bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility of a child life specialist program for oncology patients with minor children at home: Demand and implementation.
Authors: Lysecki David , Bainbridge Daryl , Akitt Tracy , Georgiou Georgia , Meyer Ralph M. , Sussman Jonathan
Published: September 2021

28

Background: Up to 24% of adult oncology patients have minor children at home. Children may experience emotional problems, somatic complaints, social isolation, depression, and post-traumatic stress as a result. Typical support networks often fail to meet the needs of these families. To address this gap, an innovative Child Life Specialist (CLS) program for patients with minor children at home was offered at a tertiary oncology center. Methods: To understand the feasibility of this program, we examined the demand for and implementation of the CLS program over its initial 10 months. Demand was characterized using administrative data (referred patient/family demographics, referral details, and disease/treatment characteristics). Implementation was described through encounter data (audience, type of visit, interventions provided, time for preparation, and time of direct interaction for each encounter). Results: The program received 100 referrals, 93 of whom accessed the program. Patients were most often female (66%) with a median age of 45 years (range: 19 to 72). 81% were parents of minor children, 10% grandparents, and 9% other. Families predominantly had multiple children (98%), most commonly school-aged (ages 5-9, 39%; 10-14, 37%). 53% of families had two birth parents co-parenting in the same household; the remainder had alternate parent/living scenarios. Most referrals came from social work (57%). Median time from diagnosis to referral was 79 days (range: 9d-6.5y). Breast cancer (26%) was the most common diagnosis, followed by gastrointestinal (19%) and hematologic (16%). Cancer phase at referral was defined as at new diagnosis (within 30d, 18%), undergoing treatment with curative intent (20%), undergoing treatment with palliative intent (39%), at end of life (within 30d, 16%) and after death/bereavement (5%). 1 patient (1%) did not have cancer. The CLS recorded 257 unique encounters. 55% of encounters included patients, 40% non-patient parents, 21% children, and 21% others. 75% were individual encounters, while 25% were group encounters. 95% of encounters that included children also included an adult. Phone calls were the most frequent encounter type (43%), but hospital visits consumed the largest proportion of recorded CLS time (38%). Mean encounter time (all visit types) included 20min for preparation and 51min of direct interaction. CLS interventions included: guidance on talking with children (67% of encounters), providing resources (37%), diagnostic teaching (21%), end-of-life support (18%), discussing change in status (10%), grief (8%), and emotional expression (4%). Conclusions: This study characterized the demand for this program and described its implementation over the pilot period. This period occurred during the Covid-19 pandemic, which dramatically altered healthcare and family visitation, likely influencing the results of this study.
Real-world treatment patterns of metastatic non-small cell lung cancer (mNSCLC) patients receiving epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs).
Authors: Shenolikar Rahul , Liu Sizhu , Tse Jenny , Cao Yao , Near Aimee
Published: September 2021

289

Background: Among mNSCLC patients positive for EGFR mutation (EGFRm), first-line (1L) treatment with an EGFR TKI is recommended for best outcomes. This study describes real-world treatment patterns of mNSCLC patients using EGFR TKIs in the 1L setting, including osimertinib, the most recently approved EGFR TKI for 1L use. Methods: Patients with ≥1 claim for an EGFR TKI (1st generation [1G]: gefitinib, erlotinib; 2nd generation [2G]: afatinib, dacomitinib; 3rd generation: osimertinib) from January 1, 2015 – April 30, 2020 were identified in IQVIA’s prescription (LRx) and medical claims (Dx) databases; first date of EGFR TKI was the index date. Patients had 12-month baseline period before index, variable follow-up after index, ≥1 lung cancer diagnosis on index or in baseline, and earliest metastatic cancer diagnosis on or 90 days before index. Kaplan-Meier analysis was used to estimate 1L treatment duration, where treatment discontinuation was defined as >60-day gap in medication supply of the index EGFR TKI. Patient characteristics and treatment patterns were stratified by 1L EGFR TKI. Results: Overall, 2,505 mNSCLC patients received 1L EGFR TKI (982 osimertinib, 1,060 1G, 463 2G). Median ages were 66-69 years, 64.6-67.1% were female, and 32.4-38.9% had central nervous system metastases on or before index. Most patients were commercially insured (50.8-62.9%), 35.3-45.9% had Medicare, and 0.6-3.3% had other payer types. Nearly all patients had 1L EGFR TKI monotherapy (97.6-99.7%). 1L treatment duration was longer for osimertinib compared to 1G or 2G EGFR TKI (median months, 17.8, 8.7, 10.5 respectively). 2L treatment was observed in 32.5% of 1G and 36.3% of 2G EGFR TKI cohorts. Osimertinib monotherapy, chemotherapy, and immunotherapy (monotherapy or combined with chemotherapy) accounted for 58.3%, 7.0%, and 4.3% of 2L treatments after 1L 1G EGFR TKI, respectively, and 60.7%, 4.2%, and 4.8% of 2L treatments after 1L 2G EGFR TKI. Conclusions: In real-world practice, 1L treatment duration is longer with osimertinib compared with other EGFR TKIs. Future studies with longer follow-up are recommended to understand treatment patterns after progression on EGFR TKIs, mainly osimertinib, given its recent approval.
Mobile-health tool for timely management of cancer treatment toxicity.
Authors: Sanyal Amit , Mistretta Sara , Fulton Morgan , Janssen Clemens walter
Published: September 2021

321

Background: Treatment related side effects after chemotherapy are common, with significant toxicities seen in 78.2% to 98.3% of patients allocated to two study arms of a lymphoma trial [1]. While most oncology clinics provide patient education before treatment, onetime delivery of large amounts of information without reiteration of crucial facts results in information gaps, delay in seeking care, culminating in potentially avoidable ED visits and hospitalizations. Technology based symptom monitoring can facilitate early detection of complications, reduce symptom burden and cost of care. Here we update our study [2] of utility of a mobile-health tool for timely management of cancer treatment related toxicities in a community-based oncology practice. Methods: A web-based mobile application consisting of a patient interface, a provider interface and an embedded analytic platform was developed. Patient ‘check-ins’ incorporating a brief introduction and chemotherapy toxicity questionnaires are delivered through automated text or email. Toxicity questionnaires are based on the NCI-PRO-CTCAE ITEMS-ENGLISH form builder. The provider interface incorporates a ‘patient records summary’ page and a ‘tracker’ page, allowing the oncology care team to monitor responses in real-time. Responses exceeding pre-specified thresholds generate a color-coded ‘flag’ and are marked for follow up. Flags result in a phone call followed by in-person evaluation if necessary. All interventions are time stamped. Patient experience is measured concurrently using a Likert-scale as well as free-text response box. Results: 310 patients were enrolled as of January 21, 2021. Median age was 64 years. There were 49% females.8916 check-ins were sent out and 2963 responses recorded for an overall response rate of 33.23%. 531 responses provided by 109 unique patients were flagged for follow up, amounting to 6% of all responses. Fatigue was the most common symptom flagged for follow-up (454), followed by nausea/vomiting or diarrhea (167), abdominal pain (140), cough/dyspnea (140) and numbness/tingling (138). Follow up was prompt, with 60% of patient symptoms followed up on the same day and of these, 84% followed-up within 4 hours of patient reported symptom. Patient experience was consistently favorable. 72% of patients reported an experience score of ≥ 4 (1-5 scale, 5 being the most favorable). Conclusions: Electronic capture of symptoms using connected technology is feasible and can be used for timely management of treatment related complications. References: Bartlett, N.L., et al., Dose-Adjusted EPOCH-R Compared With R-CHOP as Frontline Therapy for Diffuse Large B-Cell Lymphoma: Clinical Outcomes of the Phase III Intergroup Trial Alliance/CALGB 50303. J Clin Oncol, 2019. 37(21): p. 1790-1799. Sanyal, A. Mobile health tool for monitoring cancer treatment complications. 2020. ASCO Quality Care Symposium: American Society of Clinical Oncology.
Overall survival following implementation of clinical pathways for cancer care.
Authors: Ojha Rohit P. , Lu Yan , Narra Kalyani , Meadows Rachel J. , Gehr Aaron , Mantilla Emmanuel , Ghabach Bassam
Published: September 2021

328

Background: Clinical pathways are decision support tools designed to enhance accessibility and ease of use of treatment recommendations. Prior studies that evaluated cancer clinical pathways largely focused on process measures such as concordance with treatment guidelines, but little evidence is available about the effect of clinical pathways on survival. We thus aimed to evaluate the effect of cancer clinical pathways on overall survival. Methods: We used institutional registry data from the JPS Oncology and Infusion Center, which is a Comprehensive Community Cancer Program. Eligible patients were aged ≥18 years, diagnosed with first primary breast, colorectal, or lung cancer between December 2013 and December 2017 with follow-up through June 2020. We used a natural experiment framework, where intervention was implementation of clinical pathways (December 2015). The pre-intervention period was December 2013 – November 2015 and post-intervention period was January 2016 – December 2017. We used marginal structural models with stabilized inverse probability weights for each cancer type to estimate restricted mean survival time (RMST) differences and 95% confidence limits (CL) comparing overall survival between pre- and post-clinical pathways within a 36-month horizon, where weights were based on a minimal sufficient set of covariates (sociodemographics, tumor characteristics, and comorbidities) to reduce confounding bias. Results: Our study population comprised 327 breast, 254 colorectal, and 431 lung cancer patients. Median age ranged between 55 years (breast) and 60 years (lung). The frequency of racial/ethnic minorities ranged between 45% (lung) and 68% (colorectal). The frequency of uninsured patients ranged between 47% (lung) and 58% (colorectal). Adherence to pathways was consistently over 80%. RMST was largely similar between pre- and post-clinical pathways for breast (RMST difference = -0.10 months, 95% CL: -1.9, 1.7), colorectal (RMST difference = -0.48 months, 95% CL: -3.4, 2.5) and lung cancer (RMST difference = 1.1 month, 95% CL: -1.5, 3.7). Conclusions: Our results suggest that implementation of clinical pathways has minimal effect on overall survival within 36 months despite high adherence in a safety-net population, but the estimates are compatible with up to 3.4 month decrease or 3.7 month increase depending on cancer type. Longer follow-up, particularly for breast and colorectal cancer, may provide further insight. Our findings may be useful for informing deliberations about implementing clinical pathways and setting expectations about the effect of clinical pathways on overall survival.
Improving palliative care integration for patients with stage IV lung cancer at UConn Health by initiating a best practice advisory (BPA) in the electronic medical record (EMR).
Authors: Loschiavo Sarah , Holle Lisa , Guarino Carolyn , Kalish Ruth , Coppola Cheryl , Thibodeau Wendy
Published: September 2021

331

Background: The American Society of Clinical Oncology (ASCO) practice updates on the integration of palliative care into standard oncology practice provides a key recommendation that patients with advanced cancer should receive palliative care services. Specifically, ASCO recommends that all patients with stage IV cancer receive a referral to an interdisciplinary palliative care team early in their course of disease and within 8 weeks of diagnosis. At UConn Health, it has been previously documented that only 28% of patients with stage IV cancer receive a referral to the palliative care team. To improve the quality of cancer care, a BPA with standardized criteria for palliative care referral was developed and implemented for patients with stage IV lung cancer. In this pilot study, the goal was to get 80-90% of patients a referral to palliative care team within 8 weeks of stage IV lung cancer diagnosis. Methods: The Model for Improvement using Plan-Do-Study-Act Cycles was completed: 1) created an EMR report to identify patients with stage IV lung cancer; 2) completed a retrospective review of patients with stage IV lung cancer referred to palliative care 6 months prior to BPA implementation; 3) created and implemented BPA; 4) educated providers about palliative care referral and BPA; 5) retrospectively reviewed referrals 6 months following BPA implementation; and 6) evaluated potential barriers. The palliative care EMR BPA was developed in collaboration with information technology specialists. The BPA alert populates the EMR when the provider opens a patient chart or visit encounter for all patients with 1) diagnosis of lung cancer; 2) stage IV disease; and 3) does not have a current order for palliative care referral. Results: Prior to BPA implementation (January 1, 2020- July 31, 2020), 8 of 28 patients (32%) with stage IV lung cancer were referred to palliative care service. The BPA became active on 9/15/2020. Within the six months following BPA implementation, 16 patients were newly diagnosed with stage IV lung cancer. Of these 16 patients, 81% of them had a referral to palliative care made within 8 weeks of clinical staging. Several barriers were identified with current process, including lack of staging tool use by all providers; lack of documentation of all data required for staging tool to automatically calculate stage, and inability to track patients who declined palliative care appointment. Conclusions: Incorporating a BPA reminding providers to consider a palliative care referral improved referrals of patients with newly diagnosed stage IV lung cancer to the palliative care clinic within 8 weeks of diagnosis, improving compliance with ASCO’s practice guidance on integration of palliative care. Next steps are to address barriers and expand the use of palliative care referral BPA to all patients with stage IV cancer.
Reliability of claims-based measures used to assess cancer care quality.
Authors: Urick Benjamin , Burbage Sabree , Baggett Christopher , Lafata Jennifer Elston , Sanoff Hanna Kelly , Trogdon Justin G.
Published: September 2021

42

Background: As value-based payment models for cancer care expand, the need for measures which reliably assess the quality of care provided increases. This is especially true for models like the Oncology Care Model (OCM) that rely on quality rankings to determine potential shared savings. Under models like these, unreliable measures may result in arbitrary application of value-based payments. The goal of this project is to evaluate the extent to which measures used within the OCM are reliable indicators of provider performance. Methods: Data for this project came from North Carolina Medicare claims from 2015-2017. Episodes were attributed to physician practices at the tax identification number (TIN) level, lasted 6 months, and were divided into two performance years beginning 1/1/2016 and 7/1/2016. TINs with fewer than 20 attributed patients were excluded. Three claims-based OCM measures were used in this evaluation: 1) proportion of episodes with all-cause hospital admissions; 2) proportion of episodes with all-cause emergency department (ED) visits or observation stays; and 3) proportion of patients that died who were admitted to hospice for 3 days or more. Risk adjustment followed the method described by measure specifications from the OCM. Reliability was calculated as the ratio of between practice variation (e.g. signal) to the sum of between practice variation and within practice variation (e.g. noise). Variance estimates were derived from hierarchical logistic regression models used for risk adjustment. Results: For the hospitalization and ED visit measures, episode counts for years 1 and 2 were 30,746 and 28,430 and TIN counts were 86 and 84, respectively. Hospice use measures had fewer episodes (2,677 and 2,428) and TINs (36 and 33). Across all measures, median reliability scores failed to achieve the recommended 0.7 threshold and only hospice had a median reliability score above 0.5 (Table). Conclusions: These findings suggest claims-based measures included in the OCM may produce imprecise estimates of provider performance and are vulnerable to random variation. Consideration should be given to developing alternative measures which may be more reliable estimates of provider performance and to increasing minimum denominator requirements for existing measures.[Table: see text]
Associations between costs of oral hormonal therapies for prostate cancer, financial assistance mechanisms, and time on treatment.
Authors: Schwartz Eric B , Jeong Angelina , Roman Andrea , McDevitt Rachel , Henry Elyssa , Veenstra Christine M. , Caram Megan Veresh
Published: September 2021

61

Background: Numerous oral anticancer drugs approved for metastatic prostate cancer are expensive and put patients at risk for financial toxicity. Mechanisms to mitigate these costs are complex to navigate and are variable for different patient populations. We examined the impact of high costs and insurance type on time on therapy and reason for discontinuation of oral medication in patients with prostate cancer. Methods: We identified patients with prostate cancer who filled prescriptions for abiraterone or enzalutamide at our comprehensive cancer center 1/1/17-3/31/19, or who were prescribed one of these therapies but could not fill due to cost. Those with commercial insurance or Medicare part D were included. Clinical and demographic data was extracted for evaluation. Primary outcome variables included initial out-of-pocket cost, time on treatment, and failure to fill medication due to cost. Analysis using chi squared, T-tests and ANOVA was performed to assess associations. Results: We identified 193 patients. Of these, 34% had commercial insurance and 66% had Medicare part D. Mean out-of-pocket expense for the first fill was $62 for patients with commercial insurance and $582 for patients with Medicare Part D. Among those who did not fill due to cost, 9 had Medicare Part D and 1 had commercial insurance. The mean time on therapy for those with commercial insurance was 452 days vs 442 days for those with Medicare Part D. At time of data analysis, 50% of those with commercial insurance vs 45% of those with Medicare Part D remained on treatment. Of those who discontinued, 50% of those with commercial insurance did so due to progression or death vs 44% with Medicare part D. 14% with commercial insurance and 15% with Medicare part D discontinued to due patient preference or toxicities. 1 patient with Medicare part D and no patients with commercial insurance discontinued due to cost. There was no difference in time on therapy by out-of-pocket expense (average 444 days for out-of-pocket < $100 vs 477 days for out-of pocket > $100; p = 0.6) although those with an initial out of pocket expense > $100 were more likely not to fill their medication (24% vs 1%, p < 0.01). Conclusions: Costs remain high for oral prostate cancer treatments. Our findings suggest disproportionate financial burden among patients with Medicare Part D causing a significant number of patients to forego recommended therapy. While high costs did lead to failure to fill, we did not observe significant differences in time on treatment for patients with Medicare part D or with high out-of-pocket expense. Additionally, there was not a significant difference in stated reason for stopping therapy. Further research on patient perceptions of financial assistance programs and medication costs are planned.
Biosimilar uptake of filgrastim and impact on spending in Medicare Part D from 2015 to 2019.
Authors: Hussaini Syed , Gupta Arjun , Anderson Kelly E. , Ballreich Jeromie M. , Nicholas Lauren H. , Alexander Caleb
Published: September 2021

67

Background: The introduction of a filgrastim biosimilar in 2014 was associated with substantial cost savings in Medicare Part B and Medicaid programs. However, Medicare Part D is unique since it is unable to directly negotiate prices with drug manufacturers. We sought to investigate the uptake of filgrastim biosimilars and impact on spending among Part D beneficiaries. Methods: We evaluated utilization trends for filgrastim (Neupogen), filgrastim-sndz (Zarxio), and tbo-filgrastim (Granix) using the 2015-2019 Medicare Part D Prescription Drug Event data. We conducted a retrospective cross-sectional review of annual spending, number of beneficiaries, number of claims, spending per beneficiary, and spending per dosage unit. We excluded filgrastim-aafi (Nivestym) due to recent approval and adjusted for inflation using 2019 dollars. Results: In 2019, total aggregate Part D spending on filgrastim products was $78 million. From 2015 to 2019, the biosimilar share of total aggregate spending increased from $1.8 million (2%) to $44 million (56%), with combined biosimilar spending (Zarxio and Granix) eclipsing originator Neupogen in 2018 (within 4 years of FDA approval of Zarxio). Total spending on Neupogen reduced 58% from 2015 to 2019. While biosimilar uptake progressively increased every year, total aggregate spending on all filgrastim forms reduced only 7% from 2015 to 2019 ($84 million to $78 million). For all 3 forms, from 2015 to 2019, trends in spending were: average spending per claim ($3193 to $2549, -20%), average spending per beneficiary ($5880 to $6722, +15%), and average spending per dosage unit of filgrastim ($583 vs $571, -2%). Detailed results in Table. Conclusions: We demonstrate that the significant uptake of biosimilar filgrastim products in Medicare Part D from 2015 to 2019 was associated with a small decrease in aggregate spending, essentially unchanged per unit spending, and increased spending per beneficiary on filgrastim products. Our findings contrast with experiences across Medicare Part B and Medicaid, that demonstrated significant cost savings with biosimilar filgrastim uptake. This may be due to inability of Medicare Part D to directly negotiate prices with manufacturers (in contrast to Medicare Part B and Medicaid), supporting ongoing Congressional policy being debated in the United States Senate (H.R. 3).[Table: see text]
Oncology value based payment models: Where are the savings opportunities?
Authors: Oh Era Kim , Maguire Jon , Spinks Tracy E. , McNiff Landrum Kristen K. , Malin Jennifer
Published: September 2021

69

Background: Oncology practices are increasingly participating in value-based payment (VBP) arrangements; however, there is limited information on where practices have the greatest impact on reducing medical costs. Methods: United Healthcare (UHC) conducted a pilot to evaluate a VBP consisting of an episode fee, eliminating drug margin, and shared savings. The pilot was limited to members with breast, lung or colon cancer enrolled in UHC’s commercial plans. We compared total medical cost (TMC) per 120-day episode calculated from paid claims amounts for the pilot practices with a concurrent national cohort for the performance period (9/2015-9/2019) and a baseline period (1/2013-3/2015) using a difference-in-differences technique with a generalized linear regression model, adjusting for age, gender, cancer type and stage (adjuvant vs. metastatic), comorbidities, cancer surgery, radiation therapy, novel therapy, duration of therapy, and region. We categorized claims into 6 categories and estimated the impact of the VBP on costs: chemotherapy/drugs, radiation therapy, cancer surgery, cancer diagnostics, other cancer-related and other non-cancer related. In addition, we evaluated the difference in acute inpatient admission rates. Results: Patient treated in the pilot practices contributed 2,647 episodes of a total of 73,352 episode during the performance period, weighted equally between adjuvant and metastatic disease (Table). The adjusted TMC per 120-day episode was $36,434 for the national cohort and $37,215 for the participating clinics at baseline and $50,773 and $41,416, respectively during the performance period, resulting in an average decrease in TMC of $9,687 or a 20% reduction; although this varied significantly by stage and cancer type. The relative decrease in medical costs by category ranged from 13% for chemotherapy/drugs to 33% for cancer surgery and an increase in costs associated with cancer diagnostics of 7%; however, chemotherapy/drug were still associated with the largest absolute decrease in costs ($2,941). Practices participating in the pilot had a 24.7% decrease in the number of acute inpatient admissions and 12.6% decrease in the number of inpatient admission days; however, this did not reach statistical significance. Conclusions: Overall, practices participating in a VBP pilot with a commercial health plan decreased TMC per episode by 20% with savings across all cost categories except for cancer diagnostics.[Table: see text]
Association of Medicaid expansion under the Affordable Care Act and early mortality following lung cancer surgery.
Authors: Nogueira Leticia , Jemal Ahmedin , Han Xuesong , Yabroff K. Robin
Published: September 2021

76

Background: Medicaid expansion under the Affordable Care Act is associated with gains in health insurance coverage and a shift towards earlier stage diagnosis among patients with cancer. However, the association between Medicaid expansion and cancer mortality has not been well characterized. The aim of this study was to evaluate the association of Medicaid expansion with changes in early mortality, defined as death within 30 days after major NSCLC surgery, among adults discharged following major surgery for non-small cell lung cancer (NSCLC), a setting where access to care is a major determinant of death. Methods: Of the 11,627 patients selected from the National Cancer Database who were aged 45-64 (more likely to be diagnosed and die from NSCLC and not age-eligible for Medicare coverage) and were discharged from the hospital following major surgery for treatment of NSCLC between 2009 and 2018, 7,294 patients lived in expansion states and 4,333 lived in non-expansion states. Differences-in-differences (DD) analyses were used to evaluate the impact of Medicaid expansion on early mortality pre-(2009- 2013) and post-ACA (2014- 2018). Results: Early mortality among patients discharged from the hospital following NSCLC surgery statistically significantly decreased from 2.4% pre-ACA to 0.8% post-ACA among patients in Medicaid expansion states (1.6 percentage point decrease, p <.0001), but not in patients living in non-expansion states (from 2.1% to 1.6%, p = 0.2), leading to a DD of 1.1 percentage points (95% Confidence Interval = 0.1, 2.1; p = 0.03). Conclusions: This study found a decrease in early mortality following hospital discharge after NSCLC surgery post-ACA among patients living in Medicaid expansion states and no change in patients residing in non-expansion states. Medicaid expansion may be an effective strategy for improving access to care and cancer outcomes among older adults who are not age-eligible for Medicare.
Receptiveness and barriers to clinical trial participation for oncology patients from a public safety-net hospital.
Authors: Chiu Victor Yundeh , Berkowitz Jacob S. , Rodriguez Joshua , Law Jade , Lee Kristina , Torres Joe , Attai Deanna J. , Berkowitz Maurice J.
Published: September 2021

83

Background: Oncologic clinical trial enrollment is low, particularly in underserved populations. Increasing enrollment of public safety-net hospital patients is important to ensure representation of the general population and reduces cancer outcome disparities. To tailor clinical trial outreach, we sought to characterize attitudes towards trial participation of oncology patients at Olive View—UCLA Medical Center (OVMC), a public safety-net hospital in Los Angeles County. Methods: We developed a 39-question survey (Qualtrics, Provo, UT). It was administered via tablets to a convenience sample of patients in OVMC’s medical oncology clinic and infusion center during 2020—2021. The survey was offered to patients fluent in English or Spanish. Results: Of 165 patients who were offered the survey, 11 declined due to illiteracy in any language, 4 did not finish the survey. Median age was 54 (range: 20-81); 63% were female. The majority (76%) reported an annual income below $25,000; 39% did not complete high school. Self-identified ethnicity was Hispanic/Latino (73%), non-Hispanic White (12%), Asian-Pacific Islander (9%), and Black (4%). Based on a 5-point Likert scale of comfort speaking English, 48% had English proficiency (EP). Overall, 69% of patients expressed interest in trials. When considering participation, patients would seek advice from their physician (86%), family (32%), other medical staff (14%), alternative medicine practitioner (7%), friend (6%), or religious leader (4%). Concerns regarding trial participation were lack of knowledge regarding trials (47%), fear of side effects (43%), frequent visits (25%), cost (20%), transportation (14%), wage loss (9%), and inability to determine own treatment (4%). Patients found the following modalities useful for learning about trials: website (43%), paper handout (39%), video (37%), discussion with prior participants (34%). Patients with annual income > $25,000 were significantly more concerned about cost (33.3% v. 15.8%, p = 0.04) and treatment side effects (61.1% v. 36.8%, p = 0.02). EP patients were more likely to find a website (54.2% vs. 32.1%, p = 0.01) or discussion with prior participants (45.8% v. 23.1%, p < 0.01) helpful compared to low EP patients. Conclusions: There is considerable interest in oncologic clinical trials in this predominantly Hispanic/Latino population. This population had significant trust in physicians for guidance on trial enrollment, and had minimal concern for out-of-pocket cost, wage loss, or transportation issues. The majority of patients did not find additional informational resources helpful. Structural barriers rather than patient-level variables are likely the primary drivers of low oncologic trial enrollment. Future efforts should focus on improving access to appropriate trials and leveraging the physician-patient relationship for increasing trial participation.
Swabs by emergency responders (SWABBER): Enhancing care beyond the cancer center during the COVID-19 pandemic.
Authors: Allen Olivia S. , Liu Mark , Munjal Kevin , Lomboy Rex , Bhardwaj Aarti Sonia , Abdallah Alma , Massenburg Natalie , Casadiego Shawn , Smith Cardinale B.
Published: September 2021

97

Background: The COVID-19 pandemic caused sudden changes in healthcare delivery, and new policies were rapidly implemented to ensure safety for patients and staff. However, COVID-19 testing requirements presented a barrier for many patients. Outdoor testing in New York City became less feasible during colder months, and oncology patients have additional concerns, such as limited mobility and immunosuppression. To address these barriers, we created an in-home COVID-19 testing program through a partnership between Community Paramedicine and Oncology: SWABBER (SWABS by Emergency Responders). We evaluated patient use of and satisfaction with SWABBER. Methods: SWABBER began in September 2020 as an interdisciplinary initiative to offer in-home, asymptomatic COVID-19 PCR testing for patients on active treatment in an effort to provide more coordinated care and improve patient experience. Tests were performed prior to the first day of each treatment cycle at no cost to patients. Randomly selected patients completed a brief survey about their experiences with the program, with questions on a seven-point Likert scale. Sociodemographic data was collected from the EMR, and we used a chi-square test to identify differences in patient use of SWABBER by race. Results: From September 8, 2020–April 1, 2021, we saw 7,204 patients for infusion, of whom 993 (14%) participated in SWABBER. The cohort of all patients receiving treatment was 45% White, 19% Black, 6% Asian, 29% Other, and 1% Unknown race. The SWABBER cohort was 36% White, 21% Black, 12% Asian, 29% Other, and 1% Unknown race. There was a significant difference in patient race between these two groups (P < 0.00001), with more Black and Asian patients in SWABBER compared to all patients receiving treatment. A total of 406 (41%) SWABBER patients completed the patient experience survey. The mean scores for overall experience and likelihood of recommending the program were 6.9, with standard deviations of 0.56 and 0.44, respectively. Conclusions: SWABBER enabled us to deliver care directly to patients’ homes, mitigating COVID-19 exposure while promoting accessible care and providing an increased benefit for minority patients. Through SWABBER, we achieved near-perfect patient experience ratings, reduced the burden of testing, created a safer environment for patients and staff, and kept cancer care on track. Future work will evaluate ways to maintain elevated patient experience and continue striving for inclusive care beyond the pandemic.[Table: see text]
Health professionals’ attitudes toward religiosity and spirituality: a NERSH Data Pool based on 23 surveys from six continents
Authors: Kørup Alex , Søndergaard Jens , Alyousefi Nada A , Lucchetti Giancarlo , Baumann Klaus , Lee Eunmi , Karimah Azimatul , Ramakrishnan Parameshwaran , Frick Eckhard , Büssing Arndt , Schouten Esther , Butcher Wyatt , Hefti René , Wermuth Inga , de Diego-Cordero Rocio , Menegatti-Chequini Maria Cecilia , Hvidt Niels Christian
Published: September 2021

Background

In order to facilitate better international and cross-cultural comparisons of health professionals (HPs) attitudes towards Religiosity and/or Spirituality (R/S) using individual participant data meta-analysis we updated the NERSH Data Pool.

Methods

We performed both a network search, a citation search and systematic literature searches to find new surveys.

Results

We found six new surveys (N=1,068), and the complete data pool ended up comprising 7,323 observations, including 4,070 females and 3,253 males. Most physicians (83%, N=3,700) believed that R/S had “some” influence on their patients’ health (CI95%) (81.8%–84.2%). Similarly, nurses (94%, N=1,020) shared such a belief (92.5%–95.5%). Across all samples 649 (16%; 14.9%–17.1%) physicians reported to have undergone formal R/S-training, compared with nurses where this was 264 (23%; 20.6%–25.4%).

Conclusions

Preliminary analysis indicates that HPs believe R/S to be important for patient health but lack formal R/S-training. Findings are discussed. We find the data pool suitable as a base for future cross-cultural comparisons using individual participant data meta-analysis.
Constitutional law of Russia
Authors: Bendyurina Svetlana , Goncharov Mihail , Evstifeev Denis
Published: September 2021

In the textbook, in accordance with the requirements of the federal state educational standard of higher professional education of the third generation, from the standpoint of the current state of constitutional law, the issues of the course of constitutional law of Russia, the theory and practice of constitutional construction, constitutional and legal regulation of the structure of the state, the political system, society as a whole are systematically and fully disclosed.
For university students studying in the direction of training 030900 " Jurisprudence "(qualification (degree)" bachelor"," master"), graduate students and teachers of law schools, employees of state authorities and local self-government, as well as for anyone interested in constitutional law.
Tax control. Tax audits
Authors: Boltinova Ol'ga , Arzumanova Lana , Lagkueva Irina , Machehin Viktor , Tkachenko Roman , Sitnik Aleksandr , Caregradskaya Yuliya
Published: September 2021

The manual discusses one of the main institutions of tax law — tax control. The stages of the formation and development of tax control in Russia, its types, forms and methods are disclosed, tax audits, which are a comprehensive form of tax control, are covered in detail, and material on the regulation of tax control in a number of foreign countries is provided.
The publication is addressed to undergraduates studying in the direction of training 40.04.01 "Jurisprudence", studying the formation and development of tax control, as well as graduate students and teachers of legal and economic educational organizations.
“Faith so as to Remove Mountains”
Authors: Basta Pasquale
Published: September 2021

The presence of πίστις in the list of spiritual gifts in1 Cor 12:8-10 is problematic. Should not faith be the common basis of the charisms and not a particular gift? What means “faith” in 1 Cor 12:9, given that Paul includes it among the nine manifestations of the Spirit? How to understand and to translate it? Evidently, “faith” points here not simple adherence, but a very precise form of πίστις. In fact, Paul places wisdom, knowledge and “faith” in rapid succession, making them the three principal dimensions of the teaching charisms. As reflected in the repetition of the same gifts in the sequence of 13:2. Some Jewish texts talk about rabbis able to change the point of view of people whose convictions were as immovable as a mountain. They were nicknamed “mountain mover” (oker harim). Thanks to the support of rabbinic literature it becomes possible to explain the presence of πίστις among the teaching gifts in 1 Cor 12:9 and 13:2, offering a translation, certainly broad but more attentive to the semantics of the charism of faith: “if I have all the ability to deliver discourses of faith from which to convince people as immovable as mountains, but I do not have charity, I am nothing”.
Translating the Hebrew Psalms to be Sung: The 2010 Revised Grail Psalms, a Case Study
Authors: Fitzgerald Danny
Published: September 2021

This article explores the theme of “translating poetically organized discourse to be sung.” The 2010 English translation of the Hebrew Psalms, entitled The Revised Grail Psalms: A Liturgical Psalter (RGP), is presented as a case study. The Hebrew Psalms, for the most part, were composed to be sung, yet more often than not, they are translated to be read. Such translations are primarily characterized by the absence of poetic rhythm, despite the plain evidence and significance of poetic rhythm in the Hebrew. The RGP, on the other hand, privileges the rhythmic dimension of the Psalms. As a result, the RGP is said to be remarkably “adaptable to the exigencies of different musical settings,” and more importantly, eminently singable. Nonetheless, the challenges of translating and formalizing a text according to a given rhythmic principle are in practice formidable, for when translators set out to feature a lyric’s rhythmic dimension, its semantic, rhetorical, and syntactic art is often found lacking. This article examines some of the principal reasons the translators of the RGP chose to re-emphasize the Hebrew Psalms’ rhythmic art and, more importantly, how those translators negotiated some of the more problematic translation challenges that ensued from that choice.
Principal Leadership and Teacher Professional Development in a Vietnamese High School for Gifted Students: Perspectives into Practice
Authors: Tran Ngoc Hai , Ha Xuan Van , Le Vinh Anh , Nguyen An Nhu , Pham Kien The
Published: September 2021

Teacher professional development (TPD) is an important component of enhancing student learning and school education quality. Vietnamese Ministry of Education and Training is reforming education, including curricula, teaching methods, and textbooks. Many requirements have to been done to effectively implement the reform, and TPD is considered a significant contribution. Using data from an in-depth interview with the principal, teacher questionnaires, and school policy-related documents, this qualitative case-study research in a selected high school for gifted students in Central Vietnam aimed to find out how TPD had been implemented in response to education reforms in Vietnamese high schools. TPD was widely perceived and respected by the principal and teachers in this case study, and these positive perspectives were transferred into practice with numerous effectively employed TPD strategies at this high school for students’ enhanced learning and achievements.
Pressure sensing with high-finesse monolithic buckled-dome microcavities
Authors: Al-Sumaidae S. , Bu L. , Hornig G. J. , Bitarafan M. H. , DeCorby R. G.
Published: September 2021

We describe the use of on-chip buckled-dome Fabry–Perot microcavities as pressure sensing elements. These cavities, fabricated by a controlled thin-film buckling process, are inherently sealed and support stable optical modes (finesse 

>

10

3

), which are well-suited to coupling by single-mode fibers. Changes in external pressure deflect the buckled upper mirror, leading to changes in resonance wavelengths. Experimental shifts are shown to be in good agreement with theoretical predictions. Sensitivities as large as

∼

1

n
m

/

k
P
a

, attributable to the low thickness (

<

2

µ

m

) of the buckled mirror, and resolution

∼

10

P
a

are demonstrated. We discuss potential advantages over traditional low-finesse, quasi-planar Fabry–Perot pressure sensors.
Hybrid photonic-plasmonic cavities based on the nanoparticle-on-a-mirror configuration
Authors: Barreda Angela I. , Zapata-Herrera Mario , Palstra Isabelle M. , Mercadé Laura , Aizpurua Javier , Koenderink A. Femius , Martínez Alejandro
Published: September 2021

Hybrid photonic-plasmonic cavities have emerged as a new platform to increase light–matter interaction capable to enhance the Purcell factor in a singular way not attainable with either photonic or plasmonic cavities separately. In the hybrid cavities proposed so far, the plasmonic element is usually a metallic bow-tie antenna, so the plasmonic gap—defined by lithography—is limited to minimum values of several nanometers. Nanoparticle-on-a-mirror (NPoM) cavities are far superior to achieve the smallest possible mode volumes, as plasmonic gaps smaller than 1 nm can be created. Here, we design a hybrid cavity that combines an NPoM plasmonic cavity and a dielectric-nanobeam photonic crystal cavity operating at transverse-magnetic polarization. The metallic nanoparticle can be placed very close (

<
1
  
nm

) to the upper surface of the dielectric cavity, which acts as a low-reflectivity mirror. We demonstrate through numerical calculations of the local density of states that this hybrid plasmonic-photonic cavity exhibits quality factors

Q

above

10

3

and normalized mode volumes

V

down to

10

−
3

, thus resulting in high Purcell factors (

F
P

≈

10

5

), while being experimentally feasible with current technology. Our results suggest that hybrid cavities with sub-nanometer gaps should open new avenues for boosting light–matter interaction in nanophotonic systems.
Intrapleural use of urokinase and DNase in pleural infections managed with repeated thoracentesis: A comparative cohort study
Authors: Luque Paz David , Bayeh Betsega , Chauvin Pierre , Poizeau Florence , Lederlin Mathieu , Kerjouan Mallorie , Lefevre Charles , de Latour Bertrand , Letheulle Julien , Tattevin Pierre , Jouneau Stéphane
Published: September 2021

Introduction

Evacuation of infected fluid in pleural infections is essential. To date, the use of an intrapleural fibrinolytic agent such as urokinase and DNase has not yet been assessed in infections managed by repeated therapeutic thoracentesis (RTT).

Methods

We performed a retrospective comparative study of two successive cohorts of consecutive patients with pleural infections from 2001 to 2018. Between 2001 and 2010, patients had RTT with intrapleural urokinase (RTT-U). After 2011, patients received intrapleural urokinase and DNase with RTT (RTT-UD). Data were collected through a standardized questionnaire.

Results

One hundred and thirty-three patients were included: 93 were men and the mean age was 59 years (standard deviation 17.2). Eighty-one patients were treated with a combination of intrapleural urokinase and DNase, and 52 were treated with intrapleural urokinase only. In the RTT-UD, RTT failure occurred in 14 patients (17%) compared to 10 (19%) in the RTT-U group (P= 0.82). There was no difference between the two groups in intensive care unit admission, surgical referrals or in-hospital mortality. RTT-UD was associated with faster time to apyrexia (aOR = 0.51, 95%CI [0.37–0.72]), a reduced length of hospital stay (aOR = 0.61, 95%CI [0.52–0.73]) and a higher volume of total pleural fluid retrieved (aOR = 1.38, 95%CI [1.02–1.88]). Complications were rare with only one hemothorax in the RTT-UD group and no pneumothorax requiring drainage in either group.

Conclusion

Compared to urokinase only, intrapleural use of urokinase and DNase in RTT was associated with quicker defervescence, shorter hospital stay and increased volumes of pleural fluid drained. Randomized controlled trials evaluating urokinase and DNase with RTT technique would be required to confirm these results.
The amount of light reaching the leaves in seagrass (Zostera marina) meadows
Authors: Björk Mats , Asplund Maria E. , Deyanova Diana , Gullström Martin
Published: September 2021

Seagrass meadows, and other submerged vegetated habitats, support a wide range of essential ecological services, but the true extents of these services are in many ways still not quantified. One important tool needed to assess and model many of these services is accurate estimations of the systems´ primary productivity. Such productivity estimations require an understanding of the underwater light field, especially regarding the amount of light that actually reaches the plants’ photosynthetic tissue. In this study, we tested a simple practical approach to estimate leaf light exposure, relative to incoming light at the canopy, by attaching light sensitive film at different positions on leaves of Zostera marina, eelgrass, in four seagrass meadows composed of different shoot density and at two different depths. We found that the light reaching the leaves decreased linearly down through the canopy. While the upper parts of the leaves received approximately the same level of light (photosynthetic photon flux density, PPFD) as recorded with a PAR meter at the canopy top, the average light that the seagrass leaves were exposed to varied between 40 and 60% of the light on top of the canopy, with an overall average of 48%. We recommend that actual light interception is measured when assessing or modelling light depending processes in submerged vegetation, but if this is not achievable a rough estimation for vegetation similar to Z. marina would be to use a correction factor of 0.5 to compensate for the reduced light due to leaf orientation and internal shading.