, 0.92-1.00; P = .04) or uninsured (AOR, 0.58; 95% CI, 0.45-0.76; P &amp;amp;lt; .001) were less likely to have a high symptom burden documented before acute care events. Conclusions and Relevance The findings of this study highlight common symptoms preceding acute care as well as the need for further research on interventions to reduce patient burden, improve quality of life, and reduce the use of acute care in patients with cancer.
Semantic Clinical Artificial Intelligence vs Native Large Language Model Performance on the USMLE
Authors: Peter L. Elkin, Guresh Mehta, Frank LeHouillier, Melissa Resnick, Sarah Mullin, Crystal Tomlin, Skyler Resendez, Jiaxing Liu, Jonathan R. Nebeker, Steven H. Brown
Journal: JAMA Network Open (2025)

Importance Large language models (LLMs) are being implemented in health care. Enhanced accuracy and methods to maintain accuracy over time are needed to maximize LLM benefits. Objective To evaluate whether LLM performance on the US Medical Licensing Examination (USMLE) can be improved by including formally represented semantic clinical knowledge. Design, Setting, and Participants This comparative effectiveness research study was conducted between June 2024 and February 2025 at the Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, using sample questions from the USMLE Steps 1, 2, and 3. Intervention Semantic clinical artificial intelligence (SCAI) was developed to insert formally represented semantic clinical knowledge into LLMs using retrieval augmented generation (RAG). Main Outcomes and Measures The SCAI method was evaluated by comparing the performance of 3 Llama LLMs (13B, 70B, and 405B; Meta) with and without SCAI RAG on text-based questions from the USMLE Steps 1, 2, and 3. LLM accuracy for answering questions was determined by comparing the LLM output with the USMLE answer key. Results The LLMs were tested on 87 questions in the USMLE Step 1, 103 in Step 2, and 123 in Step 3. The 13B LLM enhanced by SCAI RAG was associated with significantly improved performance on Steps 1 and 3 but only met the 60% passing threshold on Step 3 (74 questions correct [60.2%]). The 70B and 405B LLMs passed all the USMLE steps with and without SCAI RAG. The SCAI RAG 70B model scored 80 questions (92.0%) correctly on Step 1, 82 (79.6%) on Step 2, and 112 (91.1%) on Step 3. The SCAI RAG 405B model scored 79 (90.8%) correctly on Step 1, 87 (84.5%) on Step 2, and 117 (95.1%) on Step 3. Significant improvements associated with SCAI RAG were found for the 13B model on Steps 1 and 3, the 70B model on Step 2, and the 405B parameter model on Step 3. The 70B model was significantly better than the 13B model, and the 405B model was not significantly better than the 70B model. Conclusions and Relevance In this comparative effectiveness research study, SCAI RAG was associated with significantly improved scores on the USMLE Steps 1, 2, and 3. The 13B model passed Step 3 with RAG, and the 70B and 405B models passed and scored well on Steps 1, 2, and 3 with or without augmentation. New forms of reasoning by LLMs, like semantic reasoning, have potential to improve the accuracy of LLM performance on important medical questions. Improving LLM performance in health care with targeted, up-to-date clinical knowledge is an important step in LLM implementation and acceptance.
Nurse Staffing Configurations and Nurse Absence Due to Sickness
Authors: Chiara Dall’Ora, Paul Meredith, Christina Saville, Jeremy Jones, Peter Griffiths
Journal: JAMA Network Open (2025)

Importance Rates of work-related stress and sickness absence are high among nurses. The consequences of sickness absence are severe for health systems’ efficiency and productivity. Objective To examine the association between nurse staffing configurations and sickness absence in hospital inpatient unit nursing teams. Design, Setting, and Participants This retrospective longitudinal case-control study using routinely collected hospital data among 4 general acute care hospitals in England examined 18 674 registered nurses (RNs) and nursing support (NS) staff working in 116 hospital units. Data were analyzed from April 1, 2015, to February 29, 2020. Exposure Nursing team skill mix, temporary staffing hours, understaffing, proportion of long shifts (≥12 hours) worked, and full-time or part-time work status in the previous 7 days. Main Outcome and Measure The main outcome was the number of episodes of sickness absence, which was defined as a sequence of sickness days with no intervening days of work. Results There were 2 690 080 shifts and 43 097 sickness episodes. The incident rates for starting a sickness episode were 2.0% for NSs and 1.4% for RNs. In total, there were 18 674 members of staff; 2 188 562 (81.6%) were shifts by staff classified as working full time and 493 400 (18.4%) by staff classified as working part time. A skill mix composed of more RNs was associated with a 2% reduction in the odds of RN sickness absence for each 10% change in the proportion of RN hours (odds ratio [OR], 0.98; 95% CI, 0.96-0.99). Moving from the lower quartile skill mix (ie, approximately 55% of the nursing hours worked by RNs) to the upper quartile (ie, approximately 75% of the nursing hours worked by RNs) was associated with a 4% reduction in odds of sickness absence. Working only long shifts in the prior 7 days was associated with a 26% increase in the odds of sickness absence for RNs compared with working no long shifts (OR, 1.26; 95% CI, 1.19-1.33). Part-time work for RNs was associated with higher sickness absence (OR, 1.09; 95% CI, 1.03-1.15). For RNs, there was a significant interaction between part-time work and RN understaffing, whereby short staffing in the previous week increased sickness absence for full-time staff but not among those working part time. NS understaffing was not associated with sickness absence for any staffing group. Conclusions and Relevance This retrospective case-control study found that exposure to RN understaffing increased the risk of sickness absence in nursing teams. Adverse working conditions for nurses, already known to pose a risk to patient safety, may also create risks for nurses and the possibility of further exacerbating staff shortages.
An Evidence Map of the Women Veterans’ Health Literature, 2016 to 2023
Authors: Karen M. Goldstein, Rachel Pace, Caroline Dancu, Sudha R. Raman, Zoe Bridges-Curry, Patrycja Klimek-Johnson, Athavi Jeevanathan, Anna H. Gallion, Tatyana Der, Amir Alishahi Tabriz, Syketha Sprague, Sharron Rushton, A. Jean Hammer, Catherine A. Sims, Jessica N. Coleman, Justin Martino, Sarah Cantrell, Adelaide M. Gordon, Morgan Jacobs, Anastasia-Stefania Alexopoulos, Dazhe Chen, Jennifer M. Gierisch
Journal: JAMA Network Open (2025)

Importance Women veterans are the fastest-growing veteran subpopulation in the US. Women veterans often experience military service–related health issues in addition to conditions common to all women. Because women veterans are more likely to receive care in the civilian setting than through the Department of Veterans Affairs (VA), all women’s health clinicians should be equipped to provide patient-centered care for women veterans. The health care of women veterans requires evidence-based care informed by population-specific scientific literature. An updated evidence map evaluating women veteran–focused health literature is needed. Objective To map the scope and breadth of women veterans’ health literature published from 2016 to 2023. Evidence Review In this systematic review, MEDLINE, Embase, and CINAHL Complete were searched for eligible articles published from 2016 to 2023. Articles reporting about US women veterans’ health outcomes or on the experience of providing care to women veterans were included. Included articles were required to report patient-level outcomes that included either data for only women veterans or reported results separately for women veterans. Articles were grouped by primary focus area based on categories previously established by the VA Women’s Health research agendas and prior evidence maps. Findings The volume of women veterans’ health literature published between 2016 and 2023 of 932 articles was double that of the prior 8 years. The largest portion of this literature was focused on chronic medical conditions (137 articles [15%]), general mental health (203 articles [22%]), and interpersonal violence (121 articles 3[13%]). Areas of greatest growth included reproductive health (physical and mental), pain, suicide, and nonsuicidal self-injury. Additionally, emerging areas of inquiry were found, including military-related toxic exposures and harassment within the health care setting. Conclusions and Relevance In this systematic review of literature focused on the health of women veterans, the volume of literature was found to have doubled and expanded in important areas that aligned with VA research priorities. However, despite the growth in research related to women veterans, several important research gaps remain within this field of study. Research addressing health issues pertinent to a growing and aging women veterans’ population will require rigorous research and program evaluations.
ctDNA Clearance as an Early Indicator of Improved Clinical Outcomes in Advanced NSCLC Treated with TKI: Findings from an Aggregate Analysis of Eight Clinical Trials
Authors: Hillary S. Andrews, Nevine Zariffa, Katherine K. Nishimura, Stephanie H. Choi, Shibing Deng, Megan Eisele, Carin R. Espenschied, Emily M. Goren, Minakshi Guha, Samuel Hong, Dilafruz Juraeva, Nicole Krämer, Li Liu, Jean-Francois Martini, Brittany A. McKelvey, Geoffrey R. Oxnard, Gary A. Pestano, Lynne Poole, Adam Rosenthal, Anna M. Szpurka, Diana Merino Vega, Christine Ward, Sameera R. Wijayawardana, Antje Hoering, Mark D. Stewart, Jeff D. Allen
Journal: Clinical Cancer Research (2025)

Abstract Purpose: Circulating tumor DNA (ctDNA) holds promise as an early endpoint to predict overall survival (OS). The creation and structured interrogation of aggregated datasets inform the hypothesis that ctDNA is reasonably likely to predict treatment benefit. Friends of Cancer Research convened a diverse working group to establish and implement an analysis plan assessing patient-level associations between changes in ctDNA levels with OS and progression-free survival (PFS). Experimental Design: The aggregate dataset included eight clinical trials representing 940 patients with biomarker-positive advanced non–small cell lung cancer treated with tyrosine kinase inhibitors. Detection of baseline and on-treatment ctDNA was assessed for associations with OS and PFS. Additionally, combinations of ctDNA detection and RECIST measurements up to 10 weeks on treatment were considered. Results: Patients with detected ctDNA at baseline that became nondetected on treatment (“clearance”) experienced improved OS compared with patients with persistently detected ctDNA (adjusted HR = 2.12, P &amp;lt; 0.001). This pattern was also seen in the subset of patients with stable disease as measured by RECIST within 10 weeks of treatment initiation (adjusted HR = 4.15, P &amp;lt; 0.001). Results were similar for PFS. Conclusions: In patients with oncogene-driven advanced non–small cell lung cancer treated with tyrosine kinase inhibitors, ctDNA clearance within 10 weeks of treatment initiation was associated with improved OS and PFS. These patient-level results support the growing evidence that demonstrates a change in ctDNA levels during treatment is associated with clinical benefit. Future prospective trials should include predefined thresholds of molecular response to advance the utility of ctDNA as an early endpoint.
Protein O-GlcNAcylation and hexokinase mitochondrial dissociation drive heart failure with preserved ejection fraction
Authors: Yuki Tatekoshi, Amir Mahmoodzadeh, Jason S Shapiro, Mingyang Liu, George M Bianco, Ayumi Tatekoshi, Spencer Duncan Camp, Adam De Jesus, Navid Koleini, Santiago De La Torre, J Andrew Wasserstrom, Wolfgang H Dillmann, Benjamin R Thomson, Kenneth C Bedi, Kenneth B Margulies, Samuel E Weinberg, Hossein Ardehali
Journal: Cell Metabolism (2025)
CD20 xCD3 bispecific antibodies for large B cell lymphoma: latest updates from 2024 ASH annual meeting
Authors: V Tomarchio, L Rigacci, O Annibali
Journal: Journal of Hematology & Oncology (2025)

Bispecific antibodies (BsAbs) represent an innovative class of off-the-shelf T-cell redirecting agents and are considered among the most promising immunotherapeutic strategies for the treatment of lymphoma. Notably, anti-CD20 × CD3 BsAbs have exhibited substantial monotherapy efficacy in patients with heavily pretreated B-cell non-Hodgkin lymphoma (B-NHL), showing a tolerable toxicity profile predominantly associated with T-cell activation-related side effects. In this study, we summarized several latest reports on CD20 × CD3 bsAbs for the therapy of Large B Cell Lymphoma (LBCL), also in first line, from the ASH 2024 annual meeting (ASH 2024).
Macrophage response to fibrin structure mediated by Tgm2-dependent mitochondrial mechanosensing
Authors: Bicong Gao, Haifeng Ni, Junhong Lai, Ning Gao, Xinxin Luo, Ying Wang, Yani Chen, Jiaying Zhao, Zhou Yu, Jing Zhang, Wenjin Cai, Guoli Yang
Journal: Bioactive Materials (2025)