bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional properties of muffin as affected by substituing wheat flour with carob powder
Authors: Červenka Libor , Fruhbauerová Michaela , Velichová Helena
Published: March 2019

Carob (Cerationa soliqua L.) pod is the good source of dietary fiber, minerals and polyphenolic substances. The aim of this study was to prepare muffin where wheat flour was substituted with carob powder, and determine some physicochemical properties. Carob powder was prepared by milling dry carob pods to particles smaller than 600 μm. Then wheat flour in muffin dough was replaced by carob powder in 5, 10, 15 and 20% (w/w) and subsequently baked at 180 °C for 20 min. It was found that the height of the muffin fortified with carob powder decreased in comparison with that in control muffin sample. Although the height of muffins decreased with the increase in level of carob powder, the differences were not statistically significant. Weight loss was similar for all the muffin samples in this study. Moisture content of muffins with carob powder was significantly higher than that in control. Addition of carob powder had also effect on water activity of muffin. While 0.905 aw was observed in control sample, significantly higher aw values were determinated in fortified muffins (0.912 – 0.923 aw). The antioxidant characteristics were determinated using spectrophotometric assays for total phenolics (TPC), total flavonoids (TFC), radical scavenging activities (DPPH, ABTS) and hydrogen peroxide scavenging (HPS). TPC values gradually increased with the increase in level of carob powder from 348.1 to 829.1 μg gallic acid.g-1 dry matter but TFC values significantly increased in muffin with 15 and 20% (w/w) of carob powder. All the antioxidant assays showed strong and positive association with the increase in level of carob powder. Addition of carob powder resulted in the increase of browning index and FAST index as a metrics of the formation of Maillard products.
Quality of biscuits as affected by addition of fibre
Authors: Šottní­ková Viera , Langová Radka , Hřivna Luděk , Nedomová Šárka , Jůzl Miroslav
Published: March 2019

The aim of the study was to propose formulas with addition of bamboo and hemp fibre and grape seed flour in an amount of 3, 6 and 9% and then assess the effect of added fibre on the quality of biscuits. A total of 20 samples were baked, in half of the samples the basic ingredient was wheat flour, and in the rest of samples spelt flour was used. During a baking experiment, it was found that the best effect on the product volume and the weight after baking had bamboo fibre. Minor baking losses occurred in biscuits with wheat flour. The best sensory results were attained with the sample having 3% of grape seed flour with a spelt flour base. The crispiest was the sample made from spelt flour with 3% of hemp fibre and the wheat samples with bamboo fibre were of the lightest colour. Control samples had the highest nutritional values and biscuits with added bamboo fibre contained the lowest energy in both formulas.
Perception of Government Accountants on Current Public Sector Accounting Practices and Implementation of Public Sector Accounting Standards in the Sri Lanka
Authors: Anojan Vickneswaran
Published: March 2019

The main aim of the study is to find out the perception of government accountants on current public sector accounting practices and implementation of public sector accounting standards in the Sri Lanka. Public sector accounting practices involve with public expenditure, budget preparation, maintain proper accounting records, assets management, public financial management and provide reports on the public expenditure and revenue. Most of the public sector organizations do not prepare final accounts on accrual basis in the Sri Lanka. Primary data used in this study which data collected from government accountants in Sri Lanka. Mean analysis confirmed that there is moderate level of public sector accounting practices and implementation of public sector accounting standards in the Sri Lanka. Correlation analysis confirmed that there is significant relationship between public sector accounting practices and implementation of public sector accounting standards. Implementation of public sector accounting standards are positively impact on the public sector’s financial reporting practices and assets management practices in the Sri Lanka. Also below 23 percentage of public sector organizations are preparing final accounts on accrual basis. More than 97 percentage government accountants have ability to prepare annual accounts on accrual basis. Government administrators, policy makers and professional institutions should motivate effective and efficient implementation of the public sector accounting standards which will lead to a healthy public sector accounting practices in Sri Lanka.
Estrategias empresariales que ha implementado la Empresa Familiar Siembras & Cosechas para la satisfacción de sus clientes, en la ciudad de Estelí periodo 2016-2017
Authors: Ramírez Navarrete Ingrid Guadalupe , Rugama Villarreyna Escarleth Elieth , Rizo Valdivia Yaritza Itzamar , Castillo Herrera Beverly
Published: March 2019

Este articulo aborda los efectos de las estrategias empresariales como franquicia implementadas por la Empresa Familiar Siembras & Cosechas para la Satisfacción de sus Clientes. La estrategia empresarial “es la determinación de la posición futura de la empresa, en especial frente a sus productos y mercados, su rentabilidad, su tamaño, su grado de innovación y sus relaciones con sus ejecutivos, sus empleados y ciertas instituciones externas.” La trascendencia de esta investigación beneficia a los propietarios de batidos Siembras & Cosechas, quienes conocerán las debilidades de su empresa y sabrán si los objetivos se han logrado satisfactoriamente. Esta investigación es de tipo Cuali-Cuantitativa (Mixta), porque se analiza a profundidad la problemática sobre las estrategias empresariales utilizadas por la Empresa, se aplicaron encuestas y entrevistas a los clientes de cada una de las sucursales de la ciudad de Estelí, para analizar el comportamiento de las variables que influyen en la satisfacción de los clientes. El principal resultado demuestra que la mejor estrategia que ha implementado la empresa para expandirse y posicionarse en el mercado ha sido las franquicias. Así mismo la calidad de sus productos ha permitido que sus clientes se sientan satisfechos. En este estudio se proponen líneas estratégicas que generen oportunidades de desarrollo a la empresa, que servirán de guía para que los encargados tomen decisiones encaminadas a mejorar las estrategias que han implementado en el transcurso de su funcionamiento.
Una mirada a la educación para el desarrollo sostenible y el ambiente en las universidades públicas de Honduras
Authors: Najarro Vargas Tania Teresa , Montenegro Mejía Carlos Roney
Published: March 2019

Repensar los valores de la sociedad humana para reconocer la «Tierra Patria» que propone Edgard Morín, que en el lenguaje de las Naciones Unidas se denomina desarrollo sostenible, marca una tendencia hacia las políticas de educación superior, el comportamiento de la generación de conocimiento e información a través de publicaciones y las declaraciones de políticas de las universidades públicas es de utilidad para identificar las acciones nacionales hacia esta tendencia. En esta investigación se identificó el interés en publicaciones de artículos indexados y publicaciones institucionales en el tema. En Honduras los documentos de modelos educativos incluyen, a nivel de macroestructura y mesoestructura, elementos que muestran intentos de integrar dimensiones del desarrollo sostenible como la dimensión social y ambiental. Los esfuerzos nacionales están siendo completados con apoyo de movimientos en la región centroamericana, como es el caso de la transversalización del currículo con los temas cambio climático y gestión de riesgo.

Palabras claveEducación superior, educación ambiental, desarrollo sostenible, publicaciones, universidades públicas
IDENTIFICAÇÃO DE CLUSTER DE CONCENTRAÇÃO DE RENDA E DEPENDÊNCIA DEMOGRÁFICA NOS VALES DO JEQUITINHONHA E MUCURI
Authors: Fonseca Samuel Ferreira da , Aguiar Heloisa Helena de
Published: March 2019

O objetivo deste trabalho foi identificar cluster de concentração de renda e dependência demográfica nos Vales do Jequitinhonha e Mucuri, por meio de análise exploratória de dados espaciais. Como procedimento metodológico usou-se revisão bibliográfica e tratamento estatístico de dados secundários (Renda Per capta Média e Razão de Dependência Demográfica) referente a 1991, 2000 e 2010. Aplicou-se o índice de Moran Global e o Indicador de Associação Espacial Local. Foram utilizados os aplicativos: GeoDA 1.8.10™, TerraView 4.2.2™ e ArcGIS 9.3™. Foram elaborados mapas coropléticos representando os clusters. Verificou-se cluster de Renda Per capta Média em Carlos Chagas e Nanuque com grau de confiança entre 95 a 99,9%, para 1991 e 2010. A Razão de Dependência foi reduzida no período estudado, entretanto, a distribuição espacial de clusters permaneceu constante nas áreas da divisa dos vales. Sugere-se que amostragens sejam realizadas nos municípios em situações críticas para verificar os efeitos oriundos da concentração de renda e dos agrupamentos em relação a Razão de Dependência Demográfica.
NOTA EDITORIAL
Authors: Ra'e Ga - O Espaço Geográfico em Análise Revista
Published: March 2019

É com grande satisfaçãoque publicamoso 46º volumeda revista Ra’e Ga -O Espaço Geográfico em Análise. A partir desse fascículoo periódicopassaa contarcom uma nova estrutura editorial, formada por editores de seçãoque atuam nos temas relacionados à Geografia Física, Geografia Humana e abordagens transversais da análise espacial. Esperamos que essas mudanças resultem em maior qualidade dos trabalhos publicados e celeridade no processo de avaliação.
Dos Montes à vila: considerações em torno da vila medieval portuguesa de Aldeia Galega da Merceana
Authors: Olaia Inês Sofia Lourenço
Published: March 2019

Pretendemos esclarecer neste artigo as circunstâncias que explicam a evolução do topónimo “Aldeia Galega”, localidade atualmente situada no Concelho de Alenquer. Para isso, analisaremos brevemente o povoamento da região e a sua evolução no tempo para justificar as mutações das designações a ela associadas, do composto “Montes de Alenquer”, que designou originalmente um espaço mais vasto, até ao “Aldeia Galega da Merceana” com que é conhecida nos nossos dias. O nosso exame centrar-se-á no momento em que todas estas alterações se detetam sucessivamente: da Idade Média aos alvores da modernidade, no período compreendido entre 1220 e 1537. Da mesma forma, abordaremos as diferenças entre a documentação produzida localmente e aquela que é produzida pelas chancelarias régias, na tentativa de compreender as razões que justificam o apêndice “da Merceana” e a forma como ele é, ou não absorvido pelos habitantes do lugar.
A construção da Cavalaria de Rei Arthur em Thomas Malory a partir do Juramento do Pentescostes
Authors: Busch Willian Perpétuo
Published: March 2019

Nossa inquirição almejou compreender como foi construída a noção de cavalaria presente no texto literário Le Morte D’Arthur, redigido por Sir Thomas Malory por volta de 1495. Como o título sugere, por se tratar de uma narrativa sobre “Rei Arthur”, nosso primeiro passo foi compreender como essa figura foi construída entre a Antiguidade e o Medievo. Cruzamos as investigações sobre “Rei Arthur” com uma breve caracterização do fenômeno da “cavalaria” em seu contexto histórico, algo que fizemos a partir dos trabalhos de George Duby1, Jean Flori2 e Dominique Barthélemy3. Nossa revisão bibliográfica dividiu-se em três momentos distintos: I) referências sobre Malory e sua identidade (em disputa); II) contexto da Inglaterra durante a vida do autor; III) estudos acadêmicos que aproximam a imagética e o simbolismo em torno da figura do Rei Arthur com o Santo Graal e a cavalaria. Tal incursão nos permitiu visualizar como essa cavalaria que aparece na literatura de Malory estava fundada na confluência dos eixos: marcialidade; corte e sacralidade, reagindo a estes de forma crítica. Trata-se de uma cavalaria difusa que nos oferece um enquadramento para compreender como contradições, conflitos e tensões sociais do período reverberavam sobre a literatura. O núcleo disso aparece dentro da literatura de Malory na forma do Juramento do Pentescostes.
Counter-effect of Refugee Movement in Culturally and Linguistically Diverse Classrooms
Authors: Solak Ekrem , Gezegin Betül Bal
Published: March 2019

The presence of refugee students in culturally and linguistically diverse classrooms relatively influences thedevelopment of local students as well. Students with different languages and cultural background in a learningenvironment create a different atmosphere and may influence the attitude of local students to other languages andcultures. Therefore, this study investigated how and to what extent native students were influenced from refugeestudents in terms of linguistic and cultural perspective. The mixed method was used in this study. Quantitative datawere collected from local students in culturally and linguistically diverse classrooms through a questionnaire andqualitative data were collected from teachers teaching in these classrooms by means of interviews. The results of thestudy revealed that there were remarkable positive effects of the integration process on both sides though variousproblems emerged in diverse classrooms. The findings of this research may also (delete) give implications about theinfluence of refugee movement for other cultures.
Gender Differences in Social Media Use and Cyberbullying in Belize: A Preliminary Report
Authors: Kasahara Grace Mariko , Houlihan Daniel , Estrada Collin
Published: March 2019

Cyberbullying is a global issue that usually occurs with increased social media usage. A number of studies have found significant gender differences in social media use and cyberbullying, although gender differences are not consistent across studies. Despite the increase in access to cellphones and Internet in Belize, no studies have investigated how adolescents are using these resources. The purpose of this study was to investigate gender differences involving how adolescents in Belize are using social media and if cyberbullying is a problem.

Results provide preliminary information about social media use and cyberbullying in Belize. It indicates that gender differences exist within social media use and cyberbully reporting, and future studies should investigate influencing cultural factors.
From the Chair
Authors: Pritchett Hallie
Published: March 2019

One of the things I had forgotten about living in the Upper Midwest after spending eleven years in Georgia is just how short the days are at this time of the year (due to the DttP publication schedule, I am writing the Chair’s Column for the Spring 2019 issue in January). On the winter solstice in December, Fargo had about eight and a half hours of daylight; it was dark when I went to work and dark when I went home. The good news is that after mid-December, the days start getting longer; as of this writing in mid-January, Fargo has gained almost a half an hour of daylight. By the summer solstice in June our days will be almost sixteen hours long and presumably quite a bit warmer. Definitely something to look forward to on a cold winter’s night!
Depository Designations
Authors: Ahrens Aric
Published: March 2019

Though the FDLP Modernization Act of 2018 failed to land on the president’s desk, the first serious attempt at a legislative solution to the structural hindrances facing the Federal Depository Library Program (FDLP) must be applauded. In particular, granting the Superintendent of Documents the authority to designate depositories is a vast improvement over the current and ancient Congressional District Model of Depository Allocation. The inadequacies of this well intentioned method of allocating depositories nationwide have been articulated since the nineteenth century.
LEGOs: Linking Units, Operations, and Area
Authors: Wickstrom Megan H. , Fulton Elizabeth , Lackey Dacia
Published: March 2019

Use those multicolored linking bricks to help students connect measurement with an understanding of number and operations as well as fractions.
CLO19-030: Duration of First Line Therapy in Metastatic Non-Small Cell Lung Cancer
Authors: Dang Jeff , Chau Sang , Delaisla Jessy , Prakash Divya , Hertler Andrew
Published: March 2019

Background: Lung cancer is the leading cause of death in the United States. We are challenged with finding the optimal treatment for patient subgroups in a real-world setting. Treatment options have expanded to include immunotherapies versus platinum-based therapies to improve the quality of cancer care. Platinum combinations are known to have overall response rates of 25%–35%, time to progression of 4–6 months, and a median survival of 8–10 months. The purpose of this study was to determine how long metastatic NSCLC patients were on first-line treatments and what characteristics potentially contribute to the duration of therapy prior to progression. Methods: All patients with a diagnosis of metastatic NSCLC that received first line treatment between January 1, 2016 and December 31, 2017 but later switched to a different treatment because of disease progression or intolerance were included in the study (n=1,222). The sample, obtained from a nationwide database of treatment requests, was stratified into 4 groups based on the type of treatment the patient received: single agent (n=66), PD-1/PDL-1 (n=157), platinum doublet (n=720), and platinum triplet (n=279). Chi-square and Kruskal-Wallis tests were performed as appropriate. Results: The findings suggested that the median duration to progression was shorter for single agents as compared to multiple agent treatments (Χ2=7.67, P=.05). The median treatment duration for the groups were as follows: 90 days for single agent, 90 days for PD-1/PDL-1, 93 days for platinum doublet, and 111 days for platinum triplet. Additional analyses were conducted to understand whether pathway adherence and growth factor usage impact the duration of time to discontinuation within each group. Conclusions: These data provide insight into the duration of first line treatments for advanced lung cancer. Shorter duration times were found for single agent treatments as compared to multiple agent treatments.
QIM19-146: A Multidisciplinary Approach to Conquer Central-Line Associated Blood Stream Infections: Establishing the Continuum of Prevention
Authors: Wallace Christine , Sullivan Jennifer , Supan Erin
Published: March 2019

Background: Central line associated blood stream infection (CLABSI) rates have been above the benchmark for our academic medical center that includes a comprehensive cancer center. In response, a 20% CLABSI reduction rate was set by the hospital Chief Medical and Associate Chief Nursing Officers. A multidisciplinary group convened to standardize central line insertion and maintenance practices. Product review showed 20 different central line insertion kits and 6 different dressing kits throughout the system. Hospital central line policy focused solely on nursing practice and there was not a policy including provider practice regarding central line insertion. A gap analysis determined dressing and insertion site integrity was compromised in 53% of our patients, including visible blood under 38% of the dressings, with oncology patients having some of our highest rates of bleeding. Objective: The purpose of this quality improvement project was to collaborate amongst disciplines to review practice, products, and policy for central line insertion and maintenance. We aimed to systematically improve practice across the central line continuum of prevention. Methods: A multidisciplinary team evaluated and defined current and best practice for policy and product changes. Implementation of best practice checklists included a team checklist to be used during insertion of every central line in the intensive care units and checklists that detailed practice steps in accordance with the updated central line policy. Central line dressing change prototypes were designed, products were compared, and approval for a standardized kit to support practice occurred. A new antimicrobial and hemostatic dressing was selected for line care to improve site integrity. The number of central line insertion kits was reduce by half and dressing kits were reduced to just one standard kit for the hospital system. Results: CLABSI rates have decreased from 7.43 cases/month to 3.6 cases/month following. Trends post-product rollout and repeat gap analysis data will be included at time of presentation. Conclusion: Reduction of CLABSI requires a multidisciplinary approach focusing simultaneously on best practices for central line insertion and maintenance. Best evidence for provider and nursing practice needs to be bundled in a comprehensive policy with checklist and products to support the standardization. Clinician evaluation and input on choosing products is critical to positive patient outcomes.
BPI19-008: Racial Disparities in Breast Cancer Treatment Based on NCCN Quality Guidelines
Authors: Agarwal Surbhi , Rao Ruta , Ansell David
Published: March 2019

Background: NCCN quality measures for breast cancer include (1) radiation therapy administered within 1 year of diagnosis for women under age 70 receiving breast-conserving surgery; (2) chemotherapy considered in 4 months of diagnosis for women under 70 with T1c or stage II/III ER/PR- tumors; (3) endocrine therapy administered within 1 year of diagnosis for women with AJCC T1 or stage II/III ER/PR+ breast cancer. These evidence-based measures promote accountability for providers and allow transparency in quality of care. Black women are less likely than white women to receive these therapies that are associated with a survival benefit. Improving adherence to guidelines can decrease the gap in mortality rates for minority women with breast cancer. Methods: We performed a retrospective chart review on patients with breast cancer between April 2010 and October 2015 at Rush University. Information collected included time of diagnosis, clinical stage, ER/PR status, surgical procedures, radiation, chemotherapy, endocrine therapy, and demographics. Chi-squared analysis was done to compare percent of black versus white women who met each quality guideline. Results: In total, 2,436 women were analyzed, of whom 30.3% were black, 66% were white, and 3.7% were other. Of this cohort, 779 women met inclusion criteria for quality guideline 1, and there was no significant difference between black and white women who did not receive radiation therapy (P=.21; 24.7% vs 20.4%). For quality guideline 2 (n=382), there was also no significant difference between black and white women who did not get chemotherapy within 4 months of diagnosis (P=.32; 36.6% vs 31.4%). However, for quality guideline 3 (n=1,222), there was a statistically significant difference between black and white women who did not get hormone therapy within a year of diagnosis (P=.0008; 36.9% vs 26.1%). Conclusions: Endocrine therapy reduces risk of recurrence and mortality in women with ER/PR positive breast cancer; however, there is a disparity between black versus white women who meet this NCCN quality measure. Further studies are needed to understand the reason for this gap in quality of care so that specific interventions can be implemented to eliminate this disparity.
CLO19-040: The Role of Adjuvant Therapy in Patients With Pathological T2N0 Resected Gastric Adenocarcinoma
Authors: Khoury John , Macari David , Ezekwudo Daniel , Werede Ayoda , Jaiyesimi Ishmael A.
Published: March 2019

Background: There is controversy surrounding the benefit of adjuvant therapy for patients with pT2N0, stage IB gastric adenocarcinoma following surgical resection. Methods: Patients with T2N0 gastric adenocarcinoma (tumor invasion into the muscularis propria) who underwent surgical resection with pathological evaluation of at least 15 lymph nodes were identified from the Surveillance Epidemiology and End Results Registry (SEER) database. Demographics, adjuvant therapy, and survival data were collected and analyzed using SPSS statistical software. Results: A total of 452 cases were identified between 2004 and 2014. Median age at diagnosis was 69. 60.2% of the patients were white, 27.7% Asian, 10.8% black, and 1.3% from other races. Adjuvant therapy was administered to 30.5% of the patients, of which 44.2% received chemoradiation, 48% chemotherapy only, and 7.2% radiation therapy only. After a median follow up of 39 months, the median overall survival (OS) was not reached in the group of patients who received adjuvant therapy versus 100 months in the group that did not receive adjuvant therapy (P=.005). The 5-year OS rate (5-YOS) was 77% for the adjuvant therapy group versus 62% for those who did not receive adjuvant therapy. Univariate analysis revealed that the hazard ratio for death [adjuvant therapy vs observation] was 0.54; 95% CI, 0.35 to 0.83. Adjuvant therapy showed statistically significant survival benefit in patients younger than 60 years of age (5-YOS, 95% vs 79%) and failed to show survival benefit in patients older than 60 (5-YOS, 63% vs 58%). Multivariate analysis revealed that age was associated with mortality, whereas sex, race, grade, tumor size, and number of lymph nodes examined were not associated with increased mortality. Conclusions: Adjuvant therapy provided survival benefit for pT2N0, stage IB resected gastric adenocarcinoma. Our results suggest that patients younger than 60 year of age may benefit the most from this therapy.
EPR19-067: Effectiveness of Breast Cancer Awareness Campaign on Internet Search Activity Compared to Other Gynecological Malignancies
Authors: Jain Akriti Gupta , Khan Abdul Kareem , Kumar Ranjeet , Wazir Mohammed , Hasan Syed Askari , Majeed Umair
Published: March 2019

Background: Breast Cancer (BC) is common, with 1 in 8 U.S. women (12.4%) developing invasive breast cancer in their lifetime. BC is associated with the most awareness campaigns with pink ribbon as its symbol. October was earmarked as the breast cancer awareness month (CAM) in 1985. Cervical (CC) and ovarian cancers (OC) are associated with a high mortality as well and have awareness months dedicated to them. The aim of these awareness drives is to change public attitude and help in early detection and ultimately prevention of various cancers. Internet search activity can be used as a method to gauge interest and awareness in the masses. We aimed to assess the popularity of BC compared to other gynecological cancers, including OC and CC. Methods: We compared the relative frequency of search terms “Breast Cancer,” “Ovarian Cancer,” and “Cervical Cancer” between January 1, 2004 and December 31, 2017 (n=168 months) using Google Trends, a public web facility of Google Inc. The software designates a reference value of 100 for the point of highest popularity and it provides relative monthly popularity scores for all the terms, which we termed as comparative interest scores (CIS). Within each cancer, average CIS was then compared for their respective awareness months (n=14 months; October for BC, September for OC, and January for CC) to the remaining months (n=154 months). Results: The mean CIS for BC was significantly higher during its CAM, 70.5 as compared to other months 35.9; p<0.001. However, for CC mean CIS during January (7.4) was not different compared to the other months (7.4); P=1.00. And for OC, CIS was significantly higher during its CAM (9.2) compared to other months (7.7); P=.0002. The peak of highest popularity for breast cancer was observed during October 2004 and all peaks corresponded to the CAM; other smaller peaks were seen during significant news events associated with BC, all of which surpassed OC and CC in those months. Overall BC CIS were significantly higher compared to CC (P<.001) and OC (P<.001). Conclusions: We conclude that BC awareness campaigns have succeeded in increasing internet search activity during its CAM but ovarian and cervical cancer campaigns especially when compared to breast cancer have not been as successful. There is still a need to increase awareness among masses. Google trends data also tells us which states in US have more internet search activity compared to others which can be used to target the relatively unaware public.
BPI19-016: Evaluation of the Use of a Single Dose Rasburicase in Prophylaxis and Management of Tumor Lysis Syndrome (TLS) Among Cancer Patients in Qatar
Authors: Kassem Nancy , El Omri Halima , Yassin Mohamed , Elazzazy Shereen
Published: March 2019

Introduction: Rasburicase is a urate oxidase enzyme used for prophylaxis and treatment of hyperuricemia associated with TLS. The recommended dose of rasburicase is 0.2 mg/kg/day for 5 days; however, recent studies have demonstrated the effectiveness of a single rasburicase dose in prophylaxis and management of hyperuricemia associated with TLS. Our institution’s TLS guideline was updated to recommend the use of a single rasburicase dose (0.2 mg/kg). The primary objective of this study was to assess the efficacy of a single rasburicase dose in controlling uric acid (UA); the secondary objective was to evaluate the impact of the institutional TLS guidelines update on consumption and cost of rasburicase. Methods: This is a single center retrospective cohort study including all patients who received rasburicase from August 2012 to March 2016 at the National Center for Cancer Care and Research (NCCCR) in Qatar. Patients were divided into 2 groups based on the prescribed number of rasburicase doses (single dose vs multiple doses). Collected data included patients’ diagnosis, laboratory parameters rasburicase dose, duration, and number of dispensed vials. UA levels within 24 hours and on day 5 of initial rasburicase dose were evaluated. Risk stratification was determined according to institutional guidelines based on disease, white blood cell count, lactate dehydrogenase level, renal function, and UA level. Results: A total of 103 patients who received rasburicase were evaluated retrospectively; rasburicase was prescribed as single dose for 65 patients (63%) and multiple doses for 38 patients (37%). The majority of patients who received rasburicase as single or multiple doses were at high risk of developing TLS, representing 68% and 84%, respectively. Baseline mean UA levels were similar in both groups: 5.4±2.9 mg/dL vs 4.7±3.2 mg/L respectively (P=.7). Normal or undetectable UA levels were observed within 24 hours in 98% of patients in the single dose group and 100% of patients in the multiple doses group. All patients in both groups had normal UA on day 5 of rasburicase with relatively similar UA levels: 1.5±1.2 mg/dL vs 0.8±1 mg/dL (P=.18). Rasburicase consumption and cost were reduced by 42.5% after the guidelines update. Conclusion: The single rasburicase dose demonstrated efficacy in controlling serum UA levels. Updating the institutional TLS guidelines had a significant impact on rasburicase consumption and led to significant cost reduction.
EPR19-075: Geographic Region and Race/Ethnicity Are Associated With Treatment and Survival for Gastric Cancer
Authors: Ulanja Mark , Rishi Mohit , Beutler Bryce , Ambika Santhosh
Published: March 2019

Introduction: Gastric adenocarcinoma (GAC) remains a lethal disease. Evidence suggests that there is increased incidence of gastric cancer among ethnic minorities as compared to whites. In addition, survival and treatment recommendations may vary based on geographic regions. Objectives: We sought to assess the impact of geographic region and race/ethnicity on treatment and survival for GAC. Methods: Data from SEER registry was used to identify patients with potentially resectable gastric adenocarcinoma (AJCC I–III) diagnosed 2004 to 2015. Exposures of interest were geographic region of diagnosis: Western (West), Midwestern (MW), Southern (SO) or North Eastern (NE), and race. The endpoints were: (1) recommendation of no surgery by the provider, (2) utilization of surgery, and (3) gastric cancer-specific survival (GCS). Multivariable logistic and Cox regression models were used to identify associations. Results: 15,991 patients were included in the analysis (West, 56.3%; NE, 16.3%; MW, 7.8%; and SO, 19.7%). On univariate analysis, the likelihood of no recommendation for surgery was highest in SO (OR: 1.35; P<.001;] West, referent). In adjusted analysis, it was lowest in NE and MW (NE aOR: 0.78; P<.001; MW aOR: 0.78; P=.002). The likelihood of no recommendation for surgery was lowest in Asians (AS) on univariate analysis (OR: AS, 0.47; P<.001); American Indian (AI) 0.59 (P=.027); Hispanic (HS) 0.85 (P=.018); whites (W) 1.01 (P=.884); Black (B) ref]. The adjusted analysis for W is (aOR: 0.86; P=.029; B-ref) and persisted for the rest of ethnicity. Patients diagnosed in NE were independently more likely to undergo surgery as compared to those in other regions (aOR: 1.25; P<.001); black individuals were less likely to undergo surgery as compared to whites, Asians, and Hispanics (P<.05 for all). Overall, a diagnosis of gastric cancer in the NE region was independently associated with superior GCS (HR=0.85; P<.001) (Table 1). Among patients who underwent surgery, those in the NE (HR=0.85; P=.001) exhibited superior GCS, but poor GCS in SO (HR=1.17; P=.001; West-ref). AS who underwent surgical intervention demonstrated superior GCS as compared to all other ethnic groups (HR=0.76; P<.001). Conclusion: There is significant difference in treatment and survival for GAC based on geographic region and race/ethnicity. Adherence to treatment guidelines and recommendations is essential to optimize outcomes for all patients.
CLO19-048: Effects of Acupuncture on Cutaneous Microcirculation by Infrared Thermography in Cancer Patients
Authors: Sawada Namie Okino , Toneti Bruna Franciely , Okino Liyoko , Maria de Paula Avelar Juliana , Baviera Amanda Fonseca , Sawada Luana Okino
Published: March 2019

Objectives: The objective of this case series was to describe the experience of the use of infrared thermography to evaluate the effects of acupuncture on cutaneous microcirculation of cancer patients. Methods: The method is a cross-sectional survey, descriptive of a series of cases of a sample for convenience. The data collection procedure had a total duration of 30 minutes, being captured images at different times during the procedure: before the needling (T0); first minute (T0a); second minute (T0b); third minute (T0c); forth minute (T0d); fifth minute (T1); tenth minute (T2); and after 15 minutes (T3) of needling. Body temperature was evaluated by infrared camera, brand FLIR, series A. The FLIR Tools software version 5.9 was used to perform the calculation of the temperatures with subsequent descriptive analysis of the data. The choice of the PC6, BP10, R6, and B62 bilateral acupoints was because of the anatomic location and energetic actions on the blood circulation. The PC6 acupoint (Neiguan) is located in the meridian of the pericardium, lies on the anterior face of the forearm approximately 2 cm (0.79 inches) below the wrist and between the flexor tendons. This acupoint is responsible for sending signals to the central nervous system, which results in the reduction of sympathetic activity. Results: According to the ANOVA test, considering P value less than or equal to .05, there were statistically significant differences in the time intervals evaluated, with P value of .004. There was a 1.7% increase in the mean temperature of the interval between T3 and T0 in the sample, that is, between the time before and after 15 minutes of needling. Conclusion: This series of cases showed the viability of the method of evaluating the effects of acupuncture on cutaneous microcirculation by infrared thermography in the rehabilitation of cancer patients. The results showed statistically significant differences in the time intervals evaluated, demonstrating the importance of the evaluation at 15 minutes after needling to accurately verify the variation of cutaneous temperature by thermography in the acupoints. It was noticed that the increase of the cutaneous temperature occurred, mainly, in the first 5 minutes after the needling, with a reduction after this time interval.
HSR19-087: Intensity of Symptom Management After Palliative Care Referral Not Associated With Reduced Imaging Intensity for Cancer Patients During the End-of-Life Period
Authors: Franc Benjamin L. , Raghavan Kesav , Copeland Timothy P. , Ladenheim Maya , Marks Angela , Pantilat Steven Z. , O’Riordan David , Seidenwurm David , Rabow Michael
Published: March 2019

Purpose: For patients with advanced cancer, palliative care (PC) referral itself results in improved quality of life and lower total health care costs. While our earlier research suggests that PC referral alone does not appear to affect imaging utilization, the effect of the intensity of services for PC symptom management on utilization of imaging services is unknown. We sought to evaluate whether an association exists between the intensity of PC symptom management services and utilization of high-cost imaging at the end-of-life. Methods/Materials: Adult cancer patients who died between January 1, 2012–May 31, 2015 were identified. A PC symptom management intensity score was determined for each patient during the last year of life based upon the number of inpatient and outpatient PC service visits and the number of problems addressed within the 8 defined domains for palliative care. Frequency of utilization of nonemergent oncologic imaging was determined for the last 3 months and the last month of life. Using chi-square and Wilcoxon-rank sum tests, effects of low (<20th percentile) and high (>80th percentile) PC symptom management intensity score on the proportion of patients imaged and mean number of studies per patient (mean imaging intensity [MII]) were compared for the last 3 months and last month of life. Results: 3,772 decedents were included, with 3,523 (93.4%) never referred to PC and 249 (6.6%) referred to PC, largely before the last month of life (70.3%). Within the last 3 months and last month of life, the proportion of patients imaged was significantly greater (P<.001) in patients with high PC symptom management intensity scores when compared to those with low PC symptom management intensity scores. There was no significant difference in the mean number of imaging studies received by either group in the last 1 month or 3 months of life. (P>.05). Conclusions: The intensity of PC symptom management in end-of-life oncologic care was not associated with decreased use of nonemergent, high-cost cancer imaging in our cohort. This may suggest an opportunity for reduced high-cost imaging through further clarification of the goals of care with both patients and oncologists, although the role of imaging in the setting of PC during the end-of-life period warrants further study as well.
QIM19-135: The Quality Oncology Practice Initiative Program: Experience in Spain
Authors: López Rafael , Antón Antonio , Aranda Enrique , Carrato Alfredo , Constenla Manuel , Cruz Juan Jesús , Díaz-Rubio Eduardo , Feyjóo Margarita , García-Foncillas Jesús , Gascón Pere , Guillem Vicente , Lugo Ilse , Rogado Álvaro , Camps Carlos
Published: March 2019

Background: Patient quality care is a discipline that has acquired enormous relevance in today’s healthcare. The Quality Oncology Practice Initiative (QOPI) is a referral worldwide in terms of quality for oncology practices. The ECO Foundation is a foundation of experts representing the major Spanish hospitals involved in the treatment of cancer patients. ECO reached an agreement with ASCO to involve Spanish hospitals in the QOPI program. Methods: 6 rounds of data collection have taken place (Fall 2015 to Round 1 2018). Practices had to register online and submit data into the QOPI platform, and the ECO Foundation offered all centers the necessary support. 17 Spanish hospitals have participated in the 6 rounds, and 7 of them have repeated participation. Core and lung cancer modules were completed. Results: During the 6 rounds, 1,877 charts were submitted by the Spanish practices. In most of the rounds, the highest scores were: pathology report confirming malignancy; number of chemotherapy cycles documented; patient consent for chemotherapy; and 5 measures of the lung cancer module. The lowest scores were: chemotherapy treatment summary provided to patient within 3 months of chemotherapy end; chemotherapy treatment summary provided or communicated to practitioner(s) within 3 months of chemotherapy end; smoking/tobacco use cessation counselling recommended to smokers/tobacco users in past year; and tobacco cessation counselling administered or patient referred in past year. The percentage of participating practices that presented results higher than 70% was successively 64%, 50%, 75%, and 100% in the last 3 rounds. For the 7 hospitals that repeated participation, 3 reported an improvement of their global scores. Regarding QOPI Certification, 3 Spanish hospitals received this accreditation in September 2017 and one in June 2018. Conclusions: These preliminary results are a good starting point for the continued implementation of the QOPI program in Spain, thus providing a well-structured approach to analyze cancer care. The ECO Foundation will continue pursuing excellence and quality with further activities like the QOPI Certification program and Quality Training Program, these being performed for the first time in Spain in 2017 and 2018, respectively.
CGE19-062: The Rs1388378 Polymorphism in the Human DIO2 Gene is Associated with Decreased L-Thyroxine Dose Requirement in Thyroidectomized Patients
Authors: Alanazi Ashwaq Mohammed , Alshalhoub Rawan , Alrasheed Maha Meshal , Abanamy Nora , Bakheet Dana , Dzimiri Nduna
Published: March 2019

Background: Patients with differentiated thyroid cancer (DTC) are usually managed with total thyroidectomy and subsequent radioiodine ablation of the remnant thyroid tissue. L-thyroxine (L-T4) therapy (about 2 µg/kg) is required for life, with a wide variation in patient dose requirements. The iodothyronine deiodinase types I, II, and III (DIO1, DIO2, and DIO3, respectively) regulate the activity of the thyroid hormone via removal of specific iodine moieties from the precursor molecule T4. During LT4 replacement, the active hormone triiodothyronine (T3) levels strictly depend on DIO2-mediated activation of LT4. Therefore, the aims of this study were to investigate the association of DIO1 and DIO2 polymorphisms with DTC and L-T4 dose requirement in the Saudi population. Methods: A total of 1,067 (560 controls and 507 DTC thyroidectomized cases) Saudi Arabs were included. Serum free thyroxine and TSH levels were measured in the cases. We genotyped 1 DIO1 variant rs2294512_G and 3 DIO2 SNPs, rs1388378_T, rs12885300_T, rs225013_T, by TaqMan assay. Results: The DIO1 and DIO2 genotyping revealed an association between L-T4 dose requirement and rs1388378_T. Patients carrying the rs1388378_T allele required a lower l-T4 dose (145.91±33.31; P=.035). No significant association was found for these SNPs with cancer risk. Conclusions: Our study identified 1 DIO2 variant associated with L-T4 dose requirement. Thyroidectomized patients carrying T allele of rs1388378 need lower L-T4 dose to maintain normal TSH level thus providing evidence in favor of customized treatment of hypothyroidism in athyreotic patients.
CLO19-056: Scalp Cooling Proved to be Successful in the Prevention of Alopecia in >7,000 Patients With Solid Tumors
Authors: van den Hurk Corina , Dercksen Wouter , Vriens Birgit , Breed Wim
Published: March 2019

Introduction: Hair loss is a frequently occurring and stigmatizing side effect of chemotherapy. Worldwide scalp cooling is being introduced to prevent chemotherapy-induced alopecia (CIA). In the Netherlands scalp cooling is implemented in many hospitals since 2005. Methods: From 2006–2017, data have been collected in a prospective, longitudinal registry. Patients with all types of solid tumors, with all stages of disease, from all ages and both sexes could participate, if they received a chemotherapy that induced severe hair loss. The hospitals were free to offer scalp cooling to their patients according to their local protocols on cooling and infusion time of the drugs. Patients were eligible for evaluation of hair loss after they received at least 2 cycles of chemotherapy or if they ceased scalp cooling because of severe hair loss after the first cycle. Data will be presented using descriptive statistics and multivariate regression analysis to explore determinants of scalp cooling efficacy. Results: Preliminary results show data of 7,378 patients from 68 hospital locations of whom 75% had breast and 8% prostate cancer. Most patients (61%) were treated in the adjuvant setting. In general, preinfusion cooling time was 30 minutes and postinfusion cooling time 90 minutes. An exception was for docetaxel, for which 20 minutes postinfusion cooling time was used in recent years. Scalp cooling efficacy varied from above 80% for taxanes monotherapy to below 10% for the combination of docetaxel, doxorubicin, and cyclophosphamide (TAC). Results from the regression analyses will be presented at the conference. Conclusion: Scalp cooling proved to be successful for most types of chemotherapy causing CIA.
HSR19-107: Nivolumab for Newly Diagnosed Classical Hodgkin Lymphoma: Patient-Reported Outcomes From CheckMate 205 Cohort D
Authors: Ramchandren Radhakrishnan , Ansell Stephen M. , Armand Philippe , Engert Andreas , Taylor Fiona , Cocks Kim , Chen Clara , Bennett Bryan , Moreno-Koehler Alejandro , Roeder Adam , Sumbul Anne , Sacchi Mariana , Cella David
Published: March 2019

Background: Patients (pts) with classical Hodgkin lymphoma (cHL) frequently experience reduced health-related quality of life (HRQoL) (Oerlemans et al, Ann Hematol 2011). Nivolumab, a fully human IgG4 anti-programmed death-1 (PD-1) immune checkpoint inhibitor monoclonal antibody, demonstrated efficacy and clinically meaningful improvement in pt-reported outcomes (PROs) in pts with relapsed/refractory cHL in cohorts A, B, and C of CheckMate 205 (NCT02181738) (Armand et al, J Clin Oncol 2018; Engert et al, ASH 2017). Nivolumab monotherapy followed by nivolumab + doxorubicin, vinblastine and dacarbazine (N-AVD) demonstrated an objective response rate of 84% in newly diagnosed cHL (cohort D of CheckMate 205; Ramchandren et al, EHA 2018). We present PROs in CheckMate 205 cohort D. Methods: Pts ≥18 years of age with untreated, advanced-stage cHL, with ECOG performance status (PS) of 0–1 received 4 doses of nivolumab monotherapy (240 mg IV Q2W) followed by N-AVD for 6 cycles (12 doses). Pts then entered the follow-up (FU) period. PROs were an exploratory endpoint, assessed using the EuroQol 5 Dimensions-3 level (EQ-5D-3L) and associated visual analog scale (EQ-VAS) in all treated pts who had both a baseline (monotherapy cycle 1) and post-baseline assessment. EQ-VAS ranges from 0–100, with higher scores indicating better HRQoL. In EQ-5D-3L, pts can report no, some, or extreme problems in each of 5 dimensions (mobility, self-care, activity, pain, and anxiety). Results: 51 pts were treated. At baseline, median age was 37 years, 63% were male, 59% had ECOG PS of 0. 49 pts (96%) completed baseline EQ-VAS. Mean EQ-VAS scores exceeded the mean baseline score at the end of monotherapy, after 2 combination cycles, at the end of therapy, and during follow-up (Table 1). The proportion of pts reporting some or extreme problems in EQ-5D-3L was numerically lower than or similar to baseline after monotherapy for all dimensions, but was numerically higher than baseline (dimensions of mobility and activity) after 2 combination cycles, and remained close to or numerically below baseline during follow-up (dimensions of self-care, activity, pain, and anxiety). Conclusions: Pt-reported HRQoL, as assessed by observed mean EQ-VAS scores, did not deteriorate from baseline during treatment with nivolumab followed by N-AVD. Proportions of pts reporting problems in individual EQ-5D-3L dimensions were generally similar to baseline during treatment and follow-up.