bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality improvement scorecards driving innovation and best practice in a large community oncology practice.
Authors: Mendenhall Molly , Drosick David Randolph , Ward Patrick J. , Davies Dan , Sheldrick Amy , Brown Aimee , Neeb Jessica louise , Noble Amanda , Waterhouse David Michael
Published: September 2024

417

Background:
Lean Six Sigma Visual Management dashboards, or scorecards, are visual tools designed to drive and improve quality patient care, operationalize best practices, and promote a culture of operational excellence. Practice scorecards create a disciplined problem-solving culture where root causes are identified, and systemic process-based improvements are implemented. Scorecards are created to show full practice data transparency, allowing all employees and sites to see each other’s data. Scorecards are designed so that providers can efficiently review the maximum amount of data, following a Green, Yellow, Red visual cue to signify goal adherence.
Methods:
Phase 1 (2018 – 2019): Clinical scorecards were created and introduced to all staff on a weekly basis focusing on a few key patient metrics (ex: pain scale, pain care plan, ACP, PHQ-9, teaching/consents, patient portal access). Phase 2 (2020 – 2022): Clinical scorecards were expanded with additional patient care initiatives. New nurse navigator scorecards created (ex: patient teaching and survivorship visits). New physician and APP scorecards created with practice-specific provider metrics. Phase 3 (2023 – 2024): Scorecards updated yearly to match practice quality initiatives. New dashboards for non-clinical employees initiated. Physician and APP compensation changed to include quality metric performance tied to financial incentive.
Results:
Over the course of 5 years, OHC quality scorecard metrics improved from below national averages (red) to exceeding top-tier threshold goals (green). Scorecard utilization increased across all areas of the business, expanding from one scorecard in 2018 to eight in 2024. Scorecards increased overall practice data transparency leading to increase practice quality metric performance. OHC staff utilize scorecards on a weekly, monthly, and quarterly basis to drive quality improvement adherence. Improved outcomes through full data transparency increased staff participation and ownership in quality metrics and led to achieved shared savings in managed care programs. Example of metrics and results: Patient NCCN Staging 36% (2588/7263) to 96% (10299/10749), Teaching/Consents 37% (423/1147) to 97% (3067/3160), and Oral regimen NCCN entry 69% (586/845) to 98% (1037/1055).
Conclusions:
Visual Management dashboards or practice scorecards are instrumental in driving and supporting practice change. Scorecards allowed OHC staff to efficiently visualize practice-wide actionable data with eye-catching colors to promote optimal clinical performance. As increased data procurement is on the rise, practices can empower their staff to drive change through data utilization. OHC’s scorecards have proven to bridge the gap to goal, facilitate transparent data sharing, and empower providers and staff toward collaboration and embracing operational excellence.
High-value care modeling: Evaluating cost conscious and potentially wasteful behaviors.
Authors: Arora Neha , Smeraglio Andrea , Wade Amanda , Carney Patricia A
Published: September 2024

42

Background:
Value-based care is key to decreasing waste, addressing increasing healthcare costs, and minimizing patient financial toxicity - especially in the treatment of high-cost diagnoses such as cancer. Medical student exposure to role-modeling of high-value care (HVC) behaviors may help shape professional identity formation and have long-term effects on future practices. Our study aimed to investigate the frequency and characteristics of faculty role-modeling of HVC in medical student core clinical rotations.
Methods:
A cross-sectional survey study was performed with third- and fourth-year medical students on clinical rotations at 11 U.S. medical schools. The survey assessed thirteen variables associated with cost conscious role-modeling behaviors or potentially wasteful role-modeling behaviors, as well as questions characterizing the rotation such behaviors were observed on, demographic information, and organizational culture around HVC.
Results:
Cost-conscious role-modeling behaviors were observed “sometimes” or “often” between 52.9-70.5% of the time across all clinical rotations, with the exception of observing a student or resident being praised for ordering a cost-effective diagnostic work-up (seen only 25.7% of the time). Potentially wasteful role modeling behaviors were observed “sometimes” or “often” 5%-14.3% of the time, except simultaneously ordering numerous tests before seeing results of initial screening tests (45.1%) and repeating tests rather than attempting to obtain recently performed test results (42.9%). HVC was most often observed on internal medicine rotations (58.3%) and least frequently on surgery rotations (34.5%). Attendings were significantly more likely to model HVC compared to residents/fellows in 5/7 domains. Organizational culture correlated with frequency of HVC behavior observed.
Conclusions:
HVC role-modeling behaviors, as observed by medical students, are variable across clinical rotations. HVC practices are essential not only within oncology, but across all medical specialties; future studies should strive to identify factors which promote or inhibit HVC modeling and understand differences between HVC education in undergraduate medical curriculum.
Can ChatGPT provide accurate financial toxicity resources to patients with cancer?
Authors: Patel Jharna , Miller Erin Leigh , Cantor Tal , Chino Fumiko , Thom Bridgette , Stasenko Marina , Aviki Emeline Mariam
Published: September 2024

425

Background:
Artificial Intelligence (AI) has potential benefits in medicine, including improving patient education, but its use in mitigating financial toxicity faced by patients with cancer is unknown. We aimed to investigate the accuracy of ChatGPT, an open access AI, responses to common financial concerns among patients with cancer.
Methods:
ChatGPT, an open access AI platform, was used to query 50 questions developed using oncologic society websites. These questions encompassed medical (n=25, concerns related to treatment costs) and non-medical financial (n=25, questions related to financial assistance) questions focused on breast, endometrial, lung, colon, and prostate cancers. The responses were scored by two financial toxicity experts with the scale: 1) correct and comprehensive, 2) correct but not comprehensive, 3) some correct, some incorrect components and 4) completely incorrect. Score discrepancies were resolved with a third reviewer. In secondary analysis, all questions were queried 3 times to assess if ChatGPT gave different/improved responses. The proportion of responses earning each score were calculated overall, within each category, and by disease site.
Results:
Overall, in the first queries, 84% of questions were scored as correct but not comprehensive (n=42/50) and 6% (n=3/50) of questions were scored as having both correct and incorrect components. Approximately 28% (n=14/50) of questions had discrepant scores that required third party review, and 10% (n=5/50) of questions never achieved a consensus. All non-medical questions were scored as correct but not comprehensive (n=25/25) with a concordance rate of 96% (n=24/25), with only 1 question sent to a third reviewer. Additional queries of non-medical questions did not yield different answers. For the medical questions, approximately 68% (n=17/25) of questions were scored as correct but not comprehensive and 12% (n=3/25) were scored as having correct and incorrect components. 52% (n=13/25) of questions were sent to a third reviewer, and 20% (n=5/25) of questions never achieved a consensus score. While additional queries of medical questions yielded different answers, the quality of the responses did not improve. For each disease site, prostate cancer questions had the highest number of discordant questions with 40% (n=4/10) that were sent to a third reviewer for scoring but a 100% (n=10/10) of responses had a score that showed correct but not comprehensive answers. Reviewer feedback was universal that ChatGPT responses did not provide helpful information to patients, even in the situations in which there was technically no inaccurate information.
Conclusions:
ChatGPT does not consistently provide accurate or helpful answers to financial toxicity concerns commonly asked by patients with cancer. Additional input from experts is necessary to aid in AI learning before this resource should be used by patients facing financial toxicity.
Patient enrollment to industry- versus NIH-sponsored cancer clinical trials.
Authors: Unger Joseph M. , Xiao Hong , Vaidya Riha , LeBlanc Michael Leo
Published: September 2024

46

Background:
The conduct of cancer clinical research in the U.S. is supported by both private and public sponsors. Industry aims to obtain new drug approvals. Federally-sponsored trials examine a broad set of research questions that are not typically addressed by industry; these trials, which are also more commonly conducted in diverse populations, were recently shown to have contributed to gains of 14 million life-years for patients with cancer. Despite the different mandates, the proportion of patients who participate in industry vs. federally-sponsored cancer studies is unknown.
Methods:
We evaluated trial enrollment patterns from 2008-2022 using ClinicalTrials.gov data. The ratio of enrollments attributable to industry versus federal sponsors was estimated. A large set of 990 estimates based on different combinations of study characteristics were generated. Point estimates were determined as the mean of combinations and confidence limits by the interquartile range (IQR). Five-year intervals were examined to smooth annual variation.
Results:
N=26,080 studies were examined. The estimated enrollment ratio from 2018-2022 for all industry vs. federally-sponsored trials was 8.1 (IQR:6.2-9.9). For adult trials, the ratio increased from 4.8 (IQR:4.4-5.3) during 2008-2012 to 9.6 (IQR:7.4-11.8) during 2018-2022; for trials in children, the ratio increased from 0.7 (IQR:0.6-0.7) to 2.3 (IQR:1.8-2.7). For adult trials, annual enrollment attributable to industry sponsorship increased from 54,127 in 2008-2012 to 113,527 for 2018-2022. In contrast, annual enrollment counts for federally-sponsored trials were flat over the entire study period, including 11,282/year for 2008-2012 and 11,798/year in 2018-2022, even as incident cancer cases in the U.S. increased 18% from 1.53 million in 2010 to 1.81 million in 2020.
Conclusions:
In the U.S., there is a growing reliance on industry to conduct cancer clinical research. Underinvestment in federally-sponsored research comes at a cost for both patients and researchers, with lost opportunities for scientific, clinical, and population advances.
The impact of oncology nutrition services on weight change among patients with head and neck or pancreatic cancers.
Authors: Natori Akina , Lopez-Pentecost Melissa , MacIntyre Jessica , An Hong Su , Kleyman Leo , Crane Tracy E
Published: September 2024

86

Background:
Weight loss is prevalent among cancer patients and correlates with lower health-related quality of life and overall survival rates. Individuals diagnosed with head and neck (HN) and pancreatic cancers face a heightened risk of weight loss due to tumor location and treatment-related side effects. Although guidelines advocate early interventions such as referral to a dietitian for tailored nutritional support, the precise impact of oncology nutrition services (ONS) on weight loss remains unclear. In this study, we investigated the longitudinal association between weight change and ONS among patients diagnosed with HN or pancreatic cancers.
Methods:
A retrospective chart review was conducted for patients diagnosed with HN or pancreatic cancers visited between January 2019 and December 2023. Inclusion criteria encompassed patients who had weight measurements taken within 30 days of their cancer diagnosis. Patient demographics, clinical characteristics, all recorded body weights, and receipt of ONS were extracted from electronic health records. Weight change (%) from the baseline was calculated at each measurement by subtracting the initial weight value. A mixed-effects model was employed to evaluate the impact of ONS on weight change, with time to weight measurement and ONS serving as interaction terms, after adjusting for demographics and clinical characteristics.
Results:
A cohort of 1305 patients was identified, predominantly comprising males (n=1014, 63%) and individuals of White race (n=1358, 85%), with a diverse ethnic distribution (Hispanic: n=620, 39%). Of these patients, 947 (73%) received ONS at any point following cancer diagnosis. Significant weight loss over time was noted among all patients (-0.53% per 6 months, p<0.001). Baseline weight, sex, ethnicity, receipt of percutaneous endoscopic gastrostomy, total parenteral nutrition, radiation, chemotherapy, and ONS were significantly associated with weight loss. Following adjustment for the covariates, patients receiving ONS showed significantly less weight loss compared to those without ONS (-0.06% [95% confidence interval (CI): -0.10, -0.03] vs. -0.04% [95% CI: -0.38, -0.23] per 6 months, p<0.001).
Conclusions:
The findings indicate that ONS plays a significant role in attenuating weight loss among patients diagnosed with HN or pancreatic cancer, irrespective of baseline demographics or clinical status. While the magnitude of weight change may appear modest, its implications are substantial long term. Early referrals to ONS should be recommended for HN or pancreatic cancer patients to mitigate weight loss.
Financial burden within first year of diagnosis for privately-insured patients with early-onset breast or colorectal cancer.
Authors: Shih Ya-Chen Tina , Xu Ying , Bradley Cathy J , Yabroff Robin
Published: September 2024

9

Background:
Rising incidence of early-onset (E-O) cancers has been observed globally. E-O breast cancer (BC) are patients (pts) diagnosed ages 18 to 44 and E-O colorectal cancer (CRC) are aged 18 to 49. Because many E-O cancers are among pts who do not meet screening eligibility criteria by age, they are often diagnosed at advanced stage, which is also more expensive to treat. Younger pts may also have lower incomes and fewer assets, increasing risk of financial burden for pts with E-O cancers. We estimated the financial burden for pts and private payors for E-O BC and CRC, compared to non-elderly pts with BC and CRC diagnosed between the age of 45 to 64 and 50 to 64 (older-onset), respectively.
Methods:
We applied a claims-based algorithm to identify pts with incident BC and CRC diagnosed between 2014 and 2021 from MarketScan Commercial Claims and Encounters Data and required 12-month continuous enrollment before and after the index diagnosis for completeness of claims. Financial burden was quantified as total and out-of-pocket (OOP) payments, calculated as the sum of deductibles, copayments, and coinsurance. We used generalized linear models and quantile regressions to compare differences in mean and median costs, respectively, between pts with E-O vs. older onset cancer, adjusting for comorbidity, region, insurance plan type, sex (for CRC) and year.
Results:
Study cohort included 58,419 pts with BC and 11,251 pts with CRC. The proportion of E-O increased from 15% in 2014 to 17% in 2022 (Ptrend<0.01) in BC and from 23% to 30% (Ptrend<0.01) in CRC. Higher percentage of E-O pts were enrolled in high-deductible plans (BC: 25% v22%; CRC: 24% vs. 21%) and received systemic therapy (BC: 61% v 49%; CRC: 57% vs. 43%). Higher percent of surgery (93% v 89%) was observed in E-O BC and radiation (21% v 16%) in E-O CRC. Pts with E-O BC and CRC had significantly higher adjusted mean and median total and OOP payments (Table).
Conclusions:
E-O BC and CRC result in substantial costs to payors and moderately higher OOP payments. OOP maximums in private insurance may offer some financial protection for pts.

E-O
Older onset
Difference
95% CIBC:

BC: Mean total pay
$182,770
$128,640
$54,130
$50445, $57817

 Median total pay
143,351
93,317
50,034
47691, 52377

 Mean OOP
6,014
5,063
951
817, 1085

 Median OOP
5,142
4,258
884
791, 978

CRC: Mean total pay
$153,446
$123,449
$29,998
$24244, $35752

 Median total pay
119,747
89,340
30,406
25216, 35597

 Mean OOP
5,429
4,791
638
428, 848

 Median OOP
4,452
4,015
437
266, 607
Adaptive learning to address gaps in metastatic breast cancer treatment with CDK 4/6 inhibitors.
Authors: Augustyniak Monica , Fleming Matthew , Finn Richard S. , Jackson Katrina , Lazure Patrice , Murray Suzanne
Published: September 2024

92

Background:
To address identified gaps in knowledge and confidence of US-based healthcare professionals (HCPs) when using cyclin-dependent kinase 4/6 inhibitors (CDK 4/6i) to treat metastatic breast cancer (mBC), an adaptive learning program (ALP) was deployed to review guideline recommendations and evidence from randomized clinical trials (RCTs) and real-world data (RWD).
Methods:
The ALP consisted of reading materials (guideline excerpts, RCTs, RWD, cases) with a virtual tutor that taught. The ALP continued to review necessary content until responders were both correct and confident (conscious competence). Impact on learning was interpreted as greater for learning objectives with the lowest accuracy score (% of correct responses) and higher distance to 100% conscious competency at baseline. Immediately post-ALP, satisfaction, perceived impact on knowledge, confidence and intent to change practice were assessed quantitatively and qualitatively. ANOVA compared continuous measures by profession.
Results:
Participants (n=261) were physicians (MD, 17%), advanced practice practitioners (APP, 20%), registered nurses (RN, 49%), pharmacists (11%), and other (3%). Mean completion time was 44 minutes and learners’ proficiency shifted +64% towards conscious competency. The learning objectives most impacted by the education are shown (Table). Learners most satisfied with the ALP (47% with 9-10 on a 10-point satisfaction scale) appreciated the challenge and reported positive impact on their knowledge and confidence, resulting in intent to change their patient-communication, clinical decisions and interprofessional collaboration when using CDK4/6i.
Conclusions:
This ALP initiative addressed the educational gaps of US HCPs regarding CDK4/6i in HR+/HER2- mBC by challenging participants to re-consider their knowledge and confidence until conscious competency was demonstrated. Engaged learners found the activity impactful and reported intent to change practice. Future studies should seek to address attrition challenges and assess long term impacts of such programs.

Top five learning objectives with lowest-ranking accuracy, by profession.

Learning Objectives (LOs) Most Impacted
Initial Scores by Profession
Final Score

ALL

MD

APP

RN

PharmD

Other

Identify appropriate CDK4/6i treatment options for a premenopausal woman with newly diagnosed HR+/HER2- mBC

54

57
53
53
62
52
100

Match RWD sources with their characteristics

56

55
60
55
61
41
100

Interpret results from the landmark CDK4/6i RCTs

58

62
61
53
64
56
100

Interpret RWE related to the use of CDK4/6i in patients who are underrepresented in RCTs*

62

62
63
58
74
65
100

Identify the latest updates from CDK4/6i RCTs

62

60
63
61
62
82
100

Average accuracy score for all 24 LOs

71

72
73
69
74
64
100

*Significantly different between professions (p<0.05; one-way ANOVA).
Access to patient assistance programs for rural cancer patients in an NCI designated comprehensive cancer center: A retrospective cohort study.
Authors: Falconer Patricia P. , Craveiro Laila , Kusluch John
Published: September 2024

94

Background:
35% of Oregon’s and 14% of Washington’s populations live in rural/frontier communities. These populations often experience a higher incidence of cancer disparities across the care continuum and a disproportionate burden of the high costs associated with cancer care compared to urban populations.
Methods:
The Oregon Health & Science University (OHSU) Knight Cancer Institute (KCI) operates a multidisciplinary cancer program catering to Oregon and Southwest Washington from its Portland-based campuses. OHSU launched an enterprise Patient Assistance (PA) program partnership with Atlas Health which included an Artificial Intelligence (AI)-powered platform integrated with the electronic health record and 4 Patient Advocates who enrolled patients into matched PA programs. Rural patients receiving intravenous (IV) infusion therapy who benefited from PA programs were compared to the overall treated population at OHSU infusion centers to determine if rural patients who are at high risk for financial toxicity were identified and provided an effective intervention. Patient zip codes were used to designate residence in urban or rural/frontier counties.
Results:
A retrospective analysis reviewed unique patients treated in the OHSU KCI infusion centers, PA Enrolled, and PA Awarded patient cohorts.
Conclusions:
The Enterprise PA program partnership notably and proportionately benefited rural communities who are at high risk for financial toxicity and experience significant cost barriers to care. OHSU collected over 599,000 which reduced the risk of bad debt for the institution and cancer related medical debt for patients. Average PA award of 1,426 was significant due to 40% of Americans cannot afford a 1,000 emergency or unexpected medical bill. This underscores that an enterprise PA program may be considered a care delivery intervention to decrease health disparities. Further study is needed to determine if increasing rural cancer patients’ access to PA programs helps improve clinical access and treatment outcomes across the spectrum of cancer care services.

Patient cohort comparison 12/15/2023-3/31/2024.

Patient Cohort
OHSU Infusion Center Cohort
Patient Assistance Enrolled Cohort
Patient Assistance Awarded Cohort

Total Number of Patients

9,197

554

420

Total Number of Patients Residing in Oregon and Washington

9,064

552

418

Total Number of Patients Residing in Oregon and Washington Rural Counties

1,668

117

122

Percentage Rural Patients

18%

21%

29%

Drug Manufacturer Co-Pay Programs

-

$ 590,785.70

$ 459,095.08

Charitable Co-Pay Assistance Programs

-

$ 96,024.70

$ 139,981.33

Total

-

$ 686,810.40

$ 599,076.41

Average Expected/Received Award Per Patient

-

$ 1,239.73

$ 1,426.37
Hurricane disasters and radiation treatment delays among patients diagnosed with non-small cell lung cancer.
Authors: Sakka Rand , Yabroff Robin , Chino Fumiko , Nogueira Leticia M
Published: September 2024

98

Background:
Hurricanes can disrupt cancer care and adversely affect health outcomes, especially for patients needing daily radiation therapy, which depends on stable electricity and safe facility access. Among patients diagnosed with locally advanced non-small cell lung cancer (NSCLC), disruptions in radiation can decrease survival. This study evaluates the associations of exposure to a hurricane disaster and radiation delays and total dose received among patients diagnosed with NSCLC.
Methods:
Patients aged ≥18 years who initiated radiation therapy for non-operable stage III NSCLC between 2004-2021 were identified from the National Cancer Database. Exposure was defined as a Federal Emergency Management Agency (FEMA) hurricane disaster declaration at the county of the treating facility during radiation treatment. Patients treated at the same facility, but at a time when no hurricane happened (i.e. unexposed) were propensity score matched in a 1:1 ratio with exposed patients on age at diagnosis, sex, lymph node involvement, comorbidity score, season, and era (radiation start year 2004 – 2009, 2010 – 2015, 2016 – 2021), to account for more active hurricane seasons in recent years. Delays in radiation treatment completion were defined as > 8 weeks between date when radiation started and ended. A two-way t-test and Mantel-Haenszel test were used to examine associations of hurricane exposure and radiation dose and treatment delays respectively.
Results:
6,260 matched patients were included, of whom 3,130 were treated at facilities exposed to hurricanes during radiation and 3,130 completed treatment at the same facilities but at a time when no hurricane exposure happened. Patients treated during hurricanes had 1.95 higher odds (95% confidence interval (CI): 1.71 – 2.24) of experiencing treatment delays compared to unexposed patients (23% of exposed patients experienced delays compared to 13% of unexposed patients). Exposed patients were more likely to have received higher radiation doses compared to unexposed patients (mean 5221.81 cGy vs. 4962.75 cGy; p < 0.0001).
Conclusions:
Patients with locally advanced NSCLC who received radiation during a hurricane disaster were more likely to experience treatment completion delays. Patients treated during a hurricane were also more likely to receive higher total doses of radiation, possibly suggesting compensation to mitigate the detrimental biological impact of radiation delays. As severe weather events become more common, comprehensive emergency preparedness plans that incorporate evidence-based strategies for mitigating adverse effects of treatment delays are essential.
Pharmacist-Led Video Consultation to Identify and Mitigate Drug Interactions Among Patients Initiating Oral Anticancer Drugs
Authors: Lichtenstein Morgan R.L. , Campbell Peter , Raghunathan Rohit , Beauchemin Melissa , Elkin Elena B. , Crew Katherine D. , Accordino Melissa , Ippoliti Cindy , Hwang Michelle , Abramova Rachel , Harden Erik , Kelly Paige , Collins Nicole , Faheem Khadija , Wright Jason D , Hershman Dawn L.
Published: September 2024

PURPOSE

The past decade has seen an increase in oral anticancer drug (OACD) approvals. Polypharmacy and drug-drug interactions (DDIs) likely contribute to OACD toxicity. We assessed a one-time pharmacist-led video consultation to identify DDIs.

METHODS

We conducted a single-arm telehealth intervention of a one-time 30-minute pharmacist-led video consultation among patients initiating OACDs. The visit focused on identifying polypharmacy and DDIs. Feasibility was defined as ≥50% completion of all study interventions. We determined the prevalence, characteristics, and severity of OACD-related potential DDIs. We also assessed the prevalence of medication list inaccuracies, polypharmacy, patient satisfaction, and patient perception of intervention acceptability, appropriateness, and feasibility.

RESULTS

Of 58 eligible patients, 43 (74%) completed the intervention and 33 (57%) completed all evaluations. Median medication per patient was nine (range 4-21), and 98% of patients had at least five prescriptions. The median number of medication list errors was two (range 0-16), with at least one error for 76% and >1 for 52%. Pharmacists identified OACD-related interactions in 18 cases (42%), including change in drug metabolism (eight), elimination (one), and absorption (three). Interactions were classified as Lexicomp categories C (13), D (five), or X (one) requiring close monitoring or a change in treatment. All patients expressed high satisfaction with the intervention and agreed or completely agreed that it was acceptable, appropriate, and feasible.

CONCLUSION

Polypharmacy, medication list errors, and DDIs are prevalent among patients initiating OACDs. A one-time remote pharmacist-led video consultation can address OACD-related DDIs, which may decrease medication complexity and improve adherence.
A Decreased Appetite for Prophylactic Total Gastrectomy
Authors: Davis Jeremy L. , Gallanis Amber F.
Published: September 2024

Total gastrectomy should be performed less often in germline CDH1 variant carriers based on mounting clinical evidence
Black Gravity, or a Hidden History of Empire
Authors: Samuel Petal
Published: September 2024

This essay takes this occasion—the thirtieth anniversary of the publication of Evelynn Hammonds’s germinal essay “Black (W)holes and the Geometry of Black Female Sexuality”—as an opportunity to explore the turn to spacetime and astrophysics in Black feminist writing and scholarship. This understudied tradition has unfolded concurrently alongside the rise of maritime and aquatic metaphors in Black studies. Focusing on the image of the black hole, the essay argues that this metaphor operates as a stimulus for confronting disciplinary objects of anxiety in Black studies, Caribbean studies, physics, and Black feminist studies. By analyzing origin stories that surround the moniker black hole in physics, the essay shows how imperial violence and notions of Black gender and sexual alterity suffused the term from its inception in the world of physics—a history that Black feminist theorists call to memory and challenge in their redeployment of the image.
The Optimal Quantity of CBDC in a Bank-Based Economy
Authors: Burlon Lorenzo , Muñoz Manuel A. , Smets Frank
Published: September 2024

We show that the estimated effect of digital euro news on bank stock valuations and lending depends on the bank’s deposit reliance and the central bank digital currency (CBDC) design features. Using a quantitative DSGE model calibrated to the euro area economy that replicates such evidence, we find that CBDC issuance yields nontrivial welfare trade-offs between, on one side, the positive expansion of liquidity services and the improved stabilization of deposit funding and lending and, on the other side, a negative bank disintermediation effect. The optimal amount of CBDC lies between 15 and 45 percent of quarterly GDP. (JEL E23, E42, E58, F33, G14, G21)
Entrepôt: Hubs, Scale, and Trade Costs
Authors: Ganapati Sharat , Wong Woan Foong , Ziv Oren
Published: September 2024

We study the global trade network and quantify its trade and welfare impact. We document that the trade network is a hub-and-spoke system where 80 percent of trade is shipped indirectly and largely via entrepôts—major hubs that facilitate trade between many origins and destinations. We estimate indirect-shipping-consistent trade costs using a model where shipments can be sent indirectly through an endogenous transport network and develop a geography-based instrument to estimate scale economies in shipping. Network and scale effects propagate local trade cost changes globally. Counterfactual infrastructure improvements at entrepôts generate ten times the global welfare impact relative to nonentrepôts. (JEL F12, F14, L92)
Σπαράγματα του χρόνου και του αστικού τοπίου
Authors: Μαρίνος Χριστόφορος
Published: September 2024

Στο πνεύμα αλλαγής και έντονης αντιπαράθεσης που εκφράστηκε στη Μεταπολίτευση ως ρήξεις με την παράδοση, τον κανόνα, αλλά και με τις καλλιτεχνικές πρακτικές προηγούμενων ετών ή γενεών, η Ρένα Παπασπύρου πρότεινε μια ριζικά διαφορετική και αμιγώς εννοιολογική προσέγγιση του αστικού τοπίου, η οποία αποκλίνει σημαντικά από τους τρόπους απεικόνισης που επικράτησαν μεταπολεμικά. Η παρούσα εργασία επιχειρεί να αναδείξει τους ευρετικούς κώδικες της Παπασπύρου διερευνώντας τις βασικές τυπολογίες που εντοπίζονται στο έργο της και λειτουργούν ως οργανωτικές αρχές. Η ενδελεχής μελέτη συγκεκριμένων έργων αποκαλύπτει τον μηχανισμό σκέψης της καλλιτέχνιδας. Μέσα από τη δημιουργική αναγνώριση των μικροστοιχείων της δομής της ύλης και τη σύλληψη της επιφάνειας ως φορέα καταστάσεων, η Ρένα Παπασπύρου προσέδωσε μια διαφορετική νοηματοδότηση στη σύγχρονη αστική εμπειρία, παράγοντας ένα έργο πολύπλευρο, ιδιοσυγκρασιακό, αενάως επίκαιρο και αφήνοντας το δικό της ίχνος στο μωσαϊκό της σύγχρονης ευρωπαϊκής τέχνης.
Study of the effects of prenatal exposure to mixtures of endocrine disruptors, on the reproductive and nervous system of mice
Authors: Παναγιωτίδου Έμιλυ-Ελισάβετ
Published: September 2024

Στα πλαίσια της διατριβής εξετάστηκαν οι επιπτώσεις της προγεννητικής έκθεσης μυών, σε περιβαλλοντικά σχετικά μείγματα ενδοκρινικών διαταρακτών (EDCs) ως προς την αναπαραγωγική και νευρολογική ανάπτυξη των απογόνων τους. Οι EDCs είναι γνωστό ότι διαταράσσουν την ορμονική λειτουργία ακόμα και σε χαμηλές δόσεις και εντοπίζονται σε βιολογικά υγρά, καθιστώντας τα αναπτυσσόμενα έμβρυα ευάλωτα στις επιδράσεις τους. Οι φθαλικές ενώσεις, τα φυτοφάρμακα και η BPA είναι κοινοί EDCs που βρίσκονται σε καθημερινά προϊόντα, με γνωστές νευρολογικές επιδράσεις και συσχετίσεις με προβλήματα αναπαραγωγής και συμπεριφοράς. Η μελέτη επικεντρώθηκε σε δύο μείγματα EDC, το Μείγμα S0 και το Μείγμα N1, τα οποία σχεδιάστηκαν με βάση τα επίπεδα έκθεσης που παρατηρήθηκαν στην επιδημιολογική μελέτη SELMA. Οι πειραματικές δοκιμές περιλάμβαναν την έκθεση εγκύων μυών σε αυτά τα μείγματα, ακολουθούμενη από την παρακολούθηση των απογόνων από την προεφηβεία έως και την ενηλικίωση. Το Μείγμα S0, που αντιπροσωπεύει τα ανθρώπινα επίπεδα έκθεσης στις φθαλικές ενώσεις, προκάλεσε μόνιμες αλλαγές στην αναπαραγωγική λειτουργία των προγεννητικά εκτεθιμένων μυών, συμπεριλαμβανομένης της τροποποίησης της λειτουργίας των γονάδων και των επιπέδων γοναδικών ορμονών, και μείωση της πρωκτογεννητικής απόστασης. Το Μείγμα N1, συνδυάζοντας φθαλικές ενώσεις, φυτοφάρμακα και BPA σε ρεαλιστικά επίπεδα έκθεσης, προκάλεσε διαταραχές στη συμπεριφορά των ενηλίκων απογόνων, όπως τροποποιημένη αντίδραση στο άγχος, αυξημένη δραστηριότητα και μειωμένη κοινωνικότητα που προσομοιάζουν με χαρακτηριστικά του ADHD, και με αλλαγές στην έκφραση γονιδίων που παρατηρήθηκαν στο μεταιχμιακό σύστημα του εγκεφάλου. Τα ευρήματα υπογραμμίζουν τους σοβαρούς αναπτυξιακούς κινδύνους που προκαλεί η προγεννητική έκθεση σε μείγματα EDC, επισημαίνοντας τη σημασία της συνεχούς έρευνας και των ρυθμιστικών μέτρων για τη μείωση πιθανών αρνητικών επιπτώσεων στην ανάπτυξη του αναπαραγωγικού και νευρικού συστήματος. Η μελέτη αυτή, ως μέρος του προγράμματοςEDC-MixRisk, συμβάλλει στον ευρύτερο στόχο πρωτοβουλιών, για την πιο ασφαλή χρήση χημικών στις μελλοντικές γενιές.
A qualitative study of the experience of head nurses in supervising nursing staff in the outpatient department
Authors: Ningsih Ropika , Setyowati Setyowati , Gayatri Dewi , Budi Indra , Nining Sri , Ahmalia Renty , Eka Brigida Wonga Wea Maria , Anshari Rusyda , Mahmud Reflin , Toding Dewiyanti
Published: September 2024

Background Outpatient services were a major aspect of hospital healthcare, primarily due to the prevalent inclination of individuals to seek efficient and expedient treatment options that could be provided within a single day. In this context, the experience of head nurses played a crucial role in providing optimum nursing care under supervision. This study aimed to explore the experience of head nurses in supervising nursing staff in the outpatient department. Method this study used a qualitative hermeneutic phenomenology design, and the participants were selected using the purposive sampling method. Result This study recruited a total of 20 head nurses in public and private hospitals in West Sumatra province. The FGD data were analyzed and coded using a total of 102 nodes, which were then used to generate 5 themes and 16 subthemes. The five major themes included the knowledge of head nurses about supervision, the performance appraisal method, the feeling of head nurses when supervising, the supervisor support for supervision, and the expectations of head nurses. Conclusion Clinical supervision in the outpatient department was crucial for the success of nurses in delivering healthcare services. The study revealed that while supervision was essential, head nurses observed that it was often perceived as fault-finding by nursing staff, which could affect individual assessment scores and sometimes led to indifference towards the process.
Factors associated with life satisfaction among family caregivers of persons living with dementia
Authors: Choi Seonho , Hwang Yeji , Cho Eui Young
Published: September 2024

Purpose: Because family caregivers provide a considerable amount of daily care to persons living with dementia, they are at risk of experiencing poor life satisfaction. Therefore, this study aimed to examine factors associated with the life satisfaction of family caregivers of persons living with dementia. Methods: Data were collected through surveys from family caregivers (N=183), and a multiple linear regression analysis was conducted to examine the factors associated with their life satisfaction. Results: The final model indicated that perceiving support from intimate others as helpful (β=.22, p<.001) was associated with greater life satisfaction, whereas a negative relationship with the care recipients (β=−.15, p=.046) and greater psychological burden (β=−.40, p<.001) were associated with poorer life satisfaction (Adjusted R2=0.49, F=20.42, p<.001). Conclusion: Public policy should focus on providing greater support to family caregivers. Furthermore, healthcare professionals should implement intervention programs for family caregivers that focus on lowering their psychological burden.
Credit Market Frictions and the Linkage Between Dispersion and Macro Uncertainty
Authors: Li Jun E.
Published: September 2024

Cross-sectional dispersion and macro uncertainty (volatility of aggregate economic variables) are conceptually distinct. However, empirically, they both comove and are countercyclical. This paper builds a general equilibrium model and demonstrates that credit market frictions allow cross-sectional dispersion to drive time-varying macro uncertainty endogenously. In the model, as firm-level productivity becomes more dispersed, more firms are pushed to the left tail of the productivity distribution, resulting in more defaults and a depletion in aggregate net worth. This mechanism generates countercyclical leverage and aggregate volatility. The model implies that the government can inject equity in economic downturns to stabilize aggregate volatility.

This paper was accepted by Lukas Schmid, finance.

Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2022.00166 .
Managerial Overextrapolation: Who and When
Authors: Huang Dayong , Lei Lijun , Wang Mengmeng , Xing Yuhang
Published: September 2024

Corporate managers overextrapolate past earnings in their earnings guidance, and this behavior is robust after including extensive controls, such as expectation management, earnings management, and overconfidence. The degree of overextrapolation is driven by the persistence of the underlying earnings process and other factors that affect representativeness heuristics, including trend, salience, and volatility. Experience and value diversity among corporate managers help mitigate this bias, whereas demographic diversity does not. Using the Tax Cuts and Jobs Act of 2017, we provide causal evidence that managers overextrapolate past earnings.

This paper was accepted by Camelia Kuhnen, finance.

Supplemental Material: The internet appendix and data files are available at https://doi.org/10.1287/mnsc.2023.00901 .
Gender, Race, and Entrepreneurship: A Randomized Field Experiment on Venture Capitalists and Angels
Authors: Gornall Will , Strebulaev Ilya A.
Published: September 2024

We study gender and race in high-impact entrepreneurship using a tightly controlled randomized field experiment. We sent out 80,000 pitch emails introducing promising but fictitious start-ups to 28,000 venture capitalists and angels. Each email was sent by a fictitious entrepreneur with randomly assigned gender and race. Female entrepreneurs received 9% more interested replies than males pitching identical projects and Asians received 6% more than Whites. Our results suggest that investors do not discriminate against female or Asian entrepreneurs when evaluating unsolicited pitch emails and that future research on investor biases should focus on networks and in-person interactions.

This paper was accepted by Tomasz Piskorski, finance.

Funding: The grant is Social Sciences and Humanities Research Council of Canada Insight Development [Grant 430-2019-00306] “Gender and racial discrimination in venture capital” through the University of British Columbia.

Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2024.4990 .
Physico-chemical properties and organoleptic acceptability of star fruit (Averrhoa bilimbi Linn.) jam with variations of natural sweeteners
Authors: Dewi Arda Rospita , Juwitaningtyas Titisari
Published: September 2024

Belimbing wuluh (Averrhoa bilimbi Linn.) is a fruit plant from Indonesia that has a very sour taste because it contains citric acid and oxalic acid. This sour taste is why this fruit has yet to be optimally utilized. This study aimed to determine the effect of natural sweetener variations on wuluh star fruit jam's physico-chemical and organoleptic properties. This study used an experimental method in which the experiment was designed in a completely randomized design (CRD) with 4 treatments and 3 repetitions. The results of this study showed that the addition of natural sweeteners to wuluh star fruit jam had a significant effect (p < 0.05) on viscosity (9143 – 9450 mpa.s), sineresis (1.295 – 4.592 mg), vitamin C test (17.540 – 25.629 mg/100g), moisture content (23.57 – 31.19%), total sugar content (58.01 – 69.41%wb) and which had no significant effect (p>0.05) on pH (3.38 – 3.64%). Meanwhile, organoleptic testing did not significantly affect taste, color, texture, aroma, and spreadability parameters.
 
Keywords: Belimbing wuluh, Cassava sugar, Corn sugar, Honey, Jam
Rejection Sensitivity: A Concept Analysis
Authors: Shin Jihye , Han Kuem Sun , Shin Hyun Jeong
Published: September 2024

Purpose: This study conducted a concept analysis of rejection sensitivity using the Walker and Avant method, to clarify its defining attributes, antecedents, and consequences. So, this contributes to a deeper understanding of its role in interpersonal relationships.Methods: Walker and Avant’s framework, this concept analysis included a thorough literature review across multiple disciplines. The literature was extracted from databases such as PubMed, Web of Science, CINAHL, and RISS.Results: Rejection sensitivity is a psychological construct encompassing several attributes, including rejection expectation, perception of rejection, and reaction to perceived rejection. This trait is influenced by various antecedents, including early life experiences, attachment style, and cultural factors. The consequences or events associated with rejection sensitivity span multiple domains and can significantly affect an individual’s life.Conclusion: According to interpersonal psychology and attachment theory, problem behavior in adolescents is a state of unsatisfied affection for parents and a response to feelings of unacceptance. Rejection sensitivity is particularly important in the Korean culture because of cultural factors.
The Influence of Positive Psychological Capital and Mindset on Grit among Nursing Students: A Cross-sectional Survey
Authors: Chang Jinjoo , Bae Eun Jung , Joung Jaewon
Published: September 2024

Purpose: This study was conducted to identify factors influencing grit among nursing students.Methods: A cross-sectional survey was conducted in September 2023 involving 135 nursing students from a college in J City, South Korea. The survey included measures of positive psychological capital, mindset, and grit. At the same time, stress, as part of the general characteristics, was evaluated through the power values of high beta waves in brain waves. Statistical analyses included t-tests, analysis of variance, Pearson’s correlation coefficient, and multiple regression analysis.Results: Positive correlations were found between positive psychological capital, mindset, and grit in nursing students. Volunteer experience and positive psychological capital were identified as significant factors influencing grit.Conclusion: To enhance grit among nursing students, it is essential to encourage participation in volunteer activities at the societal, educational, and familial levels, in conjunction with interventions to strengthen positive psychological capital.
Assessing the Heavy Metal Contamination Prevailing in Groundwater at Rishipur Village, West Bengal, India
Authors: Sarkar Lovely
Published: September 2024

The recent surge in interest surrounding water contamination has prompted a study to evaluate the water quality of groundwater in Rishipur village, Malda District, West Bengal, India. The area's groundwater is crucial for drinking, residential, and irrigation purposes due to its proximity to agricultural fields, where most local residents live. The intended purpose of the study is to comprehensively appraise the groundwater quality of a dug well, specifically analysing the intensities of different heavy-metals existing in the water, resulting in valuable insights into its quality. The native residents rely on the usage of this groundwater for drinking and domestic purposes without any purification. However, potential contamination may be present due to nearby agricultural activities. Thus, the study will enable us to make recommendations for mitigating any identified contamination. Exemplary samples of water from a well were consistently collected near the agricultural region over the course of a year, from April 2021 to March 2022. The groundwater samples were analysed for the presence of heavy elements: iron; zinc; copper; manganese; nickel; chromium; cobalt and lead to evaluate the water excellence. To ascertain the overall water eminence status, the Heavy-Metal-Pollution-Index; (HPI), was calculated, which is considered an efficient and reliable technique for water eminence assessment. In this study, the value of HPI; 101.66 in January, indicates high heavy-metal pollution, although it remained within the desired range for the rest of the months. In the analysis of the descriptive statistical data, both substantial positive and negative relations were observed, which were illustrated in a correlation coefficient matrix. Furthermore, the interaction of heavy-metal variables was also explored by utilising the R-Square values derived from the multiple linear regression analysis, which allowed to gain insights into how these variables interplayed with one another. The investigation conclusively established that the eminence of water is deemed appropriate for consumption alongside other domiciliary purposes, with the exception of January.
Assessment of Veterinary Antibiotic Use and Occurrence of Veterinary Antibiotics in Livestock Manure from Farms in Rongai Sub-County, Kenya
Authors: Joseph Maira W. , Moturi Wilkister.N. , Ogendi George M
Published: September 2024

Veterinary antibiotics are commonly used in livestock rearing to prevent diseases and stimulate growth. The release of antibiotics into the environment has become a significant environmental and public health concern. This research evaluated antibiotic use, livestock treatment, manure utilization, livestock waste treatment methods and antibiotic residues in livestock manure. Questionnaires were administered to 170 farmers rearing both cattle and poultry. Subsequently, 28 livestock manure samples from 15 cattle and 13 poultry rearing farms were collected from various farms to assess concentrations of tetracyclines (Tetracycline, Oxytetracycline) and sulfonamides (Sulfadiazine, Sulfamethoxazole) residues. Residues analysis was done using High Performance Liquid Chromatography-Diode Array Detector (HPLC-DAD). Veterinarians were the most preferred in treating both cattle and poultry in farms. Tetracyclines and sulfonamides were the most consumed class of antibiotics among both poultry and cattle rearing farmers. Compost manure and Biogas were the most preferred use of animal waste within farms. Antibiotic presence in samples was detected in 80% and 93% of cattle and poultry manure respectively. Maximum antibiotic concentrations of 16.24 and 15.18 (mg/kg) were recorded in poultry and cattle manure, respectively. There was a statistically significant difference in antibiotic concentrations in poultry and cattle manure (P<0.05). The results of this research are important in monitoring rising concerns about veterinary antibiotics on environmental and public health.