bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacokinetic Evaluation of [11C]CEP-32496 in Nude Mice Bearing BRAFV600E Mutation-Induced Melanomas
Authors: Jiang Cuiping , Xie Lin , Zhang Yiding , Fujinaga Masayuki , Mori Wakana , Kurihara Yusuke , Yamasaki Tomoteru , Wang Feng , Zhang Ming-Rong
Published: September 2018

CEP-32496, also known as RXDX-105 or Agerafenib, is a new orally active inhibitor for the mutated v-raf murine sarcoma viral oncogene homolog B1 (BRAFV600E), which has attracted considerable attention in clinical trials for the treatment of human cancers. Here, we used carbon-11-labeled CEP-32496 ([11C]CEP-32496) as a positron emission tomography (PET) radiotracer to evaluate its pharmacokinetic properties and explore its potential for in vivo imaging. Following radiotracer synthesis, we performed in vitro binding assays and autoradiography of [11C]CEP-32496 in the A375 melanoma cell line and on tumor tissue sections from mice harboring the BRAFV600E mutation. These were followed by PET scans and biodistribution studies on nude mice bearing subcutaneous A375 cell-induced melanoma. [11C]CEP-32496 showed high binding affinity for BRAFV600E-positive A375 melanoma cells and densely accumulated in the respective tissue sections; this could be blocked by the BRAFV600E selective antagonist sorafenib and by unlabeled CEP-32496. The PET and biodistribution results revealed that [11C]CEP-32496 accumulated continuously but slowly into the tumor within a period of 0 to 60 minutes postinjection in A375-melanoma-bearing nude mice. Metabolite analysis showed high in vivo stability of [11C]CEP-32496 in plasma. Our results indicate that [11C]CEP-32496 has excellent specificity and affinity for the BRAFV600E mutation in vitro, while its noninvasive personalized diagnostic role needs to be studied further.
Reconstructing Simulator Control Inputs: A Machine Learning Approach
Authors: Caddigan Eamon
Published: September 2018

Flight simulators are valuable tools for human factors research. However, some simulation platforms fail to record all of the information relevant to the researcher. While the data produced by most simulators includes details about the position and state of the simulated aircraft, some platforms do not record pilots’ control input. Missing control input data make it difficult to evaluate response times, a key behavioral measure in human factors research. Here we describe a technique that uses machine learning to reconstruct aircraft maneuvers using aircraft control surface information, which is typically available in simulator output files. This allows researchers to more accurately estimate the moment at which a pilot initiated a maneuver.
Correlating Helmet System Mass Properties with Pain Levels towards Helicopter Aircrew Neck-trouble Mitigating Solutions
Authors: Farrell Philip S. E. , Maceda Elaine , Niri Ahmed
Published: September 2018

Royal Canadian Air Force aircrew members have reported neck-trouble prevalence rates of 75%. To address this problem, a four-year project was recently completed that proposed, developed, assessed, and provided scientific advice on neck pain solutions. One of the solutions involved a Helmet System Assessment trial where helmet system mass properties and pain levels were collected from thirty-nine helicopter aircrew. These data were used to determine a relationship between head supported mass properties and pain level. The results show that experienced aircrew with chronic neck trouble have learned to manage their pain by reducing the amount of counter weights during night sorties, while novice aircrew wear counterweights that they are issued, which is often more than needed. Thus, a possible mitigating solution is to wear minimal counter weights so to delay the onset of episodic or chronic neck pain.
Connecting the Big Five Taxonomies: Understanding how Individual Traits Contribute to Team Adaptability under Workload Transitions
Authors: Devlin Shannon P. , Flynn Jake R. , Riggs Sara L.
Published: September 2018

Dynamic and data-rich domains, like those found in the military, rely heavily on teamwork for their operations. Previous work has attempted to understand how the personality of individuals contributes to overall team performance, but specific links between individual traits and team dimensions are needed. This study aims to link the dimensions from the original Big Five Trait Taxonomy to the Big Five in teamwork. Specifically, the focus was identifying which dimensions in the Big Five Trait Taxonomy influenced the Big Five in teamwork’s core component of adaptability. Ten pairs of participants completed a simulated Unmanned Aerial Vehicle control task. The best and worst performing pairs were identified and further analyzed to assess how pairs enabled adaptability when workload transitioned. The findings showed the best performing pairs enabled team adaptability effectively and had high levels of extraversion, lower levels of diversity across all dimensions, and adopted collaborative strategies to complete all the tasks. These findings suggest operational standards, technology, and training programs should be developed to foster these personality traits and collaborative-base strategies.
Machine Learning and Human Factors: Status, Applications, and Future Directions
Authors: Lau Nathan , Fridman Lex , Borghetti Brett J. , Lee John D.
Published: September 2018

As machine learning approaches ubiquity in industrial systems and consumer products, human factors research must attend to machine learning, specifically on how intelligent systems built on machine learning are different from early generations of automated systems, and what these differences mean for human-system interaction, design, evaluation and training. This panel invites five researchers in different domains to discuss how human factors can contribute to machine learning research and applications, as well as how machine learning presents both challenges and contributions for human factors.
Applying Visualization and Collective Intelligence for Rapid Group Decision Making
Authors: Dorton Stephen , Smith Chris M. , Upham Jason B.
Published: September 2018

There is a need to rapidly collect subjective data from a diverse group of contributors to facilitate argumentation and group decision making that reflects the breadth and depth of the knowledge of the collective group. Methods currently exist, although they are subject to biases and lack traceability. A method and tool have been developed to apply collective intelligence and visualization concepts to enable such rapid decision making while overcoming the identified weaknesses. A pilot study to select the best technology to solve a Naval mission requirement was performed to assess the ability of the tool to: Enable informed decision making, assess differences in contributor mental models, and identify where there is or is not consensus. The method/tool was useful to these ends, warranting further research. Lessons learned were gathered and the validity of the approach was notionally examined, driving the identification of future work to be performed.
Determinants of Association and Dissociation between Subjective and Objective Measures of Workload
Authors: Yakobi Ofir
Published: September 2018

Researchers in Human Factors and psychology are frequently interested in measuring mental workload, the limitation and capacity of the human cognitive system. Empirical data show that workload measures, although generally correlated, demonstrate disagreement in some instances. In the current work, I present a systematic investigation of the determinants of association and dissociation between subjective and objective estimates of. Specifically, I focus on the distinction between task-driven (bottom-up) efforts and goal-driven (top-down) efforts, based on findings from the metacognition literature. In three experiments, an Oddball task was performed individually or concurrently with a tracking task while task-driven and goal-driven efforts were manipulated. Subjective workload (SWL) associated with performance when efforts were task-driven, but not when goal-driven. SWL and the P3 event-related potential dissociated when efforts were goal-driven, but showed an inconsistent pattern when efforts were task-driven. These results are discussed and explained within the theoretical framework of metacognition and dual-process theories.
Human Systems Integration Risk Management Tool
Authors: Kosnik William , O’Neill Patrick , Zimmerlin Zachary
Published: September 2018

The Human Systems Integration Risk Management Tool (HSI-RMT) is a software-based interactive application designed to track, analyze, and mitigate human performance risk associated with the development of systems. It spans system development from concept formation to sustainment, that is – across the entire system acquisition lifecycle. HSI-RMT combines two previously developed tools: the HSI Capabilities and Requirements Tool (HSI-CART) and the HSI Program Risk Assessment Tool (HSI-PRAT). The former addresses HSI in capability requirements planning and the latter human performance considerations in system acquisition. HSI-RMT overlays a risk management approach onto the two tools in order to help the HSI practitioner identify, analyze, and mitigate human performance risk to program success. Tool content, in the form of best practice questions, was developed by Air Force HSI and industry subject matter experts. HSI-RMT promises to be a useful tool to help HSI practitioners manage human-centric risk across the system lifecycle. A demonstration will be given.
Analyzing Novel Interactions in Science Fiction Movies in Human Factors and HCI Courses
Authors: Jeon Myounghoon
Published: September 2018

To understand and apply Human Factors’ core knowledge more effectively, it is essential to provide a cohesive learning experience to students based on real-world applications. Researchers have developed ample ways to bring real-world examples to the classroom, but it is not always possible to obtain and demonstrate all the new technologies in the class. Specifically, it is even more difficult to discuss the design of novel technologies, which do not exist yet. To address this issue, in the present paper I introduce approaches to using Science Fiction (SF) movie analysis in Human Factors (HF) and Human-Computer Interaction (HCI) courses. After providing components and procedure of this activity, the implications of each component and examples are presented. Brief evaluation and pedagogical benefits are also discussed with movie references. I hope this can spark more discussions on innovative learning practices in the Human Factors community.
A Conceptual Qualitative Framework for Assessing Human Systems Engineering Education Outcomes and Opportunities
Authors: Roscoe Rod D. , Johnson Chelsea K. , Lande Micah , Craig Scotty D. , Gray Rob
Published: September 2018

Human systems engineering education seeks to infuse principles of applied psychology, cognitive science, human factors, and user-centered design into the engineering curriculum to help students understand the people they are engineering for (e.g., clients) and their own roles as engineers. This paper outlines a conceptual qualitative framework for formative assessment of students’ incorporation of human systems engineering concepts in their projects and documentation. The framework examines potential conceptual dimensions along with applications, sources, and depth of such knowledge, which we argue can begin to evaluate students’ work and inform iterative efforts to improve human-centered engineering education programs. Example applications of the framework based on several data sets are discussed.
Optimal Configuration of a Genetic Algorithm for Command Space Layout Analysis
Authors: Wang Wenbi
Published: September 2018

A genetic algorithm was developed to optimize the spatial layout of military command centres. This paper describes a simulation experiment in which the impact of key algorithm parameters on its search efficiency was examined. The results confirmed the benefit of a large population size and a long evolution process for improving the search effectiveness. For the parameter that controls the rate of introducing new solutions (i.e., probability of swap), a medium level configuration was found to be superior. Results of this study provide guidelines and heuristics for configuring key parameters of the proposed algorithm so that its search efficiency and computational expense are best balanced.
Preliminary Study of Obstacle Clearance and Compensatory Movements in Individuals with High Body Mass Index
Authors: Lim Sol , Luo Yue , Ebert Sheila , Jones Monica L. H. , Varban Oliver , D’Souza Clive
Published: September 2018

This study investigated the effect of obstacles of different heights on task performance and compensatory movements of six individuals with a body mass index (BMI) ≥ 30kg/m2. Obstacle heights were increased from 36cm to 66cm in 5cm increments using a method of limits. Video-based task analysis was used to develop a conceptual model of obstacle clearance and compensatory movements in response to the postural challenge of increasing obstacle heights. Results from the task analysis were used to identify temporal and kinematic performance measures of dynamic balance and postural control. Changes in obstacle clearance performance and compensatory movements may indicate heightened fall risk and could be mitigated by accessible design and assistive support features in the environment.
Home Telemonitoring Platforms for Adults with Diabetes Mellitus: A Narrative Review of Literature
Authors: Hammett Julie , Sasangohar Farzan , Lawley Mark
Published: September 2018

Diabetes mellitus in adults is a global health burden affecting 382 million people and costing over $612 billion worldwide. Remote patient monitoring is often considered to be a technological solution to the chal-lenges in healthcare delivery, yet many studies have shown mixed results or no effect on patient outcomes. A narrative review of literature was conducted to contribute to the field of technology-driven home healthcare delivery by analyzing the systems in context with the monitoring and intervention technologies. This review analyzed papers with home telemonitoring and intervention systems for adults with type 1 or type 2 diabetes. Technologies used were differentiated into four categories: telephones, mobile devices, computers, and other Internet-connected devices. Our findings suggest no clear association between the type of technology used and the outcomes of the participants. Frequency of monitoring and intervention were distinguishable by diabetic outcome metrics.
EHR to EHR Transitions: Establishing and Growing a Knowledge Base
Authors: Herout Jennifer , Saleem Jason J. , Weinger Matthew , Grundmeier Robert W. , Patterson Emily S. , Anders Shilo , Hettinger A. Zachary
Published: September 2018

Although numerous healthcare organizations have transitioned from one electronic health record (EHR) to another or are currently planning a transition, there are few documented artifacts, such as published studies or operationalizable resources, that offer guidance on such transitions. This panel seeks to begin a conversation about human factors considerations in EHR transitions from a legacy system. Panel members will discuss current literature and research on the topic as well as experiences with and lessons learned from transitions within their organizations. Panel discussion can be expected to identify new research opportunities, needed resources, and guidance for EHR vendors or healthcare facilities in the midst of or preparing for an EHR transition. Panelists will also lay out systemic issues that need to be addressed at the national policy and regulatory level. This topic is relevant not only to full-scale EHR transitions, but also has applicability for significant EHR version changes.
Electrical Somatosensory Stimulation in Early Rehabilitation of Arm Paresis After Stroke: A Randomized Controlled Trial
Authors: Ghaziani Emma , Couppé Christian , Siersma Volkert , Søndergaard Mette , Christensen Hanne , Magnusson S. Peter
Published: September 2018

Background. Arm paresis is present in 48% to 77% of acute stroke patients. Complete functional recovery is reported in only 12% to 34%. Although the arm recovery is most pronounced during the first 4 weeks poststroke, few studies examined the effect of upper extremity interventions during this period. Objective. To investigate the effect of electrical somatosensory stimulation (ESS) delivered during early stroke rehabilitation on the recovery of arm functioning. Methods. A total of 102 patients with arm paresis were randomized to a high-dose or a low-dose ESS group within 7 days poststroke according to our sample size estimation. The high-dose group received 1-hour ESS to the paretic arm daily during hospitalization immediately followed by minimum 15-minute task-oriented arm training that was considered a component of the usual rehabilitation. The low-dose group received a placebo ESS followed by identical training. Primary outcome—Box and Block Test (BBT); secondary outcomes—Fugl-Meyer Assessment (FMA), grip strength, pinch strength, perceptual threshold of touch, pain, and modified Rankin Scale (mRS); all recorded at baseline, postintervention and at 6 months poststroke. Results. There were no differences between the high-dose and the low-dose groups for any outcome measures at any time points. Improvements ⩾ minimal clinically important difference were observed for FMA, hand grip strength, and mRS in both groups. Conclusions. Providing the present ESS protocol prior to arm training was equally beneficial as arm training alone. These results are valid for patients with mild-to-moderate stroke and moderate arm impairments. We cannot exclude benefits in patients with other characteristics, in other time intervals poststroke or using a different ESS protocol. Trial Registration. ClinicalTrials.gov (NCT02250365).
An improved asynchronous energy-saving mechanism for IEEE 802.15.5-based networks
Authors: Yuan Li-yong , Lin Fei-long , Lv Jun-ke
Published: September 2018

IEEE 802.15.5 standard introduces the mesh routing which improves reliability and robustness of routing in wireless sensor network since there are multiple routes from source node to destination node. To achieve energy efficiency for a long network lifetime, the asynchronous energy saving is proposed in IEEE 802.15.5, which includes the receiver-initiated unicast mechanism and the sender-initiated broadcast mechanism. In this article, an improved asynchronous energy saving named semi-synchronous energy saving is proposed to deal with the energy inefficiency from idle listening existing in asynchronous energy saving. In semi-synchronous energy saving, every node maintains the wake/sleep schedule information of nodes in its two-hop neighborhood and uses this information to calculate the wake-up time of an interested neighbor that the data will be sent to, which reduces idle listening time in both unicast and broadcast mechanisms. A low delay routing mechanism is also proposed based on the wake/sleep schedule information of neighbors. Furthermore, the optimal guard time to guarantee receiving the wake-up notification from neighbor in the presence of clock drift is investigated for saving energy. The performance analysis and simulation evaluation show that semi-synchronous energy saving saves more than 80% of energy with less than 30% memory cost compared to asynchronous energy saving, and it also improves the time of completing broadcast and the end-to-end delay.
Sensor-cloud data acquisition based on fog computation and adaptive block compressed sensing
Authors: Liu Zhou-zhou , Li Shi-ning
Published: September 2018

The emergence of sensor-cloud system has completely changed the one-to-one service mode of traditional wireless sensor networks, and it greatly expands the application field of wireless sensor networks. As the high delay of large-scale data processing tasks in sensor-cloud, a sensor-cloud data acquisition scheme based on fog computing and adaptive block compressive sensing is proposed. First, the sensor-cloud framework based on fog computing is constructed, and the fog computing layer includes many wireless mobile nodes, which helps to realize the implementation of information transfer management between lower wireless sensor networks layer and upper cloud computing layer. Second, in order to further reduce network traffic and improve data processing efficiency, an adaptive block compressed sensing data acquisition strategy is proposed in the lower wireless sensor networks layer. By dynamically adjusting the size of the network block and building block measurement matrix, the implementation of sensor compressed sensing data acquisition is achieved; in order to further balance the lower wireless sensor networks’ node energy consumption, reduce the time delay of data processing task in fog computing layer, the mobile node data acquisition path planning strategy and multi-mobile nodes collaborative computing system are proposed. Through the introduction of the fitness value constraint transformation processing technique and parallel discrete elastic collision optimization algorithm, the efficient processing of the fog computing layer data is realized. Finally, the simulation results show that the sensor-cloud data acquisition scheme can effectively achieve large-scale sensor data efficient processing. Moreover, compared with cloud computing, the network traffic is reduced by 20% and network task delay is reduced by 12.8%–20.1%.
Soft power, culture and modernity: Responses to Bollywood films in Thailand and the Philippines
Authors: Athique Adrian
Published: September 2018

India's official embrace of the soft power concept and the popular equation of Bollywood films with India's international image are discussed here with reference to their contemporary convergence. This article seeks to make the case that the underlying claims of the soft power doctrine necessitate an empirical test at the level of grassroots reception. Further, this article also seeks to shift the emphasis from ‘impressing the West’ towards interrogating the dynamics of India's cultural diplomacy in other Asian states. With these aims in mind, this article presents two qualitative case studies from Chiang Mai, Thailand and Metro Manila in the Philippines. The responses collected indicate the inherent complexities of Inter-Asian dialogues on culture and modernity as well as the importance of the local media environment in determining perceptions of contemporary India. Ultimately, the capacity of popular culture to create a positive impression and to counter existing prejudices and misconceptions is supported in a series of reception studies. At the same time, the ‘moral superiority’ and historical legacies that are assumed to underpin India's cultural prestige in the region are challenged by the content and tone of these responses from the general public. In the contemporary setting of Association of South East Asian Nations (ASEAN), it becomes clear that the mediation of Indian culture operates within an increasingly transnational media environment and a competitive modernity that informs comparative perspectives between Asian cultures.
First-generation versus second-generation long-acting injectable antipsychotic drugs and time to relapse
Authors: Stone James M. , Roux Simon , Taylor David , Morrison Paul D.
Published: September 2018

Background:

The development of long-acting injectable formulations (LAIs) of second-generation antipsychotic drugs (SGAs) has been suggested as having advantage over first-generation antipsychotic (FGA) LAIs. In this study, we investigated the hypothesis that there was a longer time to relapse in patients with schizophrenia started on SGA LAI versus FGA LAI.

Methods:

Patients with a diagnosis of schizophrenia or schizoaffective disorder who were started on an SGA LAI while on an inpatient ward were identified through searching of the anonymised historical medical records at the South London and Maudsley NHS Foundation Trust. Patients starting FGA LAIs matched for diagnosis, age and date of hospital admission were identified. Time to readmission, discontinuation of LAI or death were identified. Kaplan–Meier plots were generated for each group, and the difference between groups analysed using log-rank methods.

Results:

There were 157 patients identified in each group. There was no difference in time to readmission, medication discontinuation or death in patients on SGA LAI versus FGA LAI.

Conclusions:

We found no evidence of advantage in terms of maintaining response in SGA LAI versus FGA LAI. Prescriber choice should be guided by other factors such as side-effect profile, patient acceptability and price.
Hematopoietic protease nexin-1 protects against lung injury by preventing thrombin signaling in mice
Authors: François Deborah , Arocas Véronique , Venisse Laurence , Aymonnier Karen , Idir Leila , Martos Raphael , Gazit Salome , Couty Ludovic , Jandrot-Perrus Martine , Camerer Eric , Boulaftali Yacine , Bouton Marie-Christine
Published: September 2018

Coagulation and fibrinolytic system deregulation has been implicated in the development of idiopathic pulmonary fibrosis, a devastating form of interstitial lung disease. We used intratracheal instillation of bleomycin to induce pulmonary fibrosis in mice and analyzed the role of serine protease inhibitor E2 (serpinE2)/protease nexin-1 (PN-1), a tissue serpin that exhibits anticoagulant and antifibrinolytic properties. PN-1 deficiency was associated, after bleomycin challenge, with a significant increase in mortality, as well as a marked increase in active thrombin in bronchoalveolar lavage fluids, an overexpression of extracellular matrix proteins, and an accumulation of inflammatory cells in the lungs. Bone marrow transplantation experiments showed that protective PN-1 was derived from hematopoietic cell compartment. A pharmacological strategy using the direct thrombin inhibitor argatroban reversed the deleterious effects of PN-1 deficiency. Concomitant deficiency of the thrombin receptor protease-activated receptor 4 (PAR4) abolished the deleterious effects of PN-1 deficiency in hematopoietic cells. These data demonstrate that prevention of thrombin signaling by PN-1 constitutes an important endogenous mechanism of protection against lung fibrosis and associated mortality. Our findings suggest that appropriate doses of thrombin inhibitors or PAR4 antagonists may provide benefit against progressive lung fibrosis with evidence of deregulated thrombin activity.
Development and validation of an endoscopic images‐based deep learning model for detection with nasopharyngeal malignancies
Authors: Li Chaofeng , Jing Bingzhong , Ke Liangru , Li Bin , Xia Weixiong , He Caisheng , Qian Chaonan , Zhao Chong , Mai Haiqiang , Chen Mingyuan , Cao Kajia , Mo Haoyuan , Guo Ling , Chen Qiuyan , Tang Linquan , Qiu Wenze , Yu Yahui , Liang Hu , Huang Xinjun , Liu Guoying , Li Wangzhong , Wang Lin , Sun Rui , Zou Xiong , Guo Shanshan , Huang Peiyu , Luo Donghua , Qiu Fang , Wu Yishan , Hua Yijun , Liu Kuiyuan , Lv Shuhui , Miao Jingjing , Xiang Yanqun , Sun Ying , Guo Xiang , Lv Xing
Published: September 2018

Background

Due to the occult anatomic location of the nasopharynx and frequent presence of adenoid hyperplasia, the positive rate for malignancy identification during biopsy is low, thus leading to delayed or missed diagnosis for nasopharyngeal malignancies upon initial attempt. Here, we aimed to develop an artificial intelligence tool to detect nasopharyngeal malignancies under endoscopic examination based on deep learning.

Methods

An endoscopic images‐based nasopharyngeal malignancy detection model (eNPM‐DM) consisting of a fully convolutional network based on the inception architecture was developed and fine‐tuned using separate training and validation sets for both classification and segmentation. Briefly, a total of 28,966 qualified images were collected. Among these images, 27,536 biopsy‐proven images from 7951 individuals obtained from January 1st, 2008, to December 31st, 2016, were split into the training, validation and test sets at a ratio of 7:1:2 using simple randomization. Additionally, 1430 images obtained from January 1st, 2017, to March 31st, 2017, were used as a prospective test set to compare the performance of the established model against oncologist evaluation. The dice similarity coefficient (DSC) was used to evaluate the efficiency of eNPM‐DM in automatic segmentation of malignant area from the background of nasopharyngeal endoscopic images, by comparing automatic segmentation with manual segmentation performed by the experts.

Results

All images were histopathologically confirmed, and included 5713 (19.7%) normal control, 19,107 (66.0%) nasopharyngeal carcinoma (NPC), 335 (1.2%) NPC and 3811 (13.2%) benign diseases. The eNPM‐DM attained an overall accuracy of 88.7% (95% confidence interval (CI) 87.8%–89.5%) in detecting malignancies in the test set. In the prospective comparison phase, eNPM‐DM outperformed the experts: the overall accuracy was 88.0% (95% CI 86.1%–89.6%) vs. 80.5% (95% CI 77.0%–84.0%). The eNPM‐DM required less time (40 s vs. 110.0 ± 5.8 min) and exhibited encouraging performance in automatic segmentation of nasopharyngeal malignant area from the background, with an average DSC of 0.78 ± 0.24 and 0.75 ± 0.26 in the test and prospective test sets, respectively.

Conclusions

The eNPM‐DM outperformed oncologist evaluation in diagnostic classification of nasopharyngeal mass into benign versus malignant, and realized automatic segmentation of malignant area from the background of nasopharyngeal endoscopic images.
‘Prescribing’ psychotropic medication to our rivers and estuaries
Authors: Ford Alex T. , Herrera Helena
Published: September 2018

The influence of pharmaceuticals on the environment is an increasing concern among environmental toxicologists. It is known that their growing use is leading to detectable levels in wastewater, conceivably causing harm to aquatic ecosystems. Psychotropic medication is one such group of substances, particularly affecting high-income countries. While these drugs have a clear place in therapy, there is debate around the risk/benefit ratio in patients with mild mental health problems. Therefore, it is necessary to evaluate the wider implications as risks could extend beyond the individual to non-target organisms, particularly those in rivers and estuaries.

Declaration of interest

None.
Active identification of patients appropriate for palliative care: Impact on use of palliative care and home care resources.
Authors: Mittmann Nicole , Liu Ning , MacKinnon Marnie , Seung Soo Jin , Look Hong Nicole , Earle Craig , Gradin Sharon , Sati Saurabh , Buchman Sandy , Wright Frances Catriona
Published: September 2018

101

Background: This research evaluates whether active identification of patients who may benefit from a palliative approach to care changes the use of palliative care and home care services. Methods: Between 2014 and 2017, Cancer Care Ontario implemented the INTEGRATE project at 4 cancer centres and 4 primary care teams. Physicians in participating sites were encouraged to systematically identify patients who were likely to die within 1 year and would benefit from a palliative approach to care. Patients in the INTEGRATE intervention group were 1:1 matched to non-intervention controls selected from provincial healthcare administrative data based on a publicly funded health system using the propensity score-matching. Palliative care and home care services utilization was evaluated within 1 year after the date of identification (index date), censoring on death, or March 31, 2017, the study end date. Cumulative incidence function was used to estimate the probability of having used care services, with death as a competing event. Rate of service use per 360 patient-days was calculated. Analyses were done separately for palliative care and home care. Results: Of the 1,187 patients in the INTEGRATE project, 1,185 were matched to a control. The intervention and the control groups were well-balanced on demographics, diagnosis, comorbidities, and death status. The probability of using palliative services in the intervention group was 80.3%, which was significantly higher than that in the control group (62.4%) with more palliative care visits in the intervention group [29.7 (95%CI: 29.4 to 30.1] per 360 patient-days) than in the control group [19.6 (95%CI: 19.3 to 19.9) per 360 patient-days]. The intervention group had a greater probability of receiving home care (81.4%) than the control group (55.2%) with more homecare visits per 360 patient-days [64.7 (95%CI: 64.2 to 65.3) vs. 35.3 (95%CI: 34.9 to 35.7)] The intervention group also had higher physician home visits as compared to the control group (36.5% vs. 23.7%). Conclusions: Physicians actively identifying patients that would benefit from palliative care resulted in increased use of palliative care and home care services.
Impact of Oncology Care Model (OCM) on episode costs and performance revenues: Considerations for oncology practices.
Authors: Shenolikar Rahul , Ryan Kellie , Shand Ben , Kane Richard
Published: September 2018

102

Background: The OCM is focused on providing high-quality, cost-efficient oncology care in Medicare. The episode payment approach introduces performance-based payments (PBPs) alongside traditional fee-for-service reimbursements. There is not yet a clear picture of the impact of the OCMs implementation on oncology practices. Methods: Using the Medicare Standard Analytic Files (5% sample) Part A and B claims, this study replicates the OCM benchmarking payment methodology. OCM episodes were triggered by qualifying Part B cancer therapies administered in an outpatient setting; all Part A and B costs that occurred in the following 6-months were included in episode costs. Claims for the baseline period (July 2012 – June 2015) were used to calculate actual episode costs, and predicted episode costs were used for benchmarks. Claims were also used to estimate OCM claims-based quality measure scores. Quality measure scores determined a practice’s performance multiplier, which is part of the PBP calculation. Results: The average ratio of OCM actual-to-predicted costs varied by tumor type. Of the 21 tumor types, 12 underpredicted costs and 7 overpredicted costs. The underpredicted tumors accounted for 43% of OCM episodes, and the overpredicted account for 51%. Central nervous system tumors and malignant melanoma were the most underpredicted cost ratios at 1.29 and 1.27, respectively. Claims-based quality measures also varied by tumor type. Aggregate scores for the three claims-based measures were < 50% for 18 tumors (65% of episodes) and ≥50% for 3 tumors (35% of episodes). Practices treating patients with tumors that are underpredicted on cost and/or score low on quality measures will have greater difficulty achieving PBPs. Conclusions: This analysis suggests that the ability of a participant to succeed in the OCM will vary depending on the types of cancers treated at the practice. Both savings and quality, as measured by OCM, will vary across cancers. For some cancers, achieving an ‘average’ cost and an ‘average’ quality score could result in below-average performance for the practice. Understanding these dynamics are critical to understanding the potential impact of the OCM at the practice level.
The quality of breast cancer quality measures.
Authors: Lane Whitney , Rushing Christel , Nussbaum Daniel , Blazer Dan G. , Greenup Rachel Adams
Published: September 2018

108

Background: To assess quality in breast cancer care, standardized metrics are needed. Many accepted breast performance metrics are based on evidence-based practice; however, most fail to reflect patient choice in treatment decisions. Given the focus on patient-centered breast care, we sought to determine how compliance with established quality metrics correlates with receipt of breast cancer care impacted by patient preference. Methods: American College of Surgeons (ACS) National Cancer Data Base facilities were designated compliant or non-compliant based on Commission of Cancer (CoC) breast metrics MASTRT, BCSRT and HT*, which all improve survival. Compliant facilities met the expected performance rate (EPR) for all three metrics, while non-compliant facilities failed to meet the EPR for any. Rates of breast conserving surgery (BCS) for early stage cancer, immediate breast reconstruction (IBR), and contralateral prophylactic mastectomy (CPM) are proposed metrics that are impacted by patient preference. For these, quality is defined as high rates of BCS, high rates of IBR, and low rates of CPM. Multivariable logistic regression models were used to estimate the association between facility level rates on these measures and the probability of treatment at a CoC compliant facility. Results: 729 facilities were included in the analysis. Based on the CoC measures, 79 (10.8%) were considered compliant and 650 (89.2%) non-compliant. Rates of BCS and IBR did not differ between compliant and non-compliant facilities; however, women treated at compliant facilities were more likely to undergo CPM (26.3% vs 21.4%; p = 0.02). In a multivariate model treatment at compliant facilities was associated with higher rates of BCS, IBR, and CPM; however, the predictive value of these metrics was minimal (Estimated OR range: 1.01-1.03). Conclusions: Rates of preference driven therapies do not differentiate CoC compliant and non-compliant hospitals. The quality of a hospital’s breast care is likely poorly measured by metrics that are influenced by, but cannot account for patient values. *MASTRT (RT≤1yr of diagnosis in women with ≥4 +lymph nodes); BCSRT (RT ≤1yr of diagnosis for women ≤70 receiving BCS); HT (hormone therapy recommended ≤1yr of diagnosis for HR-positive breast cancer)
Transition of dose-adjusted EPOCH therapy into the outpatient healthcare setting: Quality and cost considerations for outpatient treatment.
Authors: McBride Ali , Yiu Kelly , Elquza Emad , Persky Daniel Oscar , Kumar Abhijeet
Published: September 2018

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Background: Dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (EPOCH)-containing regimens are frequently utilized in lymphoma, however, outpatient EPOCH or modified inpatient/outpatient EPOCH has not been described extensively. We transitioned inpatient EPOCH to the outpatient setting and modified EPCOH to be given in the inpatient setting with rituximab outpatient to improve quality of care and access to patient assistance programs. We describe our institutional experiences with inpatient and modified EPOCH to the outpatient setting. Methods: A single-center, institutional review board-approved retrospective study was conducted for adults receiving EPOCH-based regimens. Clinical and financial data were collected by chart review for each patient. Descriptive statistics were utilized for analysis. Results: A total of 31 patients received 116 cycles of an EPOCH-containing regimen (11 [9.5%] inpatient), 54 [46.5%] outpatient, and 51 [44.0%] hybrid inpatient and outpatient). Nine outpatient cycles, 9 (17.6%) hybrid cycles and no inpatient cycles resulted in admissions for FN. Two inpatient cycles were delayed (18.2%) due to disease-related procedures and one (9.1%) was delayed due to low blood counts. Five (9.2%) outpatient cycles were delayed due to logistics (i.e. insurance delays, scheduling errors) and two (3.7%) outpatient cycles were delayed due to disease-related adverse events (bowel obstruction, chest pain). Transitioning EPOCH to the outpatient setting decreased overall costs for hospital stays on average by $19,792 per cycle with an overall approximate cost savings to the health-system of 1,114,992 dollars with 432 bed days saved. Costs savings to patients with medications assistance programs is pending final analysis. Conclusions: EPOCH-containing regimens can be safely transitioned into the outpatient setting, side effects can be monitored and outcomes optimized, to better adapt treatment strategies for individualized patient therapies. As new healthcare payment models are developed, outpatient treatments allow for adaptive financial options both for the health-system and the patient.
Variations in hospitalization and emergency department or observation (ED/OB) stays using the oncology care model (OCM) methodology in Medicare data.
Authors: Li Shuling , Peng Yi , Li Suying , Raskin Leon , Kelsh Michael Anthony , Zaha Rebecca , Gawade Prasad L. , Henry David
Published: September 2018

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Background: The Medicare OCM started in 2016 to improve oncology care and reduce costs. Two metrics for care evaluation are hospitalizations and ED/OB stays. Baseline data (2012−2015) on variations in all-cause hospitalization and ED/OB stays not resulting in hospitalization in the 21 reconciliation-eligible cancer types are not well characterized. Methods: We applied OCM methodology in Medicare fee-for-service 20% sample data to estimate 6-month patient (pt) episodes triggered by chemotherapy, as well as associated cancer type and practice, from 2012 to 2015. Proportions of episodes with hospitalization and ED/OBs stay were summarized overall and by cancer for all episodes and by practice in those with ≥20 pt-episodes. Results: In total, 485,186 pt-episodes at 13,823 practices were identified (mean episodes/practice, 35.1; median, 2; IQR, 1–15). The mean number of episodes/pt was 1.90 overall (from 1.17 in anal cancer to 2.32 in multiple myeloma [MM]). The proportion of episodes with hospitalization was 25% overall (from 14% in breast cancer [BC] to 56% in acute leukemia) and with ED/OB stays was 23% overall (from 18% in BC to 36% in liver cancer). In 2,995 practices with ≥20 total episodes, at practice-level, the proportion of episodes with hospitalization ranged (20th–80th percentile) from 14% to 31% and with ED/OB stays from 17% to 29%. For select cancers, the range of proportion of episodes with hospitalization and ED/OB stays were highest for lung cancer (LC) and lowest for BC (Table). Conclusions: The proportion of 6-month OCM episodes of care with hospitalization and ED/OB stays after chemotherapy varied by cancer and was higher for certain solid and hematological malignancies. Variations between practices and cancers are important factors when evaluating OCM performance. [Table: see text]
The impact of value-based payment on the referral of oncology patients to tobacco cessation services.
Authors: Bedard Louise , Griggs Jennifer J.
Published: September 2018

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Background: The purpose of this study is to investigate the relationship between the introduction of value-based payment, the initiation of a quality improvement project, and practices’ performance to refer or administer tobacco cessation counseling to patients. Methods: The Michigan Oncology Quality Consortium (MOQC) is a statewide quality collaborative sponsored by Blue Cross/Blue Shield of Michigan (BCBSM). MOQC uses ASCO's Quality Oncology Practice Initiative (QOPI) for measurement.Value-based payment (VBP) was introduced in 2017 by BCBSM. The VBP is achieved if a region reaches a target established for four QOPI measures. One of the four quality measures is QOPI's core measure 22bb: tobacco cessation counseling administered or patient referred. At the time the VBP was introduced, a subset of MOQC practices chose to initiate a quality project to improve performance on this measure. Analyses describes the performance of all MOQC practices with the introduction of the VBP, and performance of the practices who chose to revise their tobacco cessation processes to address performance. Results: The proportion of patients who were administered or referred to tobacco cessation services in participating MOQC practices was 49% (n = 793 charts) from abstracted rounds Spring 2014 - 2017. After the introduction of VBP, this proportion increased to 58% (n = 307 charts) in Fall 2017. Performance improved on this QOPI measure for both subsets of MOQC practices - those practices that chose to initiate a quality project focused on this measure (n = 19) and practices that selected another measure (n = 27). Practices that developed a quality project improved their aggregate proportion from 46% (Spring 2014-2017, n = 839 charts) to 51% (Fall 2017, n = 266 charts). Practices that focused on another quality measure improved from 51% (Spring 2014-2017, n = 789 charts) to 65% (Fall 2017, n = 265 charts). Conclusions: Our data suggest that the presence of VBP may have had a positive impact on referral patterns for tobacco cessation services for cancer patients. Additional analyses are required to determine if there is a combination or sequencing of VBP and process improvement strategies to optimize the delivery of quality care.
Clinical work intensity among medical oncologists.
Authors: Hudson Matthew F. , O'Rourke Mark Allen , Blackhurst Dawn W. , Caldwell Jennifer , Franco Regina A. , Russ-Sellers Rebecca , Horner Ronnie
Published: September 2018

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Background: Oncology faces workforce shortages and increasing stress. Oncology provider well-being and resilience are mediated by organizational factors through clinical work intensity. Clinical work intensity (CWI) is the level of requisite technical skill, physical and mental effort and clinical judgement necessary, plus care provision-associated stress. Suboptimal clinical work intensity may result from unfavorable practice organizational factors preceding burnout. This pilot study assess CWI experienced by medical oncologists and oncologic advanced practice registered nurses (APRNs)/nurse practitioners as a prelude to a study of provider resilience. Methods: Investigators solicited seventeen medical oncologists-12 physicians and 5 nurse practitioners-from five oncology clinics in the Northwest, Midwest, and Southern regions of the United States Providers reported on level of work intensity associated with 339 patient visits occurring over an 8 week period where for each provider 5 visits were randomly selected from each of 4 randomly selected clinic days. Intensity was measured by the NASA-Task Load Index that assesses 6 dimensions (subscales) with additional questions measuring stress and visit satisfaction. Results: Compared to medical oncologists, APRNs reported a higher work intensity score on average (38.6 vs. 32.9; p < 0.0064), and higher scores on the frustration subscale (36.5 vs. 21.5; p < 0.0001). APRNs also scored higher on stress (27.8 vs. 22.2; p < 0.048), and scored lower on provider-perceived satisfaction with the visit (73.0 vs. 81.1; p < 0.0001). There was no difference between oncologists and nurse practitioners on the other dimensions, including mental, time, and physical demand, and effort. Conclusions: Oncologic APRNs may experience greater work intensity than medical oncologists. Future research will consider whether APRN work intensity scores reflect different or disproportionate challenges owing to scope of practice, workload, or administrative responsibilities, and determine those dimensions of higher work intensity that portend provider burnout. The goal is to identify strategies optimizing work intensity among oncology providers, mitigating provider burnout and enhancing the practice environment.