bluuebunny/crossref_metadata_2025 huggingface dataset:
Expectations and needs of relatives of critically ill patients in the emergency department
Authors: Ocak Umut , Avsarogullari Levent
Published: September 2018

Background:

The care of critically ill patients is a strong indicator of service quality provided in the emergency department. Since families are the major social support sources, assessing the family members’ needs may reduce their anxiety and depression owing to the acute situation of their loved ones while improving the patients’ recovery.

Objective:

We aimed to evaluate the expectations and needs of relatives of critically ill patients to formulate solutions to improve the quality of emergency department service.

Methods:

We conducted a prospective, cross-sectional survey of 873 relatives of nontraumatic, critically ill patients who completed the Turkish version of the Critical Care Family Needs Inventory in the emergency department of a university hospital in Turkey. The needs statements were evaluated under five subheadings: meaning, proximity, communication, comfort, and support.

Results:

In total, 249 (28.5%) participants were females and 624 (71.5%) were males (mean age, 41.79 years). The “meaning” category was given the highest priority, followed by “communication,” with average points of 3.75 and 3.57, respectively. The most important needs were being informed regularly about the patient’s condition and being assured that the patient is under the best possible care, whereas personal, physical, and emotional needs were the least important.

Conclusion:

Relatives of critically ill patients primarily focus on the quality of patients’ care. Creating a positive rapport based on trust and providing a healthcare environment where the expectations and needs of relatives are met should be prioritized by emergency department physicians, nurses, and other staff while caring for critically ill patients.
On Exploring Hidden Structures Behind Cervical Cancer Incidence
Authors: Lietzén Niko , Pitkäniemi Janne , Heinävaara Sirpa , Ilmonen Pauliina
Published: September 2018

Finding new etiological components is of great interest in disease epidemiology. We consider time series version of invariant coordinate selection (tICS) as an exploratory tool in the search of hidden structures in the analysis of population-based registry data. Increasing cancer burden inspired us to consider a case study of age-stratified cervical cancer incidence in Finland between the years 1953 and 2014. The latent components, which we uncover using tICS, show that the etiology of cervical cancer is age dependent. This is in line with recent findings related to the epidemiology of cervical cancer. Furthermore, we are able to explain most of the variation of cervical cancer incidence in different age groups by using only two latent tICS components. The second tICS component, in particular, is interesting since it separates the age groups into three distinct clusters. The factor that separates the three clusters is the median age of menopause occurrence.
Financial impact from in-office dispensing of oral chemotherapy
Authors: Howard Anna , Kerr Julia , McLain Monica , Modlin Jessie
Published: September 2018

Background

Oral chemotherapy agents are being prescribed more frequently in many cancer types. In-office dispensing of oral chemotherapy agents has demonstrated clinical benefits and also shown financial benefit to third-party payers. A previous publication estimated over $200,000 in cost savings annually from in-office dispensing solely from medications returned to stock for credit. However, pharmacists in the in-office setting perform many other interventions that may affect financial outcomes.

Objective

Assess financial impact of oral chemotherapy in-office dispensing by a clinic-based oral chemotherapy program serving five outpatient cancer centers in Southern Idaho. Outcomes include calculated monetary waste and cost avoidance of oral chemotherapy prescriptions from in-office dispensing and mail-order pharmacies.

Methods

Prescriptions received by the clinic-based oral chemotherapy program for filling through in-office dispensing and mail-order pharmacies were monitored for monetary waste and cost avoidance events from December 2016 through May 2017. Information was collected on the number of returned medications, therapy discontinuations, and dose adjustments. Monetary outcomes were calculated using average wholesale price.

Results

During the six-month evaluation, prescriptions filled through in-office dispensing had a total cost avoidance of $1,020,193 ( n = 154) and total waste of $154,985 ( n = 36) resulting in an estimated net cost avoidance annually of $1,730,416. Prescriptions filled through mail-order had a total cost avoidance of $20,497 ( n = 4) and a total waste of $80,394 ( n = 15) resulting in an estimated $119,794 net annual waste.

Conclusions

In-office dispensing of oral chemotherapy provided significant cost savings to third-party payers compared to mail-order pharmacy dispensing. Continued evaluation may help further justify the importance and value of in-office dispensing.
Polymyalgia rheumatica due to pembrolizumab therapy
Authors: Iskandar Andrew , Hwang Andrew , Dasanu Constantin A
Published: September 2018

Pembrolizumab is a humanized anti-programmed cell death 1 antibody used for the therapy of several malignancies. While autoimmune adverse events are not uncommon with this agent, they are typically mild and self-limiting. Severe autoimmunity is rare but can be life-threatening. Herein, we describe a unique case of severe proximal muscle weakness and joint pain shortly after beginning therapy with pembrolizumab. Work-up revealed elevated pro-inflammatory markers leading to the diagnosis of polymyalgia rheumatica. Steroids allowed for resolution of the joint pain. We call for awareness of this rare autoimmune toxicity with pembrolizumab.
Plant synthetic biology could drive a revolution in biofuels and medicine
Authors: Mortimer Jenny C
Published: September 2018

Population growth, climate change, and dwindling finite resources are amongst the major challenges which are facing the planet. Requirements for food, materials, water, and energy will soon exceed capacity. Green biotechnology, fueled by recent plant synthetic biology breakthroughs, may offer solutions. This review summarizes current progress towards robust and predictable engineering of plants. I then discuss applications from the lab and field, with a focus on bioenergy, biomaterials, and medicine.

Impact statement

The plant synthetic biology field has exploded in the last five years, in part driven by techniques such as CRISPR and cheap DNA synthesis. This review summarizes the current state of research in plant synthetic biology, and how it is being applied to two topics: renewable fuels and chemicals, and medicine.
Social interactions in traffic: The effect of external factors
Authors: Stoll Tanja , Strelau Nadine-Rebecca , Baumann Martin
Published: September 2018

Social interactions were always part of the driving task, but the introduction of vehicle-to-vehicle and vehicle-to-infrastructure communication opens up new possibilities for cooperative interactive driving. It enables drivers to coordinate their maneuvers cooperatively with other involved traffic users. To ensure drivers’ acceptance of such automated systems it is necessary to understand the underlying mechanisms of human cooperation in traffic. In this experiment, we investigate potential influencing factors on the willingness to behave cooperatively in a lane change situation on a highway. In a video-based study, we manipulated the costs of cooperation, the situation’s criticality for the lane-changing vehicle and the way in which the intention to change the lane was indicated. Cooperative behavior is influenced by lower costs, a higher situation’s criticality and by signaling the intention to lane change. These results offer insights that may be used in the developing process of Human Machine Interfaces (HMI) for cooperatively interacting vehicles
A Systematic Review of Communication in Distributed Crews in High-Risk Environments
Authors: Rockwood Justine , Nathan-Roberts Dan
Published: September 2018

Effective communication is critical to team performance but can be impacted by the distribution of team members. Distribution is increasingly found in high-risk environments where task complexity necessitates geographic and/or temporal separation of team members. Understanding the impact of distribution on communication is critical to ensuring effective team performance. We review the research examining communication in distributed teams in high-risk environments to provide an overview of the literature to date. Articles examining communication in distributed teams were analyzed in a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Themes relevant to the research question were extracted from the studies using thematic analysis. Five themes were identified: updating shared mental models, effects of transmission lags, content of communication, communication protocols, and technological advances. The five themes identify directions for future research.
Time Pressure and Teams: Contextual Factors Influencing Task Experience when Using a Cognitive Aid
Authors: Hicks W. Braxton , Pryor Mak , Sprufera John , Greene Amy , Byrne Vicky , McLaughlin Anne Collins
Published: September 2018

Guidelines are needed to help designers create cutting-edge cognitive aids for complex procedures, particularly when those aids support non-expert operators. To create guidelines, the factors that might interact with the aid design need be explored with non-experts, such as time pressure and the number of operators. We manipulated time pressure and number of team members in setting up a medical ventilator while using a cognitive aid. We measured dependence on the aid, performance, subjective workload, and team dynamics to better understand their influence on the use of a cognitive aid to accomplish a complex task by non-expert operators. Individuals reported a significantly higher mental workload level than teams and those under time pressure reported higher temporal workload. These data can contribute to design guidelines.
Attack, Damage and Carry: Role Familiarity and Team Performance in League of Legends
Authors: Eaton Joshua A. , Mendonça David J. , Sangster Matthew-Donald D.
Published: September 2018

Objective: This research studies the impact of role familiarity on team performance by examining performance of the “Carry” role in the Multi-player Online Battle Arena gaming environment, League of Legends™. Background: Roles are typically defined as stable patterns of expectations, relationships, and behaviors. As social constructs, roles therefore include notions of status, relationships with additional social actors, and of defined sets of behaviors tied to the assigned role. We hypothesize that the importance of role familiarity in teams is mediated by the nature and extent of team members’ experience working together in defined roles. Methods: The data set used for this study is from League of Legends’ Application Program Interface and consists of ranked match play from 2011–2016. Results: ANOVA and visualization techniques are used to explore match-level data in order to address the proposed research questions. The proportion of time the same team member is assigned to the “Carry” role (role familiarity) has a direct and positive impact on team performance. Conclusions: This study shows how objective, detailed data on teamwork may be used to provide insights into questions of the composition and performance of teams. Additionally, the results illustrate the importance of role familiarity in the performance of teams. Application: This research highlights the value and feasibility of studying virtual teams for new insights into team performance.
Automation Reliability and Decision Strategy: A Sequential Decision Making Model for Automation Interaction
Authors: Acharya Aditya , Howes Andrew , Baber Chris , Marshall Tom
Published: September 2018

The question of how people make use of automation to support their decision making is becoming increasingly important. As computers provide ever greater input to the collection, analysis and interpretation of data, so they are more likely to be partners in decision making. However, when automation makes recommendations that the human disagrees with or that might be based on erroneous analysis, then this could result in a change in decision strategy. It is not simply a matter of ignoring or rejecting the recommendation but rather a matter of deciding how best to make use of the automation’s output. By modeling information search and decision strategies under different levels of information reliability, we demonstrate that it makes sense to adapt decision strategy to the information context.
Improved Monitoring Performance of Financial Trading Algorithms Using a Graphical Display
Authors: Li Yeti , Wang Xian , Burns Catherine M.
Published: September 2018

Ecological Interface Design (EID) has been applied to financial trading to derive graphical forms from work analysis models to improve monitoring performance. Automated trading requires contextual support for monitoring algorithm failures, and we designed a graphical, hybrid display inspired by EID to provide such support. We report a two-stage experiment involving a pilot study and a formal study to evaluate the hybrid display with participants who have a basic understanding of computer algorithms. The pilot study used an initial version of the trading algorithm. The formal study used similar apparatus but a modified algorithm. Results showed that the hybrid display provided better support than the conventional display for detecting algorithm failures only when the contextual support provided by the conventional and the representational visualizations was consistent. Further, we discuss the compatibility issue in designing hybrid displays.
Explaining Explanation For “Explainable Ai”
Authors: Hoffman Robert R. , Klein Gary , Mueller Shane T.
Published: September 2018

What makes for an explanation of “black box” AI systems such as Deep Nets? We reviewed the pertinent literatures on explanation and derived key ideas. This set the stage for our empirical inquiries, which include conceptual cognitive modeling, the analysis of a corpus of cases of "naturalistic explanation" of computational systems, computational cognitive modeling, and the development of measures for performance evaluation. The purpose of our work is to contribute to the program of research on “Explainable AI.” In this report we focus on our initial synthetic modeling activities and the development of measures for the evaluation of explainability in human-machine work systems.
The Effects of Cue Utilization and Target-Related Information on Target Detection during a Simulated Drone Search and Rescue Task
Authors: Shekh Shaheen , Auton Jaime C. , Wiggins Mark W.
Published: September 2018

Remotely piloted vehicles or ‘drones’ have become ubiquitous both privately and commercially. One of the numerous applications for drones involves the search and rescue for specified targets. The use of ‘cues’ during target detection has been shown to improve performance and reduce cognitive demands in many environments. This study examined the relationship between cue utilization and level of target detail during a high-fidelity simulated drone search and rescue task. Seventy-six undergraduate students from an Australian University operated a payload (long range camera) to detect a ‘target’ (a bus driver stranded in the Utah desert) while flying on a pre-programmed flight path. The results indicated that the provision of detailed target information was associated with greater rates of target detection. Further, participants with higher cue utilization were more likely to locate the target. Finally, participants with higher cue utilization, and provided with basic target information, were more likely to locate the target than participants with lower cue utilization. The practical and theoretical implications of the outcomes are discussed.
Cognitive and Affective Eye Tracking Metrics for Detecting Insider Threat: A Study of Simulated Espionage
Authors: Matthews Gerald , Wohleber Ryan , Lin Jinchao , Reinerman-Jones Lauren , Yerdon Valarie , Pope Nathanael
Published: September 2018

Insider Threat (IT) is a growing cybersecurity issue. Countermeasures based on cognitive engineering may utilize diagnostic eye fixation responses indicative of insider intent, elicited by Active Indicator Probes (AIPs). The current study embedded AIPs into an immersive simulation of espionage activities. Participants allocated to an insider role were required to monitor building images for cues to a terrorist person-of-interest, and communicate information to an external handler. Control participants performed matched normal work. Findings confirmed a previous finding that ITs show fixation responses suggestive of strategic concealment of interest. They also showed heightened attention to communications from their local controller. These results may contribute to identification of possible ITs for further screening.
Developing an Optimized UI for Traffic Incident Managers
Authors: Helgerson Andrina , Walton Jamiahus , Loya Celia , Kawell Christopher , Atwell Katherine , Monaghan Quinn , Ahuja Lakshay , Hassan Hesham , Gilbert Stephen B. , Sharma Anuj
Published: September 2018

Traffic Incident Managers (TIMs) coordinate first responders and help resolve traffic-related incidents. Currently, some use over fifteen different software applications with unique functionalities across three monitors to manage incidents, leading to redundant data entry, unnecessary task switching, and delayed responses. 40 hours of TIMs’ screens were recorded during their normal work hours at the Iowa Department of Transportation (DoT). The resulting task analysis from these videos greatly influenced the design of a simplified, web-based, user interface (UI) prototype. The new UI offers a 42.9% reduction in the steps required to manage an incident by combining the functionality of the fifteen different applications used in the existing system into a single, structured UI. This research approach offers a UI model to other DoTs that can lead to faster and more effective incident management.
Real World Strategies to Achieve Human Factors Integration
Authors: Josias Liza , Demagalski Jason , Donovan Sarah-Louise , Joy Rivera A. , Won James C.
Published: September 2018

Integrating human factors (HF) into organizational practices has long been one of the profession’s goals. Despite research that demonstrates the benefits of early HF integration, many organizations still resist or omit its inclusion in design and change management activities. The resistance is due to several reasons, including a lack of awareness of the field and misunderstandings about what the field encompasses. In this discussion panel, HF practitioners from different industries discuss effective as well as ineffective strategies for integrating HF into design and change management activities. The audience will gain relevant and applicable knowledge for improving HF integration into their organizations and industries.
A single acoustic beacon-based positioning method for underwater mobile recovery of an AUV
Authors: Zhou Ziye , Jiang Yanqing , Li Ye , Jian Cao , Sun Yeyi
Published: September 2018

This article presents a navigation method for an autonomous underwater vehicle being recovered by a human-occupied vehicle. The autonomous underwater vehicle is considered to carry underwater navigation sensors such as ultra-short baseline, Doppler velocity log, and inertial navigation system. Using these sensors’ information, a navigation module combining the ultra-short baseline positioning and inertial positioning is established. In this study, there is assumed to be no communication between the autonomous underwater vehicle and human-occupied vehicle; thus, to obtain the autonomous underwater vehicle position in the inertial coordinate, a conjecture method to obtain the human-occupied vehicle coordinates is proposed. To reduce the error accumulation of autonomous underwater vehicle navigation, a method called one-step dead reckoning positioning is proposed, and the one-step dead reckoning positioning is treated as a correction to combine with ultra-short baseline positioning by a data fusion algorithm. One-step dead reckoning positioning is a positioning method based on the previous time-step coordinates of the autonomous underwater vehicle.
Work in the age of collaborative platforms between innovation and tradition
Authors: Delfino Massimiliano
Published: September 2018

Starting from the Uber ruling of the Court of Justice of 20 December 2017 this paper tries to demonstrate how innovation in the gig economy or collaborative economy does not change the basic issues of labour law but rather requires a greater adaptation of these issues to the new digital context. The principal issue is the classification of the platform company’s providers, which follows the traditional distinction between self-employment and the dependent work relationship. At the root of that classification there are still ‘hetero-direction’ and the employer’s prerogatives, although they can assume a different and more complex physiognomy in the digital age.
Examining patterns in opioid prescribing for non-cancer-related pain in Wales: preliminary data from a retrospective cross-sectional study using large datasets
Authors: Davies Emma , Phillips Ceri , Rance Jaynie , Sewell Berni
Published: September 2018

Objectives:

To examine trends in strong opioid prescribing in a primary care population in Wales and identify if factors such as age, deprivation and recorded diagnosis of depression or anxiety may have influenced any changes noted.

Design:

Trend, cross-sectional and longitudinal analyses of routine data from the Primary Care General Practice database and accessed via the Secure Anonymised Information Linkage (SAIL) databank.

Setting:

A total of 345 Primary Care practices in Wales.

Participants:

Anonymised records of 1,223,503 people aged 18 or over, receiving at least one opioid prescription between 1 January 2005 and 31 December 2015 were analysed. People with a cancer diagnosis (10.1%) were excluded from the detailed analysis.

Results:

During the study period, 26,180,200 opioid prescriptions were issued to 1,223,503 individuals (55.9% female, 89.9% non-cancer diagnoses). The greatest increase in annual prescribing was in the 18–24 age group (10,470%), from 0.08 to 8.3 prescriptions/1000 population, although the 85+ age group had the highest prescribing rates across the study period (from 149.9 to 288.5 prescriptions/1000 population). The number of people with recorded diagnoses of depression or anxiety and prescribed strong opioids increased from 1.2 to 5.1 people/1000 population (328%). The increase was 366.9% in areas of highest deprivation compared to 310.3 in the least. Areas of greatest deprivation had more than twice the rate of strong opioid prescribing than the least deprived areas of Wales.

Conclusion:

The study highlights a large increase in strong opioid prescribing for non-cancer pain, in Wales between 2005 and 2015. Population groups of interest include the youngest and oldest adult age groups and people with depression or anxiety particularly if living in the most deprived communities. Based on this evidence, development of a Welsh national guidance on safe and rational prescribing of opioids in chronic pain would be advisable to prevent further escalation of these medicines.

Summary points

This is the first large-scale, observational study of opioid prescribing in Wales. Over 1 million individual, anonymised medical records have been searched in order to develop the study cohort, thus reducing recall bias. Diagnosis and intervention coding in the Primary Care General Practice database is limited at input and may lead to under-reporting of diagnoses. There are limitations to the data available through the Secure Anonymised Information Linkage databank because anonymously linked dispensing data (what people collect from the pharmacy) are not currently available. Consequently, the results presented here could be seen as an ‘intention to treat’ and may under- or overestimate what people in Wales actually consume.
The Effect of N-Acetylcysteine on Creatinine Measurement: Protocol for a Systematic Review
Authors: Huang Johnny W. , Clarkin Owen J. , McCudden Christopher , Akbari Ayub , Chow Benjamin J. W. , Shabana Wael , Kanji Salmaan , Davis Alexandra , Hiremath Swapnil
Published: September 2018

Background:

N-acetylcysteine (NAC) is an antioxidant which can regenerate glutathione and is primarily used for acetaminophen overdose. It is also a potential therapy to prevent iatrogenic acute kidney injury or slow the progression of chronic kidney disease. It has been considered in this context by many studies with mixed results. Notably, a biological-mechanism rationale for a protective effect of NAC has never been adequately reported. Among conflicting reports, there appears to be evidence that NAC may artificially lower measured serum creatinine without improving kidney function, potentially by assay interference. Given these mixed results, a systematic review of the literature will be conducted to determine whether there is an effect of NAC on kidney function measured with serum creatinine.

Objective:

To determine the effect of NAC on kidney function.

Design:

A systematic review and meta-analysis.

Settings:

Prospective studies, with administration of NAC, in the absence of any other change in kidney function (such as contrast administration or surgery).

Patients:

Adult humans aged 18 years old or more, either healthy volunteers or with chronic kidney disease, were administered with NAC. Populations having little to no kidney function such as in end-stage kidney disease will be excluded.

Measurements:

Serum creatinine and/or cystatin C measurements before and after NAC administration.

Methods:

An information specialist will assist in searching MEDLINE, EMBASE, and the Cochrane CENTRAL databases to identify all study types including randomized controlled trials, and prospective cohort studies reporting change in serum creatinine after NAC administration. Two reviewers will independently screen the titles and abstracts of the studies obtained from the search using predefined inclusion criteria and will then extract data from the full texts of selected studies. The weighted mean difference will be calculated for change in creatinine with NAC, using random-effects analysis. Quality assessment will be done with the Cochrane Risk of Bias tool for randomized trials and the Newcastle-Ottawa Scale for observational studies.

Results:

The outcome of interest is kidney function as reported by either change in serum creatinine and/or serum cystatin C measurement for randomized trials or comparing baseline (pre-NAC dose) values and those following the NAC dose.

Limitations:

Possible heterogeneity and publication bias and lack of mechanistic data.

Conclusions:

This systematic review will provide a synthesis of current evidence on the effect of NAC on serum creatinine measurement. These findings will provide clinicians with guidelines and serve as a strong research base for future studies in this field.

Systematic review registration:

This review is registered with PROSPERO, CRD42017055984
Low Potency of Indian Dust Mite Allergen Skin Prick Test Extracts Compared to FDA-Approved Extracts: A Double-Blinded Randomized Control Trial
Authors: Christopher Devasahayam J. , Ashok Narmada , Ravivarma Aruna , Shankar Deepa , Peterson Erik , Dinh Phuong T. , Vedanthan P. K.
Published: September 2018

Background

Skin prick testing is the most important diagnostic tool to detect immunoglobulin E-mediated allergic diseases. With increase in the number of allergy tests performed in India, it is imperative to know the potency of indigenous extracts in comparison with U.S. Food and Drug Administration (USFDA)-approved extracts.

Methods

A randomized comparison trial of Indian manufactured and USFDA-approved extracts of Dermatophagoides pteronyssinus (DP) and Dermatophagoides farinae (DF) was done at Christian Medical College & Hospital, Vellore, India from April 2014 to June 2015, to compare the skin test reactivity of indigenous allergen extracts of dust mites against validated allergen. Study enrollment included 197 patients with allergic disorders that showed sensitivity to dust mite during routine allergy skin testing. Study participants were tested with varying dilutions of DP and DF indigenous extracts along with USFDA-approved allergens in a blinded fashion. Results were recorded, and statistical significance was calculated using the Friedman rank sum test.

Results

Using the Friedman rank sum test with a Tukey adjustment for multiple comparisons, we found that the extracts in each dilution were significantly different ( P < .0001). The full strength indigenous extracts, B-DF (DF allergen standard extract from Bioproducts and Diagnostics, India) and C-DF (DF allergen extract from Creative Diagnostics, India) extracts, had mean wheal sizes of 7.69 (standard deviation [SD] 9.91) and 31.01(SD 51.04), respectively. The full strength S-DF (DF allergen extract from Jubilant Hollister Stier, Spokane, WA, USA) had a mean wheal size of 109.97 (SD 162.73), which was significantly higher ( P < .0001) than both the indigenous extracts. For each of the dilutions, the S-DF mean wheal size was significantly greater than that of the corresponding B-DF and C-DF wheal sizes. The full strength indigenous C-DP (DP allergen extract from Creative Diagnostics, India) had mean wheal size of 39.37 (SD 51.74). The full strength standard S-DP (DP allergen extract from Jubilant Hollister Stier, Spokane, WA, USA) extract had a mean wheal size of 167.66 (SD 270.80), which was significantly higher ( P < .0001) than the indigenous C-DP extract. Similar differences were seen across all dilutions.

Conclusion

The indigenous extracts have significantly lower potency compared to USFDA-approved extracts; hence, there is an urgent need for policy makers to institute stringent criteria for standardization of antigens in India.
Critical Thinking Tasks Manifested in Indonesian Language Textbooks for Senior Secondary Students
Authors: Solihati Nani , Hikmat Ade
Published: September 2018

This study aims to investigate to what extent critical thinking is manifested in the Indonesian language textbooks used by senior high school students in Indonesia. Content analysis has been adopted to determine whether the tasks in the textbooks encourage and promote students’ critical thinking skills. Ilyas’s critical thinking framework, which was the result of evaluating, examining, and synthesizing 21 critical thinking programs, strategies, tests, and taxonomies, was used for the analytic categories. The findings showed that the textbooks did not contain many tasks promoting critical thinking. Besides this, tasks potentially encouraging students’ critical thinking were not varied. The findings suggest that as critical thinking has been included as one of the education objectives in this country, textbook writers need to create more tasks promoting critical thinking; moreover, Indonesian language teachers need to be taught how to modify tasks that can promote critical thinking skills among students.
The State, Networks and Family Raj in Goa
Authors: Parobo Parag D.
Published: September 2018

Goa achieved statehood in 1987. While from 1963 to 1989 there were only two legislators with ‘dynastic ties’, since 1990, there have been 23 political families contesting elections, with 10 dynastic candidates voted to the assembly. How might we understand the rise of ‘family raj’ in Goa’s politics? What does Goa teach us about the relationship between economy and politics? This article analyses Goa’s changing political economy and argues that apart from ‘increasing financial returns associated with state power’, it is the ‘networked’ contexts of these families that catapult them and sustain their growth. Two important political families and their particular networks are discussed to show how family raj is weaved in a wider network of power and money.
Urban Ecology in the Time of Climate Change: Houston, Flooding, and the Case of Federal Buyouts
Authors: Loughran Kevin , Elliott James R. , Kennedy S. Wright
Published: September 2018

This study proposes a shift in sociology’s approach to urban ecology. Rather than foreground the social ecologies that captivated the Chicago and Los Angeles Schools, we join and extend more recent efforts to engage environmental ecologies that successively intersect with those social ecologies over time. To ground our approach, we focus on areas of urban flooding where federally subsidized buyouts of residential properties have occurred over recent decades. Drawing on data from Houston, Texas, we locate where these buyout zones have emerged and how their social ecologies have changed in ways that feed back to influence the number of local buyouts that occur. Results indicate that Houston’s buyout zones have an identifiable social ecology that has shifted over time, primarily from white to Hispanic working-class settlement as the city has grown and become more racially and ethnically diverse. Results also show that the extent to which this racial succession has occurred powerfully predicts subsequent numbers of buyouts in the area. Implications for developing an enhanced urban ecology for the twenty-first century are discussed.
Upscaling lithology and porosity-type fractions from the micro- to the core-scale with thin-section petrography, dual-energy computed tomography, and rock typing: Creation of diagenesis and porosity-type logs
Authors: Proctor Jacob M. , Droxler André W. , Derzhi Naum , Hopson Heath H. , Harris Paul (Mitch) , Khanna Pankaj , Lehrmann Daniel J.
Published: September 2018

We have developed and validated a new approach to upscale lithology and porosity-type fractions from thin sections to cores using dual energy and multiscale computed tomography (CT). A new rock-typing approach (genetic rock typing [GRT]) is proposed to upscale ⇋diagenetic mineral and diagenetic pore-type fractions, from thin sections to the core domain, eventually to create a diagenesis and porosity types logs. An extensive set of short cores from Mason County (Texas) provides a representative sample set of Late Cambrian microbial buildups and their interbuildup sediments to test the GRT approach. GRTs were defined by using a dolomite log as a proxy for diagenesis and the average percentage of dolomite from each observed depositional facies (buildup interior, buildup rind, and interbuildup sediment) as a cutoff. Dolomite, diagenetic calcite, and diagenetic porosity fractions are summed to form a diagenesis log, which captures depositional facies and the diagenetic overprint at a 0.5 mm resolution. The diagenesis log was subdivided based on the number of pore-throat size classes within each GRT and provided a framework to distribute porosity-type fractions from thin sections to log form. A high correlation coefficient is observed when the predicted extent of diagenetic alteration from the log is compared with that quantified for each thin section using image processing ([Formula: see text]). Multiscale CT imaging and dual-energy-derived logs could be directly linked to well-log photoelectric factor and bulk-density logs. This approach thus has the ability to span six orders of magnitude in resolution (500–0.0005 mm). The diagenesis log can be used to extrapolate porosity-type fractions from thin sections to logs, from which qualitative geologic interpretations can be generally translated into quantitative values.
How nonrandomized trials (NRT) inform pan-Canadian Oncology Drug Review (pCODR) expert review committee (pERC) recommendations in blood cancer.
Authors: Tiruneh Missale , Ross Stephanie , Ellis Kristina , Trudeau Maureen E. , Moltzan Catherine , McDonald Valerie , Chambers Alexandra , Haynes Adam E.
Published: September 2018

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Background: In Canada, the Canadian Agency for Drugs and Technologies in Health’s pERC makes reimbursement recommendations for cancer drugs based on pCODR reviews of best available evidence, which in some circumstances, is from Phase II NRTs. To date, the majority of pERC recommendations based on NRT evidence have been for blood cancers. Objective: To examine aspects of NRT evidence that may influence pERC reimbursement recommendations for blood cancers. Methods: Final pERC Recommendations on blood cancer reviews supported by NRTs were included (July 2011 to June 2018). Factors that influenced Final Recommendations, such as clinical benefit, alignment with patient values and cost-effectiveness, were extracted. Results: As of June 2018, 10 conditional and 6 negative decisions were made in 13 Final Recommendations. Among conditional reimbursement recommendations, substantial need for treatment options and poor prognosis with available therapies were commonly noted. Assessment of the feasibility of randomized controlled trials (RCT) varied. The magnitude of benefit was impressive or a substantial benefit was seen in subgroups with greater need. Some recommendations noted benefit above historical outcomes or consistent evidence with other indications or trials. Most recommendations reported an improvement in quality of life (QoL) and a manageable toxicity profile. Limitations included short trial follow-up. Factors affecting cost-effectiveness and alignment with patient values varied. Among negative recommendations, there was less certainty about burden of illness and need. Uncertainty about magnitude of clinical benefit was attributed to lack of direct or indirect comparison to available options, lack of long term data or comparison to historical evidence, limited QoL data, and variability in toxicity. All cases were not cost-effective and partially aligned with patient values. Conclusions: pERC may accept evidence from NRTs to make reimbursement recommendations for blood cancers when there is a high burden of illness, unmet need, reasonable demonstration of efficacy and manageable toxicities. Feasibility of RCT was not a consistent factor.
Impact of novel chronic lymphocytic leukemia drugs on public spending.
Authors: Mow Elena , Keech James , Naipaul Rohini , Beca Jaclyn Marie , Gavura Scott , Kouroukis C. Tom
Published: September 2018

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Title: Impact Of Novel Chronic Lymphocytic Leukemia Drugs On Public Spending Background: Chronic lymphocytic leukemia (CLL) is a common hematologic malignancy that mainly affects the elderly. Over the past five years, the treatment pathway for CLL has dramatically changed with the emergence of multiple novel agents. In Ontario, Canada, the Ontario Drug Benefit (ODB) program and the New Drug Funding Program (NDFP) primarily provide public coverage for CLL drugs. Given advances in treatment, we evaluated utilization trends for publicly-funded CLL drugs over a five year period (fiscal years 2012/13 to 2016/17). Methods: Drugs with primary CLL indications funded under the two public funding programs (i.e., ODB and NDFP) by 16/17 were included (n = 6). Claims and costs data were obtained from the Institute for Clinical Evaluative Sciences and Cancer Care Ontario‘s datasets. Results: Over five years, expenditures on CLL drugs have increased approximately ten-fold (1000 percent), reaching nearly CAD 43 million (i.e., USD 32.8 million) in 16/17. In the front-line setting, spending on rituximab remained consistent over the five years. Spending on single agent bendamustine decreased with the introduction of obinutuzumab which became the main cost driver by 16/17. In the previously-treated CLL population, ibrutinib has dominated expenditures since it was funded in July 2015. By 16/17, ibrutinib accounted for approximately ninety eight percent of spending in the previously-treated population. Conclusions: In the past five years, public spending on CLL drugs increased rapidly and substantially with the introduction of four novel agents, and may continue to evolve as Canadian provinces consider funding additional indications or newer agents. These findings warrant exploring whether the incremental spending is providing survival benefit or improvement in patients’ quality of life in a real-world setting. Declaration of funding: None
Washington State Community Cancer Care Report: Implications for value-based purchasing.
Authors: Panattoni Laura Elizabeth , Sun Qin , Fedorenko Catherine R. , Kreizenbeck Karma L. , Ramsey Scott David
Published: September 2018

104

Background: As quality reports are released for regions and individual clinics, an important question is whether those reports can be used for value based purchasing, particularly for community oncology clinics. We evaluated the reliability of select quality measures and estimated the likelihood that a clinic’s performance would be incorrectly categorized (misclassified) in the top quartile. Methods: We linked 2014-2016 cancer registry records for patients with enrollment and claims from Medicare and two major commercial insurers in Washington State. We calculated risk standardized rates (RSRs) for ED and hospital use during treatment and 3 quality measures for end of life care. Reliability (0-1 scale: 0-unreliabile, > 0.7 good reliability, 1 perfectly reliable) was calculated as signal/(signal + statistical noise) from hierarchical logistic regression modeling for each metric. Misclassification was characterized as the probability of false negative and false positive assignment of clinics to the top quartile of performers in the region. We generated results for 3 and 1 year performance periods. Results: Over the 3 year period, the hospitalization metrics included 7,373 patients, 25 clinics; end of life metrics included 8,165 patients; 24 clinics. Conclusions: Although these metrics had fairly high levels of reliability, approximately one-third of clinics could be incorrectly identified as a top quartile performer. Use of these metrics in value based purchasing should account for potential misclassification to minimize unintended consequences.[Table: see text]
Education, engagement, and MIPS: The new era of accountability.
Authors: Denny, DBA Diane , Gross Danielle , Markman Maurie
Published: September 2018

111

Background: As 2017 marked the start of CMS’ new Quality Payment Program (QPP), a national network of hospitals worked together with its physician practices to ensure maximum participation and benefit. Each practice consisted of multi-specialists collaborating in the treatment of oncology patients and reporting through the American Society of Clinical Oncology qualified data registry. Methods: A team was created with the primary tasks of 1) transitioning and ensuring readiness; 2) selecting and reporting on measures of interest associated with two QPP categories, Quality and Improvement Activities (IAs) and 3) educating its practices on the merits of participation. This included the creation of infographics titled MACRA 101, 201, 301 and a detailed Q&A tool for maintaining information exchange. The former was a progressive approach to educating on the law, that success is a team sport, and that public reporting of performance data is here to stay, concluding with a call to action. Results: Oncology measures were reported for the full CY17 as follows. The same quality improvement activity of data capture, metric review and process re-design became the narrative for the practices’ selection of its two required IAs. Conclusions: Although year one allowed for lesser requirements to enable transition, positioning the practices to report at the maximum level resulted in strong physician-hospital collaboration as well as the potential for financial and reputational gain. An unintended benefit was the realization that mandatory discrete fields in the practices’ EHR would benefit the practitioners in the long term as resource requirements needed to abstract from free-text is not sustainable.[Table: see text]
Changes in lung cancer screening knowledge, beliefs, and practices among health care providers.
Authors: Henderson Louise , Bearden Caitlin , Reuland Dan , Brenner Alison Tytell , Goldstein Adam , Maygarden Susan , Rivera M. Patricia
Published: September 2018

117

Background: In 2013, the U.S. Preventative Task Force began recommending lung cancer screening (LCS) annually for patients ages 55-80 years who are current or former (quit within the last 15 years) smokers with a 30 pack-year history. Since then, the proportion of eligible patients undergoing LCS has been reported to be low, ranging from 3-5%. We sought to compare LCS practices and beliefs among health care providers at a large academic medical center from 2015 to 2018. Methods: In 2015 and 2018, we surveyed physicians and residents in pulmonology, family, and internal medicine using a 23-item Qualtrics survey developed with the Tailored Design Method. To evaluate potential workforce issues in LCS we compared responses regarding provider’s opinions, referral patterns, and barriers to LCS from 2015 to 2018 using chi-squared tests. Results: Response rates were 39% in 2015 and 26% in 2018. From 2015 to 2018 there was an increase in the proportion of providers who reported LCS as beneficial (44.6% vs 75.7%, p < 0.0001), cost effective (20.0% vs 38.6%, p = 0.002), and as having enough knowledge to explain the risks and benefits of LCS (53.6% vs 75.7%, p = 0.001). In both years, the majority of providers reported time restrictions during a patient’s clinic visit meant that other problems had higher priority than LCS (65.1% vs 71.4%, p = 0.85). Over the 3-year period the proportion of providers who reported ordering a LCS exam more than doubled (32.2% to 74.6%, p < 0.00001) and the percentage who initiated discussion about the risks and benefits increased from 45.9% to 87.3%. The proportion of providers who reported that a patient asked about LCS increased (22.8% to 37.7%, p = 0.001). While some reported barriers did not change from 2015 to 2018 (concern regarding false negatives, false positives, cost to system/patients, or potential for physical/emotional harm), more providers reported low patient acceptance or adherence (7.4% vs 13.0%, p = 0.01). Conclusions: From 2015 to 2018 healthcare providers reported a more favorable opinion of LCS and a higher proportion of providers reported ordering a LCS exam. Time constraints during the patient visit remained an issue and a higher proportion reported low patient acceptance/adherence as a barrier.