bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of the structure of variable practice on the learning of a coincident timing task in children
Authors: Freudenheim Andrea M. , Tani Go
Published: November 2017

O objetivo da pesquisa foi comparar o efeito de diferentes estruturas de prática variada na aprendizagem de uma tarefa de “timing” coincidente. Participaram 80 escolares entre oito e nove anos de idade, distribuídos nos grupos bloco (BL), bloco aleatório (BAL), bloco seriado (BSR) e aleatório (AL). O instrumento utilizado foi o Temporizador de Antecipação de Bassin que permite a manipulação da velocidade de propagação de um rastro luminoso formado pelo acendimento seqüencial de 32 diodos. A tarefa consistiu em apertar o botão de resposta no momento de incandescência do último diodo da seqüência. Na fase de aquisição, as crianças realizaram 80 tentativas nas respectivas estruturas de prática. Na fase de transferência e, uma semana após, na fase de retenção, as crianças realizaram quatro tentativas, em duas velocidades diferentes das utilizadas na fase de aquisição. Nas fases de retenção e transferência não foram detectadas diferenças signiíicantes entre os grupos nas três medidas utilizadas. Estes resultados estão de acordo com a possibilidade de não encontrar efeitos de interferência contextual quando se utiliza tarefas de uma mesma classe de movimentos (Magill & Hall, 1990). No entanto, o gmpo BSR apresentou tendência de superioridade nas três medidas, implicando que estruturas de prática variada distintas podem provocar certas diferenças entre os grupos. Esta tendência c discutida e sugestões para futuras pesquisas são apresentadas
Running velocity at the anaerobic threshold in male adolescents
Authors: Tourinho Filho Hugo , Ribeiro Lilian Simone Pereira , Rombaldi Airton José , Sampedro Renan Maximiliano Fernandes
Published: November 2017

O presente estudo teve como objetivo analisar a velocidade de corrida no limiar anaeróbio (VCl), estimada através da equação proposta por Tanaka (1986), em adolescentes do sexo masculino, classificados em diferentes níveis de maturação sexual. Os sujeitos foram avaliados através de uma bateria de testes e medidas que consistiu de avaliação antropométrica, determinação do nível de maturação sexual através da avaliação de pêlos pubianos, segundo protocolo de Tanner (1962), e predição da VCl através da realização de um teste de corrida de 40 s em velocidade máxima e um teste de corrida de 5 min. Pela análise dos resultados obtidos, pôde-se verificar que a potência aeróbia, medida através do teste de 5 min, permaneceu inalterada entre os níveis 4 e 5 de maturação sexual. Com relação à potência anaeróbia, pôde-se observar um aumento progressivo seja em relação aos níveis 4 e 5 de maturação sexual, seja em relação à idade. Quanto à VCl, essa se mostrou significativamente mais alta para os garotos do nível 4 quando comparados com os sujeitos classificados dentro do nível 5 de maturação sexual, o mesmo ocorrendo quando essa variável foi analisada em função da idade, tendo-se verificado uma diminuição significante com o avanço da idade
Dynamics of group relationship: sociometric analysis of a handball team
Authors: Simões Antônio Carlos , Hata Mário , Rubio Katia
Published: November 2017

O presente estudo teve como objetivo identificar como uma equipe esportiva revela aspectos internos de relações interpessoais de aproximação cultural, afetividade e ação de comando, apresentando atletas com características comportamentais para liderar seus companheiros de grupo. O estudo foi desenvolvido com 21 atletas de uma equipe masculina adulta de handebol, com idade cronológica acima dos 19 anos, com média em tomo de 23,8 anos. Os dados foram obtidos utilizando-se como instrumento o teste sociométrico. As freqüências de escolhas emitidas e recebidas em relação a cada uma dos atletas levaram a concluir que os indivíduos se baseiam em escolhas e rejeições pessoais, para ressaltar companheiros com atributos pessoais, para liderar o grupo perante aspectos que envolvem aproximação cultural, afetividade e ação de comando. Concluiu-se também, que a percepção que cada atleta tem de si mesmo em relação aos demais companheiros, caracteriza atributos pessoais que distinguem diferentes perfis de atletas-líderes no campo sócio-cultural, afetivo e de ação de comando
Effects of moderate exercise and nutritional guidance on body composition of obese adolescents assessed by bone densithometer (dexa)
Authors: Denadai Regina Célia , Vítolo Márcia Regina , Macedo Antonio Sérgio , Teixeira Luzimar , Cezar Cláudia , Dâmaso Ana Raimunda , Fisberg Mauro
Published: November 2017

Este estudo foi desenvolvido com a finalidade de avaliar o efeito da atividade física moderada, associada à orientação nutricional, sobre a composição corporal de adolescentes obesos, para esse propósito, 11 adolescentes (7 = 12,8 anos) foram submetidos a exercício aeróbio (cicloergômetro - 60% FC máx), em duas sessões semanais, durante nove meses, sendo avaliada a composição corporal por Densitometria Óssea antes e após o período de treinamento. Os valores iniciais (I) e finais (F) para as variáveis antropométricas e da composição corporal foram: IMC (I: 33,3 ± 5,2; F: 31,8 ± 6,9* kg/m2); percentual de gordura corporal (I: 48,5 ± 6,7; F: 47,2 ±5,1* %); peso de massa magra (I: 40,6 ± 4,9; F- 42,5 ± 5,4* kg). Tais resultados indicam que, houve um aumento significativo no peso da massa magra e reduções na porcentagem de gordura corporal e no índice de Massa Corpórea (IMC). Isto sugere um provável efeito do programa de treinamento e da orientação nutricional. As adaptações observadas no presente estudo nos permitem sugerir que o exercício aeróbio e a orientação nutricional podem promover importantes adaptações sobre a composição corporal de adolescentes obesos, atenuando os efeitos adversos decorrentes da obesidade
Body composition in different periods of the menstrual cycle and the validity of the anthropometric and bioelectric impedance techniques
Authors: Glaner Maria Fátima
Published: November 2017

O propósito deste estudo foi verificar se ocorrem mudanças significativas na estimativa da composição corporal (CC) através das técnicas da pesagem hidrostática (PH), antropometria e impedância bioelétrica (IB), entre os períodos pré (PPREM) e pós-menstrual (PPOSM), bem como analisar com que acuracidade a antropometria e a IB estimam a gordura relativa (G%). Foram mensuradas 30 mulheres universitárias com idade = 24,57 ± 3,46 anos; estatura = 162,07 ± 5,89 cm; densidade (PH) = 1,0542 ± 0,0106 g/ml. Destas, 10 foram medidas nos períodos pré-menstrual (até sete dias antes de ocorrer a menstruação) e pós-menstrual (entre o segundo e até o oitavo dia após cessada a menstruação). As outras 20 mulheres foram medidas uma vez. A estimativa da CC através da técnica antropométrica foi feita conforme o procedimento desenvolvido por Cohen (1986), que usa cinco perímetros corporais. O aparelho Valhalla 1990B foi usado para estimar a CC através da IB. Os valores decorrentes da PH foram adotados como critério para validação. A análise estatística foi feita através do teste t pareado e coeficiente de correlação de Pearson, entre as variáveis nos PPREM e PPOSM. Para verificar a acuracidade das técnicas antropométrica e da IB, foram seguidos os passos sugeridos por Lohman (1992). Os valores médios para a G% no PPREM foram de 19,12 ± 6,02%, 19,61 ± 4,22%, 21,11 ± 3,45%; e, no PPOSM 19,15 ± 5,84%, 19,80 ± 3,94%, 20,84 ± 3,08%, respectivamente obtidos por IB, PH e antropometria. A CC estimada pelas três técnicas não diferiu entre os períodos menstruais. O procedimento de Cohen estimou com boa acuracidade a G%, com um erro padrão de estimativa (EPE) de 3,47%, enquanto a IB estimou com um EPE de 5,23%
Biomechanic and classical ballet: analysis of kinetics variables of saute in first position and en pointe position with pointe shoes
Authors: Picon Andreja Paley , Costa Paula Hentschel Lobo da , Sousa Filipa De , Sacco Isabel De Camargo Neves , Amadio Alberto Carlos
Published: November 2017

Os movimentos no “ballet” por vezes envolvem posições articulares extremas e esforços musculares que podem exceder as amplitudes normais de movimento, gerando assim, altos valores de estresse mecânico nos ossos e tecidos moles. O objetivo deste estudo é fazer uma avaliação dinâmica de movimentos selecionados do “ballet” clássico, com intenção de adequar a metodologia biomecánica de análise à avaliação das sobrecargas inerentes ao treinamento da dança clássica, relacionando os resultados ao problema de lesões nos pés já levantado pela literatura. Um questionário anterior identificou a presença de lesões em bailarinas não profissionais que treinam em pontas. Neste trabalho, Força Reação do Solo (FRS) e pressões plantares foram registradas através de uma plataforma de força Kistler e sensores de pressão Tekscan, respectivamente. Simultaneamente, flexão articular do joelho foi observada através de um eletrogoniômetro, afim de assegurar a regularidade dos movimentos. O valor vertical máximo da força reação do solo e picos de pressão plantar para diferentes áreas do pé são aqui discutidos em dois momentos: no “Sauté” em primeira posição e na posição “en pointe”. Os valores encontrados são apresentados em médias e discutidos por seus coeficientes de variação. Os resultados corroboram com os estudos que apontam as sapatilhas de pontas como calçados pouco seguros para a prática da dança
Physical activity level and health-related physical fitness in rural and urban boys
Authors: Glaner Maria Fátima
Published: November 2017

Desenvolveu-se este estudo com três propósitos principais: a) comparar a aptidão física relacionada à saúde (AFRS) entre os rapazes rurais e urbanos; b) verificar se ocorre associação entre o nível de atividade (NAF: inativo, moderadamente ativo, ativo e muito ativo) e a AFRS, por domicílio; c) verificar qual a proporção dos classificados como inativos, moderadamente ativos, ativos e muito ativos que atinge os critérios de referência para uma recomendada AFRS, por domicílio. Mensurou-se 101 rapazes rurais e 130 urbanos, voluntários, com idades entre 17 e 20 anos. O NAF foi estimado através do questionário desenvolvido por Pate (1995), traduzido e adaptado por Nahas (2001). A AFRS foi medida e analisada seguindo a AAHPERD (1988). As variáveis com distribuição normal foram analisadas através da estatística F (p < 0,05) e as sem distribuição normal através do teste de Kruskal-Wallis (p < 0,05). Os resultados obtidos possibilitam concluir que: os rapazes rurais possuem uma AFRS significativamente (p < 0,05) melhor que a dos urbanos; a associação entre o NAF e a AFRS é de baixa magnitude; dos rapazes rurais e urbanos classificados como inativos e moderadamente ativos nulas e/ou mínimas são as proporções deles que atendem os critérios de referência no conjunto dos componentes da AFRS; já, dos classificados como ativos e muito ativos as proporções são maiores, porém não ultrapassando 20%
Aesthetics as a value in physical education
Authors: Garcia Rui Proença , Lemos Kátia Moreira
Published: November 2017

Um dos principais objetivos da educação é de dar um mundo às crianças, pelo que “nada do que é humano se deve ignorar em educação’’ (Patrício, 1993). A estética é um importante valor do nosso tempo, pelo que a educação terá também que a considerar ao longo do seu processo. O objetivo deste trabalho é verificar como que os sistemas educativos de Portugal e do Brasil, através dos seus documentos oficiais, abordam o valor da estética na disciplina de Educação Física. Para a realização deste trabalho utilizou-se a técnica de análise de conteúdo (Bardin, 1995; Grawitz, 1993; Silverman, 2000; Vala, 1986), tendo-se verificado que os documentos gerais sobre a educação referem a estética como um valor a desenvolver na escola mas que a disciplina de Educação Física a exclui das suas preocupações. Concluímos que há um afastamento entre os grandes valores que marcam hoje o nosso mundo e as atividades desenvolvidas na Educação Física, recomendando que esta se abra às novas atividades desportivas, que enfatizam a dimensão estética do ser humano
Genetic Predisposition, Clinical Risk Factor Burden, and Lifetime Risk of Atrial Fibrillation
Authors: Weng Lu-Chen , Preis Sarah R. , Hulme Olivia L. , Larson Martin G. , Choi Seung Hoan , Wang Biqi , Trinquart Ludovic , McManus David D. , Staerk Laila , Lin Honghuang , Lunetta Kathryn L. , Ellinor Patrick T. , Benjamin Emelia J. , Lubitz Steven A.
Published: November 2017

Background:

The long-term probability of developing atrial fibrillation (AF) considering genetic predisposition and clinical risk factor burden is unknown.

Methods:

We estimated the lifetime risk of AF in individuals from the community-based Framingham Heart Study. Polygenic risk for AF was derived using a score of ≈1000 AF-associated single-nucleotide polymorphisms. Clinical risk factor burden was calculated for each individual using a validated risk score for incident AF comprised of height, weight, systolic and diastolic blood pressure, current smoking status, antihypertensive medication use, diabetes mellitus, history of myocardial infarction, and history of heart failure. We estimated the lifetime risk of AF within tertiles of polygenic and clinical risk.

Results:

Among 4606 participants without AF at 55 years of age, 580 developed incident AF (median follow-up, 9.4 years; 25th–75th percentile, 4.4–14.3 years). The lifetime risk of AF >55 years of age was 37.1% and was substantially influenced by both polygenic and clinical risk factor burden. Among individuals free of AF at 55 years of age, those in low-polygenic and clinical risk tertiles had a lifetime risk of AF of 22.3% (95% confidence interval, 15.4−9.1), whereas those in high-risk tertiles had a risk of 48.2% (95% confidence interval, 41.3−55.1). A lower clinical risk factor burden was associated with later AF onset after adjusting for genetic predisposition (
P
<0.001).

Conclusions:

In our community-based cohort, the lifetime risk of AF was 37%. Estimation of polygenic AF risk is feasible and together with clinical risk factor burden explains a substantial gradient in long-term AF risk.
Shadowy Realism
Authors: Sapir Itay
Published: November 2017

Realism is closely related to knowledge: in order to create an artwork that is a faithful account of reality, or that seeks to convey such an impression, knowledge is necessary. Some currents of seventeenth-century painting may seem to exemplify this connection; in particular, the painters following Caravaggio are usually described as realists or naturalists, and are often attributed an uncompromising ambition to transmit visual knowledge about the world, perhaps similarly to the “New Scientists.”

If the Caravaggisti do represent and transmit knowledge, however, it is a highly shadowy one. Literally speaking, the major innovation of these painters was the audacious use of darkness. More abstractly, their paintings are full of lacunae and ambiguities. Some recent discussions of realism in philosophy make it possible to conceptualize realism as “negative” or “minimal.” In this paper, such ideas will be brought to bear on Caravaggist painters in Naples just after Della Porta’s time.
The importance of correct labelling of types: an example in Tortricidae (Lepidoptera) and its rectification
Authors: AARVIK LEIF , PRINS WILLY DE
Published: November 2017

Taxonomy is the basic discipline in biology. The taxonomist defines each taxon and provides a unique name for it. Of the systematic categories, the species level is crucial. When a species is described and named, great care should be taken to ensure that all information related to the name is correct. Information on ecology, biology, distribution, etc. is linked to the name, and may be added and repeated in subsequent literature. Great confusion may arise from ambiguous descriptions and/or mislabelled figures. Therefore editors should take special care to ensure that taxonomic papers containing descriptions of new taxa receive careful refereeing and editing. Here we present a case where descriptions of new species became misleading when the labels of the type specimens were switched. If the manuscript had been more thoroughly refereed, the mistake could have been discovered and avoided.
AXIS—An Autonomous Expendable Instrument System
Authors: Fratantoni D. M. , O’Brien J. K. , Flagg C. , Rossby T.
Published: November 2017

Expendable bathythermographs (XBT) to profile upper-ocean temperatures from vessels in motion have been in use for some 50 years now. Developed originally for navy use, they were soon adapted by oceanographers to map out upper-ocean thermal structure and its space–-time variability from both research vessels and merchant marine vessels in regular traffic. These activities continue today. This paper describes a new technology—the Autonomous Expendable Instrument System (AXIS)—that has been developed to provide the capability to deploy XBT probes on a predefined schedule, or adaptively in response to specific events without the presence of an observer on board. AXIS is a completely self-contained system that can hold up to 12 expendable probes [XBTs, XCTDs, expendable sound velocimeter (XSV)] in any combination. A single-board Linux computer keeps track of what probes are available, takes commands from ashore via Iridium satellite on what deployment schedule to follow, and records and forwards the probe data immediately with a time stamp and the GPS position. This paper provides a brief overview of its operation, capabilities, and some examples of how it is improving coverage along two lines in the Atlantic.
Is Metal Particle Release Associated with Peri-implant Bone Destruction? An Emerging Concept
Authors: Fretwurst T. , Nelson K. , Tarnow D.P. , Wang H.-L. , Giannobile W.V.
Published: November 2017

Peri-implant diseases affecting the surrounding structures of endosseous dental implants include peri-implant mucositis and peri-implantitis. The prevalence of peri-implantitis ranges between 15% and 20% after 10 y, highlighting the major challenge in clinical practice in the rehabilitation of dental implant patients. The widespread nature of peri-implant bone loss poses difficulties in the management of biological complications affecting the long-term success of osseointegrated implant reconstructions. Metal and titanium particles have been detected in peri-implant supporting tissues. However, it remains unclear what mechanisms could be responsible for the elicitation of particle and ion release and whether these released implant-associated materials have a local and/or systemic impact on the peri-implant soft and hard tissues. Metal particle release as a potential etiologic factor has been intensively studied in the field of orthopedics and is known to provoke aseptic loosening around arthroplasties and is associated with implant failures. In dental medicine, emerging information about metal/titanium particle release suggests that the potential impact of biomaterials at the abutment or bone interfaces may have an influence on the pathogenesis of peri-implant bone loss. This mini-review highlights current evidence of metal particle release around dental implants and future areas for research.
Investigating the relationship between language and picture understanding in children with autism spectrum disorder
Authors: Hartley Calum , Trainer Alice , Allen Melissa L
Published: November 2017

Previous studies report that minimally verbal children with autism spectrum disorder show impaired picture comprehension when matched to typically developing controls on language comprehension. Here, we compare both picture comprehension and picture production abilities in linguistically delayed children with autism spectrum disorder and typically developing controls matched on language comprehension and language production. Participants were 20 children with autism spectrum disorder ( M age: 11.2 years) and 20 typically developing children ( M age: 4.4 years) matched on age equivalents for receptive language (autism spectrum disorder, M: 4.6 years; typically developing, M: 4.5 years) and expressive language (autism spectrum disorder, M: 4.4 years; typically developing, M: 4.5 years). Picture comprehension was assessed by asking children to identify the three-dimensional referents of line drawings. Picture production was assessed by asking children to create representational drawings of unfamiliar objects and having raters identify their referents. The results of both picture tasks revealed statistically equivalent performance for typically developing children and children with autism spectrum disorder, and identical patterns of performance across trial types. These findings suggest that early deficits in pictorial understanding displayed by minimally verbal individuals may diminish as their expressive language skills develop. Theoretically, our study indicates that development in linguistic and pictorial domains may be inter-related for children with autism spectrum disorder (as is the case for typical development).
2D isotropic elastic Gaussian-beam migration for common-shot multicomponent records
Authors: Yang Jidong , Zhu Hejun , Huang Jianping , Li Zhenchun
Published: November 2017

Gaussian-beam migration (GBM) is flexible and adaptable for imaging geologically complicated areas. It avoids some limitations, such as amplitude singularity in caustic zones and an inability to image multiple arrivals, of traditional ray-based migration approaches. Previous studies on GBM mainly focused on acoustic media. We have developed a 2D isotropic elastic GBM scheme for common-shot multicomponent records. Our method extrapolates P- and S-mode wavefields simultaneously using the Kirchhoff-Helmholtz integral solution of the isotropic elastodynamic equation. We separate the extrapolated wavefields into compressional and shear modes using the Helmholtz decomposition, and we then implement a modified dot-product imaging condition. This approach enables us to produce clear PP-images and avoid polarity reversal issues for PS-images. In addition, based on the theory of wavefield approximation in the effective vicinity of central rays, we derive a formula to compute the propagation angles of paraxial rays, which can be used to extract angle-domain common-image gathers.
Interdisciplinary palliative care services for cancer patients: Assessing quality of care and outcomes measures of successful intervention.
Authors: Li Yun Rose , Anderson Eric , Ingelson Beverly , Noorizadeh Kiarash
Published: November 2017

127

Background: Interdisciplinary palliative care (IPC) services play a critical role in improving patient care by establishing goals of care and expectations, reducing unnecessary readmissions, and limiting the resource and economic costs associated with end-of-life care. Identifying factors that impact the likelihood of readmissions and measures that help facilitate the transition of patients to hospice care may reduce these costs. Methods: We retrospectively reviewed the demographics, clinical parameters, and outcomes of nearly 500 patient consultations performed by the IPC service at our institution between 2014-2016. Focusing on patients with cancer as the primary diagnosis, we evaluated factors that increased the risk of 6-month readmission, likelihood of transitioning to hospice, and documentation of code-status at time of discharge using Fisher’s exact test and student’s t-tests. Results: Among all patients evaluated by IPC, the median age at consultation was 79.2+/-14.7, and 56.3% are male. Advanced cancer was the most common primary diagnosis (45.5%), with median age 70.9+/-16.0, and 62.1% are male. The 6-month readmission rate among oncology patients (6.5%) was not significantly greater than observed in non-oncology patients (5.9%), P = 0.95, although it was significantly lower than in Medicare patients (~20% in 30 days). Shortness of breath (SOB) was the most common chief complaint (53.9%) on admission. Compared to other chief complaints, such as failure to thrive and frailty, SOB was not associated with increased readmission rates. Reduced readmission rates were strongly reduced with transition to hospice (p < 2.1x10-4) and Do-Not-Resuscitate code status (p < 0.04). Disposition to home at discharge (p < 8.01e-05) was significantly associated with 6-month readmission, as compared to discharge to hospice (0.8%) or SNF (15.0%). Female patients (9/74) were more likely to be readmitted as compared to males (4/132), p < 0.035. Conclusions: We identified multiple predictors of 6-month readmission in our retrospective cohort, which may help stakeholders to identify opportunities to reduce readmission rates for terminal cancer patients.
Toxicity of sequential immune therapy and radiation for cervical and thoracic spine metastases.
Authors: Arscott W. Tristram , Doucette Abigail , Kumar Pallavi , Plastaras John Peter , Maity Amit , Jones Joshua Adam
Published: November 2017

130

Background: Palliative radiation is an effective treatment modality for spinal metastases. Expanding use of immune therapy in metastatic cancer raises concern that side effects from treatment may be exaggerated, particularly to sensitive organs such as the esophagus. This retrospective review evaluates the toxicity of combined radiation and immune therapy in patients with cervical or thoracic spine metastases. Methods: Patients receiving radiation for cervical or thoracic spine metastases from 2012-2017 were selected based on (1) concurrent use of immune therapy and radiation (within 7 days) OR radiation within 30 days following immune therapy, (2) 3D conformal or simpler treatment technique, and (3) minimum 30 days follow up from end of treatment. Patient demographics, radiation treatment parameters, immune therapy agent(s), and maximum toxicity were extracted from the medical record. Isoeffective dose was calculated using the EQD2 model, assuming α/β of 3. Statistical analyses included t tests. Results: Twenty-two patients were identified. Pembrolizumab was most commonly combined with radiation (8 patients), followed by nivolumab (7), ipilimumab (3), and atezoliumab (2). Two patients received both nivolumab and ipilimumab. Three patients (14%) had grade 3 toxicity requiring hospitalization (vomiting, esophagitis), 8 patients (36%) had grade 2 toxicity (esophagitis, dysphagia), 3 patients (14%) had grade 1 toxicity (hoarseness, dysphagia), 8 patients (36%) had no toxicity. Two patients (67%) with grade 3 toxicity received concurrent nivolumab and ipilimumab. Median dose was 3600 cGy (EQD2) in 10 fractions. There was a trend to greater toxicity with increased number of vertebral levels treated (mean 3.4, 4.6, 5.625 and 6.3 for toxicity grade 0, 1, 2 and 3, respectively; p= 0.053). Dose, fractionation, and immune therapy agent were not found to be significant contributors. Conclusions: In this small cohort, combined immune therapy and radiation for palliation of cervical or thoracic spine metastases suggests increased toxicity when greater number of vertebral bodies are irradiated or when combined immune therapy agents are utilized. Further investigation with a larger cohort is warranted.
A three step process to create a palliative medicine co-management model of care on an inpatient hematology unit.
Authors: Decastro Gene , Earle Bridget
Published: November 2017

141

Background: Northwell Health’s North Shore University Hospital (NSUH) campus has a dedicated hematology unit. This cohort of patients is under-represented on our inpatient palliative care service, comprising < 1% of initial consultations in 2016. Given recent recommendations by the American Society of Clinical Oncology about comprehensive cancer care, and recognizing the growing need for palliative care for patients with hematological malignancies, our goal was to initiate a concurrent hematologic and palliative care delivery model. Methods: A three step process was initiated – inpatient service buy-in and joint workgroup development, concurrent care delivery, and linkage to outpatient partners. The first step was to obtain buy-in with faculty stakeholders at our institution, including Hematology-Oncology leadership. There was immediate support for a partnership. Next, a workgroup was assembled to jointly generate a needs assessment survey to determine how best to assist in the care of these complex patients. Additionally, we identified key metrics to measure, and linked our inpatient service with outpatient care via our Supportive Oncology practice. Results: The five month process culminated in biweekly “screening rounds” with the Hematology team which were initiated in June 2017 and used as a first step to identify high-need patients for consultation. The workgroup agreed upon performance metrics which included hematologic diagnosis, reason for consult, time to consult from admission, length of stay, documentation of advance directives and goals of care, and outpatient referrals. Conclusions: Through relationship management, workgroup development, and care transition to community, an inpatient supportive care co-management model for patients with hematologic malignancies was successfully implemented using a three-step process. This format and strategy can be replicated for other services with complex patients. Future analysis of the outcome metrics will be able to provide feedback to the Palliative – Hematology services. By creating health care pathways with an emphasis on Palliative Medicine co-management, we are poised to deliver comprehensive care and measure its impact.
Using a framework for resource stratification to adapt palliative care guidelines to Sub-Saharan Africa.
Authors: Dans Maria Cristina , Abdella Kunuz , Baah-Odoom Dinah , Kintu Rinty , Kolawole Israel , Manirakiza Sebastien , Munyoro Esther , Obrien Megan , Carlson Robert W.
Published: November 2017

145

Background: The National Comprehensive Cancer Network (NCCN) is a not-for-profit alliance of 27 leading cancer centers in the United States (US), but the NCCN’s mission to improve cancer care extends world-wide. Nearly half of the registered users of the NCCN Guidelines are based outside the US, and the NCCN has developed a process for adapting its Guidelines to lower-resourced settings. The cancer burden in Sub-Saharan Africa (SSA) is significant – by 2030, annual cancer deaths in the region are projected to reach 1,000,000 people – and most cancers diagnosed in SSA are late-stage. Methods: The NCCN Framework outlines a rational approach for constructing cancer management systems to provide the highest achievable care. Each of the 4 NCCN Framework levels builds on the one before it, so care can evolve as resources grow: “Basic Resources” are essential for care; “Core Resources” add services improving disease outcomes; and “Enhanced Resources” include more cost-prohibitive services. The Guidelines themselves are the final level: evidence-based, consensus-driven recommendations from each NCCN Panel. Resource-stratification begins with modification of the Guidelines by a NCCN Framework Committee within each Panel. Results: In the case of SSA, organizers from the NCCN, American Cancer Society, Clinton Health Access Initiative, and IBM arranged 3 consensus meetings in which resource-stratified drafts of the Guidelines for Palliative Care and Cancer Pain will be refined by a committee of NCCN representatives, oncologists, and palliative care providers from Burundi, Ethiopia, Ghana, Kenya, Nigeria, Uganda, and the US. Important themes emerging from the first meeting included early screening for palliative care needs, even before tissue diagnosis, in areas with limited availability of anti-cancer therapy. In addition, cultural differences on the topic of “Physician-Aid-in-Dying” led to its replacement with guidance on caring for patients expressing a wish to die. Conclusions: Collaboration with colleagues in SSA, and other areas around the globe, to resource-stratify NCCN Guidelines will allow more systematic use of the guidelines and improve the quality, effectiveness, and efficiency of cancer care.
Call to integrate supportive care and patient reported outcomes in early phase clinical trials: An exploration of adolescent and young adult (AYA) participation on phase I trials of novel anticancer agents.
Authors: Subbiah Ishwaria Mohan , Tang Chad , Rao Arvind , Subbiah Vivek , Kurzrock Razelle , Hong David S.
Published: November 2017

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Background: Adolescent and young adults (AYA) aged 15-39 years with cancer represent a patient population with very unique needs extending into the psychosocial realm. Consequently AYA participation on cancer clinical trials has been dismally low in recent decades, particularly on early phase trials with investigational agents. In an effort to better understand AYAs with advanced cancer, we analyzed their characteristics and participation on phase I clinical trials. Methods: We queried a department database to identify 1489 consecutive pts treated on phase I trials bw Dec 2004-July 2013 and then divided into 2 age-based groups (AYA 15-39y, mid age 40-64y) for analysis of their baseline characteristics, participation, time to treatment failure (TTF), and imaging response. We then calculated the odds ratios of achieving a favorable clinical benefit (defined as a RECIST response of prolonged SD≥6m+PR+CR) for AYAs vs mid-age pts. Results: AYAs represented 15% (n = 220) of participants treated on phase I trials while 67% (n = 991) were middle age. Most AYAs were women (63% female, 33% male) w median age being 32.6 years and a median of 3 prior therapies. AYAs most commonly had GYN (n = 41, 19%), sarcoma (n = 39, 18%), GI (n = 35, 16%), thoracic/head/neck (n = 31, 14%), melanoma (n = 27, 12%), and breast (n = 20, 9%) cancers. AYA had a comparable median TTF of 3.3m to mid age pts (3.5m). Overall, 369 (37%) mid age and 96 (44%) AYAs received a non-FDA approved agent. Imaging responses among AYAs showed 93 (42%) SD including 42 (19%) prolonged SD (median duration 9.7m), 34 (15%) PR (median duration 9.5m), and 2 AYAs with a CR lasting 36.2m and 50.1m. Conclusions: AYA patients represented just 15% of phase I clinical trials participants; none of these trials measured patient reported outcomes or quality of life indices, highlighting an urgent need for comprehensive supportive care integration into AYA care to tend to the unique psychosocial, economic, and family needs of this population to ultimately identify and overcome barriers to clinical trial participation.
Living goals: Prepare to die.
Authors: Mehta Zankhana , Smith Susan , Henrichs Jane , Berger Andrea , Comstock Loreen , Davis Mellar
Published: November 2017

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Background: Living Goals (LGs), a home-based program, is a collaboration between Geisinger Health Plan, Geisinger Home care and Hospice and Palliative Medicine. Program investigated an early intervention in those with serious illness and transition to hospice in a timely manner during FY 2015- 2017. Methods: LGs visits were led by a registered nurse after referral from physicians based on the surprise question (it would not be a surprise if this patient died within one year). Nurse facilitated end-of-life discussions and provided resources available for supportive care. LGs visits were free up to 10 visits to each patient. Results: 94 patients were enrolled in LGs from 128 referrals.59 (63%) patients transitioned to hospice and 41 (69%) were transitioned within first month of LGs visit averaging 1.4 visits. 59 patients enrolled in hospice. The median length of time between LG Start of care (SOC) and Hospice SOC is 9 days (IQR: 3-73).57 LGs patients discharged from hospice had a median length of stay (LOS) of 39 days (IQR: 10-85). For the subset of patients in FY 2015 (n = 13) median LOS was 26 days (IQR: 10-57)), in FY 2016 (n = 26) the median LOS was 27 days (IQR: 7-73), in FY 2017 (n = 18) the median LOS is 66 days (IQR: 28-144). In FY 2014, 513 hospice patients were discharged before initiation of LGs and the median LOS was 19 days (IQR: 6-61). As of now, there is a significantly longer stay for LG patients than FY 2014 hospice patients (p = 0.0130). Conclusions: This innovative home based program, appears to have a great potential in the future for delivering ongoing hospice and palliative needs to seriously ill patients.
Outcomes of an innovative six-week standardized residential training course for physicians and nurses to provide primary palliative care in India.
Authors: Reddy Suresh , Vallath Nandini , Gupta Mona , Gujela Manoj , Mohan Sarath , Naik Navami , Yennu Sriram , Bruera Eduardo , Rajagopal M.R
Published: November 2017

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Background: The National Program on Palliative Care (NPPC) by the Government of India has emphasized the need for training clinicians in providing palliative care (PC) with minimum of 6 weeks of residential training. However, there are limited studies on feasibility of such standardized training in PC offered to palliative care providers interested in transition to palliative care. Aim: To evaluate the feasibility, and change in the self-reported perception of knowledge in palliative care following a 6 weeks standardized residential training course (SRTC) for physicians and nurses to provide primary PC in India. Methods: A 6 week standardized residential type educational program which combined didactics, and bedside hands on palliative care training by PC specialists in five preselected centers in India. To be eligible licensed physicians and nurses should, (a) qualify in focused interview aimed to evaluate both interest and commitment to provide primary palliative care following the training, (b) Agree to complete all the required surveys. Results: 46/53 (86%) completed the pre and post surveys. 50/53 (94%) participants completed the course and passed the certification exam. Median age (IQR) was 31 (27, 41). 53% were female and 53% were physicians. Median reported knowledge (1-5) for pain, fatigue, delirium, medical ethics were 4,3,2,2.5 before training Vs 5 (P=0.001), 5 (P=0.001), 5 (P=0.001), 5 (P=0.001) after training respectively. All other core areas improved significantly. All participants noted satisfaction with faculty as high (5/5). Conclusions: Conducting a six weeks standardized residential training course in PC for physicians and nurses in India is feasible. There was a significant improvement in self-reported knowledge of all components of palliative care curriculum. Long term impact studies are needed.
First referral to an integrated onco-palliative care program: A retrospective analysis of its timing.
Authors: Barth Claire , Colombet Isabelle , Vinant Pascale
Published: November 2017

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Background: Despite being recommended early in the course of advanced cancer, palliative care (PC) referral remains often late. Taking into account limited PC resources, disease-specific referral criteria and models of care need to be explored. In a previous work, we showed that a weekly onco-palliative meeting (OPM) allowed earlier introduction of the PC team (PCT) and decreased aggressiveness of end-of-life (EOL) care1. We describe patient’s profile when first referred to this Integrated Onco-Palliative Care program (IOPC), the timing of the referral relatively to the course of his/her disease and the impact on the trajectory of EOL care. Methods: The IOPC of our University Hospital combined a weekly OPM, dedicated to patients with incurable diseases for whom goals and organization of care need to be discussed, and/or clinical evaluation with possible follow-up by the PCT. We retrospectively analysed all patients reported for the first time at OPM between 2011 and 2013. We calculated an index of precocity, defined as the ratio of time from the first referral to death and the time from the diagnosis of incurability to death, with values ranging from 0 (late referral) to 1 (early referral). Results: Of the 416 patients included, 57% presented with lung cancer, urinary carcinoma and sarcoma. At first referral to IOPC program, 76% were receiving chemotherapy, 63% were outpatients, 56% had a PS ≤ 2 and 46% had a serum albumin level > 35g/l. The median (1st-3rd quartile) index of precocity was 0.39 (0.16-0.72), ranging between 0.53 (0.20-0.79) (earliest, for lung cancer) to 0.16 (0.07-0.56) (latest, for prostate cancer). Among 367 decedents, 42 (13%) received chemotherapy within 14 days before death, 157 (43%) died in hospice care setting. Conclusions: Most patients first referred to IOPC were still under antitumoral treatment and had intermediate prognostic markers. However the time of referral between diagnosis of incurability and death is highly variable according to cancer type, and should probably be adapted while therapies progress.1 Colombet I, et al. Effect of integrated palliative care on the quality of end-of-life care: retrospective analysis of 521 cancer patients. BMJ Support Palliat Care. 2012;2(3):239–47
Supportive care day hospital: A new tool for palliative care in cancer centers.
Authors: Bouleuc Carole
Published: November 2017

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Background: In May 2005, the Curie Institute in Paris opened the first supportive care day hospital in France. This type of new ward is now very frequent in the French comprehensive cancer centers. Methods: Patients are managed by the palliative care team with a two-part team of a physician and a nurse in order to address their supportive care needs: advanced-care symptoms, psychosocial distress, medical questions and concerns, support need in decision making, end of life care preference and advance care plan when patients or caregivers when needed. Depending of the needs identified by the palliative care team assess, at least 2 of the following healthcare professionals will intervene: oncologist, pain physician, psycho-oncologist, dietitician, social worker, physiotherapist. Coordination with the home care team takes systematically place (with general practitioner, nurse and home palliative care team). New symptoms occurrence are explored with biological test or radiographic examination when necessary. Medical procedures are sometimes performed like venous perfusion therapy, blood transfusions, or draining effusion after ultrasonic tracking. It is possible to offer the patient hypnosis, relaxation or sophrology consultation. Eventually at the end of the in-patient stay, the patient is given a medical synthesis with therapeutic recommendations and personalized care plan. 1 Physician and two nurses are needed to manage 4 patients every day. Results: In 2016 we have admitted 350 patients and performed 948 stays in our supportive rand 55% of them have breast cancer. Median survival since the first day at supportive care day hospital is 65 days. Death at home occurred in 15% of patients and in hospice for 62%. Home death is more often when patients don’t have any dyspnea are included in a home palliative care network and when they receive the last chemotherapy more than 30 days before death. More date will be shown. Conclusions: Supportive care day hospital is really a good tool for integrated palliative care, promoting collaboration with oncologists, coordination with home care teams, and advance care planning, so that patients can longer stay at home as they often hope so.
Outcomes of a Dignity Therapy/Life Plan intervention for advanced cancer patients undergoing treatment.
Authors: Dose Ann Marie , McCabe Pamela J , Sloan Jeff A.
Published: November 2017

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Background: Dignity Therapy (DT) is a psychosocial intervention used primarily at the end of life to improve quality of life and promote patient dignity, but many individuals are unable to complete it due to health decline/death. In addition, when individuals face potential mortality, they evaluate life plans to determine tasks and behaviors most important to them. Consistent with guidelines to provide palliative care interventions simultaneously with cancer treatment, the purpose of this study was to evaluate initial patient-reported outcomes of an intervention combination (Dignity Therapy + Life Plan [DT/LP]) for those with advanced pancreatic or lung cancer receiving treatment within a year of diagnosis. Methods: This was a single-arm, Phase I/II pilot study, conducted in the outpatient setting at an NCI-designated comprehensive cancer center. Dignity Therapy consisted of a focused life review intervention delivered during three outpatient oncology encounters for each patient. Interviews were audiotaped, transcribed, and edited to produce a legacy document. Participants scribed a list of 3-6 life goals for the LP intervention. Outcomes measured at baseline, immediately post DT/LP, and 3 months later were distress (Distress Thermometer), quality of life (FACT and LASA), spirituality (FaCIT-Sp-12), dignity (Patient Dignity Inventory), and purpose in life (Purpose in Life Test- Short Form). Data were analyzed with one-sample, two-sided t-tests (alternate: Wilcoxan). Results: Eighteen advanced pancreatic or lung cancer patients enrolled, mean age 64. There were no significant differences among all variables from baseline to post-DT/LP and 3 months later, with the exception of less distress experienced between baseline and 3 months after DT/LP ( p= 0.04). Conclusions: The DT/LP intervention did not show improvements in these psychosocial outcomes, but patients with advanced cancer typically experience worsening physical and psychosocial symptoms with active treatment. Therefore, maintaining these outcomes from baseline is a worthy goal, as we may be preventing further morbidity in an advanced cancer population. Further research is needed, however, given this small sample size. Clinical trial information: NCT02132325.
Characteristics of patients referred for psychology services by a palliative care inpatient consult team.
Authors: Ann-Yi Sujin , Wong Angelique , Baumgartner Karen , Carmack Cindy L. , Castro Debra , Guzman Diana , Joy Manju P , Kuriakose Leela , Lim Kyu-Hyoung , Madden Kevin , Najera John M , Pangemanan Imelda , Rajani Sabeena Qasim , Raznahan Monica , Stewart Holly A , Tanco Kimberson Cochien , Tallie Kimmie , Wei Qi , Bruera Eduardo , Zhukovsky Donna S.
Published: November 2017

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Background: From Jan 2013 to Dec 2015, only 23% of inpatient palliative care consults were referred for psychology (PSY) services. In an effort to better understand referral practices, we compared those who were referred for PSY services to those who were not. Methods: A retrospective chart review of 930 consecutive patients from Jan 2013 to Dec 2015 was conducted to collect demographic and clinical variables. 455 patients who had at least one PSY contact and 475 patients who had no PSY contact were randomly selected. In an effort to control for age, we selected 330 patients 18-39 years, 300 patients 40-64 years, and 300 patients 65 and older. Descriptive, univariate and logistic regression analyses were conducted. Results: Patients referred to PSY services (N = 455) included 267(59%) females. Majority were White(60%) and English speaking(93%). Majority were married(62%) and parents(79%). The largest cancer type was GI(20%) followed by hematological(15%). Majority had ECOG status of 3(39%) and CAGE-AID negative (82%). Patients with no psychology consult(N = 475) included 50% females. Majority were White(60%) and English speaking(79%). Majority were married(56%) and parents(70%). This sample also had majority GI cancers(18%) followed by hematological(15%). Majority had ECOG status of 3(34%) and was CAGE-AID negative(75%). Univariate variables significant for those referred for PSY services included: Female(p = .01), English language(p = .018), ECOG score of 3(p = .006), psychiatric history(p = .008), higher MEDD(p = .001) and several ESAS subscales including depression(p = .000), anxiety(p = .000), shortness of breath(p = .017), sleep (p. = .029) and spiritual pain(p = .001). Logistic regression identified psychiatric history and ESAS depression scores as significant predictors of PSY referral. Conclusions: Several univariate factors were significantly associated with referral to PSY services. Psychiatric history and ESAS depression score showed to be strong independent predictors. These results help us to understand how palliative care providers determine those they consult for PSY services. More research is needed to investigate who may benefit most from PSY referrals.