bluuebunny/crossref_metadata_2025 huggingface dataset:
A qualitative exploration of companion involvement in the presurgical consent visit for patients undergoing major surgery for advanced cancer.
Authors: Isenberg Sarina , Roter Debra , Wolff Jennifer L , Smith Thomas J. , Smith Katherine Clegg , Aslakson Rebecca
Published: November 2017

29

Background: The decision to undergo non-emergent cancer surgery is complicated by risk of mortality and diminished quality of life weighed against potential benefits of extended life and symptom management. Sometimes, unanticipated clinical information or quality of life considerations (“disruptions”) arise during these pre-surgical visits, which can lead to to the surgery’s reconsideration, postponement, or cancelation. Little is known about disruptions. This paper explores case studies of how patients, companions, and surgeons negotiate surgical plan disruptions. Methods: This study is based on secondary analysis of pre-surgical recordings with 61 patients and nine surgeons. Patients were recruited at nine surgical oncology clinics at an academic tertiary care hospital from July 2015-September 2016. Qualitative analysis incorporated existing theory and inductively developed codes. Results: Four of the 61 pre-surgical visits were identified as having a disruption. Each case study explores the presentation of the disruption, patient reaction to the disruption, companion involvement and role in the encounter, and resolution of the disruption. While each disruption involves a nuanced approach to decision making, there are cross cutting themes across the cases. Specifically, analysis of these visits explored companion roles, including: patient autonomy-enhancing behaviors and patient autonomy-detracting behaviors. This analysis also addressed variation and similarities in surgeons’ behaviors, including examples of collaborative, facilitative, and informative behaviors. Conclusions: As more high risk surgeries are performed on sicker and older patients, decision making regarding whether to pursue surgery may become increasingly complex, and lend itself more frequently to disruptions. Disruption reflects the engagement and mutual influence of multi-party participants in treatment decision making. By enhancing our understanding of disruptions, we hope to assist in the delicate communication and shared decision making needed for a patient and family centered resolution. Clinical trial information: NCT02489799.
Innovative pilot to reimburse nurse and social work-led advance care planning.
Authors: Kalisiak Angela , Hansen Lisa Kathryn , Newell Jamie , Mills Lydia
Published: November 2017

3

Background: Research has shown that advance care planning (ACP) leads to better patient care and outcomes. The Oregon Health Leadership Council (OHLC) identified ACP as an opportunity to improve care and offset costs. In 2014, the OHLC commissioned a workgroup to pilot a payment model to promote broader adoption of ACP. A community oncology provider and 4 health plans implemented the pilot for nurses (RNs) and licensed clinical social workers (LCSWs) to conduct ACP in an effort to elicit and honor patient preferences at end of life (EOL). Methods: Five RNs and 2 LCSWs underwent specific ACP training (by academic EOL educator or VitalTalk). They conducted one or more substantive ACP conversations (minimum 20 minutes) with 149 patients (89 female, 60 male; median age 64; range 24-92) between 12/5/14 and 5/9/16. Most patients had recurrent and/or metastatic cancer. Charts were reviewed in April 2017 for goals of care (GOC) discussion, ACP documents, preferences for EOL care, hospice enrollment, date of death, and death location. Results: Among all 149 patients, GOC discussion was documented for 126 (85%). Advance directives were in the chart for 34 (23%) and POLST for 53 (36%) patients. Among the 69 patients who died, 80% were on hospice (median days = 14; 15% on hospice < 3 days); 87% preferred comfort care at time of death. Three patients (4%) requested life-prolonging treatment until death. Conclusions: This pilot demonstrated that RNs and LCSWs can provide substantive ACP within robust team-based care. Hospice enrollment, POLST completion, and EOL care consistent with preferences were high. Cost data was inadequate to draw conclusions. While physician management, patient values, disease and treatment factors may also impact EOL choices, pilot data indicates that expanding ACP through trained RNs and LCSWs serves to normalize ACP as an integral component of quality care and promote outcomes congruent with GOC. [Table: see text]
Oncology care model: Early palliative care experiences and outcomes.
Authors: Spain Pamela , West Nathan , Teixeira-Poit Stephanie , Schaefer Elizabeth , Ketler Kerry
Published: November 2017

37

Background: Through the Oncology Care Model (OCM), the Center for Medicare & Medicaid Innovation at the Centers for Medicare & Medicaid Services aims to improve the effectiveness and efficiency of cancer care. OCM practices have committed to provide enhanced services to Medicare beneficiaries, including palliative care designed to optimize quality of life. This study examines if OCM practices engaging in early palliative care discussions have timely hospice referrals as well a lower aggressive end-of-life care and Medicare costs. Methods: During site visits to 30 OCM practices, we asked was How and when is palliative care introduced to patients? We used Medicare claims data to stratify the 30 practices into high or low performers based on 3 end-of-life quality measures scores. Next, we examined their scores on Cancer CAHPS shared decision making and Medicare expenditures, as well as what staff reported about the use of palliative care during site visits. Claims and CAHPS data encompass the first 6 months of OCM, July-December 2016. Site visits were conducted February - May 2017. Results: Patient risk scores were equal among practice groups. High Performers said: “Palliative care is introduced right off the bat. We provide information on hospice and palliative care so it’s not a word they find with end of life only. It’s a difficult conversation but you have to put it out there. As part of patient education, we say the differences between palliative care and hospice. Low Performers said: “Palliative care is introduced on a case by case basis. To transfer to an inpatient hospice, now you have to be on your last breath. Programs that get cut because they are not integral to the patients’ acute issues include palliative care. If hospice comes up, I pull palliative care at that point.” Conclusions: Early OCM results support growing evidence that palliative care shared decision making discussions are most beneficial near the time of cancer diagnosis. [Table: see text]
Utilizing advance care planning videos to empower perioperative cancer patients and families: Results from a randomized controlled trial.
Authors: Aslakson Rebecca , Isenberg Sarina , Crossnohere Norah L. , Conca-Cheng Alison M. , Moore Madeleine , Bhamidipati Akshay , Mora Silvia , Miller Judith , Singh Sarabdeep , Larson Susan , Swoboda Sandy , Pawlik Timothy M. , Weiss Matthew J. , Volandes Angelo E. , Smith Thomas J. , Bridges John F.P. , Roter Debra
Published: November 2017

5

Background: The feasibility and impact of integrating advance care planning (ACP) in surgical oncologic populations is unknown. We hypothesized that an ACP video could be integrated into surgical oncologic care and that patients who preoperatively viewed the video would engage in more ACP and patient-centered communication with their surgeon. Methods: Randomized controlled, phase II trial with two study arms: intervention ACP video and control (no ACP) video; and four data collection periods: enrollment, presurgical consent, postoperative one week, and postoperative one month. Participants included patients undergoing major cancer surgery recruited from nine surgical oncology clinics at a single, academic, inner city, tertiary care hospital. Main Outcomes and Measures: Primary Outcome - Content of ACP and patient-centeredness during the presurgical consent visit as measured through the Roter Interaction Analysis System (RIAS). Secondary patient outcomes – mood; goals of care; and video helpfulness. Results: Ninety-two patients (target enrollment of ninety) were enrolled over 15 months. The ACP video was successfully integrated into the intervention arm and no study-related harms were noted. Patient-centeredness was unchanged between the study arms (IRR=1.06, CI [0.87,1.3], p=0.545) and there was a trend of increased ACP content in the intervention arm (23% intervention vs. 10% control, p=0.182). There were no differences in secondary outcomes other than patients found the intervention video more “helpful” (p=0.007). There was a statistically significant increase in mood symptoms in both groups one week post-operative as compared to enrollment (p=0.01). Patients in both groups most frequently noted cure-related goals of care. Conclusions: The ACP video was integrated successfully into surgical care, well-tolerated, and thought helpful by patients, but did not significantly change the nature or ACP content in patient-surgeon pre-operative conversation. Future studies could increase the “dose” of ACP through modifying video content and/or how or who presents that content prior to surgery. Clinical trial information: NCT02489799.
Integration of end-of-life care in clinical trials for advanced malignancies.
Authors: Klil-Drori Adi Joseph , Silva Karine , Regimbald Tracy , Assouline Sarit E.
Published: November 2017

67

Background: ASCO endorses early integration of palliative care in the treatment of patients with advanced cancers and encourages patient education with regards to prognosis and participation in medical decision making. We implemented a uniform process of discussing end of life and advance directives (AD) early in the course of experimental cancer treatment and assessed whether this process is aligned with our patients' perspectives. Methods: This was a pilot study in a research unit conducting early-phase trials for patients with no remaining standard of care. Accrual goal was 15 patients in four months. We identified patients with advanced malignancies who were screened for cancer trials and approached their physicians with a request to fill out an AD form in discussion with their patients. Upon initiation of treatment, we filled out a supportive care checklist for each patient. The patients filled out a structured questionnaire probing their views on end-of-life discussion and awareness to supportive care resources on cycle 2 day 1 (Q1) and on cycle 3 day 1 (Q2). Results: Out of 41 screened, we completed checklists for 36 patients. Of these, 26 filled out Q1 and 11 filled out Q1 + Q2. Response rate to the questionnaires was 100%. The patients were diagnosed with metastatic solid tumor (23) and hematologic malignancies (3) and had 2 (0-5) previous lines of treatment. Females and males were 14 and 12, respectively. AD forms were filled out in most patients (81%), but about half (54%) reported having had AD discussions with their physicians. Most patients (73%) were aware of supportive resources (palliative care, social worker, support groups), and most (62%) actually used them while on study. Agreement in Q1 and Q2 was comparable (Table), with some rise in agreement with the timing of AD discussion. Conclusions: In the context of treatment on clinical trials, a large-scale initiative is feasible. More patients agree with time that early discussion of AD meets their goals while almost half report having had no such discussion with their physicians. [Table: see text]
Using natural language processing to assess palliative care processes in cancer patients receiving venting gastrostomy tube.
Authors: Lindvall Charlotta , Lilley Elizabeth J. , Cooper Zara , Forsyth Alexander W. , Barzilay Regina , Lorenz Karl A. , Walling Anne Margaret , Tulsky James A.
Published: November 2017

7

Background: Natural Language Processing (NLP) presents a novel method of extracting text-embedded information from the electronic health record (EHR) to improve routine assessment of palliative quality metrics such as timely advance care planning (ACP), palliative care provision (PC), and hospice referral. Methods: We identified cancer patients (ICD-9-CM codes 140-209) who received a gastrostomy tube (ICD-9-CM 43.11, 43.19, 44.32; CPT code 49440) from Jan 1, 2012, to Mar 31, 2016 at an academic medical center. We used NLP to identify palliative indication for gastrostomy tube placement by labeling clinical notes from the EHR containing the key word “venting” near the time of the procedure. Documentation of ACP, PC, and hospice referral was identified by NLP using a validated key term library. The sensitivity and specificity of the NLP method was determined by comparing outcome identification to manual chart abstraction performed by two clinicians. All NLP code was written in the open-source programming language Python. Results: NLP was performed for 75,626 documents. Among 305 cancer patients who underwent gastrostomy, 75 (24.6%) were classified by NLP as having a palliative indication for the procedure compared to 72 patients (23.6%) classified by human coders. Manual chart abstraction took > 2,600 times longer than NLP (28 hrs vs. 38 seconds). NLP identified the correct patients with high precision (0.92) and recall (0.96). ACP was documented during the index admission for 89.3% of patients. PC was documented for 85.7% and hospice referral was documented for 64.3% of these patients with advanced cancer during the index hospitalization. NLP identified ACP, PC and hospice referral with high precision (0.88-1.0) and recall (0.92-1.0) compared to human coders. Median survival was 37 days following gastrostomy tube procedure. Conclusions: NLP can greatly speed the assessment of established palliative quality metrics with an accuracy approaching that of human coders. These methods offer opportunities for facilitate quality improvement in palliative care for patients with advanced cancer.
Implementing the Bereaved Family Survey for an advanced cancer population.
Authors: Kaltman Jessica , Walling Anne Margaret , Wenger Neil
Published: November 2017

76

Background: Despite being endorsed as a National Quality Forum measure, the Bereaved Family Survey (BFS), a tool to assess a patient’s end-of-life (EOL) experience, has not been broadly used outside the Veteran’s Affairs Health System or in the outpatient setting. We adapted the BFS for an advanced cancer population and implemented it at an academic health system to identify areas for quality improvement in EOL care. Methods: Between August 2016 and May 2017, we surveyed caregivers of advanced cancer decedents. We included English-speaking decedents > 18 years of age who were continuity patients of a health system oncologist and had documentation of metastatic disease in either problem list, oncology notes, or advanced imaging. Death was verified in the chart or by obituary found via internet search. Caregivers surveyed were the appointed healthcare agent in an advance directive or the first listed contact. Scoring was done via the top-box approach. Surveys were mailed 3 months after death with a follow-up post-card reminder and phone-call at 2 and 4 weeks, respectively. Results: Of 285 eligible decedents, 242 caregivers were mailed surveys with 83 completed (34% response rate) of whom 28% died in the hospital. Mean overall BFS score was 75 out of 100. Ratings were high for overall care quality (78% Always/Usually) and staff caring (74% Always) with lower ratings for communication (58% Always), emotional/spiritual support (37% Always with 30% not wanting support) and pain control (56% Always/Usually uncomfortable). Nearly 84% of respondents felt their loved one died in the right place and 67% felt staff caring for the patient provided a dignified death. 74% of patients were referred to hospice with 64% of caregivers stating the hospice referral was timely. Write-in responses mentioned concerns about caregiver support, the quality and timeliness of hospice care and communication between physician and patient/caregiver. Over half of statements were positive remarks about a physician or ancillary staff member. Conclusions: A post-mortem survey implemented for an advanced cancer population received a modest response rate but collected valuable information regarding gaps in care quality to drive quality improvement.
Polypharmacy and out-of-pocket medication costs in the last month of life among commercially insured patients with advanced cancer: Insights from linking a regional cancer registry and insurance claims.
Authors: McDermott Cara L. , Fedorenko Catherine R. , Greenwood-Hickman Mikael Anne , Kreizenbeck Karma L. , Conklin Ted , Smith Bruce , Curtis J. Randall , Lyman Gary H. , Ramsey Scott David
Published: November 2017

79

Background: Polypharmacy, defined as the concurrent use of multiple medications, may expose patients to drug-drug interactions and excessive medication costs. Patients with advanced cancer may benefit from medication discontinuation when faced with life-limiting illness. While polypharmacy prevalence has been explored in older patients, there are limited data for younger patients with advanced malignancy. To better understand medication use in this population, we characterized medication use and associated out-of-pocket (OOP) costs in the last month of life among commercially insured subjects under age 65 who did not enroll in hospice. Methods: We linked enrollment and claims records from two regional commercial insurers to Surveillance, Epidemiology, and End Results (SEER) Cancer Surveillance System and Washington State Cancer Registry records for patients diagnosed with a stage IV solid tumor malignancy in Washington state between January 1, 2007-December 31, 2016. We excluded patients who did not incur at least 1 claim in their last month. We calculated OOP costs as the difference between allowed and paid claim amounts, adjusted to 2016 dollars. Results: See Table. Among 369 patients, the average age was 56 years (range 23-64) and 51% (n=189) were male. Patients most frequently had lung (n=149, 40%), pancreatic (n=36, 10%) or colorectal cancer (n=32, 9%). Patients had an average of 7 medication claims (range 1-26) in the last month of life; the most commonly observed non-chemotherapy claims were for opioids, benzodiazepines and anti-emetics. Conclusions: A majority of subjects incurred at least 5 medication claims in their last 30 days; almost one-third had 10 or more. Frequent claims were for medication for pain or other symptoms. OOP costs ranged considerably. Future research will focus on developing interventions to assure effective medication use congruent with patient and family preferences and goals of care. [Table: see text]
A communication strategy using a video support tool and structured family meetings for relatives of patients dying in the ICU.
Authors: Sedhom Ramy , Bajaj Jasmet , Finklestein Vadim , Tanpiengco Mindy , Barile David
Published: November 2017

81

Background: Death in the ICU is an extraordinarily stressful event. Qualitative and quantitative studies have identified effective communication between caregivers and families to be important throughout the decision making process. In many ICUs, the end-of-life family conference is an opportunity to ask questions, express concerns, and confront painful emotions with the help of compassionate professionals. Methods: A prospective study in a single ICU center. The ICU physician, palliative care team, and research nurse interviewed surrogate decision makers. The only criterion for inclusion in the study was anticipated death in one year. Patients younger than 18 were excluded from the study, as were those unable to speak English. Prior to the family meeting, families were offered an opportunity to watch a video on EOL decision-making made by the research team. The meeting itself followed a script, guided by four steps:establish diagnosis, share prognosis, elicit goals of care, recommend treatment. The investigators recorded ICU and patient characteristics on standardized forms. Results: 22 families were included. A decision to forego life-sustaining treatment and transition to comfort care or hospice was pursued by 77% of families. There were few non-beneficial interventions, such as CRRT or use of artificial nutrition; withdrawal of mechanical ventilation and vasopressors was common. Qualitative commentary suggested that time spent by providers were sufficient and the video support tool was clear and easy to understand. Conclusions: EOL family conferences improve communication between ICU staff and family members and assist families in decision making, especially for cancer syndromes. The structured family meetings offered opportunities to discuss patient’s wishes, alleviate feelings of guilt, and understand the goals of care. Patients received few non-beneficial treatments and families were likely to accept realistic goals of care. This highlights the potential role for video-support tools in advance care planning. Future studies reporting overall LOS and bereavement data are important quality markers and pending in a future report.
Quality matters: Patterns of palliative interventions in metastatic colorectal cancer (mCRC) patients.
Authors: Prince Rebecca M. , Liang Shuyin , Brar Mantaj , Ramkumar Stephanie , Scheer Adena , Wong Rebecca , Hallet Julie I. , Zimmermann Camilla , Easson Alexandra Maria
Published: November 2017

83

Background: Increasing recognition that high-quality end of life care is essential has resulted in internationally endorsed metrics allowing assessment of interventions at the end of life. Median survival for mCRC patients has improved to more than 24 months resulting in increased opportunity to undergo interventions for symptom relief at the end of life. We explored patterns of palliative interventions (chemotherapy, radiotherapy, surgery, endoscopy, drainage procedures) and outcomes in mCRC patients. Methods: A retrospective review was undertaken of all mCRC patients referred to the palliative care service from 2000 to 2010 at a tertiary cancer center in Toronto, Canada. Descriptive statistics, survival analysis and regression were employed. Results: A total of 542 patients were included of whom 52.8% were male, mean age was 62.8 years and 44.6% had stage 4 disease at diagnosis. Over the course of their disease 93.9% had an intervention at any time after their diagnosis including 27.5% of patients undergoing palliative surgery, 77% of patients had an intervention in the last year of life and 19.1% had an intervention in the last 30 days of life. The percentage of patients receiving interventions within the last 14 days of life were 1.23% for chemotherapy, 4.6% for radiotherapy, 0.5% for surgery, 10.4% for endoscopy and 23% drainage procedures. The mean time between referral to palliative care and death was 7 months (SD 10.4). For patients who received chemotherapy, the mean time between last chemotherapy and death was 9.5 months (SD 14.9). Overall survival for patients who did not receive chemotherapy was 28 months (SD 33) compared with 40 months (SD 32) for those who received chemotherapy. Regression analysis for risks of dying within 30 days of chemotherapy was limited by a low event rate. Increasing age was significantly associated with a lower risk of dying within 30 days of chemotherapy. Conclusions: In their final months of life, palliative mCRC patients undergo a significant number of interventions aiming to improve quality of life. These require considerable multi-disciplinary input with ramifications for quality care, planning for service provision and funding.
Factors associated with palliative radiotherapy in the last 30 days of life.
Authors: Wu Susan Y. , Singer Lisa , Garcia Michael A , Fogh Shannon E. , Braunstein Steve E.
Published: November 2017

84

Background: A significant proportion of patients will undergo radiotherapy (RT) within their last 30 days of life. Identifying patients who may not benefit from RT is difficult and use of predictive models for life expectancy is not routine (Chow et al., JCO 2008; Krishnan et al., Cancer 2013). Methods: Patients treated with external beam RT to a site of metastatic disease between 2012-2016 at a single institution prior to death were included in this analysis. Mann-Whitney U and chi-squared tests were used to compare patients who received RT within 30 days of death (D30RT) and those who did not. Multivariate analysis was used to identify factors associated with D30RT. Results: 518 patients accounting for 922 palliative RT courses were included. Median age at treatment was 63 yrs (IQR 54-71 yrs), median survival time was 28 months (IQR 11-53 mos) and median time from RT to death was 74 days (IQR 33-174 days). 49% of patients were metastatic at diagnosis. The most common primary sites were lung (26%), breast (19%) and prostate (10%). The most common treatment sites were bone (56%) and brain (28%). 125 patients (24%) died within 30 days of RT. D30RT was associated with older median age at treatment (64 vs. 62 yrs, p = 0.04), shorter interval since diagnosis (14 vs. 31 months, p < 0.001), liver but not brain or lung metastasis (p = 0.02, 0.43, and 0.06 respectively), lower median KPS scores (50 vs. 70, p < 0.001), lower median BMI (22 vs. 24, p = 0.001), and inpatient status at consult (56% vs. 26%, p < 0.001). Despite poor outcomes, patients who died within 30 days of RT were less likely to have hospice involved in their care (44% vs. 71%, p = 0.001). The only factor associated with hospice was longer time since diagnosis (28 months vs. 21 months, p = 0.04). D30RT was associated with higher Chow and TEACHH scores at the time of consult (p < 0.001 for both). Conclusions: A high frequency of patients received palliative RT at the end of life in our cohort. Earlier integration of palliative care or hospice services may allow patients and physicians to optimally direct treatment at the end of life. Existing life-expectancy prediction models may allow physicians to identify patients who could benefit from short treatment courses or alternative interventions to maximize quality at the end of life.
Economic impact of palliative care among elderly cancer patients.
Authors: Lebrett Wendi G. , Roeland Eric , Bruggeman Andrew , Yeung Heidi , Murphy James Don
Published: November 2017

91

Background: Randomized trials among advanced cancer patients demonstrate that early palliative care integration into usual oncology care reduces symptom burden, improves quality of life and caregiver outcomes, and may improve survival. The impact of palliative care on health economics remains poorly defined and reported cost savings are an unintentional consequence of providing care aligned with patient goals. This study determined the impact of palliative care on healthcare costs among elderly patients with advanced cancer. Methods: We conducted a matched case-control study among Medicare beneficiaries with metastatic lung, colorectal, breast and prostate cancers. We matched patients who received a palliative care consultation to similar patients who did not receive a palliative care consultation. To determine the economic impact of a palliative care consultation we compared costs between cases and controls before and after the palliative care intervention. Costs included inpatient, outpatient, home health care, hospice, and medical equipment, and were adjusted to 2011 dollars. Results: Among the 2,576 patients in this study the total healthcare costs per patient in the 30 days before palliative care consultation was balanced between palliative care ($12,881) and non-palliative care control patients ($12,335). Palliative care intervention reduced total healthcare costs after the intervention. The total cost of care per patient in the 120 days after palliative care exposure was $6,880 compared to $9,604 for controls (28% decrease; p < 0.001). The economic effect of palliative care depended on timing of the consult. Palliative care consultation within 7 days of death decreased healthcare costs by $975, whereas palliative care consultation more than 4 weeks from death decreased costs by $5,362. Conclusions: This study demonstrates that palliative care has the capacity to substantially reduce healthcare expenditures among advanced cancer patients. Furthermore, the cost reduction depends on timing of the palliative care consult.
Epithelial vimentin plays a functional role in mammary gland development
Authors: Peuhu Emilia , Virtakoivu Reetta , Mai Anja , Wärri Anni , Ivaska Johanna
Published: November 2017

In the mammary gland, vimentin intermediate filaments are expressed in stromal cells and in basal epithelial cell populations, including gland-reconstituting mammary stem cells, with largely undefined functions. Here, we have studied how vimentin deficiency affects mouse mammary gland development. We find that, in adult vimentin knockout mice (Vim−/−), mammary ductal outgrowth is delayed. The adult Vim−/− glands display dilated ducts and a reduced basal-to-luminal mouse mammary epithelial cell (MMEC) ratio indicative of altered progenitor cell activity. Accordingly, isolated Vim−/− MMECs form fewer mammospheres and basal-like organoids in vitro than their wild-type counterparts. Importantly, reduced basal MMEC number translates into defects in Vim−/− mammary gland regeneration in vivo. Global gene expression profiling of basal MMECs reveals that lack of vimentin alters multiple pathways, including adhesion, cancer and Wnt signalling. Furthermore, vimentin contributes to stem-like cell properties in MDA-MB-231 breast cancer cells, wherein vimentin depletion reduces tumoursphere formation and attenuates expression of breast cancer stem cell-associated surface markers. Together, our findings identify vimentin as a positive regulator of stemness in the developing mouse mammary gland and in breast cancer cells.
Expression of collagens in the damage area at abdominal adhesions
Authors: Shurygina Irina , Shurygina Irina , Shurygin Mikhail , Shurygin Mikhail , Rodionova Lyubov , Rodionova Lyubov , Chepurnykh Elena , Chepurnykh Elena , Ayushinova Natalia , Ayushinova Natalia
Published: November 2017

Background. Postoperative adhesions are a serious problem in surgery. However, at the present time molecular

mechanisms of the adhesion process are insufficiently studied.

Aim. To study the dynamics of expression of genes encoding the synthesis of collagen in case of damage to the serosa

on the example of the peritoneum in conditions of aseptic inflammation.

Materials and methods. Aseptic inflammatory process in the abdominal cavity was modeled (Wistar rats, n = 40).

A micro- and macroscopic picture of the damage area was studied. Immunofluorescent staining for Type I collagen

(Col 1A1) was performed. The expression of genes encoding collagen of different types was evaluated using the RT 2 -

Profiler PCR kit Array Rat Wound Healing.

Results. It has been established that the adhesion process with peritoneal damage in aseptic conditions reaches its

maximum by the 30 th day of observation. The same period coincides with the maximum of collagen synthesis in fibro-

blasts in the repair area, revealed by immunofluorescence study. The interrelation of synthesis of type I and III collagens

went as expected – the onset of expression of type III collagen (from day 3) is ahead of the expression of collagen type I

(from day 7). Peak gene expression of collagens type I, Alpha-1 and -2; type III Alpha-1, type IV Alpha-1 and -3, type V

Alpha-1, -2 and -3; type XIV Alpha-1 (Col14a1) falls on the 14th day. For the first time, active involvement of type V

alpha-3 collagen in the adhesion process was noted - we detected both early (from day 1) and maximum intensive (up

to 166.96 times increase in comparison with intact animals).

Conclusion. Perhaps, the hyperexpression of collagen V alpha-3 that we revealed is an important link in the pathogenesis

of adhesion in the abdominal cavity.
Dispatch management and organization of traffic volumes and traffic
Authors: Левин Дмитрий , Levin Dmitriy
Published: November 2017

The monograph is devoted to the description of adaptation to the real situation and implementation of normative-technical documents regulating the transportation process. First of all, the example of the plan of formation of freight trains shows a rapid response to changes in operational work.
This monograph is intended for workers involved with the transportation process, control apparatus, researchers, developers of automated control systems, students of refresher courses, and University students.
Integer Programming Formulations and Benders Decomposition for the Maximum Induced Matching Problem
Authors: Ahat Betül , Ekim Tınaz , Taşkın Z. Caner
Published: November 2017

We investigate the maximum induced matching problem (MIM), which is the problem of finding an induced matching having the largest cardinality on an undirected graph. The problem is known to be NP-hard for general graphs. We first propose a vertex-based integer programming formulation for MIM, which is more compact compared to an edge-based formulation found in the literature. We also introduce the maximum weight induced matching problem (MWIM), which generalizes MIM so that vertices and edges have weights. We adapt the edge-based formulation to MWIM, and propose a quadratic programming formulation of MWIM based on our vertex-based formulation. We then linearize our quadratic programming formulation, and devise a Benders decomposition algorithm that exploits a special structure of the linearized formulation. We also propose valid inequalities and formulation tightening procedures to improve the efficiency of our approach. Our computational tests on a large suite of randomly generated graphs show that our vertex-based formulation and decomposition approach significantly improve the solvability of MIM and MWIM, especially on dense graphs.

The online appendix and data are available at https://doi.org/10.1287/ijoc.2017.0764 .
A Flocking-Based Approach for Distributed Stochastic Optimization
Authors: Pu Shi , Garcia Alfredo
Published: November 2017

In recent years, the paradigm of cloud computing has emerged as an architecture for computing that makes use of distributed (networked) computing resources. In this paper, we consider a distributed computing algorithmic scheme for stochastic optimization, which relies on modest communication requirements among processors and most importantly, does not require synchronization. Specifically, we analyze a scheme with N > 1 independent threads each implementing a stochastic gradient algorithm. The threads are coupled via a perturbation of the gradient (with attractive and repulsive forces) in a similar manner to mathematical models of flocking, swarming, and other group formations found in nature with mild communication requirements. When the objective function is convex, we show that a flocking-like approach for distributed stochastic optimization provides a noise reduction effect similar to that of a centralized stochastic gradient algorithm based upon the average of N gradient samples at each step. The distributed nature of flocking makes it an appealing computational alternative. We show that when the overhead related to the time needed to gather N samples and synchronization is not negligible, the flocking implementation outperforms a centralized stochastic gradient algorithm based upon the average of N gradient samples at each step. When the objective function is not convex, the flocking-based approach seems better suited to escape locally optimal solutions due to the repulsive force that enforces a certain level of diversity in the set of candidate solutions. Here again, we show that the noise reduction effect is similar to that associated to the centralized stochastic gradient algorithm based upon the average of N gradient samples at each step.
Optical Packet and Burst Switched Networks Performance for Time-Dependent Video Traffic
Authors:   Electrical Engineering Department, Militar Institute of Engineering (IME), Santos Jr. Etelmar , Coelho Rosângela ,   Electrical Engineering Department, Militar Institute of Engineering (IME)
Published: November 2017

In this paper we study the performance of optical packet and burst switched networks (OSN) to supply video traffic with scaling characteristics. The optical buffering generally implemented by fiber delay lines (FDLs) is the main challenge to achieve a full-optical switching architecture. For the analysis the MIGIoo and fBm processes are considered to represent the time-dependent video traffic. These stochastic processes are examined in terms of its video traffic scaling (H), heavy-tail distribution (HTD) and autocorrelation (ACF) characterization. We show that with a small number of FDLs (25-50) of 33.92m each and no wavelength conversion an optical packet switch can achieve performance results similar to a burst architecture. Moreover, the jitter values introduced by these FDLs were lower compared to the jitter requirements of the more demanding video traffic. We also demonstrate that the video traffic scaling degree was not affect by the optical packet or burst buffeting solutions. However, the video traffic tail distribution showed to be the critical aspect to the optical switches dimensioning and thus the future optical switched network performance.
De la extirpación a la folklorización: a propósito del continuum colonial en el siglo XXI
Authors: Romero Flores Javier Reynaldo
Published: November 2017

ResumenA partir de una comprensión del momento colonial, de la constitución del ego conquiro y de la relación de éste con la Extirpación de Idolatrías; el artículo argumenta que la folklorización, al igual que la demonización, es un dispositivo que activa la enajenación del sistema de representaciones de los pueblos que habitan Abya-Yala/América. De esta forma este dispositivo sirve para reproducir el continuum colonial en el siglo XXI.
“Estética(s) decolonial(es)1”: entrevista a Pedro Pablo Gómez
Authors: González Vasquez Angélica , Ferreira Zacarias Gabriel , Gómez Pedro Pablo
Published: November 2017

Resumen En esta conversación se indaga por la cuestión decolonial de la estética, sus puntos de origen históricos y geográficos, además de sus posibilidades en el contexto de reconfiguración actual del orden mundial. Desde esta perspectiva, se pretende aclarar en qué consiste la opción decolonial, respecto de otras opciones, sin olvidar cuestiones importantes del arte, la historia, el museo, la curaduría y sus implicaciones éticas, políticas y epistémicas.Palabras clave Estética; decolonialidad; historia; poscolonialismo; cuestión decolonial
De la gestión y la política cultural. Conversación con Clarisa Ruiz Correal
Authors: Bustos Gómez Marta , Ruiz Correal Clarisa
Published: November 2017

Esta entrevista con Clarisa Ruiz Correal, hace parte de un proyecto de mayor envergadura que busca indagar por las prácticas de la gestión cultural en Colombia y en la ciudad de Bogotá principalmente a partir de la voz de sus protagonistas. En un tono autobiográfico, se pretende explorar de qué manera han configurado sus acciones, cuál ha sido su posición frente a las esferas del poder y a las instituciones o dependencias que han dirigido, cómo han asumido o sido parte de los elementos declarativos de la retórica institucional y cuál ha sido su particular visión para concretar tanto el horizonte de sentido como el desarrollo organizacional de su gestión en el campo cultural.
Comprender mi condición colonial: prácticas decoloniales para interpelar la colonialidad de género
Authors: Catherine Orozco Laura
Published: November 2017

En mi condición de estudiante de Artes Plásticas,me he visto influenciada a pensar y replantear acciones, ideas o leyes que me han sido impuestas como ciudadana, hija y mujer. Al conocer la Teoría Decolonial me propongo iniciar la revisión de una realidad mediante una serie de preguntas: ¿Qué estructuras ideológicas, políticas, administrativas y sociales me han impuesto y me han inculcado como propias? ¿Cuál es la construcción de una identidad? ¿Hasta qué punto me apropio de esto que se me ha enseñado a través de la tradición? ¿Dentro de mi producción artística, hay algo de carácter decolonial, directa o indirectamente? De esta manera inicio una reflexión que atraviesa varios de estos cuestionamientos, intentando además articularla con mis prácticas artísticas con el fin de ir elaborando una postura de análisis de las prácticas discursivas que nos construyen como personas.
Building bridges between ideas, people, and possibilities: An education professor looks back
Authors: Knapp Michael S.
Published: November 2017

The opportunity to build figurative bridges arose again and again across my career, and in places I least expected it. Close encounters with students, mentors, seminal ideas, and problematic situations kept pushing me to see new possibilities for my own and others’ learning. These encounters have occurred in my work as a scholar, teacher, advisor, participant in a collegial community, organizer of research teams, and servant of the field. I will relate and probe these stories, followed by some reflections on the lessons that may lie within them for surviving and thriving within academia, while maintaining a focus on issues of equity and social justice. But first ...[Download the PDF and read more]
An asymptotic analysis for Hamilton–Jacobi equations with large Hamiltonian drift terms
Authors: Kumagai Taiga
Published: November 2017

We investigate the asymptotic behavior of solutions of Hamilton–Jacobi equations with large Hamiltonian drift terms in an open subset of the two-dimensional Euclidean space.
The drift is given by

ε

-
1

⁢

(

H

x
2

,

-

H

x
1

)

{{\varepsilon}^{-1}(H_{x_{2}},-H_{x_{1}})}

of a Hamiltonian H, with

ε
>
0

{{\varepsilon}>0}

.
We establish the convergence, as

ε
→

0
+

{{\varepsilon}\to 0+}

, of solutions of the Hamilton–Jacobi equations and identify the limit of the solutions as the solution of systems of ordinary differential equations on a graph.
This result generalizes the previous one obtained by the author to the case where the Hamiltonian H admits a degenerate critical point and, as a consequence, the graph may have more than four segments at a node.
Reconstructing ‘John Lelamour’s’ Herbal: The Linguistic Evidence
Authors: Olalla David Moreno
Published: November 2017

Twenty years ago, George R. Keiser showed that the mutilated last quire of Lincoln Cathedral, Dean and Chapter Library, MS 91 had once contained a herbal written in Middle English. He discovered moreover that passages parallel to those reconstructable for the Lincoln manuscript appear in other texts, including an important work called John Lelamour’s Herbal after a name mentioned in its explicit, and concluded that Lelamour, an otherwise unknown fourteenth-century schoolmaster from Hereford, was the author of the original treatise that Thornton and other scribes used for the composition of their own herbals. The present article will present ample evidence which will demonstrate that Keiser’s hypothesis on a Herefordian pedigree for this textual family cannot be sustained any longer, and that the origins of this textual family should in fact be sought not too far from Scotland. A linguistic approach based on a collection of scribal modifications, both unconscious and conscious ones (i. e. copy mistakes and changes made on purpose by the several copyists), will be used for the task. This will reveal how linguistic variation between the several manuscripts can be profitably used to reconstruct the dialect of the original translation, which will here consequently be named Northern Middle English Translation of Macer Floridus’s De Viribus Herbarum (or Northern Macer for short).
Changes of photochemical efficiency and epidermal polyphenols content of Prosopis glandulosa and Prosopis juliflora leaves exposed to cadmium and copper
Authors: Gonzalez-Mendoza Daniel , Mendez-Trujillo Vianey , Grimaldo-Juarez Onecimo , Ceceña-Duran Carlos , Tzintzun-Camacho Olivia , Gutierrez-Miceli Federico , Sanchez-Viveros Gabriela , Aviles Marin Monica
Published: November 2017

The effect of metals on the photosynthetic activities and epidermal polyphenol content of Prosopis glandulosa and Prosopis juliflora leaves was investigated by the tissue tolerance test. Foliar tissues of Prosopis glandulosa and Prosopis juliflora were incubated with Cd2+ (0.001 M) or Cu2+ (0.52 M) concentrations for 96 h. The results showed that significant reductions (p < 0.05) of photochemical efficiency in P. juliflora leaves were found after 96 h of exposure to 0.52 M Cu2+ compared with Cd-treatments and controls. In contrast, P. glandulosa leaves showed a progressive increase on photochemical efficiency at 72 h after Cu-treatment. The results also showed a significant decrease (p < 0.05) of epidermal polyphenols in P. juliflora leaves after 24 h of exposure to 0.52 M Cu2+ compared with Cd-treatments and control leaves. On the other hand, the values of leaf epidermal polyphenols observed in P. glandulosa exposed to copper and cadmium did not show any difference with respect to control. These findings are very important and suggest that these compounds could be considered as a protection mechanism of P. glandulosa when is treated with these heavy metals. Finally, the results of bioaccumulation showed that the copper concentration in P. glandulosa was higher than the values detected in P. juliflora Nevertheless, the cadmium concentration in foliar tissues of P. juliflora was significantly higher than P. glandulosa after 96 h of exposure to Cu2+ or Cd2+. Therefore, future studies are necessary to elucidate the effects of heavy metals on the biosynthesis of flavonoids and participation of these compounds in the reduction of metal toxicity in Prosopis species.
Software design and implementation concepts for an interoperable medical communication framework
Authors: Besting Andreas , Bürger Sebastian , Kasparick Martin , Strathen Benjamin , Portheine Frank
Published: November 2017

The new IEEE 11073 service-oriented device connectivity (SDC) standard proposals for networked point-of-care and surgical devices constitutes the basis for improved interoperability due to its independence of vendors. To accelerate the distribution of the standard a reference implementation is indispensable. However, the implementation of such a framework has to overcome several non-trivial challenges. First, the high level of complexity of the underlying standard must be reflected in the software design. An efficient implementation has to consider the limited resources of the underlying hardware. Moreover, the frameworks purpose of realizing a distributed system demands a high degree of reliability of the framework itself and its internal mechanisms. Additionally, a framework must provide an easy-to-use and fail-safe application programming interface (API). In this work, we address these challenges by discussing suitable software engineering principles and practical coding guidelines. A descriptive model is developed that identifies key strategies. General feasibility is shown by outlining environments in which our implementation has been utilized.
Multi-Type Branching Processes Modeling of Nosocomial Epidemics
Authors: Mohamed Zeinab , Oraby Tamer
Published: November 2017

Nosocomial epidemics are infectious diseases which spread among different types of susceptible individuals in a health-care facility. To model this type of epidemics, we use a multi-type branching process with a multivariate negative binomial offspring distribution. In particular, we estimate the basic reproduction number