bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Interleukin-6 Blood Level and Chronic Obstructive Pulmonary Disease Severity
Authors: Lay Theopilus Obed , Amin Muhammad
Published: October 2020

Chronic obstructive pulmonary disease (COPD) is known as a chronic inflammatory disease that not only occurs in the lung, but also affects the systemic. A continuous chronic inflammation in COPD patients will have an increased proinflammatory cytokines, both in COPD patients’ respiratory tract and blood. Interleukin-6 (IL-6) is one of proinflammatory cytokines that increases with COPD progression. IL-6 level examination in COPD patient’s blood as a systemic inflammation indicator is convenient and quick. The research aimed to measure IL-6 level in COPD patient’s serum, to determine COPD severity level, and to analyze correlation between IL-6 and severity level. The research is an observational analytic study using cross sectional design. The samples were 38 non-exacerbated COPD outpatients who visited Lung Unit at Dr. Soetomo Teaching Hospital, Surabaya, Indonesia and met inclusion and exclusion criteria. The study found no significant correlation between IL-6, COPD severity level, COPD obstruction, first forced expiratory volume (FEV1), and FEV1/forced vital capacity (FVC), withp> 0.05. There was a significant correlation between IL-6 level, body mass index (BMI), and COPD assessment test (CAT) score, withp< 0.05, while there was no significant difference of IL-6 level between high-risk and low-risk patients, withp= 0.066 (p> 0.05). Moreover, there was a significant difference of IL-6 level between group A and D, withp= 0.040 (p< 0.05). There were no significant correlation and difference between COPD severities, COPD obstruction, FEV1, FVC, FEV1/FEC ratio, smoking duration with stable IL-6.
Association of Protein Expression P53 Mutants with Regional Lymph Gland Status on Type III of Nasofaring Patients in Carcinoma
Authors: Aswarin Riza , Yusuf Muhtarum , Wiyadi M. S.
Published: October 2020

In nasopharyngeal epithelial cells, one of the malignant diseases that have been documented involved NPC (nasopharyngeal carcinoma). Through the mutant p53 gene, there is a cancer cell mutation process relative to the role of tumor suppressor genes. With poor prognosis linked to or characterizing enormous regional lymph nodes, the implication is that through the regional lymph gland status analysis, there tends to be a determination of the progression of NPC. In this study, the central objective lay in the mutant p53 protein’s expression analysis, relative to NPC. Specifically the clinical manifestation on the focus entailed N, which represented the status of the regional lymph gland. In the study, there was the implementation of the monoclonal rabbit anti human p53 clone 318-6-11. Its role involved incorporation in the immunohistochemical cracking method, meant for the NPC tissue paraffin block-based mutant p53 protein’s expression. Also, the Anatomical Pathology Consultant was implemented in a quest towards the visual assessment of microscope light binoculars. In the findings, relative to all subjects and samples, 57.58% was the value that was established in relation to the p53 mutants’ positive expression. These findings were for the case of the N0 sample, which exhibited 0 subjects. For other situations, 7 subjects were for N3, 7 subjects also for N2, and 6 subjects for N1. Withp> 0.05, the Mann-WhitneyU-Test test gave the value ofpas 0.706, implying that the correlation between regional lymph gland and p53 protein’s positive expression was not statistically significant. These results were documented after the study focused on type III WHONPC. In summary, the study established that in type III WHONPC, the relationship between lymph and regional gland and p53 mutant expression protein was not significant.
Electric Bicycle Design with Power Charging by Using Wheel Rotation
Authors: Sibarani Marlon Tua Pangihutan , Suprianto
Published: October 2020

The development of the world of transportation is growing rapidly at this time with all the conveniences offered and very helpful to humans. One of them is an electric bicycle that can be used for everyday vehicles. Electric bicycles are vehicles that do not use fuel and do not cause air pollution or noise. The main components of this electric bicycle are direct current electric motors without brush, controller and generator, and batteries as a substitute for fuel. Based on the above reasons, this study designed an electric bicycle that utilizes wheel rotation as charging so that the electric bicycle can run continuously without charging to the power source. Testing tool on this bicycle consists of two parts, namely: with a load of 55 kg and no load. The maximum speed of this electric bicycle is 40 km/h. From the test results will be obtained the magnitude of speed, voltage and current.
Text Mining in Determining the Consistency of Lecturer Research on Science Discipline
Authors: Bustami  , Fikry Muhammad , Hamdhana Defry
Published: October 2020

This research is focused on evaluating the consistency of research conducted by lecturers on their scientific knowledge. With so many studies and diverse schemes, of course, it also produces varied research. Nevertheless, the quality of research is also the main focus of LPPM. To maintain this, one way to maintain the quality of research is to maintain the consistency of lecturers in researching following their scientific fields. Research that focuses on scientific fields will produce quality research. The products produced can also be accepted by the public and the market. in determining the consistency value of research conducted by lecturers on their scientific disciplines can be achieved with a text mining approach. Using mining and text analysis to gain insight into the topics of lecturer research, it can help writers detect the linear value of research with their field of science. TF-IDF algorithm can recognize the similarity of data in a query that has been stored as a data set. Big data sets greatly affect the success of the system in recognizing the consistency of lecturers’ research titles on their knowledge.
Study on the Stability of Non-Structural Element Using Active Tuned Mass Damper
Authors: Kim Hong-Won , Kwag Dong-Gi
Published: October 2020

Currently, the frequency of earthquakes is increasing in Korea, but due to the lack of appropriate seismic equipment, significant damage is expected. In order to solve this problem, active tuned mass damper will be developed to reduce earthquake damage in response to seismic waves, which are combined from low frequency to high frequency. In this paper, various control methods are introduced to reduce the amplitude ratio occurring at the 1st and 2nd natural frequencies for 3 DOF nonstructural elements. Through mathematical modeling, we confirm how each control method is applied and present the problems of the existing passive tuned mass damper and suggest the active tuned mass damper. To induce an active copper reducer, the response according to the control method can be predicted with a focus on the energy change rate. The active controller receives feedback from the relative displacement and relative velocity of the structure and uses it as a variable to set the control method. The passive control method and the active control method are compared through the simulation, and excellent control performance can be confirmed in the high frequency region as well as the second natural frequency. Vibration reduction performance was confirmed by each control method and the most ideal control method was selected. The optimum vibration reduction performance can be confirmed by using the signal function to always generate 180° of phase difference with respect to the speed of the structure. Not only earthquake but also mechanical vibration, wind load, etc., it can be used in all fields where damage is caused by excitation force inherent in various complex frequencies.
A Survey on Digital Image Steganography and Steganalysis
Authors: Haji Mohammed Suliman , Rahim Mohd Shafry Mohd , Ahmed Falah Y. H. , Sulong Ghazali Bin
Published: October 2020

Currently, there is a dramatic development ion aspects such as the verbal exchange of data, as well as computer-related technology. This trend has attracted growing scholarly attention, with the aspects of data protection also linked to dramatic growth in the interest of many scholars. For more than a decade, improvements have been felt in certain notable fields. They include steganalysis and steganography. Indeed, these attributes are important because they lend support to and gain application in areas such as national security, intelligence, and commercial enterprise. The aim of the current study lies in the enhancement of the attributes of steganalysis and steganography relative to image analysis, from the perspective of the pixel block-based totally adaptive steganography. The study considers several multi-decision decomposition processes and standards governing the steganalysis of images. It is also worth highlighting that the study demonstrates that through the least large beat, the matching process via the steganalysis procedure is capable of and yields superior outcomes relative to message embedment in single pixels. Indeed, the factor of images’ texture distribution does not play a significant role in hampering the aforementioned ability, if any. Overall, it is concluded that compared to flat regions, the attribute of image texture exhibits more structural randomness. Hence, hidden image embedment is more secure when high textures are involved.
System Identification Based Controller Design for Friction Stir Welding Process During Joining of Aluminium Metal Matrix Composites
Authors: Rahul S. G. , Kripa S. , Chitra R.
Published: October 2020

Friction Stir Welding (FSW) process was initially implemented by modifying the milling machines. With the advancements in robotics and automation, movement along three primary axes are made controllable using computer integration. FSW being a temperature-dependent process, the temperature at the weld zone affects the weld quality since the microstructure is totally altered by the temperature variations. If welding is done at constant process parameters by ignoring the process disturbances, it would also result in undesirable material properties. From research studies, it is understood that tool pin position and spindle speed are significant process parameters contributing to heat generation during the joining process. In this study, an attempt is made to control the spindle speed of the rotating tool by measuring tool-workpiece interface temperature and vibrational disturbances during joining of Aluminium Metal Matrix Composite (Al-MMC) plates. The system model is estimated from the experimental data using the concept of system identification. Followed by, a Smith Predictor control scheme is developed and validated in a closed loop FSW system to examine the tensile strength.
Series Solutions for South African Banks Users Using the Adomian Decomposition Method
Authors: Kekana M. C. , Tong T. O. , Shatalov M. Y. , Moshokoa S. P.
Published: October 2020

In this paper, A model for the four major South African banks namely Absa, First national, Standard and Nedbank users is developed and investigated. Series solutions for South African banks users is obtained using the Adomian decomposition method under factors emigration, immigration,
advertisement of each bank and personal interaction amongst different bank users. The results reveals that people will continue using the four South African banks as long the aforesaid parameters are intensified.
Water Molecule and Atoms Inside C60 Fullerene
Authors: Tiangtrong Prangsai
Published: October 2020

In this research, we are interested in the non-bonded interactions between a single water molecule and the atoms Li, Na, K, Rb, Cs, Ca, Ni, Zn and Pb inside a C60 fullerene using the Lennard-Jones potential function. We assume that a single water molecule is inside the endofullerene
and determine the exact formula of the interaction energy between the water molecule and the fullerene. Then we determine the interaction energy between an atom and the endofullerene to consider the interaction behaviours of each atom inside the fullerene. The results show that a water molecule
does not desire to be encapsulated inside the fullerene. Similarly, Rb, Cs and Pb act the same behaviour, where they are not stable inside the fullerene. However, some atoms which are Li, Na, K, Ca, Ni and Zn can be inside the endofullerene. Hence, the creation of endofullerene with a single
water molecule or Rb, Cs and Pb inside, an external force must be applied while that force is not necessary for Li, Na, K, Ca, Ni and Zn.
Sentiment Analysis on Movie Reviews Using Twitter
Authors: Samuel Sajay Thomas , Marikannan Booma Poolan
Published: October 2020

Machine learning can help people to perform complex tasks and solve problems as it uses historical data to learn its pattern and make predictions based on the past data. This research addresses the problem about movie reviews on social media specifically Twitter; where it will gather
the tweets on movie reviews and display a rating based on the sentiment of the tweet. Twitter is an online social media website where people from all walks of life communicate by tweeting short updates without exceeding the character limit which is 240 characters. Twitter is continuously growing
as a business and became one of the biggest platform for communication and instant messaging. Due to the large number of users, there are voluminous amounts of data available that can be used for more in depth information and insights and to get the sentiments from analysing the tweets. In
today’s world, there are many applications that are using sentiment analysis in various fields such as to gets insights about a particular brand or product. To do sentiment analysis using the traditional ways can be time consuming and becomes very complex. The aim of this research is
to investigate about the domain of sentiment analysis and incorporate a machine learning algorithm to create a system that is able to get and display the ratings of a particular movie. The machine learning algorithms used are Naïve Bayes Classifier and SVM. The algorithm with better accuracy
will be chosen for the implementation phase.
An Operational Multi-Radar Multi-Sensor QPE System in Taiwan
Authors: Chang Pao-Liang , Zhang Jian , Tang Yu-Shuang , Tang Lin , Lin Pin-Fang , Langston Carrie , Kaney Brian , Chen Chia-Rong , Howard Kenneth
Published: October 2020

Over the last two decades, the Central Weather Bureau of Taiwan and the U.S. National Severe Storms Laboratory have been involved in a research and development collaboration to improve the monitoring and prediction of river flooding, flash floods, debris flows, and severe storms for Taiwan. The collaboration resulted in the Quantitative Precipitation Estimation and Segregation Using Multiple Sensors (QPESUMS) system. The QPESUMS system integrates observations from multiple mixed-band weather radars, rain gauges, and numerical weather prediction model fields to produce high-resolution (1 km) and rapid-update (10 min) rainfall and severe storm monitoring and prediction products. The rainfall products are widely used by government agencies and emergency managers in Taiwan for flood and mudslide warnings as well as for water resource management. The 3D reflectivity mosaic and QPE products are also used in high-resolution radar data assimilation and for the verification of numerical weather prediction model forecasts. The system facilitated collaborations with academic communities for research and development of radar applications, including quantitative precipitation estimation and nowcasting. This paper provides an overview of the operational QPE capabilities in the Taiwan QPESUMS system.
Violence and Defiance of Authority in Mughal India: A Study of the Shoe Sellers’ Riot of Shahjahanabad
Authors: Haider Najaf
Published: October 2020

In March 1729 ad, the city of Shahjahanabad (Mughal Delhi) was brought to a standstill following a conflict between shoe sellers and state officials. The conflict led to a violent showdown during the Friday congregational prayer in the central mosque of the city (Jami Masjid). The shoe sellers’ riot exposed fissures based on religion, class and politics and posed a challenge to the authority of the Mughal state during the twilight of the Empire. The article is a study of the riot and the riot narratives preserved in three unpublished contemporary works. Together with a discussion of the Ahmedabad riot of 1714 ad, the article examines the nature of conflicts involving civilian population in the cities of Mughal India in the early eighteenth century and the response of political and religious authorities. An important aspect of the incidents studied in the article is the role of religion in organizing group violence even when the cause of the conflict was not necessarily religious. Conversely, cross-community support arising from patronage, class and notions of pride and honour demonstrated that religion was one among many possible forms of identity in Mughal India.
Ticagrelor-Related Severe Dyspnoea: Mechanisms, Characteristic Features, Differential Diagnosis and Treatment
Authors: Krakowiak Alicja , Kuleta Jakub , Plech Iwona , Zarębiński Maciej , Wojciechowska Małgorzata , Wretowski Dominik , Cudnoch-Jędrzejewska Agnieszka
Published: October 2020

With a growing number of patients on ticagrelor therapy after stent implantation, we observe many cases of side effects of the drug, mostly dyspnoea and bradycardia. In our article we present 2 patients, in which the symptoms were particularly severe. Then we describe possible mechanisms of these complications, explain how to carry out differential diagnosis, discuss when to switch ticagrelor to other antiplatelet drug and finally we present the way to deal with the symptoms.
Covid19 Outbreak in Victoria, Australia Update August 1, 2020
Authors: Boretti Alberto
Published: October 2020

The Victoria Covid19 outbreak is well explained by the data represented in Figure 1. To August 1, 10,931 have tested positive for a coronavirus after more than 1,633,900 tests were performed. 116 people have died from coronavirus in Victoria. The number of infected, tests performed, their ratio, and the number of fatalities as communicated daily by 1 are proposed vs. the number of days since May 31st.
Telomere biology disorder prevalence and phenotypes in adults with familial hematologic and/or pulmonary presentations
Authors: Feurstein Simone , Adegunsoye Ayodeji , Mojsilovic Danijela , Vij Rekha , West DePersia Allison H. , Rajagopal Padma Sheila , Osman Afaf , Collins Robert H. , Kim Raymond H. , Gore Steven D. , Greenberg Peter , Godley Lucy A. , Li Zejuan , del Gaudio Daniela , Subramanian Hari Prasanna , Das Soma , Walsh Tom , Gulsuner Suleyman , Segal Jeremy P. , Husain Aliya N. , Gurbuxani Sandeep , King Mary-Claire , Strek Mary E. , Churpek Jane E.
Published: October 2020

Telomere biology disorders (TBDs) present heterogeneously, ranging from infantile bone marrow failure associated with very short telomeres to adult-onset interstitial lung disease (ILD) with normal telomere length. Yield of genetic testing and phenotypic spectra for TBDs caused by the expanding list of telomere genes in adults remain understudied. Thus, we screened adults aged ≥18 years with a personal and/or family history clustering hematologic disorders and/or ILD enrolled on The University of Chicago Inherited Hematologic Disorders Registry for causative variants in 13 TBD genes. Sixteen (10%) of 153 probands carried causative variants distributed among TERT (n = 6), TERC (n = 4), PARN (n = 5), or RTEL1 (n = 1), of which 19% were copy number variants. The highest yield (9 of 22 [41%]) was in families with mixed hematologic and ILD presentations, suggesting that ILD in hematology populations and hematologic abnormalities in ILD populations warrant TBD genetic testing. Four (3%) of 117 familial hematologic disorder families without ILD carried TBD variants, making TBD second to only DDX41 in frequency for genetic diagnoses in this population. Phenotypes of 17 carriers with heterozygous PARN variants included 4 (24%) with hematologic abnormalities, 67% with lymphocyte telomere lengths measured by flow cytometry and fluorescence in situ hybridization at or above the 10th percentile, and a high penetrance for ILD. Alternative etiologies for cytopenias and/or ILD such as autoimmune features were noted in multiple TBD families, emphasizing the need to maintain clinical suspicion for a TBD despite the presence of alternative explanations.
BRAFV

600E
or mutant MAP2K1 human CD34+ cells establish Langerhans cell–like histiocytosis in immune-deficient mice
Authors: Rafiei Anahita , Wilk C. Matthias , Helbling Patrick M. , Myburgh Renier , Saito Yasuyuki , Haralambieva Eugenia , Soldini Davide , Chakraborty Rikhia , Merad Miriam , Allen Carl E. , Nombela-Arrieta Cesar , Manz Markus G.
Published: October 2020

Key Points

BRAFV600E or mutant MAP2K1 expression in human CB CD34+ HSPCs lead to Langerhans cell–like histiocytosis in immune-deficient mice. BRAFV600E-expressing human CB CD34+ HSPCs did not generate hairy cell leukemia in xenograft mouse models.
We have the program, what now? Development of an implementation plan to bridge the research-practice gap prevalent in exercise oncology
Authors: Kennedy Mary A. , Bayes Sara , Newton Robert U. , Zissiadis Yvonne , Spry Nigel A. , Taaffe Dennis R. , Hart Nicolas H. , Davis Michael , Eiszele Aileen , Galvão Daniel A.
Published: October 2020

Background

Exercise has emerged as a promising therapy for people with cancer. Novel programs have been developed to translate research into practice; however, implementation barriers have limited their success in part because successful translation of exercise oncology research into practice requires context-specific implementation plans. The aim of this study was to employ the implementation mapping protocol to develop an implementation plan to support programming of a co-located exercise clinic and cancer treatment center.

Methods

The Implementation Mapping protocol, which consists of five specific iterative tasks, was used. A stakeholder advisory group advised throughout the process.

Results

A comprehensive needs assessment was used to identify the organization’s general manager as the program adopter; oncologists, center leaders, and various administrative staff as program implementers; and the operations manager as the program maintainer. Twenty performance objectives were identified. The theoretical domains framework was used to identify likely determinants of change, which informed the selection of eight individual implementation strategies across the individual and organizational levels. Finally, an evaluation plan was developed which will be used to measure the success of the implementation plan in the project’s next phase.

Conclusion

The Implementation Mapping protocol provided a roadmap to guide development of a comprehensive implementation plan that considered all ecological domains, was informed by theory, and demonstrated an extensive understanding of the implementation context. Strong research-practitioner partnerships and effective stakeholder engagement were critical to development of the plan.
A systematic literature review of health consumer attitudes towards secondary use and sharing of health administrative and clinical trial data: a focus on privacy, trust, and transparency
Authors: Hutchings Elizabeth , Loomes Max , Butow Phyllis , Boyle Frances M.
Published: October 2020

We aimed to synthesise data on issues related to stakeholder perceptions of privacy, trust, and transparency in use of secondary data. A systematic literature review of healthcare consumer attitudes towards the secondary use and sharing of health administrative and clinical trial data was conducted. EMBASE/MEDLINE, Cochrane Library, PubMed, CINAHL, Informit Health Collection, PROSPERO Database of Systematic Reviews, PsycINFO, and ProQuest databases were searched. Eligible articles included those reporting qualitative or quantitative original research and published in English. No restrictions were placed on publication dates, study design or disease setting. One author screened articles for eligibility, and two authors were involved in the full text review process. Data was extracted using a pre-piloted data extraction template by one author and checked by another. Conflicts were resolved by consensus. Quality and bias were assessed using the QualSyst criteria for qualitative and quantitative studies. This paper focuses on a subset of 35 articles identified from the wider search which focus on issues of privacy, trust, and transparency. Studies included a total of 56,365 respondents. Results of this systematic literature review indicate that while respondents identified advantages in sharing health data, concerns relating to trust, transparency, and privacy remain. Organisations collecting health data and those who seek to share data or undertake secondary data analysis should continue to develop trust, transparency, and privacy with healthcare consumers through open dialogue and education. Consideration should be given to these issues at all stages of data collection including the conception, design, and implementation phases. While individuals understand the benefits of health data sharing for research purposes, ensuring a balance between public benefit and individual privacy is essential. Researchers and those undertaking secondary data analysis need to be cognisant of these key issues at all stages of their research. Systematic review registration: PROSPERO registration number CRD42018110559 (update June 2020).
Dietary diversity practice and associated factors among adolescent girls in Dembia district, northwest Ethiopia, 2017
Authors: Gonete Kedir Abdela , Tariku Amare , Wami Sintayehu Daba , Akalu Temesgen Yihunie
Published: October 2020

Background

Dietary diversity is defined as the number of food groups or items consumed over a reference period, and usually, it is a problem in developing countries including Ethiopia. Inadequate dietary diversity is one of a major public health problem and can result in physical, emotional, and psychological changes among adolescents. However, studies on dietary diversity among school children were very limited. Hence, this study aimed at determining dietary diversity practices and factors among adolescents in Dembia district.

Methods

A school-based cross-sectional study was conducted from March 1 to April 15, 2017, at Dembia district, northwest Ethiopia. A total of 474 study subjects were selected using the multi-stage sampling technique. A structured and pre-tested questionnaire was used to collect the data. Dietary diversity was measured through standard tool adopted from Food and Nutrition Technical Assistance (FANTA) 2016 using the 24-h recall method. A multivariable binary logistic regression model was employed to identify factors associated with a diversified diet.

Result

This study illustrated that 32.3% (95% CI 27.9–36.8) of the adolescents had adequate dietary diversity. Inadequate dietary diversity was significantly associated with being Muslim (AOR = 0.3; 95% CI 0.1–0.7), self-employment (AOR = 0.3; 95% CI 0.1–0.9), middle (AOR = 0.5; 95% CI 0.3–0.8) and high wealth category (AOR = 0.3; 95% CI 0.2–0.6), and underweight (AOR = 3.5; 95% CI 1.3–9.5).

Conclusion

The findings of this study showed that only one-third of adolescent girls have adequate dietary diversity. Low level of dietary diversification suggested points to the need for strengthening efforts targeting to improve the healthy dietary practice of adolescents by giving due attention to poor households and undernourished adolescents.
Resource utilization rates among English versus limited English proficient patients (pts) by patient-report of low health literacy (LHL).
Authors: McCleary Nadine Jackson , Haakenstad Ellana , Rowell Jessi , Cleveland Jessica , Zhang Sunyi , Lee Sherry , Hassett Michael J. , Schrag Deborah
Published: October 2020

107

Background: About 30 million people in the US report Limited-English Proficiency (LEP). LEP cancer pts are less likely to understand their medical condition(s) and are at increased risk of LHL, emergency department (ED) visits or hospitalizations. We examined the relationship between LEP, LHL, and ED visits/hospitalization in oncology. Methods: Dana-Farber Cancer Institute’s New Pt Intake Questionnaire (NPIQ) documents clinical and social determinants of health, including LHL. Pts reported LHL if they responded “a little bit”, “somewhat” or “not at all” to 1 of 2 questions: 1) “How confident are you in filling out medical forms?” and 2) “How confident are you in understanding medical statistics?”. Pts reported LEP if they noted a primary language other than English at registration. ED visits/hospitalizations were determined from Partners Healthcare System records. Statistically significant relationships between LEP, LHL and ED visits/hospitalizations and pt demographics (age, sex, race/ethnicity, zip code) and clinical (disease center, treatment intent) characteristics were determined with χ2 tests. Results: From 5/30/15 – 4/30/20, 21570 of 98200 eligible pts responded to NPIQ (response rate 22.0%). LHL differed by age (p-value < 0.001), gender (p-value < 0.001) and race/ethnicity (p-value = 0.007). Among LEP pts reporting LHL, financial distress (p-value = 0.004), emotional distress (PROMIS score; p-value = 0.014), and prior cancer (p-value = 0.006) were more prevalent; however, there was no significant statistical increase in ED visits (p-value = 0.237) or hospitalizations (p-value = 0.965) compared to LEP not reporting LHL. Conclusions: The results indicate that sociodemographic and other pt characteristics contribute to ED and hospital utilization in LEP cancer pts. Future studies will employ prospective data to examine the covariates’ predictive ability for resource utilization with LHL among LEP pts. [Table: see text]
Adherence to and determinants of guideline-recommended biomarker testing and targeted therapy in patients with gastroesophageal adenocarcinoma: Insights from routine practice.
Authors: Lau-Min Kelsey S. , Li Yimei , Eads Jennifer Rachel , Mamtani Ronac , Getz Kelly D.
Published: October 2020

12

Background: Precision oncology has transformed care for patients with advanced HER2+ gastroesophageal adenocarcinoma (GEA), where the addition of anti-HER2 therapy with trastuzumab improves overall survival and is now incorporated into national guidelines. However, little is known about adherence to and determinants of timely HER2 testing and trastuzumab initiation in routine care. Methods: We performed a retrospective study of advanced GEA diagnosed between 1/2011 and 6/2019 in the nationwide Flatiron Health EHR-derived deidentified database. We calculated annual prevalence and identified determinants of timely HER2 testing (defined within 21 days after advanced diagnosis) and timely first-line trastuzumab initiation (defined within 14 days after a HER2+ result). Log binomial regressions estimated adjusted prevalence ratios (PR) comparing timely HER2 testing and trastuzumab initiation by patient and tumor characteristics. Multiple imputation was conducted for missing data. Results: We included 6,479 patients with advanced GEA; 973 were HER2+ of whom 585 (60.1%) initiated trastuzumab. Prevalence of timely HER2 testing increased from 22.4% in 2011 to 44.5% in 2019; timely trastuzumab initiation remained stable at 18.0% over the same period. No appreciable differences in timely testing or trastuzumab initiation by age, sex, race or payer category were noted. Patients with early-stage GEA who subsequently developed metastatic disease were less likely to undergo timely HER2 testing and trastuzumab initiation than those with metastatic disease at diagnosis (PR 0.69, 95% CI 0.64-0.75 for testing; PR 0.44, 95% CI 0.28-0.69 for therapy). Similar findings were seen for patients who did not receive surgery (PR 0.56, 95% CI 0.47-0.65 for testing; PR 0.57, 95% CI 0.22-1.46 for therapy). Patients who started chemotherapy before learning their HER2 status (PR 1.42, 95% CI 1.05-1.90) and those with concordant HER2 immunohistochemistry and FISH results (PR 1.76, 95% CI 0.99-3.13) were more likely to initiate timely trastuzumab. Conclusions: Among patients with advanced GEA, guideline-recommended HER2 testing and anti-HER2 therapy initiation remain underutilized. Misclassification due to missing testing or treatment performed outside the Flatiron Network is a study limitation. Uptake of precision oncology may improve with implementation of universal HER2 testing of GEA patients regardless of stage and reflex multidisciplinary review of discordant HER2 test results.
Racial disparities in performance status among cancer patients at a community oncology practice.
Authors: Buzaglo Joanne S. , Musallam Alexander , Stepanski Edward , White Craig , Joiner Mary , Vanderwalde Ari M. , Decker Veronica
Published: October 2020

132

Background: Performance status is used to characterize patient ability to tolerate chemotherapy and as a selection criterion for clinical research. Poor performance status can exclude patients from clinical trial participation. Further, African American cancer patients are underrepresented in cancer clinical trials. The study purpose was to document performance status at the initial patient visit to a community oncology practice and to explore racial disparities between White and Black patients. Methods: This study used a retrospective, observational design with ePRO collected via the Patient Care Monitor™ (PCM). All study data were collected as part of routine clinical care at a community oncology practice during 1/2019–11/2019. An Eastern Cooperative Oncology Group (ECOG) score was automatically calculated after patients at an initial clinic visit completed a 1-item question that assessed performance status via e-tablet. Results: 6,613 patients completed the PCM survey (mean age 59; 33% male/67% female; 55.4% White, 38% Black). Cancer type was known for a subset of patients (22% breast, 9% hematologic, 4% lung, 5% colorectal, 3% prostate, 11% other types). The average ECOG score for the total sample was 0.97. 50% indicated they were able to complete their normal daily activities without any restriction; 26.9% were able to complete their normal daily activities and some light work. In contrast, 10.3% indicated they could take care of themselves, but could not work and are in bed/chair less than half the day. 10.3% could take care of themselves sometimes but could not work and are in bed/chair more than half the day. 4.5% indicated they could not take care of themselves and were in bed/chair almost always. When assessing racial differences between those self-identifying as White or Black/African American, average ECOG score was higher in Black patients [Mean(SD) = 1.03(1.24)] when compared to White patients [Mean(SD) = 0.93(1.14)] (p = 0.003). We observed a higher percentage of Black patients reported not being able to take care of themselves (51.9% Black v. 41.0% White). In contrast, a higher percentage of White patients reported being able to complete all daily activities without restriction (38.3% Black v. 54.5% White). Conclusions: This study shows significant racial disparities in performance status among patients seen at a community oncology practice with Black patients exhibiting significant worse performance status than White patients. These findings have implications for disparities in treatment outcomes and racially biased access to clinic trials.
4R program results: What is the impact of 4R care delivery model on patient self-management and which patients benefited?
Authors: Trosman Julia Rachel , Weldon Christine B. , Makower Della F. , Rapkin Bruce D. , Bozier Moreen , Perez Claudia Beth , Kulkarni Swati , Schaeffer Cathleen M. , Hoskins Kent , Gallagher Christopher , Lo Shelly S. , Grace-Louthen Cathy , Throckmorton Alyssa , Krueger Editha A. , Van Horn Jennifer , Ravelo Arliene , Yu Elaine , Schapira Lidia , Benson Al Bowen , Gradishar William John
Published: October 2020

139

Background: We previously proposed a 4R model of teamwork and patient self-management (pSM) in cancer care (NCI ASCO Teams Project, Trosman JOP 2016). 4R (Right Info/Care/Patient/Time) enables patient and care team to manage complex care with an innovative 4R Care Sequence plan, including a novel visual feature describing timing and sequence of care. We report final results of a program which tested 4R at 5 safety net and 5 non safety net US centers from 2016 to 2019. Methods: Patients with stage 0-III breast cancer received 4R plans (4R Cohort). We surveyed 4R cohort and a historical control cohort of patients receiving care at same centers pre-4R. We assessed the usefulness of 4R to the 4R cohort and the impact on pSM in 4R cohort compared to historical cohort. Results: Survey response rates: 63%, 422/670 (4R cohort); 47%, 466/992 (control). 4R significantly increased the composite pSM score and 5 of 7 pSM metrics vs control (Table). The increase was not influenced by patient age, stage or whether treated at safety net site. pSM scores increased in 4R vs control cohort to a similar extent for patients < 65 years old (74% vs 51%, p = .0001) as for patients ≥ 65 years old (78% vs 57%, p = .0002). pSM improved similarly for patients with stage 0 or I breast cancer (77% vs 56%, p = .0001) as for patients with stage II or III breast cancer (72% vs 54%, p = .0001). Safety net patients showed pSM increase (77% vs 51%, p = .0001) similar to non safety net patients (74% vs 58%, p = .0002). Within the 4R cohort, 80% found 4R useful for organizing care and 70% found the novel visual feature useful to manage care timing and sequence. Usefulness was similar for age groups and stages, but higher for safety net than non safety net patients (88% vs 74%, p = .0008). Conclusions: 4R markedly improved patient self-management in early breast cancer across age groups and cancer stages, but further enhancements are needed to benefit as many patients as possible. 4R benefits in safety net setting indicate that 4R may reduce disparities. [Table: see text]
Patient and physician decision-making on the use of novel agents in chronic lymphocytic leukemia (CLL): What drives preferences?
Authors: Le Hannah , Ryan Kellie , Wahlstrom Svea K , Pendergraft Trudy , Maculaitis Martine C , Will Oliver , Mulvihill Emily , LeBlanc Thomas William
Published: October 2020

148

Background: CLL treatment has changed dramatically with the approval of novel agents, but data to guide treatment decisions are still lacking. How patients (PTs) and oncologists (ONCs) prioritize treatment attributes is unknown. Methods: ONCs and PTs completed an online survey to quantify preferences for first-line (1L) CLL treatment with novel agents via a discrete choice experiment; ONCs and PTs chose between hypothetical treatment profiles with varying attribute levels taken from product labels, registrational trials, and real-world studies. Hierarchical Bayes models were used to estimate attribute level preference weights, which were used to compute relative importance (RI), a measure of how influential an attribute is in treatment choice out of a total of 100%. Results: For ONCs (N=151), 72% were in community practice. PTs (N=220) had a median age of 56 years; 32% were in active surveillance, 36% were in/had completed 1L treatment, and 32% were relapsed/refractory. Increasing 2-year progression-free survival (PFS) from 75% to 95% had the greatest impact on preferences, with a mean RI of 40% for PTs and 30% for ONCs (Table). When assessing trade-offs between 2-year PFS and other attributes, ONCs required the largest increase in PFS (11%) to compensate for an increased risk of atrial fibrillation (AF) from 5% to 20%. PTs required the largest increase in PFS (6%) to compensate for an increased risk of infection from 7% to 20%. ONCs (vs PTs) required 2–4-times higher increases in PFS to accept an increased risk of AF, discontinuation due to adverse events (AEs), bleeding, tumor lysis syndrome (TLS), and arthralgia/myalgia. Conclusions: ONCs and PTs valued PFS most when selecting a novel CLL agent. While both groups accepted potential risks in exchange for increased PFS, ONCs were less likely to accept a higher risk of AEs. ONCs and PTs may perceive the risks and benefits of novel agents differently. ONC–PT communication may be improved by a more focused discussion on the risks of AEs, relative to treatment outcomes, with patient goals in mind. [Table: see text]
4R program results in breast cancer: The impact of 4R Care Delivery Model on timing and sequence of guideline recommended care.
Authors: Weldon Christine B. , Trosman Julia Rachel , Makower Della F. , Rapkin Bruce D. , Perez Claudia Beth , Kulkarni Swati , Schaeffer Cathleen M. , Hoskins Kent , Gallagher Christopher , Lo Shelly S. , Grace-Louthen Cathy , Throckmorton Alyssa , Krueger Editha A. , Van Horn Jennifer , Reaves Brieyona Chardee , Ravelo Arliene , Yu Elaine , Benson Al Bowen , Schapira Lidia , Gradishar William John
Published: October 2020

15

Background: We previously proposed a 4R care delivery model which enables patients and care teams to manage timing and sequence of interdependent, time sensitive care with a novel multimodality 4R Care Sequence plan (NCI ASCO Teams Project; Trosman, JOP 2016). We report final results of a program which tested 4R at 10 US centers (4 academic and 6 non-academic) from 2016 to 2019. Methods: 4R Sequences were provided to stage 0-III breast cancer patients (4R cohort, N = 422) at participating centers. Analyses of clinical and patient-reported data compared the 4R cohort to a historical control cohort of patients who received care pre-4R at the same centers (N = 466). Results: We significantly improved 5 guideline recommended referral metrics and 4 referral completion metrics indicating receipt of care by patients who were referred (Table). Although significantly increased, referrals to dental visit and smoking cessation before treatment remained low (< 20% and < 10% respectively). Patient survey comments indicated that insufficient lead time to quit smoking or obtain fertility consult before cancer treatment was a key barrier for completing these referrals. Conclusions: 4R markedly improved referral and receipt of interdependent guideline recommended breast cancer care for most metrics. Future 4R program should optimize the timing of referrals within the 4R Care Sequence to allow sufficient time for smoking cessation and fertility care before treatment initiation. [Table: see text]
Capturing the financial hardship of cancer in military adolescent and young adult patients: A conceptual framework.
Authors: Cheung Christabel K. , Katerere-Virima Thuli , Helbling Laura E. , Thomas Bria N. , Tucker-Seeley Reginald
Published: October 2020

163

Background: Cancer can be a setback for young active-duty military patients, with potential implications for their financial well-being, early career paths, and young families. Despite the assumption of sufficient material support for military patients, cancer and its treatments still result in substantial out-of-pocket expenses and lost-opportunity costs that can lead to financial hardship. Although prior cancer survivorship studies have put forth a material, psychosocial, and behavioral conceptual framework for describing financial hardship following a cancer diagnosis, it is unknown whether this framework adequately depicts the experience of financial hardship among military adolescent and young adult (AYA) patients. The primary aim of the current study was to extend this conceptual model of financial hardship following a cancer diagnosis for application among military AYA patients. Methods: Using Gale and colleagues’ Framework Method for qualitative multi-disciplinary health research, the investigator team conducted focus groups and key informant interviews (n=24) with active-duty AYA cancer patients, cancer care providers, and commanding officers at both a military medical center and a military post in Hawaii. Subsequently, content analysis and thematic abstraction produced results that were sorted to characterize the material, psychosocial, and behavioral domains of financial hardship. Finally, investigators employed health behavioral change theories to construct a conceptual framework. Results: Data analysis revealed that young active-duty military patients’ experiences of financial hardship following a cancer diagnosis occur within material, psychosocial, and behavioral domains that are uniquely situated within the environments of AYA development and military culture. Hence, we elaborated upon an existing conceptual framework of the financial hardship of cancer, by extending it to capture two meso-level contexts that emerged from our findings: (1) life course development and (2) occupational culture. Conclusions: Differentiating individual experiences of financial hardship within the contexts of life course development and occupational culture, may enable the development of interventions that are informed by the aspect of financial hardship most impacted by cancer care for this special population. Future research should further explicate the meso-level contexts in our study, and investigate the associations among and between factors within these social and environmental contexts.
An independent oncology second opinion program: 2020 pilot project.
Authors: Leming Philip D. , Hunt Jillian M. , Herzog Thomas J. , Jazieh Abdul-Rahman , Barrett William
Published: October 2020

179

Background: The estimated number of new cancer cases in the United States in 2020 is 1.8 million with an estimated 606,000 deaths. The science and technology of oncology has dramatically increased in recent years. EMR demands, RVU reimbursements, restriction of time/visit demanded by systems, bureaucratic hurdles, and physician burnout has resulted in reduced patient-focused time available for oncologists. A pilot project for 2020 was established to determine if a fully funded oncology second opinion consult program would be feasible and have value to patients/families and their physicians. Methods: Planning started December 2019 for an independent oncology second opinion program that was of no cost to the patient, funded by The Cincinnati Cancer Foundation. The first patient was seen January, 2020. Two hours of face to face or teleconference time was spent with the patient and family including a comprehensive history and physical in face to face cases. After the initial consultation, a comprehensive literature, clinical trial, and case data review was completed. A phone call was made to the treating physician to discuss the case and recommendations. A one-time follow-up was offered to the patient where recommendations were reviewed and the patient’s questions answered. Surveys were sent to the patient and treating physicians for real-time feedback. Results: From 1/2/2020 to 6/1/2020, 70 patients were seen in consultation from 12 different hospital systems with 29 different diagnoses. 4% (3) of consultations were done by video conferencing and 96% (67) were done in person. 54% (36/67) of patient surveys were returned. The overall value of the consultation (1-5 scale with 5 being the best) to the patient was: 97% (35)-5, 3% (1)-4. 20.5% (18/88) of physician surveys were returned. The overall value of the consultation to the physician was: 83% (15)-5, 17% (3)-4. Of the 70 patients, the amount of change in the patient’s plan of care due to the consultation was: None 28.5% (20), Small 50% (35), Moderate 18.5% (13), Significant 3% (2). Conclusions: Our findings establish the feasibility of a comprehensive second opinion service in cancer. The feedback from participants support the value and acceptance of an independent oncology second opinion consultation program to both patients and referring physicians.