bluuebunny/crossref_metadata_2025 huggingface dataset:
Computational structural analysis of 3D printed hip joint implant and comparison of bio-compatible coating materials for design parameters: Coating thickness, hardness, and adhesion requirements
Authors: Uddin Ghulam Moeen , Nasir Muhammad Waqar , Arafat Syed Muhammad , Zubair Syed Wasim Hassan , Rehman Abdul , Younis Muhammad Arslan , Moazam Sara , Khan Muhammad Shazad , Niazi Sajawal Gul , Ashraf Waqar Muhammad , Adil Muhammad Taimoor
Published: November 2019

This research article presents a design parameter assessment technique for three-dimensional printed hip joint implants. A coupled experimental-simulation-based design technique, addressing minimum coating thickness, hardness, and adhesion requirements, is proposed for safe designs of individual three-dimensional printed hip joint implants. The purpose of this study is to analyze the mechanical properties of individual three-dimensional scanned hip joint human bone geometry through numerical simulation and relate these properties to hardness and adhesion values of bio-compatible coatings. The hardness and adhesion experimental results are discussed, which are then related to numerically obtained normal and shear stresses. Finite element analysis on original bone three-dimensional scanned model along with experimental results for investigating the minimum design requirements has not been reported before. Four ceramic coating materials, that is, alumina, CoCrMo, TiN, and zirconia, are discussed for each routine human physical activity. A comprehensive mesh independence study is conducted to ensure that the mesh has no effect on the variation of results. After finite element analysis, it was concluded that the pelvis bone can be taken as a vital bone for recommending design conditions. The finite element results are then coupled with experimental results as the maximum principal stress obtained from the finite element analysis is used to obtain minimum hardness requirements. Similarly, maximum shear stress obtained from the finite element analysis is used to obtain minimum adhesion requirements for three-dimensional printed implants. The coating thickness necessary to obtain minimum hardness and adhesion requirements is then predicted for TiN coating case.
Cupronickel B10 and YG6 interface friction characteristics tested on a friction device for metal cutting
Authors: Liu Chunjian , Xu Daochun , Li Qingqing
Published: November 2019

Friction behavior is an important component of the metal-cutting mechanism. A simple and effective friction device that can yield the desired friction characteristics is required. In this article, a friction device with a solid–liquid–gas vibration reduction was proposed to research the interface friction characteristics. The interface friction characteristics of cupronickel B10 and YG6 were obtained through the new friction device, including the friction force, friction temperatures, and friction coefficient. The results show that an experimental solid–liquid–gas vibration reduction is feasible and effective to obtain the interface friction characteristics. The relationship between the friction-interface temperature T2 and the measured-point temperature T1 that was obtained by a heat-conduction model is linear. For cupronickel B10 and YG6, the friction coefficient gradually decreases with an increase in friction speed, and increases initially and then decreases with an increasing load. Based on the effect of friction temperature, friction speed, and load, a friction model for the interface friction characteristics of cupronickel B10 and YG6 was obtained.
How to Notice Kaleidoscopic Legal Places: Lessons From a Mural, a Street in Redfern, and Walking the City on Aboriginal Country
Authors: Barr Olivia
Published: November 2019

What happens when we walk past a faded mural? What changes when that mural is finally restored? As we place our feet on the ground, and brush past a painted brick wall, is it possible to see, feel, or listen to law and its stories told, retold, heard, or not heard? Perhaps, but this requires some quite challenging conceptual shifts in how we experience and understand the materialization of law, and its locations, especially when multiple laws inhabit the same place. My argument is that different types of law inhabit physical spaces differently, whether state, federal, local, or Aboriginal. Sometimes, in fact often, different laws simultaneously inhabit the same place, as in the case of a mural called “40,000 Years” that runs down a long, low brick wall in inner-city Redfern in Sydney, Australia. In this article, I delve into the paint, bricks, and restoration of this mural to unravel how it shares, hosts, holds, refracts, and aesthetically materializes different types of visible and invisible laws, including a variety of western and Aboriginal laws. When multiple laws cohabit, such as they do with this mural located on a city street that is also Aboriginal Country, fractal patterns of different types of law emerge, criss-crossing the physical landscape, creating what I call a “kaleidoscopic legal place.”
Impact of risk management culture on supply chain resilience: An empirical study from Indian manufacturing industry
Authors: Kumar Siva , Anbanandam Ramesh
Published: November 2019

The frequency of supply chain disruptions is growing. The recent supply chain disruptions and their costs emphasize the need for resilient supply chains. Therefore, the main purpose of this study is to investigate interactions between critical antecedents of supply chain resilience including risk management culture, supply chain connectivity, visibility, collaboration, agility, their impact on supply chain resilience, and finally on firm performance. Using the same antecedents and literature support, an empirical model has been proposed. The proposed model has been tested using rigorous statistical analysis such as reliability, convergent, and discriminant validity tests. Partial least squares-structural equation modelling has been used to validate the proposed model and the interdependencies between the critical antecedents. An important finding of this research is that organizations, using the proposed model, can develop and improve supply chain resilience capability by establishing the risk management culture through improving the risk awareness among employees and conducting periodic risk assessment exercises. In addition, the study suggests that organizations trying to achieve supply chain resilience must develop sufficient supply chain connectivity and visibility through adopting information and communications technologies and visibility tools for quick response and recovery from supply chain disruptions. Data collected from the Indian manufacturing sector are used to validate the model. The holistic view presented by the proposed model describes the inter-relationships between critical antecedents to achieve supply chain resilience. Concluding remarks and future research avenues have been presented.
Second-line treatment of EGFR T790M-negative non-small cell lung cancer patients
Authors: Liao Bin-Chi , Griesing Sebastian , Yang James Chih-Hsin
Published: November 2019

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are the currently recommended treatment for advanced EGFR mutation-positive non-small cell lung cancer (NSCLC). Acquired resistance inevitably develops, with the EGFR T790M mutation comprising approximately 55% of the mechanisms of resistance following first- or second-generation EGFR-TKI therapy (e.g. gefitinib, erlotinib, afatinib, and dacomitinib). Patients without T790M are a heterogeneous group for whom platinum-based chemotherapy is currently recommended as a second-line treatment. In addition to secondary mutations in EGFR (e.g. T790M), the currently known resistance mechanisms can be classified into the following three categories: bypass pathways, downstream signaling pathways, and histologic transformations. Given the evolving knowledge and convenience of diagnosing acquired resistance mechanisms by next-generation sequencing and liquid biopsy, exploratory studies targeting these resistance mechanisms and incorporating immunotherapy into the treatment paradigm have become the mainstream of future development. This review focuses on acquired resistance mechanisms other than T790M that develop after first- or second-generation EGFR-TKI therapy. Exploratory second-line treatments targeting resistance mechanisms as well as combination immunotherapy and chemotherapy in ongoing clinical trials are reviewed here. We also highlight the recent development of next-generation sequencing and liquid biopsy in this field.
“And Today’s Top Donator is”: How Live Streamers on Twitch.tv Monetize and Gamify Their Broadcasts
Authors: Johnson Mark R. , Woodcock Jamie
Published: November 2019

This article examines cultural and economic behavior on live streaming platform Twitch.tv, and the monetization of live streamers’ content production. Twitch is approximately the thirtieth most-viewed website in the world, with over 150 million spectators, and 2 million individuals around the world regularly broadcasting. Although less well-known than Facebook or Twitter, these figures demonstrate that Twitch has become a central part of the platformized Internet. We explore a seven-part typology of monetization extant on Twitch: subscribing, donating and “cheering,” advertising, sponsorships, competitions and targets, unpredictable rewards for viewers, and the implementation of games into streaming channels themselves. We explore each technique in turn, considering how streamers use the affordances of the platform to earn income, and invent their own methods and techniques to further drive monetization. In doing so, we look to consider the particular kinds of governance and infrastructure manifested on Twitch. By governance, we mean how the rules, norms, and regulations of Twitch influence and shape the cultural content both produced and consumed within its virtual borders; and by infrastructure, we mean how the particular technical affordances of the platform, and many other elements besides, structure how content production on Twitch might be made profitable, and therefore decide what content is made, and how, and when. Examining Twitch will thus advance our understanding of the platformization of amateur content production; methodologically, we draw on over 100 interviews with successful live streamers, and extensive ethnographic data from live events and online Twitch broadcasts.
Patient Experience Drivers of Overall Satisfaction With Care in Cancer Patients: Evidence From Responders to the English Cancer Patient Experience Survey
Authors: Gomez-Cano Mayam , Lyratzopoulos Georgios , Abel Gary A
Published: November 2019

Background:

Surveys collecting patient experience data often contain a large number of items covering a wide range of experiences. Knowing which areas to prioritize for improvements efforts can be difficult.

Objective:

To examine which aspects of care experience are the key drivers of overall satisfaction with cancer care.

Methods:

Secondary analysis of the National Cancer Patient Experience Survey. Logistic regression was used to examine the relationship between overall satisfaction and 10 core questions covering aspects of experience applicable to all patients. Supplementary analyses examined a further 16 questions applying only to patients in certain groups or on specific treatment pathways.

Results:

Of 68 340 included patients, 58 697 (86%) rated overall satisfaction highly (8 or more out of 10). The strongest predictors of overall satisfaction across all models were responses to 2 questions on experience of care administration and care coordination (odds ratio [OR] = 2.11, 95% confidence interval [95% CI = 2.05-2.17, P < .0001; OR = 2.03, 95% CI = 1.97-2.09, P < .0001, respectively, per 1 standard deviation change).

Conclusion:

Focusing improvement efforts on care administration and coordination has potential to improve overall satisfaction with oncological care across diverse patient groups/care pathways.
The impact of depressive symptoms on the burden of cluster headache: Results of the EUROLIGHT Cluster Headache Project, an Internet-based, cross-sectional study of people with cluster headache
Authors: Pohl Heiko , Gantenbein Andreas R , Sandor Peter S , Schoenen Jean , Andrée Colette
Published: November 2019

Many patients affected by cluster headache (CH) have a co-morbid depression. The aim of this study is to evaluate how the burden of disease is influenced by depressive symptoms measured by a depression score. The study was cross-sectional and Internet-based. We included individuals with a self-reported diagnosis of CH and asked them to fill out the EUROLIGHT questionnaire, which includes a depression score. The number of headache days was higher among patients with higher depression scores. In these participants, worrying about future attacks, avoiding triggers, believing to have earned less and avoiding to talk about the disease were more common as well. Individuals with higher depression scores reported a significantly higher burden of disease. It is possible that fear of pain, self-concealment and fear of impoverishment are consequences of the depression attributed to the headache disorder.
How I treat acute myeloid leukemia in the era of new drugs
Authors: DiNardo Courtney D. , Wei Andrew H.
Published: November 2019

The acute myeloid leukemia (AML) treatment landscape has changed substantially since 2017. New targeted drugs have emerged, including venetoclax to target B-cell lymphoma 2, midostaurin and gilteritinib to target FLT3, and ivosidenib and enasidenib to target mutant isocitrate dehydrogenase 1 and 2, respectively. Other additions include reapproval of gemtuzumab ozogomycin to target CD33, glasdegib to target the hedgehog pathway, and a liposomal formulation of daunorubicin and cytarabine (CPX-351). Genomically heterogeneous AML has a tendency to evolve, particularly under selective treatment pressure. For decades, treatment decisions have largely centered around chemotherapy drug intensity. Physicians now have access to an increasing number of drugs with novel mechanisms of action and distinctive side-effect profiles. Key issues faced by hematologists in this era of new drugs include (1) the timely identification of actionable mutations at diagnosis and at relapse; (2) deciding which drug to use among several therapeutic options; and (3) increasing awareness of how to anticipate, mitigate, and manage common complications associated with these new agents. This article will use 3 case presentations to discuss some of the new treatment challenges encountered in AML management, with the goal of providing practical guidance to aid the practicing physician.
Using deep reinforcement learning to speed up collective cell migration
Authors: Hou Hanxu , Gan Tian , Yang Yaodong , Zhu Xianglei , Liu Sen , Guo Weiming , Hao Jianye
Published: November 2019

Background

Collective cell migration is a significant and complex phenomenon that affects many basic biological processes. The coordination between leader cell and follower cell affects the rate of collective cell migration. However, there are still very few papers on the impacts of the stimulus signal released by the leader on the follower. Tracking cell movement using 3D time-lapse microscopy images provides an unprecedented opportunity to systematically study and analyze collective cell migration.

Results

Recently, deep reinforcement learning algorithms have become very popular. In our paper, we also use this method to train the number of cells and control signals. By experimenting with single-follower cell and multi-follower cells, it is concluded that the number of stimulation signals is proportional to the rate of collective movement of the cells. Such research provides a more diverse approach and approach to studying biological problems.

Conclusion

Traditional research methods are always based on real-life scenarios, but as the number of cells grows exponentially, the research process is too time consuming. Agent-based modeling is a robust framework that approximates cells to isotropic, elastic, and sticky objects. In this paper, an agent-based modeling framework is used to establish a simulation platform for simulating collective cell migration. The goal of the platform is to build a biomimetic environment to demonstrate the importance of stimuli between the leading and following cells.
Acceptance Prediction for Answers on Online Health-care Community
Authors: Liu Qianlong , Liao Kangenbei , Tsoi Kelvin Kam-fai , Wei Zhongyu
Published: November 2019

Background

With the development of e-Health, it plays a more and more important role in predicting whether a doctor’s answer can be accepted by a patient through online healthcare community. Unlike the previous work which focus mainly on the numerical feature, in our framework, we combine both numerical and textual information to predict the acceptance of answers. The textual information is composed of questions posted by the patients and answers posted by the doctors. To extract the textual features from them, we first trained a sentence encoder to encode a pair of question and answer into a co-dependent representation on a held-out dataset. After that,we can use it to predict the acceptance of answers by doctors.

Results

Our experimental results on the real-world dataset demonstrate that by applying our model additional features from text can be extracted and the prediction can be more accurate. That’s to say, the model which take both textual features and numerical features as input performs significantly better than model which takes numerical features only on all the four metrics (Accuracy, AUC, F1-score and Recall).

Conclusions

This work proposes a generic framework combining numerical features and textual features for acceptance prediction, where textual features are extracted from text based on deep learning methods firstly and can be used to achieve a better prediction results.
Rice defense responses are induced upon leaf rolling by an insect herbivore
Authors: Shi Jin-Hua , Sun Ze , Hu Xin-Jun , Jin Huanan , Foba Caroline Ngichop , Liu Hao , Wang Chao , Liu Le , Li Feng-Feng , Wang Man-Qun
Published: November 2019

Background

Plant defense against herbivores begins with perception. The earlier plant detects the harm, the greater plant will benefit in its arm race with the herbivore. Before feeding, the larvae of the rice pest Cnaphalocrocis medinalis, initially spin silk and fold up a leaf. Rice can detect and protect itself against C. medinalis feeding. However, whether rice could perceive C. medinalis leaf rolling behavior is currently unknown. Here, we evaluated the role of leaf rolling by C. medinalis and artificial leaf rolling in rice plant defense and its indirect effect on two important C. medinalis parasitoids (Itoplectis naranyae and Apanteles sp.) through a combination of volatile profiling, gene-transcriptional and phytohormonal profiling.

Results

Natural leaf rolling by C. medinalis resulted in an increased attraction of I. naranyae when compared to the undamaged plant after 12 h. Volatile analysis revealed that six out of a total 22 components significantly increased in the headspace of C. medinalis rolled plant when compared to undamaged plant. Principal component analysis of these components revealed similarities in the headspace of undamaged plant and artificially rolled plant while the headspace volatiles of C. medinalis rolled plant deferred significantly. Leaf rolling and feeding by C. medinalis up-regulated the plant transcriptome and a series of jasmonic acid (JA) and salicylic acid (SA) related genes. While feeding significantly increased JA level after 12 to 36 h, rolling significantly increased SA level after 2 to 12 h. Compared to artificial rolling, natural rolling significantly increased JA level after 36 h and SA level after 2 and 12 h.

Conclusions

Our findings suggest that natural leaf rolling by C. medinalis can be perceived by rice plant. The detection of this behavior may serve as an early warning signal in favor of the rice plant defenses against C. medinalis.
Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: an electronic health record based cohort study
Authors: Gordon Nancy P. , Lin Teresa Y. , Rau Jyoti , Lo Joan C.
Published: November 2019

Background

Few large cohort studies have examined the prevalence of diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), obesity, and smoking among middle-aged and older adults in the major Asian-American ethnic groups and Native Hawaiian/Pacific Islanders (PIs). The aim of this study was to evaluate how prevalence of these conditions and risk factors differs across Asian-American and PI ethnic groups and compares with an aggregated All Asian-American racial group.

Methods

This study used a cohort of 1.4 million adults aged 45 to 84 who were Kaiser Permanente Northern California health plan members during 2016. The cohort included approximately 274,910 Asian-Americans (Chinese, Filipino, Japanese, Korean, Southeast Asian, South Asian, other), 8450 PIs, 795,080 non-Hispanic whites, 107,200 blacks, and 210,050 Latinos. We used electronic health record data to produce age-standardized prevalence estimates of DM, HTN, CAD, obesity (using standard and Asian thresholds), and smoking for men and women in all racial/ethnic subgroups and compared these subgroups to an aggregated All Asian-American racial group and to whites, blacks, and Latinos.

Results

We found large differences in health burden across Asian-American ethnic subgroups. For both sexes, there were 16 and > 22 percentage point differences between the lowest and highest prevalence of DM and HTN, respectively. Obesity prevalence among Asian subgroups (based on an Asian BMI ≥ 27.5 kg/m2threshold) ranged from 14 to 39% among women and 21 to 45% among men. Prevalence of smoking ranged from 1 to 4% among women and 5 to 14% among men. Across all conditions and risk factors, prevalence estimates for Asian-American and PI ethnic groups significantly differed from those for the All Asian-American group. In general, Filipinos and PIs had greater health burden than All Asians, with prevalence estimates approaching those of blacks.

Conclusions

In a population of middle-aged and older adult Northern California health plan members, we found substantive differences in prevalence of chronic cardiovascular conditions, obesity, and smoking across Asian-American ethnic groups and between Asian-American ethnic groups and an aggregated All Asian racial group. Our study confirms that reporting statistics for an aggregated Asian-American racial group masks meaningful differences in Asian-American ethnic group health.
Interventions to improve discharge from acute adult mental health inpatient care to the community: systematic review and narrative synthesis
Authors: Tyler Natasha , Wright Nicola , Waring Justin
Published: November 2019

Background

The transition from acute mental health inpatient to community care is often a vulnerable period in the pathway, where people can experience additional risks and anxiety. Researchers globally have developed and tested a number of interventions that aim to improve continuity of care and safety in these transitions. However, there has been little attempt to compare and contrast the interventions and specify the variety of safety threats they attempt to resolve.

Methods

The study aimed to identify the evidence base for interventions to support continuity of care and safety in the transition from acute mental health inpatient to community services at the point of discharge. Electronic Databases including PsycINFO, MEDLINE, Embase, HMIC, CINAHL, IBSS, Cochrane Library Trials, ASSIA, Web of Science and Scopus, were searched between 2000 and May 2018. Peer reviewed papers were eligible for inclusion if they addressed adults admitted to an acute inpatient mental health ward and reported on health interventions relating to discharge from the acute ward to the community. The results were analysed using a narrative synthesis technique.

Results

The total number of papers from which data were extracted was 45. The review found various interventions implemented across continents, addressing problems related to different aspects of discharge. Some interventions followed a distinct named approach (i.e. Critical Time Intervention, Transitional Discharge Model), others were grouped based on key components (i.e. peer support, pharmacist involvement). The primary problems interventions looked to address were reducing readmission, improving wellbeing, reducing homelessness, improving treatment adherence, accelerating discharge, reducing suicide. The 69 outcomes reported across studies were heterogeneous, meaning it was difficult to conduct comparative quantitative meta-analysis or synthesis.

Conclusions

The interventions reviewed are spread across a spectrum ranging from addressing a single problem within a single agency with a single solution, to multiple solutions addressing multi-agency problems. We recommend that future research attempts to improve homogeneity in outcome reporting.
Opioid use disorder and treatment: challenges and opportunities
Authors: Hoffman Kim A. , Ponce Terashima Javier , McCarty Dennis
Published: November 2019

Background

Addiction health service researchers have focused efforts on opioid use disorder (OUD) and strategies to address the emerging public health threats associated with the epidemics of opioid use and opioid overdose. The increase in OUD is associated with widespread access to prescription opioid analgesics, enhanced purity of heroin, the introduction of potent illicit fentanyl compounds, and a rising tide of opioid overdose fatalities. These deaths have become the face of the opioid epidemic.

Main Text

OUD is a chronic disorder that usually requires both medications for opioid use disorder (MOUD) and psychosocial treatment and support. Research has found that MOUD with an opioid receptor agonist (methadone), partial agonist (buprenorphine), or opioid antagonist (extended-release naltrexone) can support recovery. Despite compelling evidence that MOUD are effective, they remain underutilized. More research is needed on these therapies to understand the feasibility of implementation in clinic settings.

Conclusion

This special issue focuses on how health services research has emerged as an important contributor to efforts to control the opioid epidemic in North America and Europe.
The effects of androgen deprivation therapy and radiation therapy on cancer-related fatigue.
Authors: Saligan Leorey
Published: November 2019

10

Background: Fatigue is a common symptom characterized by incapacitating tiredness. Androgen deprivation therapy (ADT) in combination with radiotherapy (RT) is one of the standard treatments for prostate cancer. Fatigue often worsens during RT with concomitant ADT and it persists long after treatment completion. The purpose of this study is to examine the effects of combined ADT and RT on fatigue in prostate cancer men and in a fatigue mouse model. Methods: 64 participants were recruited and followed at baseline, midpoint, completion, and 1 year post-RT. Two cohorts of men: +ADT cotinued after RT (n=27), +ADT during RT only (n=20), and -ADT (n=17). Fatigue was measured using FACT-F. Male C57BI/6 mice (n=55) were randomly placed into 2 groups: +ADT and –ADT (control). Mice were further subdivided into +RT and –RT (sham) groups. Voluntary Wheel Running Activity (VWRA) data from all mice were recorded for 6 days post-irradiation and the total average of all 6 days was used for analysis. Results: Fatigue (n=64) worsened during RT ( p=.02 at midpoint, p=.04 at completion). ADT significantly affected fatigue development over time (F3,42 = 3.80, p=.02) with the most significant difference occurring at midpoint ( p<.001) and completion of RT ( p<0.001). VWRA significantly decreased in mice that received the combination of ADT and irradiation, compared to those that received only ADT + sham radiation ( p=.001) and no ADT + sham radiation ( p=.004). Transcription factor A, mitochondrial (TFAM) in brain cortical samples was significantly reduced in irradiated mice compared to control mice ( p=.014). Glucose transported type 4 (GLUT4) in brain cortices was significantly reduced in irradiated mice compared to non-irradiated mice ( p=.0057). GLUT4 was also significantly reduced in irradiated mice receiving ADT compared to control mice receiving sham RT ( p=.043). Conclusions: There is a significant combined effect of ADT and RT on fatigue in both humans and mice. Mitochondrial function/neuronal bioenergetic markers were altered in the cortices of irradiated mice that received concomitant ADT. These findings suggest that fatigue experienced by subjects who receive ADT + RT could be attributable to impaired cortical energy production.
Derivation and implementation of a machine learning approach to prompt serious illness conversations among outpatients with cancer.
Authors: Parikh Ravi Bharat , Manz Chris , Chivers Corey , Regli Susan B , Braun Jennifer , Jones Joshua Adam , Mamtani Ronac , Draugelis Michael , Bekelman Justin E. , Navathe Amol S. , Patel Mitesh S. , Shulman Lawrence N. , Schuchter Lynn Mara , O'Connor Nina
Published: November 2019

131

Background: Machine learning (ML) algorithms can accurately identify patients with cancer at risk of short-term mortality and facilitate timely conversations about treatment and end-of-life preferences. We developed, validated, and implemented a ML algorithm to predict mortality in a general oncology setting, using electronic health record (EHR) data prior to a clinic visit. Methods: Our cohort consisted of patients aged ≥18 years who had an encounter in outpatient oncology practices within a large academic health system between February 1st and July 1st, 2016. We randomly split the sample into training (70%) and validation (30%) cohorts at the patient-encounter level. We trained three ML algorithms to predict 180-day mortality and describe performance in the holdout validation cohort. From October 2018 to February 2019, we used the best-performing algorithm to generate weekly lists of high-risk patients at a single community oncology practice and studied the impact on rates of documented serious illness conversations (SICs). Results: Among 62,377 encounters used to train the algorithms, 7.4% involved a patient who died within 180 days. Gradient boosting and/or random forest outperformed logistic regression in all metrics (Table), and the gradient boosting model had superior discrimination and calibration. In the gradient boosting model, observed 180-day mortality was 45.5% (95% CI 39.0-52.3%) in the high-risk group vs. 3.3% (95% CI 2.9-3.7%) in the low-risk group. In a survey of oncology clinicians, 59% of patients flagged as high-risk were appropriate for a serious illness conversation in the upcoming week (response rate 52%). Five months after implementing the intervention, average monthly documented SICs increased by 23% (31.7 to 39). Conclusions: A ML algorithm based on EHR data accurately identified patients with cancer at risk of short-term mortality, was concordant with oncologists’ assessments, and was associated with more SICs.

[Table: see text]
Results of a pilot randomized controlled trial: A couple-based meditation intervention for patients with metastatic lung cancer and their partners.
Authors: Milbury Kathrin , Li Yisheng , Durrani Sania , Liao Zhongxing X. , Yang Claire Chunyi , Tsao Anne S. , Cohen Lorenzo , Bruera Eduardo
Published: November 2019

135

Background: Although mindfulness-based interventions have been widely examined in patients with early stage cancer, the feasibility and efficacy of these types of programs are largely unknown in the palliative care setting. We developed a couple-based intervention integrating meditation training with emotional disclosure exercises to target psychological distress in patients with metastatic lung cancer and their partners. Methods: Dyads completed baseline self-report measures and were then randomized to a couple-based meditation (CBM), a supportive-expressive (SE), or a waitlist control (WLC) group. Couples in the CBM and ES groups attended 4 weekly, 60 min. therapist-led sessions that were delivered via FaceTime. All groups were reassessed 1 month and 3 months later. Results: Seventy-five patients (51% female; mean age = 64 years) and their partners’ (52% female; mean age = 64 years) were randomized (63% consent rate) of which 79% completed the first and 65% completed the second follow-up assessments. Attrition was mainly due to patients’ death (44%). Although attendance was high in both groups (means: CBM = 3.12; SE = 3.08), dyads in the CBM group indicated greater benefit (P < .003) and usefulness (P < .05) of the sessions compared to those in the SE group. Compared with the WLC group, patients in the CBM group reported significantly lower depressive symptoms (P = .02; d = .49; CES-D means: CBM = 7.87; SE = 11.51; WLC = 12.76) and cancer specific distress (P = .05; d = .44; IES means: CBM = 12.40; SE = 16.34; WLC = 18.22). Similarly, compared with the WLC group, partners in the CBM group reported significantly lower depressive symptoms (P = .02; d = .58; means: CBM = 7.18; AC = 8.91; WLC = 11.62). For both patients and partners, there were no effects between SE and WLC groups. While small effects (d = .22-.42) in favor of the CBM group relative to the SE group were revealed, these differences were not significant. Conclusions: It seems to be feasible, acceptable and possibly efficacious to deliver dyadic interventions via FaceTime to couples coping with metastatic lung cancer. Mindfulness-based interventions may be of value to manage symptom burden in the palliative care setting. Clinical trial information: NCT02596490.
Piloting workshops to enhance hope among patients with advanced breast cancer and oncologists.
Authors: Shah Mirat , Ferguson Anna K. , Gutfeld Orit , Corn Dvora , Varadhan Ravi , Stearns Vered , Smith B. Douglas , Smith Thomas J. , Corn Benjamin W.
Published: November 2019

137

Background: Hope is a modifiable entity that can be separated from cancer outcome. Increasing hopefulness in patients with advanced breast cancer and oncologists may be of intrinsic value. The feasibility and efficacy of a short intervention to increase hopefulness in these groups are unknown. Methods: We enrolled eligible participants at 2 medical centers into 2 cohorts- 1 for patients with advanced breast cancer and 1 for oncologists. The intervention, a half-day hope enhancement workshop (HEW), was conducted in groups of 10-15 participants within each cohort. Participants completed evaluations including the Adult Hope Scale (AHS) and Herth Hope Index (HHI) pre-workshop, post-workshop, and at 3 months. Mean scores were compared across time points within each cohort using paired t-tests. Results: Ten out of 13 consented patients (76.9%) and all 26 consented physicians (100%) participated in the HEW, meeting our feasibility threshold. In patients, the mean AHS score increased significantly from 50.60 (SD 4.88) pre-workshop to 56.50 (SD 4.74) post-workshop (t = 3.99, p = 0.003); the mean HHI score also increased but this trend was not significant. In oncologists, the increases in mean AHS and HHI scores post-workshop were smaller and not significant. A summary is shown in the table. Post-workshop, patients and physicians were inclined to apply what they learned. However, at 3 months, less than half of participants responded to the evaluation. Mean AHS and HHI scores in patients fell back to baseline values. Conclusions: A short intervention to enhance hope was feasible and associated with increased hopefulness in patients, which was not maintained. Next steps for patients include “maintenance hope therapy” with earlier follow-up and more sustained contact post-workshop. Among oncologists, we hypothesize that for those not grappling with poor prognoses, reframing hope may be less effective, and they may feel less urgency to augment their hopefulness. [Table: see text]
Depression and anxiety symptoms in bereaved caregivers of patients with advanced cancer.
Authors: El-Jawahri Areej , Greer Joseph , Jackson Vicki A. , Gallagher Emily R. , Kamdar Mihir , Rinaldi Simone , Temel Jennifer S.
Published: November 2019

17

Background: Caregivers of patients with advanced cancer experience substantial caregiving burden and psychological distress during the illness course. However, data on depression and anxiety symptoms in bereaved caregivers and factors associated with their psychological distress are lacking. Methods: We conducted a secondary analysis of 168 caregivers enrolled in a randomized trial of early palliative care integrated with oncology care versus oncology care alone for patients newly-diagnosed with incurable lung and non-colorectal gastrointestinal cancers and their caregivers who completed bereavement assessments at 3 months after their loved one’s death. We used the Hospital Anxiety and Depression Scale (HADS) to assess patients’ and caregivers’ depression and anxiety symptoms at baseline within 8 weeks of diagnosis, and at 3-4 months after the patient’s death (for caregivers). We asked caregivers to rate patient’s physical and psychological distress in the last week of life on a 10-point scale. We used linear regression adjusting for randomization and cancer type to explore associations between patient and caregiver factors and bereaved caregivers’ depression and anxiety. Results: 30.4% (51/168) and 43.4% (73/168) of bereaved caregivers reported clinically significant depression and anxiety symptoms, respectively. Younger patient age (B = -0.06, P = 0.041), higher patient baseline anxiety (B = 0.28, P = 0.002), and caregiver rating of worse physical (B = 0.28, P = 0.035) and psychological (B = 0.41, P < 0.001) distress experienced by the patient at the end of life (EOL) were associated with worse depression symptoms in bereaved caregivers. Only caregiver factors, including age (B = -0.07, P = 0.004), female sex (B = 1.60, P = 0.024), and rating of worse psychological distress experienced by the patient at the EOL (B = 0.42, P < 0.001) were associated with worse bereaved caregivers’ anxiety symptoms. Conclusions: Bereaved caregivers of patients with advanced cancer experience substantial psychological distress which is associated with their perceptions of their loved one’s distress at the EOL. Interventions to optimize EOL care for patients and reduce bereaved caregivers’ psychological distress are needed.
Accrual and retention trends among diverse patients in a supportive cancer care trial.
Authors: Hanvey Grace A. , Padron Adaixa , Kacel Elizabeth L. , Ulfig Chantel , Pereira Deidre B.
Published: November 2019

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Background: Despite reporting similar levels of willingness to participate in clinical trials, minority cancer patients remain underrepresented in research interventions. The purpose of this analysis was to examine participant age, race, and ethnicity as predictors of study interest, eligibility, enrollment decision, and attrition in an intervention providing supportive care for women with cancer. Methods: Patients from the UF&Shands Gynecologic Oncology Service (N = 568) were approached for recruitment to either a six-week cognitive-behavioral intervention for insomnia and pain or a psychoeducational control condition. These women were queried about their willingness to participate in the study, interest level, and reasons for declining participation if they did not wish to enroll in the trial. Among enrolled patients (N = 64), predictors of attrition were explored. Results: Of approached patients, 57.2% were older than age 60, 14.7% were non-White, and 3.2% were Hispanic. Chi-square analyses indicated that there were no significant differences in interest level by age [χ2(2,441) = 2.732, p = .255], race [χ2(2,439) = 2.019, p = .364], or ethnicity [χ2(2,431) = 3.242, p = .198]. Eligible minority patients were significantly more likely to enroll than were non-Hispanic Whites [χ2(1,364) = 4.125, p = .042], with Hispanic recruitment driving this difference (p = .011). Survival analyses demonstrated no differences in attrition hazard based on age (B = -.088, p = .825), race (B = .583, p = .275), or ethnicity (B = -19.518, p = .999) among enrolled patients. Conclusions: In our supportive cancer clinical trial (CCT), there were no significant differences in trial interest across racial and ethnic minority groups. In fact, Hispanics were more likely to enroll than non-Hispanics. Furthermore, neither race nor ethnicity was a significant predictor of trial attrition. Future investigation is needed to better understand racial and ethnic disparities in cancer research enrollment, motivators and barriers to participation in supportive cancer care trials, potential inconsistencies in accrual patterns among minority cancer patients, and best practices for enrolling and retaining diverse participants for supportive CCTs. Clinical trial information: NCT02609880.
Multiple chronic conditions and intensity of end-of-life care among patients with cancer.
Authors: McDermott Cara L. , Engelberg Ruth , Sorror Mohamed Lotfy , Sibley James , Curtis J. Randall
Published: November 2019

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Background: Multiple chronic conditions (MCCs) are associated with increased intensity of end-of-life (EOL) care in many conditions but their effect has not been well explored in patients with cancer. We examined intensity of EOL care and advance care planning (ACP) by patients with cancer and MCCs versus those without MCCs to better understand how MCCs affect EOL healthcare use in this population. Methods: Our sample included patients with cancer in the UW Medicine system who died between 2010-2017. MCCs were defined using the Dartmouth Atlas of Healthcare for the most common categories of severe illness in the last two years of life. These included chronic pulmonary disease, coronary artery disease (CAD), heart failure, severe chronic liver disease, chronic renal disease, dementia, diabetes with end organ damage, or peripheral vascular disease. Patients were categorized as having none or 1+ MCCs. We used a claims-based indicator for the presence of functional limitation. Outcomes included ACP documentation in the electronic health record, death in hospital, and inpatient or ICU admission in the last month of life. We performed logistic regression for all outcomes controlling for confounders defined a priori (age at death, race, sex, marital status, insurance, education, functional limitation). Results: Of 15,092 patients with cancer, 10,596 (70%) had 1+MCCs (range 1-8 MCCs). Common MCCs were pulmonary (25%), CAD (23%), and renal (18%). Those with MCCs were older (median 66 years (range 18-104) vs 63 years (range 18-102)), with more functional limitations (65% vs 43%). Those with 1+ MCC had more ACP documentation (43% vs. 23%) compared to those with no MCCs. Patients with 1+ MCC were more likely to die in hospital (OR 1.86, 95% CI 1.72-2.02) and to have inpatient (OR 2.45, 95% CI 2.20-2.72) or ICU admissions (OR 2.95, 95% CI 2.55-3.42) in their last 30 days versus patients with cancer and no MCCs. Conclusions: Among patients with cancer in a single healthcare system, patients with cancer and MCCs were more likely to have ACP documentation, die in hospital and experience high-intensity hospital-based care at or near EOL. Further research is needed to explore if such high-intensity care is aligned with patient and family goals for care.
Movement in the wrong direction: Inaccurate change in prognostic understanding and its predictors.
Authors: George Login , Epstein Andrew S. , Prigerson Holly Gwen
Published: November 2019

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Background: Prognostic understanding research has primarily focused on improvements in the accuracy of patient understanding and factors driving such improvements. However, could patients with a terminal prognosis become more inaccurate in their understanding, and what factors predict such change? Methods: In a multi-site prospective study, 184 advanced cancer patients, whom oncologists expected to die within 6 months, were assessed twice (median time 5 weeks apart). Potential predictors were examined at the first assessment: age, gender, education, marital and insurance status, race, ethnicity, geographical region, cancer type, physical and psychological quality of life, and religious beliefs in end-of-life care. The accuracy of prognostic understanding was measured at both assessments using a 4-item index (understanding of terminal illness status, shortened life-expectancy, disease incurability, and advanced stage). Patients with lower prognostic understanding scores at the second assessment compared to the first assessment were categorized as demonstrating more inaccurate understanding. Results: 18.5% ( n = 34) of patients became more inaccurate in their prognostic understanding. Race ( p < .01), geographic region ( p = 0.03), and religious beliefs ( p < .01) emerged as significant correlates. Specifically, being non-white, being from South-Western/Western United States, and holding stronger religious beliefs were associated with higher likelihood of prognostic understanding becoming more inaccurate. Simultaneously examining these three predictors in a logistic regression model showed likely overlap in their predictive ability, with race ( p = 0.45) and geographic region ( p = .32 & .72, dummy coded) becoming non-significant, and religious beliefs retaining marginal significance ( p = .06). Conclusions: Some patients with a terminal prognosis may become more inaccurate in their prognostic understanding, and this may be more likely among those with stronger religious beliefs. The findings additionally raise the potential role of inaccurate prognostic understanding in contributing to the racial, religious, and regional disparities currently found in end-of-life care.