bluuebunny/crossref_metadata_2025 huggingface dataset:
Transportation barriers to health care and mortality risk among the U.S. adults with history of cancer.
Authors: Jiang Changchuan , Deng Lei , Wang Qian , Perimbeti Stuthi , Han Xuesong
Published: September 2021

121

Background: Lack of transportation delayed medical care for approximately 6 million Americans in 2017. Prior studies showed cancer survivors tend to have more healthcare service use, higher medical cost, and adverse clinical outcomes. It is important to understand the prevalence of, risk factors for, and long-term health consequences of transportation barrier to health care among cancer survivors. Methods: We identified cohorts of adult with history of cancer (n = 25,317) and adults without history of cancer (n = 422,797) from the 2000-2014 National Health Interview Survey (NHIS). Transportation barriers were measured as medical care delay due to lack of transportation in the past 12 months using a survey question. The prevalence of transportation barriers was estimated using multivariable logistic models. Risk of mortality estimated with weighted Cox’s proportional hazards models with age as the time scale, adjusting for sex, race/ethnicity, educational attainment, marital status, region, comorbidities, and survey year. All analyses accounted for complex survey design using SAS statistical software, version 9.4 (SAS Institute Inc.), and SAS callable SUDAAN 11.0.3. Results: After adjustment for sociodemographic factors and comorbidities, the prevalence of transportation barrier were significantly higher among cancer survivors than among respondents without cancer history (2.1% vs 1.6%, p = 0.001, adjusted odd ratio [OR], 1.22; 95% confidence interval (95CI): 1.10-1.35). Cancer survivors with transportation barrier were more likely to be younger, female, Hispanic or Asian/Pacific Islander, less educated, unmarried, public insurance beneficiary or uninsured, and with more comorbidities. Among all participants, cancer survivors with transportation barrier had the highest adjusted mortality risk (hazard ratio [HR]: 2.12, 95CI: 1.81-2.49); followed by cancer survivors without transportation barrier (HR: 1.53, 95CI: 1.42-1.65); and adults without a cancer history with transportation barrier (HR: 1.50; 95CI: 1.45-1.55) compared with adults with neither a cancer history nor transportation barrier. Conclusions: Transportation barriers to health care had a disproportionate impact on cancer survivors, especially those who are underserved, and who have more medical needs. Increased risk of mortality was observed among adults with and without a cancer history who delayed care due to lack of transportation. It highlights the need for efforts to mitigate transportation barriers to medical care during a time of rapid change in transportation and telehealth technology.
Scaled integration of FDA approved biosimilars: Closing the knowledge and adoption gaps.
Authors: Waterhouse David Michael , Burdette Caleb , Davies Dan , Drosick David R. , Mendenhall Molly
Published: September 2021

15

Background: Biosimilars are clinically equivalent and highly similar to brand yet cost significantly less. Financial savings are shared by patients, practices and payers, ranging anywhere from 21-24% based on 10/01/20 ASP data from CMS. The effective conversion to biosimilar products is vitally important to total cost-of-care savings and can be achieved without negatively affecting patient outcomes. Physician understanding and confidence in biosimilar products is seen as a major conversion barrier. Methods: Interchangeability is an FDA designation that allows generic drugs to be substituted for reference drugs at the pharmacy, without a physician’s consent. Currently no biosimilar has that FDA approval for interchangeability. Building on previous pharmacy auto-substitution processes with therapeutic interchange, a formalized biosimilar policy and SOP was developed to automate conversion from the reference biologic product to the P&T/Physician approved biosimilar. Workflow changes were instituted to alleviate the provider burden of patient-by-patient decisions and placed them with the pharmacy review team. Full staff support and understanding on biosimilar usage was endorsed through mandatory biosimilar education of physicians, advanced practice providers, pharmacists, nurses, financial navigators and prior authorization team members and tracked using meeting attendance and the online E-learning system. Patient education was verified using established teaching visits by tracking documentation in the electronic health record (EHR). Quantitative metrics and reports were developed to assist in tracking the number of unique patients receiving the brand or biosimilar agents. Billed product units per month were also tracked to facilitate auditing and assure accuracy. Baseline brand/biosimilar utilization data for Rituximab, Trastuzumab, and Bevacizumab was collected from July 1, 2019 through December 31, 2020. Results: During the baseline period of 7/01/19 – 12/31/19, biosimilar conversion ranged from 0% (trastuzumab) to 8.4% (rituximab). Following full staff education and physician consent, systematic auto-conversion to biosimilar products was initiated on January 1, 2020. Conversion rates based upon billed biosimilar units likewise improved from 11.7% (baseline) to 90.2% (2021 Q1) for rituximab, 8.4% to 87.4% for trastuzumab, and 0% to 90.0% for bevacizumab. Conclusions: Rapid and near-complete conversion from brand product to FDA approved biosimilar is feasible, measurable and can be scaled.[Table: see text]
Predictors of adherence to patient reported outcomes and psychosocial needs questionnaire in a culturally diverse ambulatory oncology setting: The My Wellness Check Program.
Authors: Natori Akina , Sookdeo Vandana Devika , Koru-Sengul Tulay , Schlumbrecht Matthew , Calfa Carmen , MacIntyre Jessica , Moreno Patricia , Garcia Sofia F. , Penedo Frank J.
Published: September 2021

173

Background: Electronic health record (EHR) integrated symptom monitoring using patient reported outcomes (PRO) has been associated with improved outcomes, including health-related quality of life (HRQoL), in cancer survivors. However, these improvements have been documented through reasonably high completion rates of PRO measures in predominantly non-Hispanic White patient populations using only English language assessments. This study aimed to 1) examine factors associated with the completion of PRO assessments and 2) test differences in referrals to cancer support services between PRO responders and non-responders in a cohort of cancer survivors with significant racial, ethnic, and primary language diversity. Methods: A retrospective analysis (October 2019-February 2021) was performed for patients who were assigned the My Wellness Check (MWC) program at a tertiary, comprehensive cancer center. MWC is an EHR-based PRO assessment and referral program that uses PROMIS computer adaptive tests for depression, anxiety, pain, fatigue, and physical function as well as a psychosocial needs assessment. MWC PRO questionnaire is available in English or Spanish based on patient preference. Demographic and clinical characteristics of patients were collected and incorporated in multivariable binary logistic regression model to examine factors associated with completion of the MWC PRO questionnaires. The frequency of referrals to cancer support services was compared by Chi-square test between MWC PRO responders and non-responders. Adjusted odds ratio (aOR) and 95% confidence interval (95%CI) were calculated. Results: Of the 5306 patients eligible to complete MWC PRO questionnaire, the majority were female (64.1%), White (86.9%), Hispanic (65.8%), English speaker (55.4%), and 46.0% were responders. Patients who were younger than 65 (aOR 1.39; 95%CI 1.22-1.59; p < 0.0001), female (1.23; 1.09-1.41; p = 0.0019), non-Hispanic/Latino (1.43; 1.25-1.64; p < 0.0001), living with partners ( = 1.28; 1.13-1.46; p = 0.0001), and receipt of active treatment (1.37; 1.18-1.58; p < 0.0001) were significantly associated with MWC PRO completion. Responders were referred to cancer support services more often than non-responders (16.6% vs 5.4%, p < 0.0001). Conclusions: Patient-level and clinical factors predict completion of PRO measures, and responders were more likely to have a referral to cancer support services. To optimize supportive care for ambulatory cancer patients, further research is needed to identify factors that can promote patient engagement, particularly in patients who are under-utilizers of such services.
Coaches Activating Reaching and Engaging Patients (CAREPlan): A randomized controlled trial combining two evidence-based interventions to improve goals of care documentation.
Authors: Parikh Divya Ahuja , Asuncion Mary Khay , Hansen Jennifer , Seevaratnam Briththa , Khateeb Sana Indravadan , Rosenthal Eben Lloyd , Teuteberg Winifred , Patel Manali I.
Published: September 2021

2

Background: In our prior work, community or lay health worker-led goals of care interventions improved goals of care documentation by clinicians and decreased health care use at the end of life. Other studies have demonstrated improvements in provider-patient communication and goals of care documentation using the Serious Illness Care Program. The objective of this study was to determine whether the combination of these two interventions could improve goals of care documentation among patients with advanced stages of genitourinary cancers at an academic center. Methods: A randomized controlled trial was conducted from April 3, 2019, through October 30, 2019, among patients with metastatic or recurrent cancer on at least second line therapy in the urologic oncology clinics at Stanford Cancer Center. Patients were randomized to usual care or the intervention with a lay navigator trained to assist patients with establishing end-of-life care preferences using the Serious Illness Conversation Guide. The primary outcome was goals of care documentation by the primary oncologist. We used intent to treat analyses, descriptive statistics to compare demographic and clinical factors, and a logistic regression adjusting for imbalance to determine the effect on the primary outcome. Results: Two-hundred participants were randomized and included in the intent to treat analysis. Median age was 72 years, majority were male (n=175, 87.5%) and self-identified as non-Hispanic white (n=123, 61.5%). The majority had prostate cancer (n=110, 53.5%), followed by kidney cancer (n=51, 25.5%), and urothelial cancer (n=29, 14.5%) and most had stage IV disease at diagnosis (n=186, 93%). There were no significant differences in demographic or clinical factors except for gender; there were more females on the control arm (n=8 vs n=17, p=0.01) thus analysis of the primary outcome was adjusted for gender. The adjusted analysis showed that at 12 months post-enrollment, the intervention significantly increased goals of care documentation by the primary oncologist as compared to the control group (53.7% vs 32.6%, p=0.002). Conclusions: The CAREPlan program increased goals of care documentation by the primary oncologist at this single academic medical center. Clinical trial information: NCT03856463.
Advance care planning in metastatic cancer patients: A quality improvement initiative.
Authors: Oppenheim Steven , Figlin Robert A. , Seferian Edward G. , Scher Kevin S. , Reed Margaret R , Irwin Scott , Rosen Bradley T.
Published: September 2021

22

Background: The initiative aimed to increase the rate of advance care planning (ACP) activities for outpatients with metastatic cancer. Methods: The project was sponsored by the institution’s Quality Committee in collaboration with the Cancer Quality Committee, Oncology Division, Tumor Boards, and Medical Group. Metastatic cancer patients were identified by ICD-10 coding and later by oncologist electronic health record (EHR) documentation of metastatic status. ACP activities were defined as either an ACP note, Advance Directive, Physician’s Order for Life Sustaining Therapy, or a palliative medicine (PM) consultation. The EHR was revised to include a section for ACP documentation. Quarterly reports were sent to oncologists with data comparing their rate of ACP activities for patients with metastatic cancer with peers. Oncologists’ identities were initially blinded and later unblinded. Oncologists received a monthly list of their metastatic patients without any ACP activities. Results: The study covered 5201 unique cancer patients cared for by 60 oncologists each year. The rate of ACP activities for metastatic cancer patients increased from 37% in 2017 to 57% at the end of 2020. Data on individual ACP activities are pending analysis. The ACP activities were driven most by PM consultations, which rose from 12% to 39%. Conclusions: This initiative successfully increased ACP activities for patients with metastatic cancer. ACP activities are an essential step to achieve goal concordant care. Given that the main driver of increased ACP activities was PM referrals, further work will be required to strengthen oncologist’s ACP skills and improve access to PM.
Differential impact of inpatient and outpatient palliative care on end-of-life outcomes in hospitalized patients with cancer.
Authors: Urman Arielle R. , Buss Mary K. , Besaw Robert J. , Dodge Laura E. , Lee Kathleen A. , Yeh Jonathan C.
Published: September 2021

24

Background: Palliative care (PC) improves outcomes for patients with advanced cancer, and current ASCO guidelines recommend early outpatient referral. However, recent data show that PC teams at many cancer centers see more inpatient consults than outpatient visits; the comparative impact of inpatient versus outpatient PC is not well-described. For this reason, we conducted a retrospective cohort study of hospitalized cancer patients to quantify exposure to inpatient/outpatient PC, and to describe associations between PC exposure and end-of-life (EOL) quality measures including hospice utilization, advance care planning (ACP), and intensity of care. Methods: We identified all patients admitted to one cancer center’s inpatient oncology unit during one fiscal year (10/1/2017-9/30/2018). Demographics, admission statistics, inpatient/outpatient PC visits, and EOL outcomes were abstracted from the electronic medical record. Decedents were identified through chart review and public obituaries. Results were summarized by descriptive statistics, and standard statistical tests were used to evaluate associations between PC exposure and EOL outcomes. Results: 842 patients were hospitalized in one year. 522 patients died by the study end-date of 10/1/2020 and were included in analysis. 50% of decedents had any PC exposure prior to death, but only 21% had an outpatient PC visit. Patients seen by PC were younger at time of death, (median: 67 vs 72 years; p <.001) and more likely to be female (52% vs 42%; p =.03). Compared to patients never seen by PC, patients with any PC exposure were significantly more likely to enroll in hospice (78% vs 44%; p <.0001), have do-not-resuscitate status (87% vs 55%; p <.0001), have scanned ACP documents (53% vs 31%; p <.0001), and die at home or inpatient hospice instead of in the hospital (67% vs 40%; p <.01). PC exposure was not associated with differences in 30-day re-admissions, systemic cancer therapy in the last 14 days of life, or intensive care (ICU) utilization in the last 30 days of life. Notably, PC exposure was associated with longer hospital length-of-stay (LOS) (8.4 vs 7.2 days), but this association was reversed for patients seen by outpatient PC versus all others (6.3 vs 8.2 days; p <.01). Patients seen by outpatient PC also had longer hospice LOS (46.5 vs 27.1 days; p <.01) and less EOL ICU use (6% vs 15%; p <.05) compared to all others. Conclusions: In this large retrospective study of hospitalized patients with cancer, PC exposure was associated with significant improvements in multiple EOL quality measures. The subset of patients seen by outpatient PC experienced additional benefits, including shorter hospital LOS, longer hospice LOS, and less EOL ICU utilization. These findings point to differential effects between inpatient and outpatient PC, underscoring the importance of early, longitudinal PC involvement.
Veterans Affairs hematology/oncology clinic video telehealth experience.
Authors: Shah Nikesh , Shah Savan , Prithviraj Gopi Kesaria
Published: September 2021

281

Background: Many of the 40,000 veterans annually diagnosed with cancer have limited access to Hematology/Oncology care. An existing method to improve access in the Veterans Affairs (VA) system is the e-consultation, which allows text-based consultation by specialty services. However, many patients require more in-depth care than is feasible by e-consult. Amidst the COVID-19 pandemic, the James A. Haley VA (JAHVA) Hematology/Oncology department implemented VA video connect (VVC) telehealth visits to allow providers to connect with patients in their homes. Our aim was to assess the implementation of this novel telehealth service and assess provider perceptions via questionnaires. Methods: We reviewed charts of patients seen via VVC by the JAHVA Hematology/Oncology department. We gathered data including patient demographics, zip code, primary visit diagnosis, and date of visit. We adapted a previously validated telehealth usability questionnaire by Parmanto et al. Providers were surveyed about perceptions of VVCs prior to implementation and 1 year later. Responses were assessed via 5-point Likert scale. Results: From May 2020 to April 2021, 1290 VVCs were conducted. Median VVCs per month was 106 (range 26 to 161), with peak in June 2020. 71% of patients were ³65 years, 24% were 45-64 years, and 5% were <45 years. 77% of patients were white, 16% African American, 3% other, and 4% declined to answer or were of unknown race. 87% of patients were male. 12.5% of visits were for new consults. 41% of visits were for primary neoplasm-related diagnoses, 27% for hematologic diagnoses, and 32% for other. The mean residential distance from our clinic was 37.2 miles (range 0-212.7 miles). Sixteen Hematology/Oncology providers (faculty, fellows, advanced practice providers) completed the initial questionnaire, and 12 completed the follow-up questionnaire. See table for selected results. Conclusions: VVCs are a feasible method to provide remote access to care for patients. Utilization peaked in summer 2020, at the height of the COVID-19 pandemic. Providers were overall satisfied with video visits, though preference for in-person visits increased with time. Provider concern regarding personal and patient exposure to COVID-19 may have impacted perceptions regarding VVCs. Utilizing the PDSA cycle, future steps include identifying specific patient diagnoses and identifying reasons for VVC failure and using this data to optimize the experience for pati ent and providers.[Table: see text]
Determining the cancer diagnostic interval using administrative data in a cohort of patients with pancreatic cancer.
Authors: Karim Safiya , Paterson Bailey , Kong Shiying , Mahar Alyson , Webber Colleen , Lee-Ying Richard M. , Cheung Winson Y. , Groome Patti
Published: September 2021

336

Background: Pancreatic cancer is a leading cause of cancer death, largely due to vague presenting symptoms and late stage at diagnosis. Population-based administrative data can be a valuable resource for studying the diagnostic interval. The objective of this study was to determine the first encounter in the diagnostic interval and to calculate that interval in a cohort of patients with pancreatic cancer using an empirical approach. Methods: This is a retrospective, cohort study of patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) from 2007 – 2015 in Alberta, Canada. We used the Alberta Cancer Registry (ACR), physician billing claims, hospital discharge and emergency room visits to identify health encounters that occurred more frequently in the 3 months prior to diagnosis compared to those in the 3-24 months prior to diagnosis. We used statistical control charts to define the lookback period for each encounter category and identify the earliest encounter that represented the start of the diagnostic interval (index contact date). The end of the interval was the diagnosis date. Quantile regression was used to determine factors associated with the diagnostic interval. Results: We identified 3142 patients with PDAC. Median age of diagnosis was 71 (IQR 61-80). We identified an index contact date in 96.5% of the patients. The median length of the diagnostic interval was 76 days (IQR 21-191; 90th percentile 276 days). A higher Elixhauser comorbidity score (+18.57 days/ 1 point increase, 95% CI 16.07-21.07, p < 0.001) and stage 3 disease (+22.55 days, 95% CI 5.02-40.08, p = 0.01) was associated with a longer diagnostic interval. Conclusions: In this cohort of patients with pancreatic cancer, there was a wide range in the diagnostic interval with 10% of patients having a diagnostic interval approaching one year. Diagnostic interval research using administrative databases can understand variations in diagnosis times, can inform early detection efforts and can improve quality of care.
Death Anxiety, Immortality Projects and Happiness: A Utilitarian Argument Against the Legalization of Euthanasia
Authors: Van der Haak Donovan
Published: September 2021

The current, utilitarian debate on the relation between euthanasia and happiness focusses primarily on the subject of dying patients. Where some utilitarians stress how euthanasia may relieve suffering in the process of dying, others emphasize the importance of respecting the autonomy of others to make decisions like these themselves.  However, less attention has been paid to how legalizing euthanasia may impact the human decision-making processes of those still in a healthy and mentally sound state. This paper aims to shed light on this relatively underdeveloped subject within utilitarian theory. In particular, I focus on euthanasia’s most contested form: active, voluntary euthanasia. I draw on Ernst Becker,  who argues that moderate death anxiety stimulates people to work on ‘immortality projects,’ decisions that help them cope with the concept of death. Subsequently, I draw on several studies to defend the notion that immortality projects are indirectly conducive to happiness because they stimulate healthy decisions and long-term, human progress. Additionally, immortality projects counterbalance decisions that are based on an excessive drive for short-term pleasure. As euthanasia can make dying less painful, I argue it may diminish death anxiety to significant degree, and thereby also an incentive to work on immortality projects. This brings me to the conclusion that legalizing euthanasia is problematic from a utilitarian point of view, considering the observation that immortality projects are indirectly conducive to happiness.
Religious Dimensions in Transhumanist and Posthumanist Philosophies of Science
Authors: Juozelis Evaldas
Published: September 2021

The article discusses transhumanism and posthumanism as marginal trajectories of the modern philosophy of science, which, however, distinctly influence the mainstream narrative of science and societal relations. Among the decisive determinants of this impact is trans/posthumanism’s para-religious content that replenishes a conceptualised process of cutting-edge scientific practices and ideals. In particular, transhumanism and posthumanism evolve as ideological exploiters of seemingly obsolete forms of religiosity, for they simultaneously exploit and reinvent the entire apparatus of the scientific, political, and moral activity in Western societies. Avant-garde secular worldviews tend to be religious in the sense that their ultimate quest is the transformation of humans into certain historical entities, which are capable of rearranging their own systems of order.
No God, no God's Eye: A Quasi-Putnamian Argument for Monotheism
Authors: Gafvelin Åke
Published: September 2021

Metaphysical realism is the thesis that “the world consists of some fixed totality of mind-independent objects” such that “there is exactly one true and complete description of 'the way the world is'”. In the first part of this essay, I will present Hilary Putnam’s worry with metaphysical realism. Secondly, I will argue that metaphysical realists must commit to metaphysical anthropocentrism in order to solve Putnam’s problem. Thirdly, I will argue that metaphysical anthropocentrism requires monotheism. Lastly, I argue that metaphysical realism is true. Therefore, we must be ontologically committed to God.
Reconsidering Burke’s and Arendt’s Theories on “The Rights of Man”: A Surprising Plot Twist?
Authors: Chountis Ioannes
Published: September 2021

Edmund Burke can perhaps be considered as the father of modern conservatism. Hannah Arendt was a very eclectic thinker who embraced ideas from the traditions of liberalism and republicanism. They both commented on the issue of the “Rights of Man” and rejected their abstract and metaphysical nature. And, it was Arendt who saw a ‘certain pragmatism’ in Burke’s ideas. Is this coincidence of opinion a surprising plot twist? An unintentional ‘alliance’ against the naturalness of the “Rights of Man?” This paper first discusses the real relationship between Burke’s and Arendt’s theories on human rights. In the first part, the ideas of the two thinkers are presented and examined. In the second part, the main convergences and divergences are identified. Through a careful reading of the Burkean and Arendtian corpus, it is shown that Arendt agreed with Burke that human rights cannot be abstract or metaphysical. On the other hand, Arendt, being autonomous in her critique, argued for one universal and inalienable right, that is ‘the right to have rights,’ i.e. the right to belong to political community. In overall, the analysis endeavors to provide an answer to the question as to what degree did Arendt endorse Burke’s theories on the “Rights of Man.”
Solutions to indefinite weakly coupled cooperative elliptic systems
Authors: Clapp Mónica , Szulkin Andrzej
Published: September 2021

We study the elliptic system \begin{equation*} \begin{cases} -\Delta u_1 - \kappa_1u_1 = \mu_1|u_1|^{p-2}u_1 + \lambda\alpha|u_1|^{\alpha-2}|u_2|^\beta u_1, \\ -\Delta u_2 - \kappa_2u_2 = \mu_2|u_2|^{p-2}u_2 + \lambda\beta|u_1|^\alpha|u_2|^{\beta-2}u_2, \\ u_1,u_2\in D^{1,2}_0(\Omega), \end{cases} \end{equation*} where $\Omega$ is a bounded domain in $\mathbb R^N$, $N\geq 3$, $\kappa_1,\kappa_2\in\mathbb R$, $\mu_1,\mu_2,\lambda> 0$, $\alpha,\beta> 1$, and $\alpha + \beta = p\le 2^*:={2N}/({N-2})$. For $p\in (2,2^*)$ we establish the existence of a ground state and of a prescribed number of fully nontrivial solutions to this system for $\lambda$ sufficiently large. If $p=2^*$ and $\kappa_1,\kappa_2> 0$ we establish the existence of a ground state for $\lambda$ sufficiently large if, either $N\ge5$, or $N=4$ and neither $\kappa_1$ nor $\kappa_2$ are Dirichlet eigenvalues of $-\Delta$ in $\Omega$.
LA REPRESENTACIÓN DE LA MUJER EN LA ROMA DE LA POSGUERRA: EL TEATRO DE ENNIO FLAIANO.
Authors: Martín Clavijo Milagro
Published: September 2021

La mayoría de las mujeres que aparecen en la obra dramática del escritor italiano Ennio Flaiano (1910-1972) responden fundamentalmente al perfil general de mujer emancipada y liberada, quizás en exceso, al prototipo de mujer que aparece en La dolce vita de Fellini, en la que el autor colaboró como guionista. Son mujeres que no se presentan a sí mismas, sino a través de sus relaciones con los hombres protagonistas del teatro de Flaiano, de lo que les hacen sentir o no. La mayoría de ellas pertenecen al círculo intelectual-artístico de la Roma de la posguerra, mujeres liberadas pero que, en realidad, todavía desempeñan un papel secundario respecto al hombre. Mujeres en busca de la ‘gran ocasión’, el matrimonio, y es en este campo, el de las relaciones personales más íntimas en el que se van a mover todas las mujeres que aparecen en su teatro. Se trata fundamentalmente del amor, o más bien el deseo carnal, que parte de los personajes masculinos hacia las mujeres.
MAROSA Y EL DEVENIR (1932-2004).
Authors: Rubio Graciela
Published: September 2021

Marosa Di Giorgio fue una escritora uruguaya que destacó tanto en poesía como en prosa. Su obra poética se caracteriza por un constante devenirqueafectadirectamente a ladimensión temporal de los textos. El presente trabajo analiza los diferentes aspectos temporales y cómo enriquecen la lectura de los poemas de la autora.
LA VICTIMIZACIÓN DE MADAME MERLE IN THE PORTRAIT OF A LADY Y LA SOCIEDAD EUROPEA COMO AGENTE OPRESOR.
Authors: Filgueira Figueira Marina
Published: September 2021

Este estudio se centra en uno de los personajes principales de la novela The Portrait of a Lady DE Henry James y el papel de la sociedad europea en el proceso de victimización femenina. Este análisis pretende ofrecer una nueva perspectiva de la novela y la representación del malvado personaje de Madame Merle. Su metodología consiste, por un lado, en un enfoque cronológico y por el otro, un enfoque sincrónico. La contradicción entre la información recogida tras los análisis nos ha permitido llegar a la conclusión de que el personaje de Madame Merle debe analizarse a la luz del concepto de victimización femenina
The Effectiveness of Multiplex Teaching Method in Mastering Vocabulary for Deaf Students
Authors: Subasno Yohanes , Degeng I Nyoman Sudana , Pali Marthen , Hitipeuw Imanuel
Published: September 2021

This study aims to measure the effectiveness of “multiplex teaching method” in mastering vocabulary for deaf students. Multiplex teaching method consists of picture language, sign language, printed-word language, written language, and spoken language. The research was designed as a single subject research (SSR) with baseline, intervention, and maintenance phase (A-B-A’ design). The research subjects consisted of two deaf students in special school of SLB Bhakti Luhur Malang, Indonesia. In addition, a special education teacher and an observer were involved in this study. The intervention instrument comprised five lesson plans (LP), each containing a vocabulary of four words. The data were analyzed using intra-condition and inter-condition graphical inspection with a focus on data stability, trends, and score changes. The effectiveness was determined by the Percentage of Non-Overlapping data (PND). The change of score from A'/A achieved by Subject-1 was 7.86 points, while Subject-2 obtained 7.68 points. Subject-1 obtained an average PND B/A of 100% and average PND A'/B of 82.5%. Subject-2 achieved an average PND B/A of 99% and PND A’/B of 90%. Thus, multiplex teaching method is very effective in helping deaf students master vocabulary.
Development of Academic Optimism Model in Learning for Junior High School Students
Authors: Ratnawati Vivi , Setyosari Punaji , Ramli M. , Atmoko Adi
Published: September 2021

Academic optimism has an essential role in the adjustment of students in school. This study aimed to examine a model of academic optimism formed from democratic parenting, school climate, internal locus of control, and students’ self-concept. This a cross-sectional non-experimental design research design involved 335 Junior High School students in Kediri. The data collection tool was a scale while the data analysis technique was Structural Equation Modeling (SEM) analysis. The results showed that the theoretical model for developing academic optimism in Junior High School students was in line with the research data and obtained empirical support (X2 = 246.056 < 255.6018; p = 0.110 > 0.05), so this model is feasible and can be used in samples that have been studied. In general, this study adds knowledge about positive psychology studies and supports democratic parenting, school climate, self-concept, and internal locus of control as ultimate factors for creating students’ academic optimism.
The Spatial Thinking Process of the Field-Independent Students based on Action-Process-Object-Schema Theory
Authors: Bintoro Henry Suryo , Sukestiyarno Y.L. , Mulyono Mulyono , Walid Walid
Published: September 2021

Spatial thinking has roles to facilitate learners to remember, understand, reason, and communicate objects and the connections among objects that are represented in space. This research aims to analyze the spatial thinking process of students in constructing new knowledge seen from the field-independent cognitive style learners based on Action-Process-Object-Schema (APOS) theory. APOS theory is used to explore spatial thinking processes which consist of mental structures of action, process, object, and schema. This research is qualitative research with an exploratory method. It provided the students' opportunity to solve problems alternately until the method found the most appropriate subjects for the research objectives. The subjects were 2 students of Mathematics Education in the fourth semester of Universitas Muria Kudus Indonesia. The data collection techniques were started by distributing the validated and reliable spatial thinking questions, the cognitive style question, and the interview. The applied data analysis consisted of data reduction, presentation, and conclusion. The findings showed (1) spatial thinking process of holistic-external representation typed learners were indicated by the representative thinking element, abstract-illustrative figure expression to communicate and complete the tasks correctly, (2) spatial thinking process of the holistic-internal representation typed learners were indicated by the representative means, having ideas, connecting with the previous knowledge in the forms of symbols and numbers, and finding the final results correctly although incomplete.
Association of comorbidity between Opisthorchis viverrini infection and diabetes mellitus in the development of cholangiocarcinoma among a high-risk population, northeastern Thailand
Authors: Thinkhamrop Kavin , Khuntikeo Narong , Laohasiriwong Wongsa , Chupanit Pornpimon , Kelly Matthew , Suwannatrai Apiporn T.
Published: September 2021

Background

Cholangiocarcinoma (CCA) is a category of lethal hepatobiliary malignancies. Previous studies have found that Opisthorchis viverrini infection and diabetes mellitus (DM) are closely correlated with CCA. However, few studies have discussed the association of CCA with a combination of both O. viverrini infection and DM. This study aimed to assess the correlation of CCA with various combinations of O. viverrini infection and DM among a high-risk population in northeastern Thailand.

Methodology

This study included participants from 20 provinces in northeastern Thailand who had been screened for CCA in the Cholangiocarcinoma Screening and Care Program (CASCAP) between 2013 and 2019. Histories of O. viverrini infection and DM diagnosis were obtained using a health questionnaire. CCA screening used ultrasonography with a definitive diagnosis based on histopathology. Multilevel mixed-effects logistic regression was performed to quantify the association, which is presented as adjusted odds ratios (aOR) and their 95% confidence intervals (CI).

Principal findings

Overall, 263,776 participants were included, of whom 32.4% were infected with O. viverrini, 8.2% were diagnosed with DM, and 2.9% had a history of both O. viverrini infection and DM. The overall rate of CCA was 0.36%. Of those infected with O. viverrini, 0.47% had CCA; among those with DM, 0.59% had CCA and among those infected with O. viverrini and had DM, 0.73% had CCA. Compared with participants who were not infected with O. viverrini and were non-DM, the aOR for those infected with O. viverrini and with DM was 2.36 (95% CI: 1.74–3.21; p-value <0.001).

Conclusions

The combination of O. viverrini infection and DM was highly associated with CCA, and these two conditions had a combined effect on this association that was greater than that of either alone. These findings suggest that CCA screening should have a strong focus on people with a combination of O. viverrini infection and DM.
Assessment of small-intestine permeability in healthy Nigerian children is altered by urinary volume and voiding status
Authors: Afolami Ibukun , Samuel Folake Olukemi , Mwangi Martin , Oderinde Michael , Diepeveen-de Bruin Marlies , Melse-Boonstra Alida
Published: September 2021

Objective

This study aimed to uncover the effect of voided urinary volume on small intestine permeability ratios in healthy children.

Methods

We assessed small intestine permeability in 155 apparently healthy children, aged 3–5 years old, without any visible symptoms of disease, in a rural, malaria-endemic setting in Nigeria, using a multi-sugar test solution, comprising lactulose, sucrose, mannitol, and rhamnose. Children were categorized into low urinary volume (LV) and high urinary volume (HV), based on the volume of urine voided per kg body weight per hour. LV children voided less than 25th percentile of the total population, while HV children voided greater than 75th percentile of the total population. Urinary volume excreted over a 90-minute period after administration of the test solution was measured, and differences in sugar ratios were compared between children with high (HV) and low urinary volumes (LV), as well as between children who voided (VC) or who were not able to void (NVC) before administration of the test solution.

Results

Urinary mannitol and rhamnose recovery were 44% (p = 0.002) and 77% (p<0.001) higher in HV children compared to LV children respectively, while urinary lactulose recovery was 34% lower (p = 0.071). There was no difference in urinary sucrose recovery between groups (p = 0.74). Lactulose-mannitol ratio, lactulose-rhamnose ratio and sucrose-rhamnose ratio were all significantly higher in children in the LV group compared to children in the HV group (p<0.001). In a multiple regression analysis, urinary volume and voiding status combined, explained 13%, 23% and 7% of the variation observed in lactulose-mannitol, lactulose-rhamnose and sucrose-rhamnose ratios, respectively.

Conclusion

Sugar permeability ratios vary significantly with total urinary volume in multi-sugar small-intestine permeability tests. Voiding status before sugar administration appears to influence lactulose recovery, lactulose-rhamnose and sucrose-rhamnose ratios independently of total urinary volume. Evidence from this study suggests the need to take urinary volume into account when conducting multi-sugar small-intestine permeability tests.
Tooth retention predicts good physical performance in older adults
Authors: Musacchio Estella , Binotto Pierluigi , Perissinotto Egle , Sergi Giuseppe , Zambon Sabina , Corti Maria-Chiara , Frigo Anna-Chiara , Sartori Leonardo
Published: September 2021

Background

Oral health is closely related to both physical and psychological well-being, as it enables individuals to eat, speak, and socialize. The number of teeth is the most used indicator of oral health. Several reports document a relationship of dental status with a variety of indicators of general health but longitudinal studies employing standardized physical performance tests are infrequent in the scientific literature.

Subjects and methods

The Italian elderly participating in the Pro.V.A. longitudinal Study (3099 subjects aged 65+ at baseline, 2196 at the 5-year follow-up 1 and 1641 at the 7-year follow- up 2) underwent detailed interview and extensive clinical and instrumental examination that included validated physical performance measures. Participants were classified into 4 groups according to the number of remaining teeth: 0, 1–7, 8–19, and 20+. To explore the association of the number of remaining teeth with physical function and disability, we performed logistic regression analyses with models progressively adjusted for a wide number of covariates, namely anthropometric (gender, age, BMI), comorbidity (cardio-vascular, osteoarticular, and neurological diseases including depression), muscle strength (assessed for upper and lower limbs), lifestyle (smoking status, alcohol use, leisure time activities) and socioeconomical status (education, income, marital status, loneliness).

Results

Dental status correlated with most comorbidities, lifestyle, and socio-economic variables at the univariate analysis at baseline and at follow-ups. A good dental status was significantly associated with better physical functioning and lower disability. The presence of 20+ teeth resulted significantly protective (reference group: 0 teeth) versus mobility-related disability (OR = 0.67), disability (OR = 0.54) and inability to perform heavy duties (OR = 0.62), at follow up 1 and low physical performance score (OR = 0.59) at follow up 2. Conversely, the detrimental effect of edentulism, explored in subjects with or without dentures, was present but not as straightforward. Conclusion. The assessment of a geriatric patient should include an oral evaluation as a good dental status is a crucial component of successful aging.
Cytotoxicity, antimicrobial and antioxidant activities of mosses obtained from open habitats
Authors: Wolski Grzegorz J. , Sadowska Beata , Fol Marek , Podsędek Anna , Kajszczak Dominika , Kobylińska Agnieszka
Published: September 2021

Mosses are mainly the object of ecological and taxonomic research. This group of plants are still underestimated by scientists in other aspects of research. Recent research has shown that these plants contain remarkable and unique substances with high biological activity. Five species of mosses from a large urban ecosystem were identified for present study. In order to determine their biological potential, multifaceted studies were carried out, including: total phenolics content, antioxidant activity, antimicrobial and antifungal study, cytotoxicity evaluation, and scratch assay to assess pro-regenerative effect in the context of their possible use as the ingredients of biologically active cosmetics. Additionally, determination of individual phenolic compounds in selected extracts of the tested mosses was made. Research showed that Ceratodon purpureus and Dryptodon pulvinatus extracts had the greatest potential as antioxidants and antimicrobial activity. The cytotoxicity assessment indicated that the extracts from Dryptodon pulvinatus and Rhytidiadelphus squarossus exerted the strongest negative effect on mouse fibroblast line L929 viability at higher concentrations. While, the extract from Tortulla muralis best stimulated human foreskin fibroblast line HFF-1 proliferation and wound healing. The research on individual phenolic compounds content in the extracts tested indicated over 20 peaks on UPLC chromatograms. The conducted study has shown that mosses, especially so far unexplored species of open ecosystems, and e.g. epilytic habitats, may be a valuable source of biologically active substances and thus may constitute important medical and cosmetic possibilities.
Replicating prediction algorithms for hospitalization and corticosteroid use in patients with inflammatory bowel disease
Authors: Gan Ryan W. , Sun Diana , Tatro Amanda R. , Cohen-Mekelburg Shirley , Wiitala Wyndy L. , Zhu Ji , Waljee Akbar K.
Published: September 2021

Introduction

Previous work had shown that machine learning models can predict inflammatory bowel disease (IBD)-related hospitalizations and outpatient corticosteroid use based on patient demographic and laboratory data in a cohort of United States Veterans. This study aimed to replicate this modeling framework in a nationally representative cohort.

Methods

A retrospective cohort design using Optum Electronic Health Records (EHR) were used to identify IBD patients, with at least 12 months of follow-up between 2007 and 2018. IBD flare was defined as an inpatient/emergency visit with a diagnosis of IBD or an outpatient corticosteroid prescription for IBD. Predictors included demographic and laboratory data. Logistic regression and random forest (RF) models were used to predict IBD flare within 6 months of each visit. A 70% training and 30% validation approach was used.

Results

A total of 95,878 patients across 780,559 visits were identified. Of these, 22,245 (23.2%) patients had at least one IBD flare. Patients were predominantly White (87.7%) and female (57.1%), with a mean age of 48.0 years. The logistic regression model had an area under the receiver operating curve (AuROC) of 0.66 (95% CI: 0.65−0.66), sensitivity of 0.69 (95% CI: 0.68−0.70), and specificity of 0.74 (95% CI: 0.73−0.74) in the validation cohort. The RF model had an AuROC of 0.80 (95% CI: 0.80−0.81), sensitivity of 0.74 (95% CI: 0.73−0.74), and specificity of 0.72 (95% CI: 0.72−0.72) in the validation cohort. Important predictors of IBD flare in the RF model were the number of previous flares, age, potassium, and white blood cell count.

Conclusion

The machine learning modeling framework was replicated and results showed a similar predictive accuracy in a nationally representative cohort of IBD patients. This modeling framework could be embedded in routine practice as a tool to distinguish high-risk patients for disease activity.
Association between vesicoureteral reflux, urinary tract infection and antibiotics exposure in infancy and risk of childhood asthma
Authors: Hsu Yu-Lung , Lin Cheng-Li , Wei Chang-Ching
Published: September 2021

Background

The use of antibiotics for treating infection in childhood and their association with increased risk of asthma remain controversial. Infants diagnosed with vesicoureteral reflux (VUR) belong to a unique population who are administered antibiotics for a long time and are susceptible to recurrent UTI. It is interesting to study the risk of asthma in these infants with or without VUR.

Methods

Taiwanese children born between 2000 and 2007 were enrolled in population-based birth cohort study. Participants diagnosed with VUR and UTI within first year were classified into four groups (VUR, UTI, VUR and UTI, and control). We calculated follow-up person-years for each participant from the index date until the asthma diagnosis, their withdrawal from the insurance system (because of death or loss to follow-up), or till the end of 2008. The risk of asthma was compared between the 4 cohorts by using Cox proportional hazards model analysis, adjusted hazard ratio (aHR), and 95% confidence interval (95% CI).

Results

Children diagnosed with VUR (n  =  350), UTI (n  =  15542), VUR and UTI (n  =  1696), and randomly selected controls (n  =  17588) were enrolled. The overall rate of incidence of asthma was found to be 1.64-fold, 1.45-fold, and 1.17-fold higher in the UTI, VUR/UTI, and VUR cohorts than in the controls (5.60, 5.07, and 4.10 vs. 3.17 per 100 person-years), respectively. After adjusting the potential factors, the overall risk of asthma remained the highest in UTI (aHR: 1.74, 95% CI : 1.65 to 1.80) followed by VUR/UTI (aHR: 1.56, 95% CI : 1.40 to 1.75) and VUR cohorts (aHR: 1.25, 95% CI: 0.96 to 1.62). The incidence of asthma was higher in boys than in girls.

Conclusion

The nationwide retrospective cohort study demonstrated that short-term therapeutic dose of antibiotics for UTI in infants with or without VUR has a positive correlation with the prevalence of childhood asthma. Significant risk of childhood asthma was not observed when VUR cohort was exposed to long-term low-dose of prophylactic antibiotics.