Afatinib use in recurrent epithelial ovarian carcinoma.

•Genomic tumor testing is an important tool in guiding treatment for gynecologic malignancies.•Targetable mutations may lead to new therapies in gynecologic cancer treatment.•Her2/neu mutations in serous ovarian carcinomas can be targeted with ERBB2 inhibitors.•Afatinib shows promising response rates in lung cancers carrying Her2/neu mutations.•Afatinib may be effective in serous ovarian tumors exhibiting Her2/neu or ERBB2 mutations

Seeing Things Differently: Art, Law and Justice in the Scottish Feminist Judgments Project

This paper illustrates how turning to art rather than focusing solely on legal reform can form part of an alternative response to gender inequality that allows for deeper understandings of social (in)justice. We show how the Scottish Feminist Judgments Project – a collaborative endeavour by legal academics, practising lawyers, judges, artistic contributors and representatives from the third sector – can offer those who engage with our art the experience of hearing and seeing law in different ways. More specifically, we explore how art can open law up to scrutiny, render vivid the impact of legal decisions, and create richer and more democratic communities of understanding. At the same time, by discussing  knowledge differentials and the quandaries of creating art ethically, we also highlight some of the challenges involved in engaging in artistic-legal collaboration

Who Are the Young People Choosing Web-based Mental Health Support? Findings From the Implementation of Australia's National Web-based Youth Mental Health Service, eheadspace

BACKGROUND: The adolescent and early adult years are periods of peak prevalence and incidence for most mental disorders. Despite the rapid expansion of Web-based mental health care, and increasing evidence of its effectiveness, there is little research investigating the characteristics of young people who access Web-based mental health care. headspace, Australia’s national youth mental health foundation, is ideally placed to explore differences between young people who seek Web-based mental health care and in-person mental health care as it offers both service modes for young people, and collects corresponding data from each service type. OBJECTIVE: The objective of this study was to provide a comprehensive profile of young people seeking Web-based mental health care through eheadspace (the headspace Web-based counseling platform), and to compare this with the profile of those accessing help in-person through a headspace center. METHODS: Demographic and clinical presentation data were collected from all eheadspace clients aged 12 to 25 years (the headspace target age range) who received their first counseling session between November 1, 2014 and April 30, 2015 via online chat or email (n=3414). These Web-based clients were compared with all headspace clients aged 12 to 25 who received their first center-based counseling service between October 1, 2014 and March 31, 2015 (n=20,015). RESULTS: More eheadspace than headspace center clients were female (78.1% compared with 59.1%), and they tended to be older. A higher percentage of eheadspace clients presented with high or very high levels of psychological distress (86.6% compared with 73.2%), but they were at an earlier stage of illness on other indicators of clinical presentation compared with center clients. CONCLUSIONS: The findings of this study suggest that eheadspace is reaching a unique client group who may not otherwise seek help or who might wait longer before seeking help if in-person mental health support was their only option. Web-based support can lead young people to seek help at an earlier stage of illness and appears to be an important component in a stepped continuum of mental health care

Current Directions in Medical Student Well-Being

Traditionally, topics pertaining to student well-being have been conspicuously sparse throughout medical school curricula. This contradiction has been well documented in human health literature, and the academic medical community has developed strategies to respond to this need. A literature review of terms pertaining to medical student wellness was conducted to generate 34 unique articles. The articles were categorized based on three common themes: mental health, diversity, and work-life balance. In mental health, institutional changes such as professional and peer-to-peer counseling have demonstrated promising improvements. The advent of pipeline programs and student research fellowships has increased learning environment diversity. Finally, wellness programming in recreation and the arts, as well as academic shifts to pass-fail grading, have proven successful in improving work-life balance. While many of these initiatives have enriched the mental well-being of medical students, there remains a critical need to standardize these practices nationally

Management of High-Risk Obstetrical Patients with Morbidly Adherent Placenta in the Age of Resuscitative Endovascular Balloon Occlusion of the Aorta

Obstetric hemorrhage is the leading cause of maternal morbidity and mortality worldwide. At highest risk of massive obstetric hemorrhage, are women with morbidly adherent placenta (MAP). The complications associated with MAP are even more devastating in very high-risk obstetrical patients, where blood transfusion is not an option, either due to lack of resources or patient refusal, such as for Jehovah’s Witnesses. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally-invasive technique used in trauma surgery to control non-compressible hemorrhage. REBOA is emerging as useful tool for managing high-risk obstetric surgery for MAP. This review aims to provide a framework for use of REBOA in obstetric care in challenging circumstances

Extracting detailed oncologic history and treatment plan from medical oncology notes with large language models

Both medical care and observational studies in oncology require a thorough understanding of a patient's disease progression and treatment history, often elaborately documented in clinical notes. Despite their vital role, no current oncology information representation and annotation schema fully encapsulates the diversity of information recorded within these notes. Although large language models (LLMs) have recently exhibited impressive performance on various medical natural language processing tasks, due to the current lack of comprehensively annotated oncology datasets, an extensive evaluation of LLMs in extracting and reasoning with the complex rhetoric in oncology notes remains understudied. We developed a detailed schema for annotating textual oncology information, encompassing patient characteristics, tumor characteristics, tests, treatments, and temporality. Using a corpus of 10 de-identified breast cancer progress notes at University of California, San Francisco, we applied this schema to assess the abilities of three recently-released LLMs (GPT-4, GPT-3.5-turbo, and FLAN-UL2) to perform zero-shot extraction of detailed oncological history from two narrative sections of clinical progress notes. Our team annotated 2750 entities, 2874 modifiers, and 1623 relationships. The GPT-4 model exhibited overall best performance, with an average BLEU score of 0.69, an average ROUGE score of 0.72, and an average accuracy of 67% on complex tasks (expert manual evaluation). Notably, it was proficient in tumor characteristic and medication extraction, and demonstrated superior performance in inferring symptoms due to cancer and considerations of future medications. The analysis demonstrates that GPT-4 is potentially already usable to extract important facts from cancer progress notes needed for clinical research, complex population management, and documenting quality patient care.Comment: Source code available at: https://github.com/MadhumitaSushil/OncLLMExtractio

Target Selection for the LBTI Exozodi Key Science Program

The Hunt for Observable Signatures of Terrestrial planetary Systems (HOSTS) on the Large Binocular Telescope Interferometer will survey nearby stars for faint emission arising from ~300 K dust (exozodiacal dust), and aims to determine the exozodiacal dust luminosity function. HOSTS results will enable planning for future space telescopes aimed at direct spectroscopy of habitable zone terrestrial planets, as well as greater understanding of the evolution of exozodiacal disks and planetary systems. We lay out here the considerations that lead to the final HOSTS target list. Our target selection strategy maximizes the ability of the survey to constrain the exozodi luminosity function by selecting a combination of stars selected for suitability as targets of future missions and as sensitive exozodi probes. With a survey of approximately 50 stars, we show that HOSTS can enable an understanding of the statistical distribution of warm dust around various types of stars and is robust to the effects of varying levels of survey sensitivity induced by weather conditions.Comment: accepted to ApJ