bluuebunny/crossref_metadata_2025 huggingface dataset:
Home- and Community-Based Speech, Language, and Hearing Services for People with Intellectual and Developmental Disabilities
Authors: Friedman Carli , McNamara Ellyn
Published: May 2018

Speech language and hearing (SLH) services can improve people with intellectual and developmental disabilities’ (IDD) health, autonomy, and community participation. The aim of this study was to explore how SLH services are offered to people with IDD across the nation, particularly in fiscal year 2015 Medicaid Home and Community Based Services (HCBS) 1915(c) waivers ( N = 111 waivers). Findings revealed, unlike Medicaid state plans, HCBS waivers were often utilized to offer SLH services in alternative settings, like participants’ homes, and provide long-term habilitative care rather than immediate acute care. Given increased risk for and under identification of communication and hearing disorders in people with IDD, adequate access to sufficient SLH services is essential to ensure the rights of people with IDD.
Toward Competitive Employment for Persons with Intellectual and Developmental Disabilities: What Progress Have We Made and Where Do We Need to Go
Authors: Wehman Paul , Taylor Joshua , Brooke Valerie , Avellone Lauren , Whittenburg Holly , Ham Whitney , Brooke Alissa Molinelli , Carr Staci
Published: May 2018

Progress toward competitive integrated employment (CIE) for people with intellectual and developmental disabilities (IDD) over the last 40 years has been mixed. Despite evidence showing that supported employment interventions can enable adults with IDD to effectively get and keep jobs, national rates of integrated employment remain below a third of the working-age population. Progress is being made to improve these outcomes. Pathways have been identified that lead to CIE through supported employment, customized employment, internship experiences, and postsecondary education. The recent passage of the Workforce Innovation and Opportunity Act (WIOA) has created fresh momentum and increased the onus on interagency collaboration. This article examines what is known about promoting CIE through these pathways and highlights recommendations for future research and policy change. Recommendations for the future provide direction toward positive change for CIE into the 21st century.
Morgagni Hernia Repair: A Review
Authors: Sanford Zachary , Weltz Adam S. , Brown Jermaine , Shockcor Nicole , Wu Nan , Park Adrian E.
Published: May 2018

Anteromedial subcostosternal defects, also known as a diaphragmatic hernia of Morgagni (MH), allow potentially life-threatening herniation of the abdominal organs into the thorax. Constituting only a small fraction of all types of congenital diaphragmatic hernias, correct diagnosis of MH is often delayed, owing in large part to nonspecific associated respiratory and gastrointestinal complaints. Once identified, the primary management for both symptomatic and incidentally discovered asymptomatic cases of MH are surgical correction because the herniated contents present increasing risk for strangulation. Various thoracic and abdominal surgical approaches have been described without a clear consensus on preference for operative repair technique. In this article, the literature regarding management of MH within the past decade is reviewed, and an illustrative case of laparoscopic repair of a MH with novel reinforcement using a Falciform ligament onlay flap is presented.
“He Told Me to Check My Health”: A Qualitative Exploration of Social Network Influence on Men’s HIV Testing Behavior and HIV Self-Testing Willingness in Tanzania
Authors: Conserve Donaldson F. , Alemu Dawit , Yamanis Thespina , Maman Suzanne , Kajula Lusajo
Published: May 2018

Men continue to test for HIV at a low rate in sub-Saharan Africa. Recent quantitative evidence from sub-Saharan Africa indicates that encouragement to test for HIV from men’s network members is associated with higher previous HIV testing and HIV self-testing (HIVST) willingness. Leveraging this positive network influence to promote HIVST among men is a promising strategy that could increase HIV testing. This study investigated the reasons and strategies men used to encourage their peers to test for HIV and the outcomes in order to inform the development of a social network-based HIVST intervention for men called STEP (Self-Testing Education and Promotion). Twenty-three men from networks locally referred to as “camps” were interviewed to explore reasons for encouraging HIV testing, strategies to encourage HIV testing, and outcomes of HIV testing encouragement. Reasons men reported for encouraging their peers to test for HIV included awareness of their peers’ risky sexual behavior, knowing an HIV-positive peer, and having HIV testing experience. Strategies for encouraging testing included engaging in formal and informal conversations and accompanying friends to the clinic. Encouragement outcomes included HIV testing for some men while others remained untested due to lack of privacy in the clinic and fear of HIV stigma. Willingness to self-test for HIV and an interest to educate peers about HIVST were other outcomes of HIV testing encouragement. These findings underscore the potential of leveraging men’s existing HIV testing encouragement strategies to promote HIVST among their peers.
Healthy Weight and Cardiovascular Health Promotion Interventions for Adolescent and Young Adult Males of Color: A Systematic Review
Authors: Garbers Samantha , Hunersen Kara , Nechitilo Meredith , Fisch Marylynn , Bell David L. , Byrne Mary Woods , Gold Melanie A.
Published: May 2018

Cardiovascular disease is the leading cause of mortality in the United States, accounting for one fourth of deaths. Higher rates of obesity put Hispanic and Black men at increased risk. The American Heart Association cites diet quality, physical activity, and body weight as alterations responsive to health promotion intervention. Prevention strategies need to begin in adolescence and the emerging adulthood years to impact cumulative risk factors. A scoping review identified search terms and this was followed by a systematic review of Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed databases for articles published in English from January 1, 2002, through May 11, 2017. This review explores community-based content, delivery, recruitment, or retention strategies used with young men of color aged 15 to 24 years. Of 17 articles describing 16 individual interventions and 1 describing multiple interventions (with samples ranging from 37 to 4,800), 13 reported significant results in one or more domains. No studies specifically targeted the needs of young men and only three had more than 50% male participants. There was a gap in studies that addressed young men in the ages of interest with most interventions reaching participants aged 11 to 19 years. Cultural tailoring was addressed through recruitment setting, interventionist characteristics, community involvement, and theoretical frameworks such as motivational interviewing that allow individual goal setting. Because young men seek access to preventive health services less than young women, it is suggested that interventions that are community based or use push technology (send information directly to the user) be increased.
Formation control for car-like mobile robots using front-wheel driving and steering
Authors: Chen Haojie , Yang Hong’an , Wang Xu , Zhang Ting
Published: May 2018

To solve the problem of front wheels being jammed due to the passive trajectory tracking of the conventional car-like robot in the leader–follower formation control, we propose a novel car-like robot with the integration of front-wheel driving and steering. We establish its kinematic model, then analyze its controllability via the method of chained form system, and design the trajectory-tracking controller via the backstepping method. Simulations and experimental results validate our algorithm. This novel car-like robot with the integration of front-wheel driving and steering system not only avoids the jamming in the formation motion, but also owes the advantages of compacter structure, lighter body, and lower energy consumption.
Development of release velocity and spin prediction models for passing machines in American football
Authors: Hollaus Bernhard , Raschner Christian , Mehrle Andreas
Published: May 2018

This article focuses on the development of release velocity and spin prediction models for oval shaped footballs with a state-of-the-art passing machine. Since the trajectory of the ball can be predicted with aerodynamic models, the state of the ball at release time is of interest. At present, no prediction model for this initial state exists. This study measured release spin and velocity. A prediction model was developed based on various ball wear and measured release spin and velocity for different machine configurations. To sensor the motion, a high-speed camera with post image processing was used and release spin and velocity were calculated via regressions. The goal was to predict the release velocity within ±3% in 90% of all relevant cases, depending on the passing machine’s configuration. In addition, the dependency on the wear of the football was investigated. The results show that the release velocity can be predicted, independently of the wear of the ball, with the required accuracy for a reasonable range of machine configurations. For the release spin, a less accurate prediction model was developed. Both prediction models, their limitations and determination are presented in graphical form.
Differential Response of Bovine Mature Nucleus Pulposus and Notochordal Cells to Hydrostatic Pressure and Glucose Restriction
Authors: Saggese Taryn , Thambyah Ashvin , Wade Kelly , McGlashan Susan Read
Published: May 2018

Objective

The nucleus pulposus of the human intervertebral disc contains 2 cell types: notochordal (NC) and mature nucleus pulposus (MNP) cells. NC cell loss is associated with disc degeneration and this process may be initiated by mechanical stress and/or nutrient deprivation. This study aimed to investigate the functional responses of NC and MNP cells to hydrostatic pressures and glucose restriction.

Design

Bovine MNP and NC cells were cultured in 3-dimensional alginate beads under low (0.4-0.8 MPa) and high (1.6-2.4 MPa) dynamic pressure for 24 hours. Cells were cultured in either physiological (5.5 mM) glucose media or glucose-restriction (0.55 mM) media. Finally, the combined effect of glucose restriction and high pressure was examined.

Results

Cell viability and notochordal phenotypic markers were not significantly altered in response to pressure or glucose restriction. MNP cells responded to low pressure with an increase in glycosaminoglycan (GAG) production while high pressure significantly decreased ACAN gene expression compared with atmospheric controls. NC cells showed no response in matrix gene expression or GAG production with either loading regime. Glucose restriction decreased NC cell TIMP-1 expression but had no effect on MNP cells. The combination of glucose restriction and high pressure only affected MNP cell gene expression, with decreased ACAN, Col2α1, and ADAMTS-5 expression.

Conclusion

This study shows that NC cells are more resistant to acute mechanical stresses than MNP cells and provides a strong rationale for future studies to further our understanding the role of NC cells within the disc, and the effects of long-term exposure to physical stresses.
In Vitro Effects of Cetylated Fatty Acids Mixture from Celadrin on Chondrogenesis and Inflammation with Impact on Osteoarthritis
Authors: Hudita Ariana , Galateanu Bianca , Dinescu Sorina , Costache Marieta , Dinischiotu Anca , Negrei Carolina , Stan Miriana , Tsatsakis Aristidis , Nikitovic Dragana , Lupuliasa Dumitru , Balanescu Andra
Published: May 2018

Objective

Cetylated fatty acids are a group of naturally occurring fats of plant and/or animal origin. Cetyl myristoleate, in particular, was initially involved in osteoarthritis related research as its therapeutic administration prevented experimentally induced arthritis in Swiss Albino mice. In this context, the aim of our study was to investigate the possible mechanisms of Celadrin cetylated fatty acids action at the cellular level inflammation related pain relief and chondrogenesis.

Design

For this, we tested the effects of the cetylated fatty acids mixture from Celadrin on an in vitro scaffold-free 3-dimensional mesenchymal stem cells culture model of chondrogenesis. Furthermore, we treated stimulated mouse macrophage cells with the cetylated fatty acids mixture to investigate the expression profile of secreted inflammatory cytokines.

Results

The cetylated fatty acids mixture from Celadrin significantly decreased the production of IL-6, MCP-1, and TNF, key regulators of the inflammatory process, in stimulated RAW264.7 mouse macrophage cells. The treatment with cetylated fatty acids mixture initiated and propagated the process of chondrogenesis as demonstrated by the increased expression and deposition of chondrogenic markers by the differentiating mesenchymal cells.

Conclusion

The cetylated fatty acids mixture from Celadrin reduces inflammation in vitro by significantly decreasing the expression of IL-6, MCP-1, and TNF in stimulated RAW264.7 mouse macrophage cells. These compounds facilitate the chondrogenic differentiation process of human adipose-derived stem cells by stimulating the expression of chondrogenic markers under chondrogenic induction conditions.
Deconstructing the algorithmic sublime
Authors: Ames Morgan G
Published: May 2018

This special theme contextualizes, examines, and ultimately works to dispel the feelings of “sublime”—of awe and terror that overrides rational thought—that much of the contemporary public discourse on algorithms encourages. Employing critical, reflexive, and ethnographic techniques, these authors show that while algorithms can take on a multiplicity of different cultural meanings, they ultimately remain closely connected to the people who define and deploy them, and the institutions and power relations in which they are embedded. Building on a conversation we began at the Algorithms in Culture conference at U.C. Berkeley in December 2016, we collectively study algorithms as culture (Seaver, this special theme), fetish (Thomas et al.), imaginary (Christin), bureaucratic logic (Caplan and boyd), method of governance (Coletta and Kitchin; Lee; Geiger), mode of inquiry (Baumer), and mode of power (Kubler).

[Box: see text]
Evaluation of Islet Purification Methods for Making a Continuous Density Gradient and Loading Tissue
Authors: Ebi Nana , Miyagi-Shiohira Chika , Hamada Eri , Tamaki Yoshihito , Masamoto Mariko , Makishi Erika , Nakashima Yoshiki , Kobayashi Naoya , Saitoh Issei , Watanabe Masami , Noguchi Yasufumi , Kinjo Takao , Noguchi Hirofumi
Published: May 2018

Islet purification is one of the most important steps of islet isolation for pancreatic islet transplantation. We previously reported that a purification method using large plastic bottles effectively achieved a high yield of islets from porcine pancreas. In this study, we evaluated the methods for making a continuous density gradient and loading tissue. One method involved loading digested tissue on top of a continuous density gradient (top loading). The other method involved mixing digested tissue with low-density solution and then making a continuous gradient (mixed loading). There were no significant differences between the 2 purification methods in terms of the islet yield, rate of viability or purity, score, or in the stimulation index after purification. Furthermore, there were no marked differences in the attainability or suitability of posttransplantation normoglycemia. Our study shows the equivalency of these 2 methods of islet purification.
Predicting School Counselors’ Supports and Challenges When Implementing the ASCA National Model
Authors: Fye Heather J. , Miller Lynne Guillot , Rainey J. Steve
Published: May 2018

This study examined a national sample of school counselors and their ability to implement the American School Counselor Association (ASCA) National Model. Percentage of time spent in noncounseling duties, perceived level of principal support, and principals’ knowledge of school counselors’ appropriate roles were statistically significant predictor variables for school counselors’ ability to implement the ASCA National Model. We discuss implications for the school counseling profession.
Watching the Trauma: Witnessing the Partition
Authors: Jha Sadan
Published: May 2018

The academic discourse of the mass violence that took place during the Partition/Independence of India and Pakistan has acquired certain maturity over the decades. The corpus of literature generated has been insightful and path-breaking. In the backdrop of this scholarship, the current article attempts to engage with the experiences of witnessing and emphasize upon transformative potential of such encounters. With few Partition-based Hindi films, this study also looks at the landscape of the Partition on the celluloid, where the screen converges with history and where the memory of trauma generates guilt. Mobilising the fieldwork conducted seventeen–eighteen years ago in Delhi, Ajmer and Jammu along with the cinematic representations and written corpus on the Partition, an engagement with the figure of a witness in this article will hopefully allow us to engage with memory, archive and the mass violence with fresh questions and perspectives.
The Necessity of Transitioning from Generic Legal Clinics to Specialized Environmental Law Clinics in MENA Region with Focus on Iran
Authors: Torabi Maryam , Noori Seyed Masoud
Published: May 2018

Legal clinics in the MENA region countries—like in other developing parts of the world—might be in a position, especially in their first years of activity, where they are obliged to provide legal assistance in various areas to the vulnerable groups of the society due to two factors. First, there is a lack of specialized and professional activists and volunteers, alongside the need for other resources like funds and supporting organizations. Second, the basic civil needs in the society that have not been met by other juridical organizations are diverse, and, therefore, they are passed on to legal clinics trying to meet the basic legal information and needs of the society, let alone concentrating on specialized matters such as environmental subjects. The main outline of this article is to indicate that for having a more effective performance by legal clinics in the legal structure of their countries, it is necessary that they transition from offering legal aid and teaching laws in every area to much more specialized fields like environmental law due to the local needs of where they are situated and referring to their professional human resources. If clinics specialize in special areas of law such as environmental law, they would gain at least two achievements—first, being able to protect the vulnerable ecology of their local rich environment and to enrich their own knowledge on their rights and laws they should be aware, and second, these specialized clinics would have the opportunity to play a creative and significant role in the legal and juridical system of the country, for example, through comparative studies, exposing the new point of view to the jurists and judges, drafting new legal bills and altering the existing impractical laws that do not answer the local needs.
Teaching Missiology in and for World Christianity: Content and Method
Authors: Phan Peter C.
Published: May 2018

The article begins with a brief definition of “World Christianity” and elaborates three theses for conceiving the relationship between missiology and theology, the understanding and practice of Christian missions, and the teaching of missiology. I argue that outside missiology there is no theology. I also reject the separation between church history and missiology, the division between the historic churches of the West and the “mission lands” of the rest, and a narrow focus of the goal of Christian missions on conversion and church-planting. Finally, I recommend a shift from “church history” to “history of Christianity.”
Representation of actions and outcomes in medial prefrontal cortex during delayed conditional decision-making: Population analyses of single neuron activity
Authors: Francoeur Miranda J. , Mair Robert G.
Published: May 2018

Background:

To respond adaptively in a dynamic environment, it is important for organisms to utilise information about recent events to decide between response options.

Methods:

To examine the role of medial prefrontal cortex in adaptive decision-making, we recorded single neuron activity in rats performing a dynamic delayed non-matching to position task.

Results:

We recorded activity from 1335 isolated neurons, 458 (34%) with criterion event-related activity, of which 431 (94%) exhibited 1 of 10 distinct excitatory response types: five at different times relative to delivery (or lack) of reinforcement following sample and choice responses and five correlated with movements or lever press actions that occurred multiple times in each trial. Normalised population averages revealed a precisely timed cascade of population responses representing the temporal organisation behavioural events that constitute delayed non-matching to position trials. Firing field analyses identified a subset of neurons with restricted spatial fields: responding to the conjunction of a behavioural event with a specific location. Anatomical analyses showed considerable overlap in the distribution of different response types in medial prefrontal cortex with a significant trend for dorsal areas to contain more neurons with action-related activity and ventral areas more responses related to action outcomes.

Conclusion:

These results indicate that medial prefrontal cortex contains discrete populations of neurons that represent the temporal organisation of actions and outcomes during delayed non-matching to position trials. They support the hypothesis that medial prefrontal cortex promotes flexible control of complex behaviours by action–outcome contingencies.
The top 5 issues in EU medicines policy for 2018
Authors: Natsis Yannis
Published: May 2018

The present analysis looks at the key issues which dominate the EU medicines policy agenda during 2018 namely the proposed regulation on European collaboration on Health Technology Assessment (HTA), the ongoing discussion around the role of intellectual property related incentives in biomedical R&D, the future of initiatives such as BeNeLuxA, the role of the European Medicines Agency and the reaction of the pharmaceutical companies to the unprecedented debate around access to medicines in Europe.
Plasma hepcidin is associated with future risk of venous thromboembolism
Authors: Ellingsen Trygve S. , Lappegård Jostein , Ueland Thor , Aukrust Pål , Brækkan Sigrid K. , Hansen John-Bjarne
Published: May 2018

Key Points

Iron deficiency may explain the association between RDW and risk of VTE. Contrary to the hypothesis, increasing plasma levels of hepcidin, a biomarker of iron stores, were associated with increased risk of VTE.
The impact of chronic airway disease on symptom severity and global suffering in Canadian rhinosinusitis patients
Authors: Luu Kimberly , Sutherland Jason , Crump Trafford , Liu Giuping , Janjua Arif
Published: May 2018

Background

Patients with Chronic Rhinosinusitis (CRS) can suffer from a significant decline in their quality of life. CRS patients have a high prevalence of comorbid conditions and it is important to understand the impact of these conditions on their CRS-related quality of life. This study measures the impacts of chronic pulmonary comorbidities on quality of life, pain, and depression scores among patients with CRS awaiting Endoscopic Sinus Surgery (ESS).

Methods

This study is based on cross-sectional analysis of prospectively collected patient-reported outcome data collected pre-operatively from patients waiting for ESS. Surveys were administered to patients to assess sino-nasal morbidity (SNOT-22), depression and pain. The impact of pulmonary comorbidity on SNOT-22 scores, pain and depression was measured.

Results

Two hundred fifthy-three patients were included in the study, 91 with chronic pulmonary comorbidity. The mean SNOT-22 scores were significantly higher among patients with chronic pulmonary comorbidities than among patients without (37 and 48, respectively). This difference is large enough to be clinically significant. Patients with chronic pulmonary comorbidities reported slightly higher depression scores than those without.

Conclusions

This study found that among CRS patients waiting for ESS, chronic pulmonary comorbidities are strongly associated with significantly higher symptom burden.
A systematic review of randomized controlled trials (RCTs) of exercise interventions using digital activity trackers (E-DAT) in cancer patients.
Authors: Schaffer Kerry , Panneerselvam Narmadha , Loh Kah Poh , Herrmann Rachel , Kleckner Ian , Dunne Richard Francis , Lin Po-Ju , Heckler Charles E. , Bruckner Lauren B. , Storozynsky Eugene , Ky Bonnie , Mohile Supriya Gupta , Mustian Karen Michelle , Fung Chunkit
Published: May 2018

108

Background: Exercise ameliorates cancer and treatment-related toxicities but adherence to exercise is a barrier. Few studies in the general population suggest that E-DAT may improve exercise adherence. We conducted a systematic review to examine the effects of E-DAT on physical function, health-related quality of life (HRQOL), and serum inflammatory markers during and after cancer treatment. Methods: We used PubMed, Embase, and the Cochrane Library to identify RCTs of E-DAT in cancer patients aged ≥18 years published in English between 1/1/2008 and 7/27/2017. Two authors independently reviewed the titles of articles from the search (n = 160), removed duplicates (n = 49), and reviewed the remaining 111 articles for eligibility and substantive results. We excluded RCTs that used digital activity trackers solely for data collection. Results: Twelve RCTs met eligibility criteria, including 1,450 patients (mean age: 50-70 years) with the following cancers: breast (n = 5 RCTs), colon or breast (n = 2), prostate (n = 1), acute leukemia (n = 1) and various type (n = 3). Duration of E-DAT ranged from 4-24 weeks. Follow-up period was 4-24 weeks with retention of 54-95%. Half of the RCTs had E-DAT with in-person exercise training and the rest had self-directed training. The technology component of E-DAT included pedometers (n = 8); pedometers with smart phone application (n = 1), Wii-Fit (n = 1), or heart rate monitor (n = 1); and a wireless sensor with accelerometer, gyroscope, and magnetometer (n = 1). Adherence to E-DAT was > 70% in 5 of 7 RCTs. Compared to controls (exercise interventions without digital activity trackers or standard of care), E-DAT significantly improved the step count in 60% of 5 RCTs, activity level in 56% of 9 RCTs, and HRQOL in 56% of 9 RCTs (all p < 0.05), with no significant changes of inflammatory markers (i.e. TNF, CRP, c-peptide) in 2 RCTs. No significant correlations were found between duration of E-DAT with adherence (Spearman’s r = 0.16; p = 0.75) or study retention (Spearman’s r = -0.42; p = 0.17). Conclusions: This systematic review shows that E-DAT is feasible to implement in cancer patients. Future research should examine the optimal type, dose and schedule of E-DAT.
Feasibility pilot implementation of a low-dose CT screening program.
Authors: Yoon Joo Hyung , Lofters Aisha , Liu Geoffrey
Published: May 2018

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Background: The National Lung Cancer Screening Trial showed 20% reduction in lung cancer mortality with low dose CT (LDCT) screening. The highest risk populations for developing lung cancer are commonly found among lower socioeconomic groups. 30% of patients enrolled with St. Michael’s Hospital Academic Family Health Team (SMHAFHT) are below the low-income cut-off. This study aims to implement LDCT screening at SMHAFHT using the Knowledge-to-Action framework. Methods: Stakeholders were engaged to adapt an existing Princess Margaret Cancer Centre (PMCC) LDCT program with focus groups, interviews, and patient post-LDCT interviews to assess barriers and facilitators. Patients were referred from SMHAFHT to PMCC for LDCT. PLCO2012 scores stratified patient risk, and those at highest risk were chosen. Results: 12 patients were assessed for eligibility; 7 (56%) qualified and 5 (42%) completed LDCT at PMCC. 11 (92%) patients assessed were from two Smoking Cessation Clinics (SCC) within SMHAFHT. Those at SCC (vs LDCT) group were younger (51±12 vs 69±7, p = 0.001), had lower Charlson comorbidity index scores (2.1±1.8 vs 3.4±1.7, p = 0.15) and had fewer pack years (37±24 vs 56±16, p = 0.06). The SCC (vs LDCT) group had comparable prevalence of males (64% vs 66%), COPD (30% vs 33%), personal cancer history (5% vs 0%), family history of lung cancer (17% vs 20%), and proportion of patients reporting the lowest quartile of household income (95% vs 80%), all p > 0.05. Thematic analysis yielded the following barriers among practitioners: limited study awareness, difficulty providing consent forms and lack of time. Top patient reported barriers included fear: of positive results, LDCT and follow up procedures. Practitioner facilitating factors included greater research coordinator involvement, while patients reported clear communication of LDCT risks and benefits and accessibility of PMCC. Conclusions: Implementation predominantly took place within SMHAFHT SCCs. Barriers for future intervention were identified. Differences between participants of SCC and LDCT screening can be attributed to selection of the highest-risk group with PLCO2012 scores. Implementing LDCT screening at SCCs allowed for the recruitment of those below the low-income cut-off.
Barriers of EQ5D-5L implementation into routine clinical practice: A multisite evaluation.
Authors: Baek Justine , Tse Tiffany , Brown M Catherine , Skitch Amy , Chen Judy , Liang Mindy , Naik Hiten , Eng Lawson , Howell Doris , Xu Wei , Shultz David , Brezden Christine B. , Liu Geoffrey
Published: May 2018

11

Background: As numbers of cancer survivors increase, health-related quality of life and healthcare service utilization warrant closer attention, which requires routine valuations such as health utility scores (e.g. EQ5D-5L). EQ5D-5L implementation into routine clinical practice requires systematic evaluation to assess project scalability with goals of eventual roll-out across all 15 Ontario cancer centres in all disease sites. Methods: We used the Canadian Institutes of Health Research’s Knowledge-to-Action (KTA) framework as a guide to assess implementation of EQ5D-5L in two outpatient cancer populations; St. Michael’s Hospital’s general breast cancer clinic (GBR) and Princess Margaret Cancer Centre’s multidisciplinary brain metastases clinic (MBM), chosen to represent two very different organizational structures and patient populations. KTA steps from landscape assessment and engagement of stakeholders through to pilot implementation using paper surveys are reported. Results: After assessing 270 patients (GBR = 137; MBM = 117) across 57 days, implementation issues at the two sites were noted. GBR clinic’s larger and more general patient base was associated with a lower average socioeconomic status than MBM clinic, which targets a specialized patient population. More barriers to implementation at GBR were systemic and organizational in nature, whereas barriers at MBM were associated with patient management, where patients’ functional disabilities or neglect to return completed questionnaires hindered data collection. For both sites, successful EQ5D-5L implementation was contingent on senior management support and engagement of multiple stakeholders throughout the implementation process, leading to site-specific suggestions. Conclusions: Differing implementation strategies at both sites is reflective of target sites’ distinctive systemic and organizational characteristics and findings can be used to inform the translation of EQ5D-5L to other sites. We present recommendations to aid scalability and implementation efforts, including future transition to electronic routine assessments.
Implementation of an electronic referral smoking cessation tool into clinical practice across cancer clinics of different disease sites and institutions.
Authors: Afzaal Tamoor , Chen Lina , Baek Justine , Tse Tiffany , Chan Kelvin K. , Brown M. Catherine , Howell Doris , Selby Peter , Giuliani Meredith Elana , Jones Jennifer M. , Skitch Amy , Brezden Christine B. , Eng Lawson , Eisen Andrea , Liu Geoffrey
Published: May 2018

112

Background: Cancer Care Ontario, the government's cancer management agency, mandated routine collection of smoking data province wide (catchment of > 13 million individuals), but did not mandate specifics of a smoking cessation program for cancer patients, despite known benefits. Referral rates to smoking cessation clinics for cancer patients are low. In 2014, Princess Margaret Cancer Centre developed an electronic, patient-driven e-referral tool shown to improve referral rates, known as the smoking Cessation E-referrAl SystEm (CEASE). The objective of this study is to assess the feasibility for expanding this program through adoption and implementation of the CEASE tool to 5 additional clinics across 3 different Cancer Centres. Methods: The Canadian Institute of Health Research’s Knowledge-to- Action (CHIR KTA) framework guided the assessment. Feasibility was addressed through situational assessments, pilot implementation, and clinic/patient feedback in at least two cycles, with procedural changes made at the conclusion of each cycle. Clinics were selected to cover a wide range of hospital, clinic styles, and disease sites. Results: Pilot implementation occurred over 21 clinic days (Jun 2017- Aug 2017); 123 patients were enrolled in the pilot studies in breast, gastrointestinal, head and neck, and thoracic sites. Feasibility assessment in each clinic identified similarities and differences in resource availability, access to authority figures, and patient flow patterns. After the feasibility assessment, a pilot implementation identified English as a second language and the lack of patient's tablet/technological experience as the main barriers for implementation in 4 of 5 clinics. The use of volunteers assisting patients with the survey helped address these barriers. Strong internet connection, short survey length and staff engagement were seen as universal common facilitators to implementation in all 5 clinics. Conclusions: Despite different outpatient environments, common barriers and potential solutions were identified, which will help with scalable future widespread implementation of CEASE across the province of Ontario.
Assessment of pulmonary function test abnormalities in adult survivors of childhood cancer.
Authors: Bassal Mylene , Story Eden , Chang Lynn , Nair Vimoj , Reisman Joseph , Voduc Nha , Radhakrishnan Dhenuka
Published: May 2018

117

Background: As childhood cancer survival approaches 85%, it is increasingly recognized that childhood cancer survivors (CCS) are at risk for long-term therapy-related complications. Data suggest that pulmonary function test (PFT) abnormalities occur in as many as 84.1% of CCS. Our aim was to assess the prevalence and nature of respiratory abnormalities in adult CCS and to correlate these abnormalities with therapeutic exposures and health behaviors. Methods: Patients who received pulmonary toxic therapy routinely undergo PFTs at their first visit to the POGO AfterCare clinic in Ottawa, Canada. We conducted a retrospective review of all patients seen in clinic from August 2015 until December 2016. PFT results, treatment exposures and health habits were documented. We used NHANES-III prediction equations for PFT interpretation, with expiratory flows and lung volumes of ≥80% predicted as cutoffs for normal. Results: Of a total of 200 patients, 48 received pulmonary toxic therapy and 38 underwent PFTs. Mean age at the time of PFT was 28.8 years (18.5-57.5 years) and the mean time from diagnosis was 17.4 years (3.4-47.5 years). Although no patients reported respiratory symptoms, 42% (16/38) demonstrated a mild restrictive ventilatory defect, 11% (4/38) had mild airflow obstruction, 18% (7/38) had an isolated reduction in diffusion capacity and 1 patient had a moderate mixed obstructive/restrictive abnormality. Only 26% (10/38) had normal lung function. Of those with restrictive defects, all received radiation and 50% were also exposed to pulmonary toxic chemotherapy. All patients with obstructive defects received radiation therapy in combination with bleomycin. Tobacco or marijuana use was reported in 26% (10/38) of the cohort, and in 29% (8/28) of those with PFT abnormalities. Conclusions: PFT abnormalities are common among adult CCS who received pulmonary toxic therapy. Studies evaluating the change in pulmonary function abnormalities over time and their correlation to cardiopulmonary exercise testing and lung imaging are required to inform the health impact on these survivors.
Risk prediction model for heart disease among endometrial cancer survivors.
Authors: Hashibe Mia , Blackburn Brenna , Park Jihye , Rowe Kerry G. , Snyder John , Wan Yuan , Deshmukh Vikrant , Newman Michael , Fraser Alison M , Smith Ken R , Herget Kim , Werner Theresa Louise , Setiawan Veronica Wendy , Hu Nan , Ganz Patricia A. , Gaffney David K. , Lee Yuan-Chin Amy
Published: May 2018

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Background: There are an estimated 760,000 endometrial cancer survivors alive in the US today. We previously reported on increased heart disease (HD) risk among endometrial cancer survivors from our population-based cohort study. Although there are many risk prediction models for the risk of endometrial cancer, there are none to our knowledge for endometrial cancer survivors. Methods: We identified 2,994 endometrial cancer patients in the Utah Population Database, which links data from multiple statewide sources. We estimated hazard ratios with the Cox proportional hazards model for predictors of five-, ten- and fifteen-year risks. The Harrell’s C statistic was used to evaluate the model performance. We used 70% of the data randomly selected to develop the model and the rest of the data to validate the model. Results: A total of 1,591 patients were diagnosed with HD. Increased risks of HD among endometrial cancer patients were observed for older age, obesity at baseline, family history of HD, previous disease diagnosis (hypertension, diabetes, high cholesterol, COPD), distant stage, grade, histology, chemotherapy, and radiation therapy. The C-statistics for the risk prediction model were 0.69 for the hypothesized risk factors for HD, 0.56 for clinical factors, and 0.71 when statistically significant risk factors were included. With the final model selected, as one example, the absolute risks of HD were 17.6% at 5-years, 24.0% at 10-years and 32.0% at 15 years for a woman diagnosed with regional stage, grade I endometrial cancer in her fifties, was white, was obese at cancer diagnosis, had a family history of HD but no previous history of HD herself, had hypertension, but no history of diabetes or high cholesterol or COPD, and had radiation therapy treatment but no chemotherapy. The AUCs were 0.79 for the 5-year, 0.78 for the 10-year and 0.78 for the 15-year predictions. Conclusions: We developed the first risk prediction model for HD among endometrial cancer survivors within a population-based cohort study. Risk prediction models for cancer survivors are important in understanding long-term disease risks after cancer treatment is complete. Such models may contribute to management plans for treatment and individualized prevention efforts.
Impact of quality of life on employment and marital status in long-term cancer survivors treated in a referral center in Mexico.
Authors: Remolina Bonilla Yuly Andrea , Armengol Alonso Alejandra , Trejo rosales Raul Rogelio
Published: May 2018

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Background: Worldwide there is an increasing number of cancer survivors (CS); in the United States in 2016 there were more than 15 million CS and are predicted to increase to 20 million in 2026. In Mexico (GLOBOCAN 2012), new cancer cases were 148.000 and at least 69.000 will survive. Therefore, it is necessary to focus on cancer survivor’s quality of life (QOL) and its effects in social aspects. Methods: A cross-sectional study was performed including 205 CS with history of non-metastatic cancer (aged ≤65 years, ≥ 2 years from diagnosis and off chemo- or radiotherapy). The QOL-CS questionnaire developed by City of Hope Medical Center was used to measure QOL. Participants reported employment and marital status changes during or after cancer treatment. The aim of this study was to evaluate QOL in CS and its association with employment and marital status. A multivariate logistic regression analysis was conducted to estimate odds ratios (OR). Results: Of the 205 CS 70.2% were women and 29.8% men. Median age at the time of the study was 56 years. Median survival time from diagnosis was 83.6 months. 37.1% had history of invasive breast, 18% colorectal and 8.8% testicular cancers. Disease-related marital status changes presented in 15.6%, 26.8% lost or changed work and 36.6% decreased their work hours. Distress about initial diagnosis, cancer treatment, family and financial burden had the worst score in the QOL-CS. We found no differences in QOL between gender, income, age at diagnosis or type of tumor, but having received chemotherapy was associated with worst QOL (OR 7.33 CI 95% 1.99-26.96 p = 0.003) as well as self-reported neuropathy (OR 2.34 CI 95% 1.06-5.19 p = 0.032). Those with low QOL-CS scores (≤6) were more likely to have a disease-related change in employment (OR 2.34 CI 95% 1.19-4.61 p = 0.014). Disease-related marital status changes were higher in who experienced work status variations (OR 3.87 CI 95% 1.21-12.4 p = 0.023). Conclusions: this is one of the first studies in Mexican CS that associate QOL with relevant social roles. In this cohort having received chemotherapy has the greatest impact in QOL. CS with low QOL were more likely to have changes in employment and therefore, in the marital status.
Effect of immunotherapy and stereotactic radiosurgery on cognitive function and quality of life in long term survivors of metastatic brain malignancies.
Authors: Reddy Naveen Kumar , Brown Franklin , Hess Judith , Fogarasi Miklos C. , Chiang Veronica
Published: May 2018

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Background: Use of whole brain radiation, radiosurgery, targeted therapies, and more recently, immunotherapies have resulted in improved survival for patients with brain metastases. As patients live longer, it is becoming increasingly important to understand the long-term cognitive function (CF) and quality of life (QOL) changes associated with these therapies. Methods: The Yale Gamma Knife Database was searched for patients surviving greater than 2 years after brain metastasis diagnosis. Of 79 patients identified, 19 were willing to participate in study. All participants underwent a single assessment session of cognitive tests that evaluated executive function (TMTa and TMTb), processing speed (COWA), memory (HVLT), and quality of life (FACT-Br). Results: Within the whole group, mean age was 65.5 years (range 50-88), median time from brain metastasis diagnosis to testing was 60 months (range 25.6-120.6). Mean number of lesions treated was 3.8 (range 1-10). Mean total lesion volume treated was 14.1 mm3 (range 0.6 - 39). Only 2 patients were treated with whole brain radiation therapy. Patient scores were compared to validated normative data for their age group. Patients performed worse than normal for their age on TMTb (p < 0.0001), total word recall (p < 0.0001) and discriminative ability (p = 0.0004). Patients performed as expected for age on TMTa, animal naming, FAS, and % retention. A negative correlation was seen between executive function results and QOL (TMTa: r = -0.569, p ≤ 0.05, TMTb: r = -0.484, p ≤ 0.05) and a positive correlation was seen between processing speed results and QOL (r = 0.672, p ≤ 0.001). Conclusions: In patients surviving more than 2 years after diagnosis and successful treatment of brain metastases, this study shows that portions of executive function and memory are worse than expected for their age, while cognitive processing speed is similar to norms. Cognitive function was correlated with QOL; patients with lowered cognitive function reported a lower quality of life. Given this preliminary data, a further study in a larger population is needed to determine if certain treatments preferentially predispose patients to declines in CF and QOL.
Developing and evaluating a training intervention to address fear of cancer recurrence.
Authors: Berrett-Abebe Julie , Maramaldi Peter , Cadet Tamara
Published: May 2018

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Background: Growing numbers of cancer survivors are increasingly receiving care from primary care providers (PCPs), who often lack cancer-specific expertise. In addition to long-term effects from cancer, survivors tend to be older with multiple chronic conditions, often leaving psychosocial concerns such as fear of cancer recurrence (FCR) unaddressed. This study reports the development and testing of a continuing education intervention to train PCPs to identify and address FCR. Methods: The training was developed through key-informant interviews with 42 health care professionals, researchers, and cancer survivors. The 30-minute training was then delivered and pilot-tested with a total of 46 participants, including physicians, PAs, NPs, nurses, and social workers in six discrete primary care practices. A one group pre-test, post-test design was used to evaluate the effectiveness of the training. Participants completed self-report surveys consisting of 5 domains developed from Social Cognitive Theory and Kirkpatrick’s Evaluation of Training Programs. Data were analyzed using descriptive statistics, paired-sample t-tests, and ANOVAs. Results: ± 10.9. Participants reported high levels of confidence that the training would change their practice, although they also identified barriers to action. Results of t-tests indicated that the training significantly increased participants’ knowledge and self-efficacy. With the except of 1 knowledge domain, no significant differences were found in multivariate analyses. Conclusions: This study demonstrated that a brief, on-site interprofessional training is feasible in a range of primary care practices, well-received by participants, and achieved goals of improved knowledge, self-efficacy and confidence to implement anticipated practice behavior changes. Such training efforts are important, as quality healthcare for increasing numbers of cancer survivors can be improved through continuing education efforts for their PCPs.