bluuebunny/crossref_metadata_2025 huggingface dataset:
The Mediating Role of Coping Style: Associations Between Intimate Partner Violence and Suicide Risks Among Chinese Wives of Men Who Have Sex With Men
Authors: Wu Weizi , Zhang Ye , Goldsamt Lloyd , Yan Fang , Wang Honghong , Li Xianhong
Published: November 2018

The wives of men who have sex with men, known as “ Tongqi” in China, have increasingly attracted public attention due to their potential risks of suicide and sexually transmitted infections and HIV. However, few studies have explored the association between intimate partner violence (IPV) and suicide risk or the mediating effect of coping style on these associations among Tongqi in China. To describe these relationships, a cross-sectional online survey was conducted in China from February 2016 to February 2017. A questionnaire, which consisted of the Revised Conflict Tactics Scales, the Simplified Coping Style Questionnaire, the Beck Scale for Suicidal Ideation, and reports of suicide attempts, was completed by 178 Chinese Tongqi. Bootstrap tests were performed to determine the mediating role of coping styles on the association between IPV and suicide risks. The median IPV score was 14 (range: 0-50), with the domain of negotiation ranking highest. The average coping style score was .37±.73; 61.2% of Tongqi have had suicidal ideation, and 11.8% had attempted suicide. IPV was significantly correlated with suicidal ideation ( rs = .19, p < .01) and suicide attempts ( rs = .29, p < .001). Participants with a negative coping style had higher suicidal ideation ( rs = –.39, p < .01) and suicide attempts ( rs = –.22, p < .01). Coping style had a full mediating effect on the association between IPV and suicidal ideation and a partial mediating effect on suicide attempts. Chinese Tongqi experienced high level of IPV and suicide risks. IPV contributed to the suicide risks of Chinese Tongqi, but these associations were mediated by coping style. Therefore, interventions to improve mental health and prevent suicide risks of Chinese Tongqi should focus on helping them develop a positive coping style to achieve the goal of Healthy China in 2030.
Neuroscience and HR Concepts and Applications
Authors: Rao B. S.
Published: November 2018

Every company is created to address the need of the consumer that exists for a long time in the market and retain the leadership position in their market segment. Consistently companies are failing on this. Today companies invest a good amount of time and effort in building the state-of-the-art manufacturing and best of technologies for the ease of doing business. The core of all these to operate and implement is the people. How many companies are able to invest proactively on people to think better and find ways to retain their position. In my observation, the companies who invest more on people who can think better and come out of their limitation are able to reap the benefits. The neuroscience-based executive coaching consistently gives an ROI (return on investment) from 5 to 42 times based on the situation and ability to monetise and execute the new thinking.
Is Annual Income a Predictor of Completion of Advance Directives (ADs) in Patients With Cancer
Authors: Saeed Fahad , Xing Guibo , Tancredi Daniel J. , Epstein Ronald M. , Fiscella Kevin A. , Norton Sally A. , Duberstein Paul R.
Published: November 2018

Context:

Completion of advance directives (ADs) enhances the likelihood of receiving goal-concordant treatments near the end of life. Previous research on community samples have shown that completion of ADs is less common in lower socioeconomic status demographic group; there is a paucity of such research in patients with cancer.

Objectives:

To study the effect of income and education on the completion of ADs.

Hypothesis:

Patients with cancer having lower incomes and education levels would be less likely to report completing ADs.

Methods:

We conducted cross-sectional analyses of data provided by patients (n = 265) enrolled in the Values and Options in Cancer Care clinical trial. Patients with advanced cancer reported whether they had (1) completed a living will or (2) designated a health-care proxy. Response options for both questions were yes (scored 1), no (scored 0), and unsure (scored 0). We studied the association of lower household income (≤US$20 000) and education level (never attended college) with AD scores.

Results:

Patients with lower annual incomes had lower AD scores (estimate −0.44; confidence intervals [CI]: −0.71 to −0.16, P = .001); the association between higher educational attainment (some college or more) and completion of ADs was not statistically significant (estimate 0.04, CI: −0.16 to 0.24, P = .70).

Conclusion:

Interventions to promote completion of ADs among lower income patients with serious illnesses are needed.
International Licensing of Technology: An Empirical Study of the Differences between Licensee and Non-Licensee Firms
Authors: Atuahene-Gima Kwaku
Published: November 2018

Despite the increasing importance of international licensing as a source of new technology for many firms, limited research has investigated the differences between licensee and non-licensee firms’ characteristics. An analysis of a sample of Australian firms indicates that licensee firms are significantly different from non-licensee firms along management characteristics, management's perceptions of competition in their industry, and of the costs and benefits of licensing. Surprisingly, no statistically significant differences were found between the two types of firms regarding internal capabilities. Implications from these findings are discussed.
Executive Insights: Pan-European Marketing—Myth or Reality
Authors: Halliburton Chris , Hünerberg Reinhard
Published: November 2018

Should firms treat Europe as a single market with standardized marketing, or should national European markets be treated differently? Which aspects of marketing lend themselves to a more Europe-wide or “Pan-European” approach? What is the relevant definition of Europe? Although currently “Pan-European” marketing is more of a myth than a reality, the trends point toward greater integration, therefore companies need to reassess their European marketing strategies and adapt their marketing operations and programs accordingly, using a coherent framework such as the one proposed in this article.
A Conceptual Framework of Export Marketing Information Use: Key Issues and Research Propositions
Authors: Souchon Anne L. , Diamantopoulos Adamantios
Published: November 2018

Information use within an export setting has been neglected in most studies’ they focus instead on the acquisition of information rather than its use. Knowledge use as a topic, however, has been under investigation in the social sciences since the mid-1970s. Various conceptualizations have been developed, and emphasis has been placed upon the multidimensional nature of knowledge use. This article reviews the literatures on export information and general knowledge use, and integrates them into a model of export information use. Specifically, different types of information use are distinguished, their antecedents are identified, and their effect on export decision making and ultimate export success is indicated. A number of propositions to guide further research are also developed.
Executive Insights: The Super Sales Force—Politicians in the World Market
Authors: Dubinsky Alan J. , Hanafy Abdalla
Published: November 2018

Exporting has become a popular means for businesses to augment sales and profitability and for countries to improve their gross domestic product and balance of trade. As a complement to export selling, high-level government officials increasingly are providing export promotional assistance to their nations’ industries. Much of what is known about this “high-level government selling, “ however, is based on conventional wisdom and anecdotal evidence. This article reports the results of a study that examined non-U.S. politicians’ export selling efforts. Data were obtained from surveys of foreign embassy diplomats in the United States. Findings offer insights into what government officials are doing to stimulate sales of their countries’ exports.
Product-Category Dynamics and Corporate Identity in Brand Extensions: A Comparison of Hong Kong and U.S. Consumers
Authors: Han Jin K. , Schmitt Bernd H.
Published: November 2018

Should the focus of a brand-extension strategy be on product-category related factors (e.g., the fit between the extension and the core product) or should consumers’ attention be drawn to characteristics of the company providing the extension (e.g., company size)? Examining this issue experimentally in Hong Kong and in the United States with samples of students and working professionals, we find that for U.S. consumers, perceived fit is much more important than company size; for Hong Kong consumers, company size does not matter for high fit extensions, but does matter for low fit extensions. We suggest the value of collectivism may explain the relative higher importance of corporate identity for East Asian consumers. East Asian consumers rely on companies as interdependent, collective societal entities to reduce the risk of a low fit extension, whereas U.S. consumers— as individualists— place higher importance on their own judgment regarding the product fit rather than cues such as company size.
Executive Insights: Virtual Services Go International: International Services in the Marketspace
Authors: Berthon Pierre , Pitt Leyland , Katsikeas Constantine S. , Berthon Jean Paul
Published: November 2018

The Web overcomes many of the traditional problems inherent in the marketing of international services. In this new era of cyberservice, marketing managers must reappraise their approach to marketing services in general and international services in particular. The defining characteristics of services—intangibility, simultaneity, heterogeneity, and perishability—are a service marketing challenge but can be managed successfully, because the Web is an outstanding tool for mass customization that combines the best of mass production and customization. The authors use a series of exemplary cases to illustrate how international firms can use the Web to enhance the marketing of services across national boundaries. They offer a diagnostic checklist that can be employed to evaluate the effectiveness of a firm's Web site in providing international services.
Ethnic Entrepreneurial and Marketing Systems: Implications for the Global Economy
Authors: Iyer Gopalkrishnan R. , Shapiro Jon M.
Published: November 2018

The role of immigrant ethnic entrepreneurs in the small business milieu of the developed world has been studied within sociology for the past three decades. This article attempts to generate interest in the study of ethnic entrepreneurs within marketing and international business, especially noting the distinct business and marketing systemic features of ethnic entrepreneurial networks. Using prior literature and the findings from a qualitative study, the authors build some elements of a theory of ethnic business systems and demonstrate aspects on which such systems differ from other business firms and networks, especially in the United States. The authors argue that ethnic enterprises make tremendous contributions to local and international economies while bridging small business, globalization, and the nation-state in interesting ways.
Keeping the Flame Lit: The Value of the Long-Term Permanence of a Science Club
Authors: García-Guerrero Miguel , Michel-Sandoval Bertha , Esparza-Manrique Viridiana , Rodríguez-Pinedo Amelia , Raudales-Hernández Vianey , Pliego-Madero Astrid , Bernal-Miranda Dayan , González-Sánchez David , Aranda-Gutiérrez Roberto , Rosales-Valadez Omar , Pérez-Padilla Javier , Patiño-De-Santiago Paulina
Published: November 2018

Science clubs are programs that allow people (especially children and youngsters) to meet regularly outside of school programs and engage with science and technology activities. Clubs encourage participants to foster attitudes, capabilities, and knowledge related to STEM fields with the goal of promoting interest and passion about science. As such programs provide big opportunities to improve the impact of public communication of science activities, it is really important to look at the impacts of such programs. Quark Group runs the Children Science Club since 2002, and up to 2016, it developed science recreation activities with 711 children and young people. In order to establish the influence the club had on its participants, we conducted a survey that provided 244 answers. This article presents the findings of this follow-up study.
How Do Professionals Assess Sexual Recidivism Risk? An Updated Survey of Practices
Authors: Kelley Sharon M. , Ambroziak Gina , Thornton David , Barahal Robert M.
Published: November 2018

Forensic evaluators may be assisted by comparing their use of instruments with that of their peers. This article reports the results of a 2017 survey of instrument use by forensic evaluators carrying out sexual recidivism risk assessments. Results are compared with a similar survey carried out in 2013. Analysis focuses primarily on adoption of more recently developed instruments and norms, and on assessment of criminogenic needs and protective factors, and secondarily, on exploring factors related to differences in evaluator practice. Findings indicate that most evaluators have now adopted modern actuarial instruments, with the Static-99R and Static-2002R being the most commonly used. Assessment of criminogenic needs is now common, with the STABLE-2007 being the most frequently used instrument. Evaluators are also increasingly likely to consider protective factors. While a majority of evaluators uses actuarial instruments, a substantial minority employs Structured Professional Judgment (SPJ) instruments. Few factors discriminated patterns of instrument use.
Competitive position of the expanded Panama Canal in the shipment of liquefied natural gas
Authors: Carral Luis , Tarrío-Saavedra Javier , Crespo-Pereira Diego , Fernández-Campoamor Marina , Sabonge Rodolfo
Published: November 2018

The appearance of new gas extraction technologies has led to surplus production in the United States (Gulf of Mexico). At the same time, energy consumption in Asia has increased significantly and Japan has introduced important changes to its post-Fukushima energy policies. Taken together, these factors have resulted in an imbalance in production and consumption between the Atlantic and Pacific Maritime Areas. Over the same period of time, the Panama Canal expansion opened, permitting transit by liquefied natural gas vessels for the first time. These developments are reflected in the current order book for liquefied natural gas carriers, which is composed entirely of ships in the new Neopanamax category. The canal transit fees and new propulsion systems for these ships—dual fuel diesel electric and electronically controlled gas injection—significantly impact the price of cargo at the destination. This study conducts a sensitivity analysis of the variables for transportation costs in order to determine the expanded Canal’s competitive position. In addition, the study uses a Monte Carlo simulation to obtain the most representative values for total cost based on factors such as the type of propulsion and fuel as well as the distance traveled. The analysis clearly demonstrates the competitiveness of exporting liquefied natural gas via the Panama Canal from terminals in the Gulf of Mexico and the Caribbean to consumers in Asia, as well as the competitiveness of the canal itself versus alternative routes. With respect to propulsion systems, the study demonstrates the greater competitive advantage of electronically controlled gas injection propulsion.
Preschool anxieties: Constructions of risk and gender in preschool teachers’ talk on physical interaction with children
Authors: Åberg Magnus , Hedlin Maria , Johansson Caroline
Published: November 2018

Previous research shows that inexperienced preschool teachers experience anxiety in physical interaction with children. Against this backdrop, this article investigates how student-teachers and newly graduated preschool teachers talk about the risk of being accused of inappropriately touching children. This article is based on interviews with 20 women and men who recently started working in preschools, or who are soon to graduate as preschool teachers. Building on the notion of relational touch, the article shows that concerns over touch involve much more than the physical act itself. Relations among teachers, parents, children, management and policies are actualised in the informants’ narratives, narratives that are also tied to notions of gender and gender equality. The article shows that anxiety over touch is not gender-specific. The concept of relational touch is suggested as a tool to gain a nuanced understanding of the worries that especially newly educated preschool teachers can experience in relation to touch.
Functional optical coherence tomography of retinal photoreceptors
Authors: Yao Xincheng , Son Taeyoon , Kim Tae-Hoon , Lu Yiming
Published: November 2018

Age-related macular degeneration (AMD) is the leading cause of severe vision loss and legal blindness. It is known that retinal photoreceptors are the primary target of AMD. Therefore, a reliable method for objective assessment of photoreceptor function is needed for early detection and reliable treatment evaluation of AMD and other eye diseases such as retinitis pigmentosa that are known to cause photoreceptor dysfunctions. Stimulus-evoked intrinsic optical signal (IOS) changes promise a unique opportunity for objective assessment of physiological function of retinal photoreceptor and inner neurons. Instead of a comprehensive review, this mini-review is to provide a brief summary of our recent in vitro and in vivo optical coherence tomography (OCT) studies of stimulus-evoked IOS changes in animal retinas. By providing excellent axial resolution to differentiate individual retinal layers, depth-resolved OCT revealed rapid IOS response at the photoreceptor outer segment. The fast photoreceptor-IOS occurred almost right away (∼ 2 ms) after the onset of retinal stimulation, differentiating itself from slow IOS changes correlated with inner neural and hemodynamic changes. Further development of the functional IOS instruments and retinal stimulation protocols may provide a feasible solution to pursue clinical application of functional IOS imaging for objective assessment of human photoreceptors.

Impact statement

Retinal photoreceptors are the primary target of age-related macular degeneration (AMD) which is the leading cause of severe vision loss and legal blindness. An objective method for functional assessment of photoreceptor physiology can benefit early detection and better treatment evaluation of AMD and other eye diseases that are known to cause photoreceptor dysfunctions. This article summarizes in vitro study of IOS mechanisms and in vivo demonstration of IOS imaging of intact animals. Further development of the functional IOS imaging may provide a revolutionary solution to achieve objective assessment of human photoreceptors.
A Statistical Analysis of the Influence of Multi-Stage Hot-Drawing on the Overall Orientation of Biodegradable Aliphatic-Aromatic Co-Polyester Fibers
Authors: Younes Basel , Fotheringham Alex , El-Dessouky Hassan M. , Haddad Ghassan
Published: November 2018

Biodegradable as-spun linear aliphatic-aromatic co-polyester (AAC) fibers were processed under a fractional factorial design as a function of hot-drawing conditions using appropriate experimental and statistical methodology. The multi-stage hot-drawing process and overall orientation of the biodegradable AAC fibers were characterized and statistically analyzed. The results obtained showed that the most effective and significant parameters influencing fiber overall orientation are the draw ratio and the drawing temperature. Birefringence is affected positively by draw ratio and plate temperature, and negatively by drawing temperature, the interaction between drawing stage and relaxation temperature, relaxation temperature and the interaction between draw ratio and spin finish. From results and analysis, a combination of factor levels was designed for controlling the birefringence of the material studied using the regression equations obtained. A new forecasting statistical model has been suggested for optimizing the drawing process effect. Such optimized (AAC) fibers could be used in agricultural, horticultural and other textile applications.
An Experimental Study of RC Beams with Varying Concrete Strength Classes Externally Strengthened with CFRP Composites
Authors: Cosgun Turgay
Published: November 2018

It is known that the vast majority of buildings in Turkey are made out of reinforced concrete (RC). The 1999 Kocaeli and Düzce, the 2010 Elaziğ, and the 2011 Van earthquakes that occurred in Turkey revealed that the most significant factor in causing damage to buildings, or their collapse, was the use of low quality concretes, i.e., concretes with low strength values, in their construction This reveals that the load bearing members of these structures should be reinforced against the effects of possible earthquakes. The aim of the present study is to investigate the effect of carbon fiber reinforced polymer (CFRP) usage on the behavior of beams made out of low strength concrete. Within the scope of the study, the results of the experimental and numerical analysis for 14 RC beams, to which CFRP plates were applied on their lower surface, as well as for two reference beams, were presented for the case of collapsing. From the start of the test to the end, load, deflection and deformation data obtained from the beams were collected and then, by the identification of the collapsing mechanism as well as the load-deflection relation, the behavior of the beams was discussed in detail. In the numerical study, moment capacities were obtained for CFRP applied beams with different concrete strength values by using the material properties of the specimens examined in the mechanical test. The results of the numerical analysis were compared with those of the experimental tests, which were found to be consistent with each other.
Two-dimensional preventive maintenance optimum for equipment sold with availability-based warranty
Authors: Su Chun , Cheng Longfei
Published: November 2018

Selecting complex equipment with availability requirements as the object of study, this article investigates an availability-based warranty policy. Under this policy, apart from providing repairs or replacements upon failures, the manufacturer guarantees a negotiated availability level of products during the warranty period. In order to satisfy the availability requirement of the warranted products with rational cost, two-dimensional preventive maintenance strategy is carried out by the manufacturer, which is scheduled by considering the age and usage of the warranted items. By optimizing two-dimensional preventive maintenance strategy, this study aims to meet products’ availability requirement with the lowest cost from the manufacturer’s perspective. Moreover, customized preventive maintenance programs are designed for different customer categories. Finally, we provide a numerical example to verify the effectiveness of the proposed availability-based warranty policy. The results demonstrate that two-dimensional preventive maintenance strategy is superior in terms of warranty cost and operational availability. Meanwhile, customized preventive maintenance policy is more beneficial to both the transaction sides.
Improvements in Thigh Strength Symmetry Are Modestly Correlated With Changes in Self-Reported Function After Anterior Cruciate Ligament Reconstruction
Authors: Pottkotter Kristy A. , Di Stasi Stephanie L. , Schmitt Laura C. , Magnussen Robert A. , Paterno Mark V. , Flanigan David C. , Kaeding Christopher C. , Hewett Timothy E.
Published: November 2018

Background:

The association between quadriceps strength and functional outcomes after anterior cruciate ligament reconstruction (ACLR) is a focus of current research, while evaluations of hamstring strength are limited, despite the frequent use of hamstring autografts.

Purpose/Hypothesis:

The purpose of this study was to determine the relationship between changes in quadriceps and hamstring strength symmetry and self-reported outcomes before ACLR and at 12 and 24 weeks after surgery. We hypothesized that improvements in quadriceps and hamstring strength symmetry would be correlated with improvements in self-reported outcome measures within the first 6 months after ACLR.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Thirty patients who underwent ACLR with a hamstring autograft were enrolled. Quadriceps and hamstring strength and Knee injury and Osteoarthritis Outcome Score (KOOS) values were assessed before and at 12 and 24 weeks after ACLR; limb symmetry indexes for strength were calculated at each time point. The Friedman and Wilcoxon signed-rank tests were used to analyze changes in KOOS values over time. Spearman rank-order correlations were used to test the relationship between changes in strength and KOOS values between each time point.

Results:

Hamstring and quadriceps limb symmetry significantly increased with time ( P ≤ .03). Fair correlations were observed between changes in the hamstring index and changes in the KOOS Symptoms subscore from before surgery to 12 weeks postoperatively ( r = 0.48; P ≤ .05). Changes in the quadriceps index (QI) were moderately correlated with changes in the KOOS Sport/Recreation subscore ( r = 0.60; P = .001), and fair correlations were seen between the QI and the KOOS Quality of Life subscore ( r = 0.39; P ≤ .04) from preoperatively to 12 weeks after surgery. Moderate correlations were seen between the QI and the KOOS Sport/Recreation subscore ( r = 0.57; P = .005) from 12 to 24 weeks after surgery.

Conclusion:

Improvements in quadriceps and hamstring strength symmetry were modestly associated with improvements in athletes’ perceived function in the first 6 months after ACLR. Specifically, improvements in hamstring symmetry were associated with improvements in knee symptoms within the first 12 weeks postoperatively, while improvements in quadriceps symmetry were associated with improvements in self-reported sport function throughout the first 6 months after ACLR. The restoration of strength symmetry within the first 6 months may be a critical component of rehabilitation aimed at maximizing function after ACLR. Further investigation is warranted to comprehensively evaluate whether the timing of strength gains predicts future function, including those who successfully return to their preinjury activity level after ACLR.
Leadership Development Through Change Management: A Neuroscience Perspective
Authors: Kiran C.S. , Tripathi Parul
Published: November 2018

The complex and agile environment in which organisations operate today, with ever-changing technology penetrating every facet of our lives more than ever before, has led to a key challenge for the leaders of today, effectively managing change in organisations. The agile environment means organisations are required to go through changes on a regular basis and at a rapid pace. Today, leaders are required more than ever to understand the complex dynamics of human behaviour in organisations, to effectively navigate and manage change. Recent developments in the field of neuroscience have helped gain a much deeper, scientific understanding of human behaviour. Needless to say, the understanding of these neuroscience perspectives will open up tremendous opportunities for leaders to be more effective at the workplace. The article details a few such perspectives of neuroscience which are critical in change management and concurrent leadership development.
Altered functional connectivity in the fear network of firefighters with repeated traumatic stress
Authors: Jeong Hyeonseok , Park Shinwon , Dager Stephen R. , Lim Soo Mee , Lee Suji L. , Hong Haejin , Ma Jiyoung , Ha Eunji , Hong Young Sun , Kang Ilhyang , Lee Eun Hee , Yoon Sujung , Kim Jieun E. , Kim Jungyoon , Lyoo In Kyoon
Published: November 2018

Background

Firefighters are routinely exposed to various traumatic events and often experience a range of trauma-related symptoms. Although these repeated traumatic exposures rarely progress to the development of post-traumatic stress disorder, firefighters are still considered to be a vulnerable population with regard to trauma.

Aims

To investigate how the human brain responds to or compensates for the repeated experience of traumatic stress.

Method

We included 98 healthy firefighters with repeated traumatic experiences but without any diagnosis of mental illness and 98 non-firefighter healthy individuals without any history of trauma. Functional connectivity within the fear circuitry, which consists of the dorsal anterior cingulate cortex, insula, amygdala, hippocampus and ventromedial prefrontal cortex (vmPFC), was examined using resting-state functional magnetic resonance imaging. Trauma-related symptoms were evaluated using the Impact of Event Scale – Revised.

Results

The firefighter group had greater functional connectivity between the insula and several regions of the fear circuitry including the bilateral amygdalae, bilateral hippocampi and vmPFC as compared with healthy individuals. In the firefighter group, stronger insula–amygdala connectivity was associated with greater severity of trauma-related symptoms (β = 0.36, P = 0.005), whereas higher insula–vmPFC connectivity was related to milder symptoms in response to repeated trauma (β = −0.28, P = 0.01).

Conclusions

The current findings suggest an active involvement of insular functional connectivity in response to repeated traumatic stress. Functional connectivity of the insula in relation to the amygdala and vmPFC may be potential pathways that underlie the risk for and resilience to repeated traumatic stress, respectively.

Declaration of interest

None.
Efficacy variables in patients with cancer versus patients without cancer treated with methylnaltrexone or placebo: An analysis of two placebo-controlled studies.
Authors: Chamberlain Bruce , Rhiner Michelle , Slatkin Neal E , Stambler Nancy , Israel Robert Joseph
Published: November 2018

1

Background: A post-hoc analysis of pooled data from two randomized, double-blind studies and their open-label extensions evaluated whether baseline characteristics and efficacy endpoints differ between cancer and noncancer adults with advanced illness and opioid-induced constipation treated with methylnaltrexone (MNTX) or placebo. Methods: Patients received SC MNTX 0.15 mg/kg or placebo (study 302) and SC MNTX 8 mg (38≤62 kg), 12 mg (≥62 kg), or placebo (study 4,000) every other day for two weeks and received the same doses of MNTX as needed during the first 2 weeks of the open-label extensions. Double-blind populations were stratified by those with/without cancer. Efficacy endpoints included rescue-free bowel movements (RFBMs) within 4 hours after each dose for ≥2 of the first 4 doses; time to rescue-free laxation; rescue laxatives use; and ≥3 RFBMs/week and ≥1 RFBM/week in ≥3 of 4 weeks. Results: Median baseline opioid use (mg/day) was greater in cancer (187.9 placebo [n=114]; 180.0 MNTX [n=116]) versus noncancer patients (80.0 placebo [n=71]; 120.0 MNTX [n=62]). MNTX significantly ( P<0.0001) improved the proportion of cancer (56.9%) and noncancer (58.1%) patients with an RFBM within 4 hours after each dose for ≥ two of the first four doses versus placebo (5.3% cancer; 11.3% noncancer). Median time to laxation was significantly ( P≤0.0002) shorter in cancer (0.96 hours) and noncancer (1.25 hours) patients 24 hours after the first dose of MNTX versus placebo (22.53 and >24 hours, respectively). Rescue laxatives were used by 39.7% of cancer and 30.6% of noncancer MNTX patients versus 51.8% of cancer and 39.4% of noncancer placebo patients. Of 108 open-label extension double-blind MNTX patients, 79 (73.1%) achieved ≥3 RFBMs/week with ≥1 RFBM/week increase in ≥ three of four weeks versus 48 (46.6%) of 103 double-blind placebo patients (data from double-blind and first two weeks of open-label). Conclusions: MNTX treatment improved the laxation response, with a faster onset of laxation in patients with and without cancer, and reduced the need for rescue laxatives vs placebo. Improvements over placebo continued into the first two weeks of the open-label extensions for MNTX-treated patients. Clinical trial information: NCT00672477, NCT00402038.
Palliative inpatient radiation therapy: The challenge of treatment non-completion.
Authors: Kuo Jeffrey V. , Daroui Parima , Farol Hanako Y. , Sehgal Varun , Ramsinghani Nilam S.
Published: November 2018

106

Background: By virtue of their disease acuity and symptom burden, inpatients are good candidates for radiation therapy but may also be at risk of not benefitting from treatment due to premature treatment discontinuation or early demise. The current study describes the inpatient radiation therapy experience at an academic medical center. Methods: Patients receiving palliative radiotherapy in the hospital at any point in their care form the study population. Dose prescriptions were determined on an individual basis by the faculty radiation oncologist. Brachytherapy, IORT, and radiosurgery cases were excluded. Descriptive data was aggregated for analysis. Results: 315 courses given to 275 inpatients between January 2013 and September 2017 form this analysis. Mean age was 56.5 yrs. 96% began as inpatients. The top hospitalization indications were pain (32%), neurological symptoms (9%), and dyspnea (7%). The top treatment indications were spinal metastases (34%), brain metastases (21%), and non-spine bone metastases (12%). The estimated median survival of the entire group was 8.9 wks (range <1 – 189). Ten courses were given during the terminal hospitalization. The overall rate of treatment non-completion was 18%. Non-completion and survival figures for the most common indications provided. Spine treatments in which shorter courses predominated had a non-completion rate (12%) that was lower than for the overall group. The rate of treatment non-completion was particularly high for brain metastases (28%). Conclusions: Hospitalized patients receiving palliative radiation therapy carry a poor prognosis. Their significant symptom burden and limited life expectancies place them at risk for treatment non completion. While short courses developed for spine irradiation are associated with lower non-completion rates, longer courses seen as appropriate for brain irradiation are associated with particularly high non-completion rates.[Table: see text]
Complementary and integrative medicine use for individuals seeking conventional medical oncology care in Chile: Prevalence and patient characteristics.
Authors: Lopez Gabriel , Salas Claudio Alejandro , Cadiz Fernando , Barriga Carolina , Gonzalez Pilar , Acevedo Sandra , Raimilla Patricia , Pincheira Pia , Naing Aung , Quiroga Marta
Published: November 2018

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Background: Complementary and integrative medicine (CIM) use during cancer care has increased in western medical settings. Little is known about interest in and use of CIM approaches by oncology patients in South America. Methods: Patients presenting for conventional outpatient or inpatient medical oncology care at the Clinica Alemana in Santiago, Chile (March-June, 2017) were asked to complete a survey about their interest in and use of CIM approaches. Goals included determining prevalence of CIM use and exploring associations between CIM use and patient characteristics. Statistical analyses included two-tailed t-test for continuous variables, Fischer’s exact test for categorical variables, and logistic regression for association between CIM use and other variables. Results: Of 432 patients surveyed, 66.7% had a diagnosis of breast cancer, 84.8% were women, the majority between ages 40-60 (32.7%). Of those surveyed, 221 (51.5%) reported CIM use. No association was found between CIM use and sociodemographic variables (sex, age, education, income). Patients with breast cancer (44.6%) reported CIM use, compared to 64.8% of other cancer types (p=0.0001). Most commonly reported CIM types used included herbals (49.1%), vitamins/minerals (40.8%), prayer/meditation (40.4%), and special diets (38.5%). Most frequent reasons for CIM use included “do everything possible” (72%), “improve my immune function” (67.8%), “reduce treatment related side effects” (32.7%), and “recommended by family/friend” (32.7%). Most (43.4%) reported starting CIM use at the time of cancer diagnosis, with only 55.4% sharing information regarding CIM use with their medical team. Majority reported benefits from CIM use (60%). No differences were observed in self-reported quality of life between those using versus not using CIM. Conclusions: The majority of patients receiving conventional oncology care reported engaging in CIM use, with just over half of users communicating with their oncology team about their CIM use. Increased awareness of regional differences in CIM use may help increase communication regarding this topic and contribute to improved outcomes.
Discontinuation of poly(adenosine diphosphate-ribose) polymerase inhibitors due to adverse events in patients with recurrent ovarian cancer: A meta-analysis of three phase III trials.
Authors: Thein Kyaw Zin , Sultan Anita , Zaw Myo , Swarup Sriman , Han Myat M. , Myat Yin Mon , Jones Catherine , Hardwicke Fred L. , Awasthi Sanjay
Published: November 2018

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Background: Ovarian cancer is the fifth leading cause of cancer-related death among women. Poly adenosine diphosphate ribose polymerase (PARP) inhibitors maintenance has shown to improve survival in patients with recurrent ovarian cancer. Yet, there are notable adverse events which led to treatment discontinuation, interruption, or dose reduction. We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of PARP inhibitors discontinuation due to adverse events. Methods: MEDLINE, EMBASE databases and meeting abstracts from inception through June 2018 were queried. Phase III RCTs which employed PARP inhibitors maintenance in ovarian cancer and mentioned treatment interruption, dose reduction and treatment discontinuation due to adverse events were included. Mantel-Haenszel (MH) method was used to calculate the estimated pooled risk ratio (RR) with 95% confidence interval (CI). Random effects model was applied. Results: Three phase III RCTs with a total of 1,401 patients with recurrent ovarian cancer were eligible. The study arm used olaparib or niraparib or rucaparib while the control arm utilized placebo. The randomization ratio was 2:1 in all studies. The incidence of treatment interruption due to adverse events was 578 (61.8%) in study group versus 46 (9.8%) in control arm. The relative risk for treatment interruption was statistically significant at 5.87 (95% CI: 2.24 – 15.36, P < 0.001). The reduction in dose was reported in 496 (53.1%) in PARP inhibitors arm versus 37 (7.9%) in control group. The pooled RR for dose reduction was 7.49 (95% CI: 3.44 – 16.29, P < 0.001). The treatment discontinuation rate was 11.4% higher with PARP inhibitors than with control arm (RR - 6.84; 95% CI: 3.51 – 13.34, P < 0.001). Conclusions: Our study showed that patients on PARP inhibitors experienced some adverse events which led to significant drop outs although the definitive advantage to PARP inhibitors is still shown in the studies. Preemptive measures with proper supportive care will aide in reducing those toxicities, improve patients’ quality of life and may probably affect patients’ compliance.
Hospice palliative care program management, setup, and operation with a national pilot study in Haidian, Beijing.
Authors: Zhang Zetao , Zhu Yi , He Zhaoping , He Yuling , Wang Naning , Zhao Jianping
Published: November 2018

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Background: In 2016, an inpatient hospice palliative care ward was initiated in Beijing Haidian Hospital, which was the first pilot study program in Beijing. Challenges of implementing the program and the process to facilitate change in the hospital’s and society culture in China. Methods: This program has been partnered with Ovation Health International and Hospice Palliative Care Alliance of China Foundation at beginning of the program development in order to streamline the program design and establish standard operating procedures. The program was operated by a multi-disciplinary team which is the first of these kinds of team structure in Chinese health system, including the program manager, physicians, nurses, social workers, psychologic counsellors, chaplains, and volunteers. Results: The program has served over 200 patients and their families in the first year. The inpatient hospice unit has 2 specially decorated rooms with 6 in-patient beds, a meeting room, and a farewell room. The program has expanded its palliative care counselling service to the entire hospital and affiliated community nursing homes and will plan to expand the number of beds to 20 in the inpatient hospice unit. The implementation of the program has been full of obstacles, encompassing the lack of trained professionals, limited financial resources, higher staff turnover, and professional misunderstanding and public rejection. Now upgraded to a National Pilot model of China, the trial program team led by the program manager, has overcome core barriers/challenges in team building, team enablement, resource supporting, public education, and society awareness to keep the program growth. Conclusions: The lessons learned from the experience of developing the first hospital-based hospice palliative care program in the capital of China will be presented. Particularly, barriers and challenges, both modifiable and non-modifiable, will be shared as well as facilitating factors. The authors will share the pathway to partner across disciplines, with policy makers, and in research, education, and practice. This helps the team in the creation of new knowledge and in continuing to establish the evidence-based value of palliative care in China.
Oncology fellows' current practice regarding concurrent outpatient oncology and palliative care.
Authors: Johnson Amy , Fettig Lyle , Newton Erin V. , Comer Amber
Published: November 2018

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Background: It is accepted that Palliative Care provides additional support and improves overall care to oncology patients. Literature supports early referral and integration of Palliative Care with standard oncology care and is a guideline from the American Society of Clinical Oncology. In order to make palliative care integration a standard of care, Oncology Fellows should be learning to integrate during their fellowship years. There is little information regarding the Palliative Care experience in the outpatient setting for Oncology Fellows in the United States. This study looked at the current practice model in regards to concurrent Oncology and Palliative Care in the outpatient setting. Methods: An electronic nationwide survey of medical Oncology Fellows was conducted in the second half of the academic year in 2018. Results: 43 of 191, 22.5% Fellows contacted at 17 institutions responded. 98% of the fellows’ hospital systems offered ambulatory palliative care with 79% having a palliative care specialist available during their ambulatory Oncology clinic. 55% of the Fellows’ patient referrals are occurring when they still have multiple lines of cancer directed treatment planned, and the most common initial referral reason is for symptom management. 97% of fellows agree or strongly agree that it is appropriate to refer patients to ambulatory Palliative Care while patients are still undergoing active cancer treatment. 95% indicate they would strongly agree or agree with having a Palliative Care team in their future outpatient clinics. Although no participants stated their initial consult request was for psychosocial and/or spiritual support, 95% strongly agreed or agreed that Palliative Care helps ensure these issues are addressed. Conclusions: Early integration of Palliative Care is occurring in the 17 responding institutions around the country as 97% of Fellows agree or strongly agree that it is appropriate to refer patients to ambulatory Palliative Care while patients are still undergoing active cancer treatment. 95% of oncology fellows indicate they would strongly agree or agree with having a Palliative Care team in their future outpatient clinics.
Correlation of demographic factors with length of treatment and survival in a palliative radiation oncology population.
Authors: Hertan Lauren Michelle , Nichipor Alexandra , Khouj Yaseer Mohammed , Zaslowe-Dude Cierra , Balboni Tracy A. , Krishnan Monica Shalini
Published: November 2018

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Background: Radiation is often used to palliate symptoms in patients with advanced cancer and the number of fractions used can vary significantly from as short as a single fraction (SF) to up to a multiple week course. No data currently exists regarding demographic factors and their influence on survival and fractionation decisions. The aim of this project is to investigate the association of demographic factors with survival, likelihood of SF use in patients (pts) receiving RT for bone metastases, and likelihood of hypofractionation (HF) (≤ 5 fx) in pts being treated for any palliative reason, excluding those receiving partial brain RT (PBRT) which includes stereotactic radiosurgery, and stereotactic radiation therapy. Methods: We retrospectively reviewed charts of pts treated with palliative RT between 1/2015 – 5/2017 at 2 tertiary centers and 4 community satellite practices. Demographic factors analyzed are included in table 1. Logistic regression was used to evaluate the associations between the factors and outcomes. Results: A total of 928 pts were included in the survival analysis. In the two subset analyses, 373 pts were included in the bone metastasis analysis and 745 were included in the analysis of all patients excluding pts receiving PBRT. In pts treated for bone metastases, consult type (inpatient vs. outpatient) was the only significant factor on multivariate analysis, with inpatient consults being more likely to get SF (HR = 2.169, =.025). In the pts receiving palliative RT (excluding PBRT), race and consult location (tertiary vs. community) were significant. Non-white pts (HR=0.527, p=.012) and pts treated in the community (HR=.778, p<.001) were less likely to get HF. Gender (male vs. female), consult location (tertiary vs. community), and consult type (inpatient vs. outpatient) were significant on multivariate analysis for survival (HR=1.243, p=.028; HR=1.602, p<.001; HR=2.301, p<.001, respectively). Conclusions: This analysis suggests that demographic factors may affect both survival and decision making regarding fractionation in patients receiving palliative radiation. Further investigation into the reasons for these differences is needed.