bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of depression and anxiety on cancer patients' perceptions of lifestyle behaviors.
Authors: Corbett Kathryn , Huang Jingyue , Liu Sophia , Smith Elliot Charles , Farzanfar Delaram , Balaratnam Karmugi , Pinto Dixon , McCartney Alexandra , Chen RuiQi , Basgaran Amedra , Alton Devon , Brown M. Catherine , Howell Doris , Li Madeline , Xu Wei , Liu Geoffrey , Eng Lawson
Published: November 2019

141

Background: Health behaviors including tobacco use, alcohol consumption, and physical activity (PA) can impact outcomes in cancer survivors. While the peri-diagnostic period can be a "teachable moment" for behavior change, patients may face barriers including mental health comorbidities. We have previously identified that patient perceptions of behaviors can influence behavior change. Here, we evaluated the impact of anxiety and depression on patient perceptions of these behaviors. Methods: Cancer patients from all disease sites were surveyed (2016-17) on their smoking, alcohol habits, and PA, and perceptions of the impact of these behaviors on fatigue, survival, and quality of life (QofL). Survey data were linked with same day Edmonton Symptom Assessment Symptom (ESAS) anxiety and depression scores. Logistic regression models evaluated the impact of anxiety and depression on patient perceptions. Results: Of 496, 53% were male; median age, 60 years. At diagnosis, 20% were current smokers, 47% were current drinkers, and 67% were not meeting PA guidelines. 30% screened positive for anxiety (ESAS anxiety > 3) and 34% screened positive for depression (ESAS depression > 2); mean [standard deviation] scores were 1.9 [2.3] for anxiety and 1.5 [2.2] for depression. Most current smokers (> 80%) perceived smoking to negatively impact fatigue, survival and QofL. Smokers screening positive for anxiety were more likely to perceive smoking as harmful on survival (OR=9.09, 95% CI (1.15-100), P=0.04); greater ESAS anxiety scores were associated with perceiving smoking to worsen survival (OR=1.51 per point, 95% CI (1.04-2.17), P=0.03). While those less physically active at diagnosis (> 65%) felt that PA improves fatigue, survival and QofL and half of current drinkers (45%-50%) felt that alcohol worsens outcomes, anxiety and depression were not found associated with perceptions (P > 0.10). Conclusions: Among current smokers, greater anxiety scores and those screening positive for anxiety were more likely to perceive continued smoking as harmful to survival. Mental health comorbidities were not found to have an impact on patient perceptions of the effect of alcohol consumption and PA on fatigue, survival, and QofL.
Characteristics of caregiving: A prospective, observational study of lung cancer patients and their informal caregivers.
Authors: Lee Charlotte T. , Gonsalves Clarelle L. , Gao-Kang Jenny , McKay Brittney Jayne , Pickrell Wyatt G. , Sabzvari Tara , Yalda Sandra , Barker Ruth F.
Published: November 2019

18

Background: Cancer self-management involves active partnership between patients and their informal caregivers (ICs). There is a dearth of literature on ICs to lung cancer patients. Multi-modality treatment and profound challenges in symptom management and lifestyle adjustment are hallmarks of this population. This study aimed to describe the characteristics of, and resources utilized by ICs to lung cancer patients and examine the association between symptom severity and a) caregiver burden and b) perceived support. Methods: This study was conducted at a cancer centre north of Toronto, Canada. Dyads of lung cancer patients receiving outpatient treatment and their self-identified ICs (N = 39) were recruited. Upon consent, participants completed a one-time survey which assessed study variables employing previously validated instruments, including: patient’s functional status, caregiver burden, caregiver’s perceived social support and utilization of resources to enhance self-management. Descriptive analysis was used to describe our sample and frequency of resource utilization. Pearson’s correlation was used to examine the association between symptom severity and a) caregiver burden and b) perceived support. Results: The study sample consisted of middle-aged patients and caregivers (median 55-64 years). A majority of caregivers were female (76.2%), received education above college level (56.1%) and were immediate family members (80.9%). The most frequently utilized resources were the lung cancer patient handbook (48.8%), followed by personal support worker (29.3%). Caregiver support group was the least utilized (10%) resource. Patient’s symptom severity was negatively correlated with one aspect of caregiver burden, caregiver’s self-esteem (r = -0.36, p < 0.05). Conclusions: Findings indicated similarities in caregiver demographics to carers of other patient populations. Informational support and material aid appeared to be the most important resources. Patients’ well-being had the greatest impact on caregivers’ self-esteem, indicating implications on person-centred care and collaborative patient-provider relationships to support patient self-management.
A prototype mobile application to improve communication about symptom management.
Authors: LeBlanc Matthew Roger , LeBlanc Thomas William , Smith Sophia Kustas
Published: November 2019

27

Background: Cancer patients report many physical and emotional symptoms which can go unreported and underestimated resulting in unmet needs. Research suggests systematic collection of symptom data is associated with decreased emergency department use, increased quality of life, treatment toleration and overall survival. The multiple myeloma (MM) patient population is noted to have high symptom burden and represent an important target for intervention. This project aimed to develop a prototype app to facilitate MM patient/clinician communication about symptom management. Methods: 15 MM patients and 11 MM clinicians were interviewed to better understand patients’ symptom experience and management practices and preferences. Insights gained guided development of a prototype MM Coach mobile app. The think aloud protocol and cognitive interviewing were used to test usability and the prototype was iteratively refined. Results: Subjects highlighted a need for better symptom tracking over time, medication adherence tools, and real-time feedback to help patients self-manage symptoms. Our prototype app contains several modules designed to facilitate MM patient symptom management. 1) Track Symptoms; Using the Edmonton Symptom Assessment Scale patients track bothersome symptoms whenever they occur. 2) Track Medications; Patients can set up medication alerts and log medication use. 3) Track Mood; Patients record and track their distress level using the Distress Thermometer. 4) Relaxation Tools; This module contains a number of useful mind body activities such as guided imagery. 5) Get Support; Links to MM and non-MM related sources of support. 6) Prepare for Appointments; This module facilitates patients’ prioritizing issues to facilitate productive clinical encounters. 7) Insights; Patients and clinicians can review trends in symptom burden and medication adherence. 8) Learn; Educational content on topics relevant to MM symptoms such as pain, fatigue, depression. Conclusions: Our team is currently working with mobile app developers to build a version for the iOS AppStore and Android GooglePlay store. A pilot will be conducted to evaluate acceptability and feasibility in preparation for a clinical trial.
Factors associated with time to palliative radiotherapy in an academic radiation oncology clinic.
Authors: Hughes Ryan T. , Nagatsuka Moeko , Glenn Chase , Johnson Adam G. , Brown Doris R.
Published: November 2019

56

Background: Palliative radiotherapy (PRT) is a common and effective modality for the relief of symptoms due to malignancy. Members of the supportive care team may be hesitant to refer for PRT due to concerns regarding timeliness of treatment and patient/caregiver time burden. The current structure of most radiation oncology clinics is not conducive to the delivery of timely PRT and few metrics aimed at quality improvement have been reported. Methods: We reviewed all courses of PRT delivered at our institution between January 2017 and December 2018. Hematologic/myeloma primary and postoperative cases were excluded. The dates of referral, consultation, PRT planning simulation, PRT start and end were recorded. An inherent delay was noted if PRT was purposefully delayed (workup, imaging). Time to PRT (TTPRT) was defined as the number of days between referral and start of PRT. A remaining life ratio (RLR) representing TTPRT as a proportion of survival from the time of referral, was developed as a practical metric to represent timeliness of PRT with respect to prognosis. Results: 338 courses of PRT were included from 67% outpatient and 33% inpatient referrals. Indications included pain (55%), neurologic deficits/brain metastases (23%), respiratory symptoms (10%), bleeding (6%) and other (7%). Median TTPRT was 13 d (IQR 4-19), comprised of: referral to consult (3 d), consult to simulation (4 d), and simulation to PRT (6 d). Factors associated with TTPRT included ECOG, PRT indication, site (non-spine bone, chest, or brain), outpatient referral and delay. TTPRT was not associated with age, gender, rural residence, distance to hospital, race, median household income, insurance or marital status. Of 229 patients who died, factors associated with increased RLR were outpatient referral (13% v. 5%), abdomen/pelvis treatment site (16% v. 9%) and delay (17% v. 8%). Conclusions: TTPRT is associated with patient, treatment, and systematic factors, some of which are associated with increased RLR, elucidating several opportunities for improvement. Based on these results, our group has established a dedicated Palliative Radiation Oncology Clinic focused on timely, quality PRT, the outcomes of which will be assessed prospectively.
Comparative analysis of internal medicine physicians’ perspectives and attitudes when addressing palliative care needs in heart failure and cancer patients.
Authors: Katiyar Vatsala , Araujo Tiago , Vohra Ishaan , Pichardo Rayli , Mukthinuthalapati Vijaya Venkatasubbaraya Pavan Kedar Vijaya Venkatasubbar , Yadav Neha
Published: November 2019

7

Background: Palliative care (PC) is heavily centered on patients with advanced and often incurable malignancies. Despite having a comparable symptomatic burden and worse mortality rates than some types of cancer, heart failure (HF) patients have decreased rate of palliative service referral of approximately 7%, as opposed to 48% in those with malignancies. We aim to understand the differences in the attitudes of physicians when addressing the PC needs for patients with advanced HF and malignancies. Methods: All the internal medicine residents at our institute were asked to fill out a structured paper-based questionnaire. The survey tool consisted of both Likert-type scales and open-ended questions focused on their attitude and perceptions while managing patients with advanced HF and Stage IV malignancy. Descriptive statistics and intergroup comparisons were then made for all quantifiable variables (Table). Results: Of the 137 medicine residents, 120 (87.6%) completed the survey. 70% were males and 96.6% residents were in the age group of 25-34 years. 62.5% residents had done a PC rotation prior to answering the survey and they were more comfortable in initiating goals of care (GOC) discussion for these patients. More residents were comfortable communicating the prognosis of patients with HF as compared to cancer patients irrespective of the level of training. Of the 26 residents interested in pursuing cardiology as a subspecialty, only 5 (19.2%) thought that the 5-year mortality of advanced HF ≥50%. Conclusions: Physicians often underestimate the symptom burden and mortality of HF patients and are less likely to consult PC for them. Early integration of PC in the management of HF patients is recommended and physicians need to be educated on these guidelines. [Table: see text]
Feasibility of a collaborative palliative and oncology care intervention to improve symptoms and coping during head and neck chemoradiation.
Authors: Bauman Jessica Ruth , Panick Jessie , Galloway Thomas James , Ridge John A. , McShane Melissa , Chwistek Marcin , Collins Molly , Kinczewski Leigh , Murphy Kathleen , Welsh Marie , Farren Matthew , Clark Mollie , Kelly Jacqueline , Schuster Katherine , Stokes Lauren , Amrhein Sheila , Bender Florence , Egleston Brian L. , El-Jawahri Areej , Fang Carolyn Y
Published: November 2019

73

Background: Patients receiving curative chemoradiation treatment (CRT) for head and neck cancer (HNC) undergo one of the most intensive treatments in oncology, resulting in immense physical and psychological symptoms. Integrated palliative care can improve symptoms and coping in patients with advanced cancer, but has not been evaluated in patients with curable solid tumors. Thus, we are conducting the first pilot study of a collaborative palliative and oncology care intervention among patients receiving CRT to assess feasibility and acceptability. Methods: Eligible participants include newly diagnosed HNC patients starting curative-intent CRT. The intervention entails weekly in-person palliative care (PC) visits integrated with standard oncology care during CRT, followed by 4 weekly phone calls after CRT ends. The PC visits are conducted primarily by a PC RN, with a supervising MD or NP available. Visits focus on coping and managing prominent symptoms during CRT. PC clinicians also receive a weekly patient-reported symptom assessment. Acceptability of the intervention is assessed at 1 month post CRT. The primary outcome is feasibility, defined as a >50% enrollment rate with >70% of participants attending at least half of the PC visits. Planned accrual is 20 patients. Results: We have enrolled 88% (14/16) of eligible patients to date. 11/14 (79%) have p16+ disease. All 14 have completed CRT and are evaluable for feasibility. Participants attended 98% (94/96) of all possible PC visits and completed 99% (95/96) of weekly symptom assessments. PC clinicians spent an average of 35.5 minutes (SD 15.1) per visit with participants. Among the 10 participants who completed the intervention and are evaluable for acceptability, 100% found the intervention “very helpful” and would “definitely recommend” it to others undergoing CRT. Conclusions: An integrated PC intervention to improve symptoms and coping during CRT for HNC is both feasible and acceptable with a high enrollment rate, excellent intervention compliance, and high patient satisfaction. Future studies will evaluate the effects of the integrated intervention on patient-reported outcomes and health care utilization. Clinical trial information: NCT03760471.
Frequency of burn-out among palliative care physicians participating in continuing medical education.
Authors: Reddy Suresh , Yennu Sriram , Tanco Kimberson Cochien , Anderson Aimee Elizabeth , Guzman Diana , Williams Janet L. , Liu Diane D. , Bruera Eduardo
Published: November 2019

77

Background: There is a growing concern about high frequency of burn out (BO) among physicians, and higher among palliative care providers, reported to be in the range of 62%. There are very limited studies done among Palliative Care (PC) physicians. Objective: The main objective of our study was to determine the frequency of burnout among PC physicians participating in PC Continuing Medical Education (CME). Secondary objectives included determining characteristics of physicians who expressed higher BO and also to determine overall attitudes towards PC practice. Methods: During 2018 Annual Hospice & Palliative Medicine Board Review Course, we conducted a survey of 41 questions to determine the frequency of BO among physicians. This included Maslach Burn Inventory ( MBI )–General. The survey was given to both the in house and webinar participants. Results: Of 110 physicians who were given the surveys, 91/110 (83%) completed surveys. The median age was 48 years with 59 (65%) being females, 74 (81%) married. Majority, 41 (46%) were in community practice. 24 (38%) were in practice for more than 6 years, and 52 (57%) were board certified. 56 (62%) practiced PC for more than 50 % of time. Majority, 69 (76%) were doing clinical work. The median number of physician in the group practice was 3. 35 (38 %) of participants reported at least one symptom burnout based on MBI criteria. Only being single/separated correlated significantly with burn-out (p = 0.056). PC work is appreciated at their place of work by 73 (80%), 58 (64%) reported insurance was a burden, electronic medical record as a burden by 58 (64%), and 82 (90%) of physicians felt optimistic about continuing PC in future. Conclusions: BO among palliative care physicians who attended a board review course tends to be high, but lower than previously reported. Physicians who choose to attend CME may have unique motivating characteristics to cope better with stress and BO. More research is needed to better characterize BO among PC physicians.
Factors associated with improvement in uncontrolled cancer pain without increasing opioid daily dose among patients seen by an inpatient palliative care team.
Authors: Haider Ali , Qian Yu , Lu Zhanni , Naqvi Syed M. , Zhuang Amy , Nguyen Kristy , Reddy Akhila Sunkepally , Arthur Joseph Anthony , Tanco Kimberson Cochien , Williams Janet L. , Wu Jimin , Liu Diane D. , Bruera Eduardo
Published: November 2019

9

Background: Increasing total opioid dose is the standard approach for managing uncontrolled cancer pain. Other than simply increasing the opioid dose, palliative care interventions are multidimensional and may improve pain control in the absence of opioid dose increase. The purpose of this study was to determine the proportion of patients referred to our inpatient palliative care (IPC) team who achieved clinically improved pain (CIP) without opioid dose increase. Methods: We reviewed consecutive patients referred to our IPC team. Eligibility criteria included: 1) taking opioid medication; 2) having ≥ 2 consecutive visits with the IPC team; 3) Edmonton Symptom Assessment Scale (ESAS) pain score ≥ 4 at consultation. We assessed patient demographics and clinical variables, including cancer type, opioid prescription data (type, route, oral morphine equivalent daily dose [MEDD]), presence of opioid rotation, psychological consultation, changes in adjuvant medications (e.g., corticosteroids, benzodiazepines, and neuroleptics), and achievement of CIP. Results: Of the 300 patients enrolled, CIP was achieved in 196 (65%) patients. Of CIP patients, 85 (43%) achieved CIP without an increase in MEDD. CIP without MEDD increase was associated with more adjuvant medication changes (P = 0.003), less opioid rotation (P = 0.005), and lower symptom distress scale of ESAS (P = 0.04). Conclusions: Nearly half of patients achieved CIP without MEDD increase, suggesting that multidimensional palliative care intervention is effective in improving pain control in many opioid-tolerant patients without the need to increase the opioid dose.
Routine Edmonton Symptom Assessment System (ESAS) scores in epithelioid malignant pleural mesothelioma (eMPM) patients undergoing palliative systemic therapy.
Authors: Dietrich Kristen , Zhan Luna Jia , Herman Michael , Nagaratnam Subiksha , Corbett Kathryn , Patel Devalben , Hueniken Katrina , Xu Wei , Brown M. Catherine , de Perrot Marc , Cho John , Leighl Natasha B. , Bradbury Penelope Ann , Liu Geoffrey
Published: November 2019

96

Background: Palliative chemotherapy, the mainstay for incurable eMPM, is offered to patients with good standing performance status (ECOG 0-1). We determined the proportion of eMPM patients experiencing moderate (Mod) to severe (Sev) symptoms while on palliative chemotherapy using ESAS symptom scores at diagnosis and during first and subsequent lines of systemic therapy. Methods: ESAS scores (0=no symptom; 10=worst symptom) were routinely captured in eMPM patients at Princess Margaret (Toronto, Canada). Retrospective chart review collected ESAS, clinical, treatment and outcome data. ESAS scores and proportions were summarized within baseline, firstline, and subsequent lines of therapy. Mod symptom was defined as ESAS scores of 4-6, and Sev as 7-10. ESAS scores between treatment lines were analyzed by Mann-Whitney U tests. Locally weighted smoothing (LOESS) plots assessed ESAS scores over treatment duration. Results: Of 37 palliative eMPM patients, the most frequent baseline symptoms were fatigue (33% Mod, 25% Sev), dyspnea (27% Mod; 17% Sev), anxiety (21% Mod; 21% Sev) and depression (34% Mod; 4% Sev). Overall well-being was poor in 45% of patients (31% Mod; 14% Sev). Compared to baseline, patients on firstline therapy reported increased pain ( p = 0.002), poor appetite ( p = 0.005) and nausea ( p = 0.02); decreased depression ( p = 0.03) and anxiety ( p = 0.006); and stable well-being ( p = 0.27). In patients well enough for subsequent therapy, patients reported reduced drowsiness ( p = 0.01) and improved overall well-being ( p = 0.04) compared to firstline therapy. LOESS plot patterns were similar between firstline and subsequent lines of treatment. Conclusions: eMPM patients had high symptom scores at the time of diagnosis. However, patients’ depression and anxiety decreased when starting initial treatment, and general well-being was stable. Of patients fit enough for subsequent lines of therapy, there were improvements in drowsiness and overall well-being. When selectively used, palliative systemic therapy of all lines are associated with some improved symptoms, but pain, poor appetite, and nausea need to be monitored and managed more effectively.
Time-Driven, Activity-Based Cost Analysis of Radiation Treatment Options for Spinal Metastases
Authors: Boyce-Fappiano David , Ning Matthew S. , Thaker Nikhil G. , Pezzi Todd A. , Gjyshi Olsi , Mesko Shane , Anakwenze Chidinma , Olivieri Nicholas D. , Guzman Alexis B. , Incalcaterra James R. , Tang Chad , McAleer Mary F. , Herman Joseph , Ghia Amol J.
Published: November 2019

PURPOSE:

Several treatment options for spinal metastases exist, including multiple radiation therapy (RT) techniques: three-dimensional (3D) conventional RT (3D-RT), intensity-modulated RT (IMRT), and spine stereotactic radiosurgery (SSRS). Although data exist regarding reimbursement differences across regimens, differences in provider care delivery costs have yet to be evaluated. We quantified institutional costs associated with RT for spinal metastases, using a time-driven activity-based costing model.

METHODS:

Comparisons were made between (1) 10-fraction 3D-RT to 30 Gy, (2) 10-fraction IMRT to 30 Gy, (3) 3-fraction SSRS (SSRS-3) to 27 Gy, and (4) single-fraction SSRS (SSRS-1) to 18 Gy. Process maps were developed from consultation through follow-up 30 days post-treatment. Process times were determined through panel interviews, and personnel costs were extracted from institutional salary data. The capacity cost rate was determined for each resource, then multiplied by activity time to calculate costs, which were summed to determine total cost.

RESULTS:

Full-cycle costs of SSRS-1 were 17% lower and 17% higher compared with IMRT and 3D-RT, respectively. Full-cycle costs for SSRS-3 were only 1% greater than 10-fraction IMRT. Technical costs for IMRT were 50% and 77% more than SSRS-3 and SSRS-1. In contrast, personnel costs were 3% and 28% higher for SSRS-1 than IMRT and 3D-RT, respectively ( P < .001).

CONCLUSIONS:

Resource utilization varies significantly among treatment options. By quantifying provider care delivery costs, this analysis supports the institutional resource efficiency of SSRS-1. Incorporating clinical outcomes with such resource and cost data will provide additional insight into the highest value modalities and may inform alternative payment models, operational workflows, and institutional resource allocation.
American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on the Role of Neuromonitoring in Perioperative Outcomes: Electroencephalography
Authors: Chan Matthew T. V. , Hedrick Traci L. , Egan Talmage D. , García Paul S. , Koch Susanne , Purdon Patrick L. , Ramsay Michael A. , Miller Timothy E. , McEvoy Matthew D. , Gan Tong J. ,   on behalf of the Perioperative Quality Initiative (POQI) 6 Workgroup
Published: November 2019

Electroencephalographic (EEG) monitoring to indicate brain state during anesthesia has become widely available. It remains unclear whether EEG-guided anesthesia influences perioperative outcomes. The sixth Perioperative Quality Initiative (POQI-6) brought together an international team of multidisciplinary experts from anesthesiology, biomedical engineering, neurology, and surgery to review the current literature and to develop consensus recommendations on the utility of EEG monitoring during anesthesia. We retrieved a total of 1023 articles addressing the use of EEG monitoring during anesthesia and conducted meta-analyses from 15 trials to determine the effect of EEG-guided anesthesia on the rate of unintentional awareness, postoperative delirium, neurocognitive disorder, and long-term mortality after surgery. After considering current evidence, the working group recommends that EEG monitoring should be considered as part of the vital organ monitors to guide anesthetic management. In addition, we encourage anesthesiologists to be knowledgeable in basic EEG interpretation, such as raw waveform, spectrogram, and processed indices, when using these devices. Current evidence suggests that EEG-guided anesthesia reduces the rate of awareness during total intravenous anesthesia and has similar efficacy in preventing awareness as compared with end-tidal anesthetic gas monitoring. There is, however, insufficient evidence to recommend the use of EEG monitoring for preventing postoperative delirium, neurocognitive disorder, or postoperative mortality.
Comparison of Hemoglobin Measurements by 3 Point-of-Care Devices With Standard Laboratory Values and Reliability Regarding Decisions for Blood Transfusion
Authors: Johnson Marianne , Marwick Peter C. , Coetzee Johan F.
Published: November 2019

BACKGROUND:

We compared the accuracy of 3 point-of-care testing (POCT) devices with central laboratory measurements and the extent to which between-method disagreements could influence decisions to transfuse blood.

METHODS:

Hemoglobin concentrations [Hb] were measured in 58 adult patients undergoing cardiothoracic surgery using 2 Ilex GEM Premier 3500 blood gas analyzers (BG_A and BG_B) and a HemoCue Hb-201+device (HemoCue). Measurements were compared with our central laboratory’s Siemens Advia 2120 flow cytometry system (laboratory [Hb] [Lab[Hb]]), regarded as the gold standard. We considered that between-method [Hb] differences exceeding 10% in the [Hb] range 6–10 g/dL would likely erroneously influence erythrocyte transfusion decisions.

RESULTS:

The 70 Lab[Hb] measurements ranged from 5.8 to 16.7 g/dL, of which 25 (36%) were <10.0 g/dL. Measurements by all 4 devices numbered 57. Mean POCT measurements did not differ significantly (P> .99). Results of the Bland–Altman analyses revealed statistically significant bias, with predominant underestimations by all 3 POCTs predominating. HemoCue upper and lower limits of agreement (LOA) were narrower, and the 95% confidence intervals (95% CIs) of the LOAs did not overlap with those of BG_A and BG_B. Similarly, a narrow mountain plot demonstrated greater precision for the HemoCue. Comparing BG_A with BG_B revealed no bias and narrow LOA. Error grid analysis within the [Hb] range 6–10 g/dL revealed that 5.3% of HemoCue measurements were beyond the permissible 10.0% error zone in contrast to 19.0% and 16.0% of the blood gas measurements. Possible inappropriate transfusion decisions based on POCT values generally erred toward unnecessary transfusions. Calculations of Cohen κ statistic indicated better chance-corrected agreement between HemoCue and Lab[Hb] regarding erythrocyte transfusions than the blood gas analyzers.

CONCLUSIONS:

All 3 POCT devices underestimated the Lab[Hb] and cannot be used interchangeably with standard laboratory measurements. BG_A and BG_B can be considered to be acceptably interchangeable with each other. Whereas the HemoCue had little bias and good precision, the blood gas analyzers revealed large bias and poor precision. We conclude that the tested HemoCue provides more reliable measurements, especially within the critical 6–10 g/dL range, with reduced potential for transfusion errors. Decisions regarding erythrocyte transfusions should also be considered in the light of clinical findings.
Synthesis of a Novel Re(I)-Ru(II)-Re(I) Trinuclear Complex as an Effective Photocatalyst for CO2 Reduction
Authors: Umemoto Akinari , Yamazaki Yasuomi , Saito Daiki , Tamaki Yusuke , Ishitani Osamu
Published: November 2019

Supramolecular photocatalysts, which consist of redox photosensitizer and catalyst units, have recently attracted attention in the field of artificial photosynthesis. Aiming to construct a durable supramolecular photocatalyst for CO2 reduction, a new Re–Ru–Re trinuclear complex was successfully developed, where one Ru unit, acting as photosensitizer, was linked to two Re units, acting as catalysts, through ethylene chains. The novel complex was synthesized by creating two chelate moieties on the ligand of a Ru complex using the Negishi-coupling reaction, which were then coordinated to Re complexes. This trinuclear complex selectively photocatalyzed the reduction of CO2 to CO under visible light irradiation, with high durability compared with the corresponding Ru–Re binuclear complex and a mixed system of model mononuclear complexes. Absorption spectra and mass spectroscopic data of the reaction solutions revealed a rapid consumption of the electrons on the one-electron reduced species of the Ru unit, which led to suppression of the Ru unit decomposition, thereby maintaining its photosensitizing ability and product selectivity.
Robust Service Network Design Under Demand Uncertainty
Authors: Wang Zujian , Qi Mingyao
Published: November 2019

Freight forwarding companies commonly encounter difficulties in handling uncertainties, especially demand uncertainty under the circumstances of no sufficient historical data or accurate forecasting approach. A two-stage robust optimization method is proposed for service network design under demand uncertainty. We employ probability-free uncertainty sets to illuminate the potential scenarios and develop a column-and-constraint generation approach as the solution method to solve the introduced robust models exactly. As indicated by the numerical results, the algorithm we proposed herein performs better than the Benders decomposition approach in terms of computing speed and quality of the solution. Comparative results demonstrate the robustness of the proposed models. We also analyze the structural properties of robust solutions, which provide operational flexibility against uncertainty.
Menakar Mahar: Studi tentang Masyarakat Santri di Desa Karangbesuki Sukun, Kota Malang
Authors: Izzuddin Ahmad
Published: November 2019

Islamic marriage rules in practice form values that are lived out and practiced in the context of cultural society so that they emerge as symbols as a form of the dialectical process between religious values and cultural values. As an example of the concept of dowry in Islam which has two dimensions, the universality of the values adhered to by all its adherents and also the value locality that is formed from the dialectical process that occurs between religious teachings and the local culture of the adherents. This was seen in the santri community in Karangbesuki Village, Malang City in determining the dowry in their marriage by identifying aspects of the normative dowry in the fiqh that they embraced into their marital culture.
Evoked Frontal and Parietal Field Potential Signatures of Target Detection and Response Inhibition in Rats Performing an Equiprobable Auditory Go/No-Go Task
Authors: Nanda Payal , Morris Allyn , Kelemen Jessica , Yang Jane , Wiest Michael C.
Published: November 2019

To characterize the rat as a potential model of frontal-parietal auditory processing during sustained attention, target detection, and response inhibition, we recorded field potentials (FPs) at multiple sites in medial-dorsal frontal and posterior parietal cortex simultaneously while rats performed an equiprobable auditory go/no-go discrimination task. Event-related potentials (ERPs) were calculated by averaging tone-triggered FPs across hit, miss, false alarm (FA), and correct rejection (CR) trials separately for each recording session, and five peak amplitudes (termed N1, P2, N2, P3E, and P3L) were extracted from the individual-session ERPs. Comparing peak amplitudes across different trials types indicated a statistically significant amplification of the P2 peak on hit trials that accompanies detection of the target tone prior to the behavioral go response. This result appears analogous to human ERP phenomena during auditory target discrimination. Conversely, the rat P3 responses were not associated with target detection as in the human ERP literature. Likewise, we did not observe the “no-go N2” or “no-go P3” responses reported in the human literature in association with response inhibition, which might reflect differences in task context or a difference in auditory processing between rats and humans. We also present analyses of stimulus-induced spectral power and interarea coherence to characterize oscillatory synchronization which may contribute to ERPs, and discuss possible error-related processing at the N2, P3E, and P3L peaks.
Gli3 Regulates Vomeronasal Neurogenesis, Olfactory Ensheathing Cell Formation, and GnRH-1 Neuronal Migration
Authors: Taroc Ed Zandro M. , Naik Ankana S. , Lin Jennifer M. , Peterson Nicolas B. , Keefe David L. , Genis Elizabet , Fuchs Gabriele , Balasubramanian Ravikumar , Forni Paolo E.
Published: November 2019

During mammalian development, gonadotropin-releasing-hormone-1 neurons (GnRH-1ns) migrate from the developing vomeronasal organ (VNO) into the brain asserting control of pubertal onset and fertility. Recent data suggest that correct development of the olfactory ensheathing cells (OEC) is imperative for normal GnRH-1 neuronal migration. However, the full ensemble of molecular pathways that regulate OEC development remains to be fully deciphered. Loss-of-function of the transcription factor Gli3 is known to disrupt olfactory development, however, if Gli3 plays a role in GnRH-1 neuronal development is unclear. By analyzing Gli3 extra-toe mutants (Gli3Xt/Xt), we found that Gli3 loss-of-function compromises the onset of achaete-scute family bHLH transcription factor 1 (Ascl-1)+vomeronasal progenitors and the formation of OEC in the nasal mucosa. Surprisingly, GnRH-1 neurogenesis was intact in Gli3Xt/Xtmice but they displayed significant defects in GnRH-1 neuronal migration. In contrast, Ascl-1nullmutants showed reduced neurogenesis for both vomeronasal and GnRH-1ns but less severe defects in OEC development. These observations suggest that Gli3 is critical for OEC development in the nasal mucosa and subsequent GnRH-1 neuronal migration. However, the nonoverlapping phenotypes between Ascl-1 and Gli3 mutants indicate that Ascl-1, while crucial for GnRH-1 neurogenesis, is not required for normal OEC development. Because Kallmann syndrome (KS) is characterized by abnormal GnRH-1ns migration, we examined whole-exome sequencing data from KS subjects. We identified and validated aGLI3loss-of-function variant in a KS individual. These findings provide new insights into GnRH-1 and OECs development and demonstrate that humanGLI3mutations contribute to KS etiology.

SIGNIFICANCE STATEMENTThe transcription factor Gli3 is necessary for correct development of the olfactory system. However, if Gli3 plays a role in controlling GnRH-1 neuronal development has not been addressed. We found that Gli3 loss-of-function compromises the onset of Ascl-1+vomeronasal progenitors, formation of olfactory ensheathing cells in the nasal mucosa, and impairs GnRH-1 neuronal migration to the brain. By analyzing Ascl-1nullmutants we dissociated the neurogenic defects observed in Gli3 mutants from lack of olfactory ensheathing cells in the nasal mucosa, moreover, we discovered that Ascl-1 is necessary for GnRH-1 ontogeny. Analyzing human whole-exome sequencing data, we identified aGLI3loss-of-function variant in a KS individual. Our data suggest thatGLI3is a candidate gene contributing to KS etiology.
An eigenvalue problem for the differential operator with an integral condition
Authors: Jakubėlienė Kristina
Published: November 2019

We analyze solution of a two-dimensional parabolic equation with a nonlocal integral condition by a locally one-dimensional method. The main aim of the paper is to deduce stability conditions of a system of one-dimensional equations with one integral condition. To this end, we analyze the structure of the spectrum of the differential operator with an integral condition.
A weighted limit theorem for periodic Hurwitz zeta-function
Authors: Lukašonok Oleg
Published: November 2019

In the paper, a weighted limit theorem for weakly convergent probability measures on the complex plane for the periodic Hurwitz zeta function is obtained.
A transformation formula with primitive character
Authors: Balčiūnas Aidas
Published: November 2019

We prove a transformation formula for the exponential sum involving the divisor function, and primitive character modulo q. This formula can be applied to obtain meromorphic continuation for the Mellin transform of the square of Dirichlet L-function with primitive character.
The homogeneous structure in a Cartan space
Authors: Mazėtis Edmundas
Published: November 2019

The homogeneus almost product structure on the Finsler space have Lieviu Popescu studied. In this paper we study the integrability conditions for the homogeneus product structure in Cartan space with Miron connection.
On the asymptotic topology of groups and spaces. Part I
Authors: Otera Daniele Ettore
Published: November 2019

This note presents a few basic notions of the topology at infinity of groups and manifolds, from a low-dimensional topological viewpoint. In particular, we will talk about some topological conditions ensuring the tameness of ends of spaces.
Numerical study of monomer-monomer reactions on composite catalysts: well-mixed species model
Authors: Katauskis Pranas , Sakalauskas Justas
Published: November 2019

A nonlinear mathematical model describing the kinetics of a bimolecular heterogeneous catalytic reaction proceeding on a supported catalyst is studied. The model is based on the Langmuir–Hinshelwood surface reaction mechanism assuming that all species are well-mixed. The catalytic surface size influence on the catalytic reactivity and product concentration is investigated numerically for different arrangements of the adsorption sites.
PERFORMANSI PERTUMBUHAN RUMPUT LAUT (Kappaphycus alvarezii) DENGAN MENGGUNAKAN BIBIT HASIL KULTUR DAN NON KULTUR JARINGAN DI BBPBL LAMPUNG
Authors: Harapan Sri Budiani Samsu , Mawarti Retno Ayu , Mulyono Mugi
Published: November 2019

Rumput laut merupakan salah satu komoditas perikanan penting di Indonesia. Salah satu jenis rumput laut yang dibudidayakan oleh masyarakat adalah Eucheuma cottonii atau yang biasa disebut Kappaphycus alvarezii. Permasalahan yang dihadapi pembudidaya adalah pemilihan bibit rumput laut yang berkualitas. Kajian ini bertujuan untuk mengetahui pertumbuhan dan keuntungan budidaya rumput laut Kappaphycus alvarezii dengan menggunakan bibit hasil kultur jaringan dan non kultur jaringan dengan berat awal tanam sebesar 50 gram. Metode pengumpulan data menggunakan metode observasi, meliputi penimbangan berat dan pengukuran kualitas air (suhu, kecerahan, kedalaman, pH, salinitas, DO). Hasil kajian menunjukkan pertumbuhan bibit rumput laut yang menggunakan bibit hasil kultur jaringan mempunyai pertumbuhan yang lebih baik (berat rata-rata akhir 655,31 gram, pertumbuhan mutlak 605,3 gram dan LPH 6,32%) untuk bibit kultur jaringan, sedangkan bibit non kultur jaringan (berat rata-rata 385,39 gram, pertumbuhan mutlak 335,39 gram, dan LPH 4,98%). Berdasarkan perhitungan analisa finansial sederhana,keuntungan yang didapatkan dari penjualan rumput laut yang menggunakan bibit hasil kultur jaringan Rp. 689.200 sedangkan bibit non kultur jaringan sebesaran Rp 221.200 artinya bibit kultur jaringan lebih menguntungkan.
PENINGKATAN PRODUKTIVITAS IKAN LELE (Clarias sp.) SISTEM BIOFLOK DI PESANTREN MODERN DARUL MA’ARIF LEGOK, INDRAMAYU
Authors: Yumna Asy Syafa , Rukmono Djumbuh , Panjaitan Amyda Suryati , Mulyono Mugi
Published: November 2019

Ikan lele merupakan sumber protein hewani yang bernilai ekonomis dan kebutuhannya  terus meningkat setiap tahun. Keunggulan teknologi bioflok yang mampu menggenjot produktivitas ikan menjadi lebih tinggi dengan penggunaan lahan yang tidak terlalu luas. Tujuan penelitian adalah mengevaluasi teknis budidaya ikan lele sistem bioflok, implementasi intervensi untuk meningkatkan produktivitas budidaya ikan lele sistem bioflok, mengevaluasi performa kinerja budidaya ikan lele sistem bioflok setelah implementasi intervensi, menganalisis finansial budidaya ikan lele sistem bioflok. Hasil penelitian menunjukkan rata-rata performansi kinerja budidaya dan produktivitas mengalami peningkatan, sedangkan, rasio konversi pakan mengalami kenaikan. Intervensi berdasarkan prioritas usulan pemecahan masalah yakni penambahan kuantitas blower dan titik aerasi, pembuatan water level, sampling mingguan dan membeli benih bersertifikat. Implementasi yang dilakukan mampu meningkatkan dari produktivitas sebesar Rp526.687 menjadi sebesar Rp1.242.187 dengan tingkat kelangsungan hidup sebesar 71%. Berdasarkan hasil analisis finansial layak untuk dilanjutkan dengan R/C Ratio sebesar 1,06.
LA EMPRESA FAMILIAR COMO CLAN: RECURSOS Y UNICIDAD
Authors: Arista Zabala Ricardo
Published: November 2019

RESUMEN

Este trabajo se enfoca en la empresa familiar, siendo su principal objetivo realizar una revisión del constructo de la familiaridad y específicamente de la dimensión de la identidad familiar, al teorizar como un primer cercamiento, la manera en que esta se construye a partir de la integración de distintos enfoques teóricos como lo son la teoría basada en recursos, la teoría de la identidad organizacional y la estructuración organizacional rescatada de la teoría de costos de transacción. La discusión gira en torno a los orígenes de una identidad colectiva en las organizaciones y como en este caso, será un punto de diferenciación entre las empresas familiares y aquellas que no lo son mediante proposiciones lógicas construidas a partir de la revisión de la literatura relevante al tema.
Teatervitenskap. Teaterhistorie og forestillingsanalyse
Authors: Trolie Tor
Published: November 2019

This article gives an insight into the beginnings and developments of the department of Theatre Studies at the Unviersity of Bergen. Looking back at its 50 years of existence as a subject at the University, professor Tor Trolie charts the changing paradigms of Theatre Studies in Bergen and its relationship to the theatre and performing arts.
Das vereinheitlichte digitale Typenschild
Authors: Dogan Alaettin , Zhang Yuanheng , Fay Alexander
Published: November 2019

Im Zuge der Globalisierung und der damit einhergehenden Vielzahl an gesetzlichen sowie institutionellen Vorgaben kommen konventionelle Typenschilder an ihre Grenzen der Inhaltsdarstellung. Im Rahmen des Projektes Digitales Typenschild des ZVEI wurde ein Konzept erarbeitet, das mit Hilfe der Verwaltungsschale diese Grenzen aufbricht und eine vollständig digitale Umsetzung eines Typenschildes darstellt. Das digitale Typenschild soll dabei nicht nur eine Antwort auf die aktuellen Herausforderungen an ein Typenschild liefern, sondern auch die Grundlage für weitere neue, datengetriebene Geschäftsfelder eröffnen.
Okul Yöneticilerinin Çokkültürlü Eğitim Tutumlarına ve Demokratik Tutumlarına İlişkin Görüşleri: Bir Karma Yöntem Çalışması
Authors: ARSLAN Aysel , ÇALMAŞUR Hilal
Published: November 2019

Bu çalışmada ilköğretimde görev yapan okul
yöneticilerinin çokkültürlü eğitime ilişkin görüşlerinin belirlenmesi;
amaçlanmaktadır. Araştırmada, nicel ve nitel verilerin bir arada kullanılmasına
olanak veren karma yöntem kullanılmıştır. Araştırmanın çalışma grubunu 31’i
bayan, 69’u erkek 100 okul yöneticisi oluşturmaktadır. Araştırmanın nicel
verilerinin analizinde; Kolmogorov-Smirnov (K-S), Aritmetik Ortalama, Standart
Sapma, Bağımsız T Testi, Anova, Pearson Korelasyon Katsayısı; nitel verilerinin
analizinde frekans ve içerik çözümleme teknikleri kullanılmıştır. Nicel analiz
sonuçlarına göre, okul yöneticilerinin çokkültürlü eğitim tutumlarının
cinsiyet, okul türü, okuldaki görev, branş; demokratik tutumlarının okul türüne
göre anlamlı farklılığa sahip olduğu belirlenmiştir. Okul yöneticilerinin
çokkültürlü eğitim tutumları ile demokratik tutumları arasındaki korelasyona
bakıldığında pozitif yönde ve orta düzeyde (0.57) bir ilişkinin bulunduğu
belirlenmiştir.
Teknoloji Destekli Probleme Dayalı Öğretim Uygulamalarının Matematik Başarısına Etkisi
Authors: ÇETİN Yücel , MİRASYEDİOĞLU Şeref
Published: November 2019

Bu çalışmanın amacı Teknoloji Destekli Probleme
Dayalı Öğrenme Uygulamalarının (TPU) öğrencilerin fonksiyon konusundaki
akademik başarıları üzerindeki etkisini belirlemektir. Bu çalışmada Statik
Karşılaştırma Gruplu ön deneysel desen kullanılmıştır. Deney grubuna TPU,
kontrol grubuna ise geleneksel öğretim uygulanmıştır. Uygulama 1 ay (20 ders
saati) sürmüştür. Uygulama öncesinde deney ve kontrol gruplarının matematik
başarıları bakımından denk oldukları uygulanan hazırbulunuşluk testi ile
belirlenmiştir. Uygulama sonunda TPU’nun fonksiyon konusundaki akademik başarıya
etkisi olup olmadığının anlaşılması için Fonksiyon Başarı Testi uygulanmıştır.
Yapılan analizler sonucunda deney ve kontrol grupları arasında fonksiyon konusunda
akademik başarıları açısından deney grubu lehine istatistiksel olarak anlamlı bir
farklılık bulunmuştur.
Implementation of Design-Based Research in Software Engineering Education: A Case of Final Project Course
Authors: ÖZYURT Özcan , ÖZYURT Hacer
Published: November 2019

This study aims to carry out final projects that
were designed and coded within the scope of Software Engineering Final Project
course in accordance with design-based research and observe the process hereof.
Students developed their final projects pursuant to design-based research
within the framework of a study that lasted for 8 weeks in total in spring term
2017-2018. Having been developed by relevant researchers, observation and
control form were used in the study as data gathering tools. Processes of these
projects that were developed via these forms were recorded on a weekly basis.
Throughout this study, in which totally 8 students participated and 5 projects
were created, the whole process of “Which one is your choice?”, a mobile
application development project, was described. All stages of design and
realization of this project, in which Mobile-D software development method was
used, were revealed in detail. This study describes the details of a
design-based research process which was operated on a real software project.
The result of the study casts light upon effective utility of this method in
project-based courses particularly in software engineering education and
generally in engineering education.