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Kim DY, Swetter SM, Huhmann L, Dizon MP, Ferguson JM, Osborne TF, Spence AC, Ziad A, Fillmore N, Hartman RI. Real-world effectiveness of immune checkpoint inhibitors and BRAF/MEK inhibitors among veteran patients with cutaneous melanoma. J Am Acad Dermatol 2024; 90:620-623. [PMID: 37924953 DOI: 10.1016/j.jaad.2023.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/25/2023] [Accepted: 10/22/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Daniel Y Kim
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center, Palo Alto, California; Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Linden Huhmann
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Matthew P Dizon
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Thomas F Osborne
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Radiology, Stanford University School of Medicine, Palo Alto, California
| | - Allyson C Spence
- Department of Medical Oncology, Stanford University Medical Center, Palo Alto, California
| | - Amina Ziad
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nathanael Fillmore
- Harvard Medical School, Boston, Massachusetts; Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts
| | - Rebecca I Hartman
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Dermatology Section, VA Integrated Service Network 1 (VISN-1), Jamaica Plain, Massachusetts.
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Lin E, Zwolinski R, Wu JTY, La J, Goryachev S, Huhmann L, Yildrim C, Tuck DP, Elbers DC, Brophy MT, Do NV, Fillmore NR. Machine learning-based natural language processing to extract PD-L1 expression levels from clinical notes. Health Informatics J 2023; 29:14604582231198021. [PMID: 37635280 DOI: 10.1177/14604582231198021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Introduction: PD-L1 expression is used to determine oncology patients' response to and eligibility for immunologic treatments; however, PD-L1 expression status often only exists in unstructured clinical notes, limiting ability to use it in population-level studies. Methods: We developed and evaluated a machine learning based natural language processing (NLP) tool to extract PD-L1 expression values from the nationwide Veterans Affairs electronic health record system. Results: The model demonstrated strong evaluation performance across multiple levels of label granularity. Mean precision of the overall PD-L1 positive label was 0.859 (sd, 0.039), recall 0.994 (sd, 0.013), and F1 0.921 (0.024). When a numeric PD-L1 value was identified, the mean absolute error of the value was 0.537 on a scale of 0 to 100. Conclusion: We presented an accurate NLP method for deriving PD-L1 status from clinical notes. By reducing the time and manual effort needed to review medical records, our work will enable future population-level studies in cancer immunotherapy.
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Affiliation(s)
- Eric Lin
- VA Boston Healthcare System, Boston, MA, USA
- McLean Hospital, Institute for Technology in Psychiatry, Belmont, MA, USA
| | | | - Julie Tsu-Yu Wu
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer La
- VA Boston Healthcare System, Boston, MA, USA
| | | | | | | | - David P Tuck
- VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Danne C Elbers
- VA Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mary T Brophy
- VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Nhan V Do
- VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Nathanael R Fillmore
- VA Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
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La J, Wu JTY, Branch-Elliman W, Huhmann L, Han SS, Brophy M, Do NV, Lin AY, Fillmore NR, Munshi NC. Increased COVID-19 breakthrough infection risk in patients with plasma cell disorders. Blood 2022; 140:782-785. [PMID: 35605185 PMCID: PMC9130311 DOI: 10.1182/blood.2022016317] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/30/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jennifer La
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
| | - Julie Tsu-Yu Wu
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Division of Oncology, VA Palo Alto Healthcare System; Palo Alto, CA
| | - Westyn Branch-Elliman
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
- VA Boston Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Linden Huhmann
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
| | - Summer S Han
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA
| | - Mary Brophy
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
- Section of Hematology and Medical Oncology, Boston University School of Medicine, Boston, MA
| | - Nhan V Do
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
- Section of Hematology and Medical Oncology, Boston University School of Medicine, Boston, MA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Albert Y Lin
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Division of Oncology, VA Palo Alto Healthcare System; Palo Alto, CA
| | - Nathanael R Fillmore
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; and
| | - Nikhil C Munshi
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; and
- Section of Hematology/Oncology, VA Boston Healthcare System, Boston, MA
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Beene D, Collender P, Cardenas A, Harvey C, Huhmann L, Lin Y, Lewis J, LoIacono N, Navas-Acien A, Nigra A, Steinmaus C, van Geen A. A mass-balance approach to evaluate arsenic intake and excretion in different populations. Environ Int 2022; 166:107371. [PMID: 35809487 PMCID: PMC9790973 DOI: 10.1016/j.envint.2022.107371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 06/09/2023]
Abstract
Unless a toxicant builds up in a deep compartment, intake by the human body must on average balance the amount that is lost. We apply this idea to assess arsenic (As) exposure misclassification in three previously studied populations in rural Bangladesh (n = 11,224), Navajo Nation in the Southwestern United States (n = 619), and northern Chile (n = 630), under varying assumptions about As sources. Relationships between As intake and excretion were simulated by taking into account additional sources, as well as variability in urine dilution inferred from urinary creatinine. The simulations bring As intake closer to As excretion but also indicate that some exposure misclassification remains. In rural Bangladesh, accounting for intake from more than one well and rice improved the alignment of intake and excretion, especially at low exposure. In Navajo Nation, comparing intake and excretion revealed home dust as an important source. Finally, in northern Chile, while food-frequency questionnaires and urinary As speciation indicate fish and shellfish sources, persistent imbalance of intake and excretion suggests imprecise measures of drinking water arsenic as a major cause of exposure misclassification. The mass-balance approach could prove to be useful for evaluating sources of exposure to toxicants in other settings.
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Affiliation(s)
- Daniel Beene
- Community Environmental Health Program, Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Philip Collender
- Environmental Health Sciences, University of California, Berkeley. of California, Berkeley, Berkeley, CA, United States
| | - Andres Cardenas
- Environmental Health Sciences, University of California, Berkeley. of California, Berkeley, Berkeley, CA, United States
| | - Charles Harvey
- Earth and Environmental Engineering, Massachusetts Institute of Technology, Cambridge MA, United States
| | - Linden Huhmann
- Earth and Environmental Engineering, Massachusetts Institute of Technology, Cambridge MA, United States
| | - Yan Lin
- Geography and Environmental Studies, University of New Mexico, Albuquerque, NM, United States
| | - Johnnye Lewis
- Community Environmental Health Program, Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Nancy LoIacono
- Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Ana Navas-Acien
- Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Anne Nigra
- Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Craig Steinmaus
- Environmental Health Sciences, University of California, Berkeley. of California, Berkeley, Berkeley, CA, United States
| | - Alexander van Geen
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY, United States.
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