bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ensemble-based seismic inversion for a stratified medium
Authors: Gineste Michael , Eidsvik Jo , Zheng York 
Published: October 2019

Seismic waveform inversion is a nontrivial optimization task, which is often complicated by the nonlinear relationship between the elastic attributes of interest and the large amount of data obtained in seismic experiments. Quantifying the solution uncertainty can be even more challenging, and it requires considering the problem in a probabilistic setting. Consequently, the seismic inverse problem is placed in a Bayesian framework, using a sequential filtering approach to invert for the elastic parameters. The method uses an iterative ensemble smoother to estimate the subsurface parameters, and from the ensemble, a notion of estimation uncertainty is readily available. The ensemble implicitly linearizes the relation between the parameters and the observed waveform data; hence, it requires no tangent linear model. The approach is based on sequential conditioning on partitions of the whole data record (1) to regularize the inversion path and effectively drive the estimation process in a top-down manner and (2) to circumvent a consequence of the ensemble reduced rank approximation. The method is exemplified on a synthetic case, inverting for elastic parameters in a 1D medium using a seismic shot record. Our results indicate that the iterative ensemble method is applicable to seismic waveform inversion and that the ensemble representation indeed indicates estimation uncertainty.
Seismic geomorphology of shoal-water deltaic and mixed carbonate-siliciclastic beach-bar systems in hanging wall of rift basins: Paleogene of the Raoyang Sag, Bohai Bay Basin, China
Authors: Chen Hehe , Zhu Xiaomin , Shi Ruisheng , Zhang Zili 
Published: October 2019

Recent studies of ancient rift basins focus on the tectonosedimentary models, which emphasize the control of tectonics on the distribution and evolution of depositional systems in rift basins, whereas these studies seldom address stratigraphic dominated depositional models. Compared to footwall depositional systems, hanging wall depositional systems are especially underexplored due to their fine-grained, thin-layered, and widely distributed features. We integrated seismic data, cores, and well logs to define the dispersal of hanging wall depositional systems that are related to the fluctuation of lacustrine level in the late synrift and postrift stages. We identified one third-order sequence (SQ1) on the seismic reflection data and subdivided five fourth-order sequences (SSQ1–SSQ5) based on the features of parasequence sets. The strata in SQ1 record a complete regressive and progressive lacustrine process. We interpreted shoal-water deltaic systems and mixed carbonate-siliciclastic beach-bar systems in the SQ1. Within SSQ1 and SSQ2, sediments fed from the northwest, west, and southwest, and developed shoal-water deltaic systems with an average width range of the distributary channel belts within 680–1220 m. In SSQ3, beach-bar systems gradually changed from clastic beach bars to mixed carbonate-siliciclastic beach bars in a basinward direction. Clastic beach-bar systems and mixed carbonate-siliciclastic beach-bar systems were extending north–northeast with an average length of approximately 3.5–8 km and a width of 1–4 km. For those in SSQ4 and SSQ5, shoal-water deltaic systems prograded into the lacustrine, and distributary channel belts occur with an average width range within 520–880 m. We developed a spatial and temporal quantitative evaluation of deltaic and beach-bar reservoirs within a third-order sequence on the hanging wall dip slope, and it has potential worldwide implications for other hanging wall dip slopes in rift basins.
Phase IIb, Randomized, Double-Blind Trial of GC4419 Versus Placebo to Reduce Severe Oral Mucositis Due to Concurrent Radiotherapy and Cisplatin For Head and Neck Cancer
Authors: Anderson Carryn M. , Lee Christopher M. , Saunders Deborah P. , Curtis Amarinthia , Dunlap Neal , Nangia Chaitali , Lee Arielle S. , Gordon Sharon M. , Kovoor Philip , Arevalo-Araujo Roberto , Bar-Ad Voichita , Peddada Abhinand , Colvett Kyle , Miller Douglas , Jain Anshu K. , Wheeler James , Blakaj Dukagjin , Bonomi Marcelo , Agarwala Sanjiv S. , Garg Madhur , Worden Francis , Holmlund Jon , Brill Jeffrey M. , Downs Matt , Sonis Stephen T. , Katz Sanford , Buatti John M. 
Published: October 2019

PURPOSEOral mucositis (OM) remains a common, debilitating toxicity of radiation therapy (RT) for head and neck cancer. The goal of this phase IIb, multi-institutional, randomized, double-blind trial was to compare the efficacy and safety of GC4419, a superoxide dismutase mimetic, with placebo to reduce the duration, incidence, and severity of severe OM (SOM).PATIENTS AND METHODSA total of 223 patients (from 44 institutions) with locally advanced oral cavity or oropharynx cancer planned to be treated with definitive or postoperative intensity-modulated RT (IMRT; 60 to 72 Gy [≥ 50 Gy to two or more oral sites]) plus cisplatin (weekly or every 3 weeks) were randomly assigned to receive 30 mg (n = 73) or 90 mg (n = 76) of GC4419 or to receive placebo (n = 74) by 60-minute intravenous administration before each IMRT fraction. WHO grade of OM was assessed biweekly during IMRT and then weekly for up to 8 weeks after IMRT. The primary endpoint was duration of SOM tested for each active dose level versus placebo (intent-to-treat population, two-sided α of .05). The National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.03, was used for adverse event grading.RESULTSBaseline patient and tumor characteristics as well as treatment delivery were balanced. With 90 mg GC4419 versus placebo, SOM duration was significantly reduced ( P = .024; median, 1.5 v 19 days). SOM incidence (43% v 65%; P = .009) and severity (grade 4 incidence, 16% v 30%; P = .045) also were improved. Intermediate improvements were seen with the 30-mg dose. Safety was comparable across arms, with no significant GC4419-specific toxicity nor increase of known toxicities of IMRT plus cisplatin. The 2-year follow-up for tumor outcomes is ongoing.CONCLUSIONGC4419 at a dose of 90 mg produced a significant, clinically meaningful reduction of SOM duration, incidence, and severity with acceptable safety. A phase III trial (ROMAN; ClinicalTrials.gov identifier: NCT03689712 ) has begun.
Evaluating uptake and patient satisfaction with an out-of-pocket cost tracker for gynecologic cancer patients undergoing treatment.
Authors: Liang Margaret , Summerlin Sarah S. , Boitano Teresa KL , Blanchard Christina T. , Bhatia Smita , Huh Warner King , Pisu Maria 
Published: October 2019

101 Background: Tracking expenses may be useful to minimize financial distress in cancer patients. Our objective was to evaluate uptake and satisfaction with an out of pocket (OOP) cost tracker for gynecologic cancer patients on treatment. Methods: Within a longitudinal survey to assess financial burden among gynecologic cancer patients starting a new line of systemic therapy at a tertiary-care cancer center, we provided worksheets for participants to track their OOP expenses voluntarily. We assessed patient usage and satisfaction at 3 and 6 months. Financial distress was measured using Comprehensive Score for Financial Toxicity < 26. Results: Among 121 participants with an average age of 59 years, 34 (28%) were African-American and 33 (27%) had a high school diploma or less. Half (55/110, 50%) of participants reported annual income < $40,000. Most participants had health insurance (113/121, 93%) and were unemployed (77/118, 65%). Forty-nine of 121 (40%) participants reported ever using the OOP cost tracker at 3 or 6 months. Those who used the cost tracker stated it was helpful to track costs (86%, 73%), easy to use (97%, 100%), and useful for budgeting (42%, 24%) at 3 and 6 months. Participants reported using the cost tracker at least weekly (33%, 19%), every 2 weeks (36%, 27%), or monthly (31%, 54%) at 3 and 6 months. Twelve participants returned their OOP cost trackers for review with a median use of 5.5 months (range 3-10). Average monthly patient-reported OOP costs (range) were: $41 ($0-$584) for direct non-medical costs (i.e., transportation, lodging), $15 ($0-$120) for outpatient services, $13 ($0-$150) for medications/supplies, and $9 ($0-$100) for hospital services. Use of the OOP cost tracker at 3 months was not associated with financial distress at baseline (p = 0.30) or at 3 months (p = 0.89). Qualitative analysis showed the OOP cost tracker reminded patients to save receipts and to track categories of cost they would not have otherwise considered. Conclusions: 40% of gynecologic cancer patients undergoing treatment used an OOP cost tracker worksheet and found it helpful and easy to use. Direct non-medical costs accounted for the highest average monthly patient-reported OOP cost.
Utilization and costs of breast cancer screening for women in their 40s in a privately insured U.S. population.
Authors: Kunst Natalia R. , Long Jessica B. , Xu Xiao , Busch Susan , Richman Ilana , Kyanko Kelly A. , Gross Cary Philip 
Published: October 2019

105 Background: Despite ongoing debate about the effectiveness of initiating breast cancer screening at age 40, there is less attention paid to costs implications associated with the alternative screening starting ages. We assessed the annual costs of different screening strategies for privately insured women aged 40-49, as well as regional cost variation. Methods: We used a limited data set from Blue Cross Blue Shield (BCBS) Axis, the largest source of commercial US claims data. We identified the unit costs and frequencies of screening and subsequent evaluation for beneficiaries with continuous coverage through 2017. A Monte Carlo simulation model was developed to evaluate the annual costs of three alternate screening strategies: 1) current clinical practice, 2) annual screening beginning at age 40, or 3) annual screening beginning at age 45. The following procedures were included: screening (2-D and 3-D mammogram), supplementary ultrasound, recall (diagnostic 2-D and 3-D mammogram and ultrasound), MRI, and biopsy. We examined variability in screening-related costs across hospital referral regions (HRRs), and identified the main contributors to regional variation. Results: Overall, 69% of women in their 40s received a mammogram in 2017, resulting in an annual cost of $200 per beneficiary. This cost varied nine-fold across HRRs (range: $60-550 per beneficiary). The median cost of mammograms varied substantially across regions (2-D median cost: $206; range: $100-463; 3-D median: $271; range: $104-676). Variability in the cost of 2-D and 3-D mammogram was the main contributor to the variation in annual screening-related costs across HRRs, explaining 37% and 27% of the total variation, respectively. Screening all women beginning at age 40 would be associated with an annual cost of $309 per beneficiary (range: $127-664). Initiating screening at age 45 would cost $153 per beneficiary (range: $61-319). Conclusions: In current practice, breast cancer screening in women ages 40-49 is common, and costs $200 per eligible female beneficiary annually. Screening all women beginning at age 40 would increase the median screening-related costs by over 50%, although the cost implications vary substantially across regions.
A budget impact model for biosimilar myeloid growth factors (MGFs) within the Oncology Care Model (OCM): An oncology group practice perspective.
Authors: McBride Ali , Wang Weijia , Li Edward C. , Balu Sanjeev , Campbell Kim 
Published: October 2019

108 Background: Value-based programs, such as the OCM, provide incentives for healthcare providers to lower costs and improve patient outcomes. Use of biosimilar vs. reference MGFs for febrile neutropenia (FN) prophylaxis (Px) has been suggested as one strategy to help practices meet these goals. The purpose of this study is to quantify the potential impact of using biosimilar MGFs on OCM metrics from a US practice perspective. Methods: The budgetary impact of two scenarios of MGF Px for a hypothetical panel of 500 patients in 1 year receiving 6 cycles of FN-risk stratified chemotherapy (CT) was assessed; model inputs for the rates of MGF Px based on FN risk were estimated from the literature. The first scenario compares the projected 1-year total (i.e., drug and administration) costs of using LA-EP2006 (a proposed Sandoz pegfilgrastim biosimilar) vs. reference pegfilgrastim, assuming the same MGF utilization rate within the 500 patients. The second scenario evaluates the cost implications of expanding access to LA-EP2006 for 10% more patients receiving intermediate-FN risk CT and the subsequent impact on MGF costs and FN-related healthcare utilization costs (e.g., emergency visits, hospitalizations, outpatient management). MGF costs were derived from publically available data; healthcare resource utilization and costs were estimated from the literature. Results: For 500 patients receiving CT, 107 were estimated to receive MGF Px, resulting in total costs of $3.02 million (M) for reference pegfilgrastim and $2.42 M for LA-EP2006 with $1.05 M in FN-related healthcare utilization costs. If MGF access (using LA-EP2006) were expanded to 10% more patients receiving intermediate-FN risk CT, 129 patients would receive MGF Px at a cost of $2.91 M; FN-related healthcare costs would decrease by $27,155. Conclusions: Using biosimilar vs. reference pegfilgrastim can help OCM-participating practices reduce their drug costs. Potentially, a practice can address an existing gap in FN prevention by expanding biosimilar MGF access for patients receiving intermediate-FN risk CT, which may help to meet OCM metrics such as reducing hospitalizations and emergency visits.
Pathways impact on OCM drug cost.
Authors: Csik Valerie Pracilio , Minetola Jared , Walsh Karen , Ramirez Michael J. , Hurwitz Mark 
Published: October 2019

109 Background: Oncology care, including drugs, represents a significant portion of US healthcare spending. Cost of Part B drugs has increased at a rate 5.7x that of overall Medicare spending (1997-2004). As a participant in the Oncology Care Model (OCM), we found drug costs represent a majority of our total costs. To reduce treatment (Tx) variability, our NCI-designated cancer center chose to implement pathways. Pathways are a clinical decision-support tool that use evidence-based care maps accounting for efficacy, toxicity and cost. At one institution, use of pathways contributed to $15k in savings for stage IV lung cancer Tx. We hypothesized pathway driven Tx standardization would favorably impact total chemotherapy (CTx) costs at the implementation site. Methods: In July 2018, we implemented pathways in Medical and Radiation Oncology for new starts or changes in Tx. Oncologists accessed the tool through our EMR, selected and placed orders for Tx. OCM quarterly data was used to compare 2 quarters immediately pre- and post-pathway implementation. The cancer-mix-adjusted Per-Member-Per-Month (PMPM) Allowed Amounts for CTx were compared between 3 groups; patients on-pathway, patients off-pathway and patients for which the pathways tool was not used (no utilization). PMPMs were evaluated pre- and post-implementation and an ANOVA test was used to evaluate significance of the difference between the two periods. Results: PMPM CTx costs decreased 4.6% between pre- and post-pathway implementation when oncologists followed pathways. By comparison, the off-pathway cohort and the no utilization groups had increases of 0.9% and 17.7% respectively. An evaluation of cost difference proved significant (p < .0001). Breast patients on-pathway had a cost decrease of 20%, compared to increases of 32% and 11% for off-pathway and no utilization groups, respectively. Conclusions: Pathway use reduced variation, a known contributor to healthcare costs, and therefore may be an effective cost control tool. Additional quarters of claims data is needed post-implementation to fully define the impact of pathways on total cost. [Table: see text]
Impact of an oncology acute care clinic (ACC) in a comprehensive cancer care setting to reduce emergency visits and subsequent hospitalizations: A pilot study.
Authors: Chaudhuri Anamika , Wagner Andrew J. , Bunnell Craig A. , Gross Anne , Green Emma , Bowers Danielle , Fraile Belen 
Published: October 2019

110 Background: Emergency Department (ED) visits and subsequent hospitalizations are a major source of healthcare resource utilization and costs among cancer patients, compromising quality of care and patient satisfaction. Emerging evidence, including OCM and other alternative payment models suggest many of these visits may be preventable and effectively managed in oncology-specific urgent care clinics. Little is known about such care delivery models in the comprehensive cancer care arena. Methods: As part of larger effort to provide better, efficient, timely care to patients, an acute care clinic (ACC), appropriately staffed to provide ancillary services, was set up in an academic hospital outpatient setting with hours of operations 10:30- 8:00 pm to effectively manage patients with cancer-related symptoms. The objective was to change the site of care for patients who would otherwise be seen in the ED and discharged home as well as to potentially decrease the frequency of hospitalization following ED evaluation by providing oncology subspecialized care. A retrospective analysis of 4 months pre- and post-intervention was performed with emergency visits per 1000 visits per month as the primary outcome and subsequent hospitalizations as a secondary outcome. Results: A total of 1593 patients (821 pre-intervention and 772 post-intervention) were included. Preliminary analysis revealed a 7% observed reduction in ED visits (0.25 vs 0.23 visits per month per 1000 visits; p = 0.85) for oncology patients which otherwise would have seen a 12% increase, following the historical trend. Data also suggest more effective avoidance of acute care settings with discharge disposition for patients from ED pre-intervention versus ACC post-intervention being 32% vs 72% home, 67% vs 13% inpatient, 1% vs 6% ED respectively. Conclusions: The creation of an ACC to manage urgent patient visits in an ambulatory setting decreased ED visits and the likelihood of patient admission. Although initial findings suggest improved preliminary outcomes, further analysis is required to make any causal inference on the true impact of ACC intervention for reduction of ED and hospitalizations.
The role of facility variation on racial disparities in use of hypofractionated whole breast radiotherapy.
Authors: Laucis Anna Mary Brown , Jagsi Reshma , Griffith Kent A. , Dominello Michael M. , Walker Eleanor M. , Abu-Isa Eyad I. , Dilworth Joshua T. , Vicini Frank , Kocheril Paul George , Browne Cynthia Holland , Mietzel Melissa A. , Moran Jean M , Hayman James , Pierce Lori J. ,   Michigan Radiation Oncology Quality Consortium, supported by Blue Cross Blue Shield of Michigan, and the Blue Care Network as part of the BCBSM Value Partnerships Program
Published: October 2019

141 Background: Concerns about racial disparities in the adoption of medical advances motivate investigation of the use of hypofractionated radiotherapy, a less burdensome and less costly approach that is efficacious for most patients with early-stage breast cancer. Methods: A prospectively collected statewide quality consortium database from 25 institutions was queried for breast cancer patients who completed hypofractionated (HF) or conventionally fractionated whole breast radiotherapy (RT) from 1/2012-12/2018. We used patient-level multivariable modeling to evaluate associations between HF use and race, controlling for patient and facility factors, and multilevel modeling to account for patient clustering within facilities. Results: Of 10,318 patients analyzed, 80% self-reported their race as White, 18% as Black, and 2% as Asian, similar to statewide and national distributions. 31% of Whites were treated at academic centers compared to 65% of Blacks and 65% of Asians. In 2018, HF was utilized in 75% of Whites versus 60% of Blacks and 68% of Asians. On patient-level multivariable analysis (see Table), Black and Asian race were significantly associated with a lower likelihood of HF receipt, despite accounting for treatment year, age, laterality, BMI, breast volume, comorbidities, stage, triple-negative status, IMRT use, academic center treatment, and 2011 ASTRO Hypofractionation Guideline eligibility. On multilevel analysis, race was no longer significantly associated with HF receipt. Conclusions: We observed thatBlack and Asian patients receive hypofractionated RT less often, despite more frequent treatment at academic centers. Multilevel modeling eliminated this disparity, suggesting that differences in facility-specific HF use may contribute. Further inquiry is needed to determine if reduction of facility-level variation may reduce disparities in accessing HF treatment.[Table: see text]
Patient navigation (PN) for colorectal cancer screening (CRC): Experience in program implementation for underserved neighborhoods of Cleveland, Ohio.
Authors: Glass Katherine , Seals Aqeel 
Published: October 2019

147 Background: Cleveland, Ohio has high rates of colorectal cancer (CRC). 50% of CRC in Cleveland is late stage, and rates of CRC screening in Cleveland are low. Colonoscopy is a screening method for CRC, but barriers exist for the underserved population of Cleveland. The Fecal Immunohistochemical Test (FIT) is a less-costly and non-invasive CRC screening method that has demonstrated increased uptake in CRC screening for underserved populations. Previous literature has demonstrated that Patient Navigation (PN) can increase screening rates in underserved populations through education and assistance to overcome barriers to care. Little, however, has been published about the impact of pairing PN with a program that encourages either colonoscopies or FIT utilization to complete screening. Methods: Community members were educated about both colonoscopies and FIT in a neutral manner. After education, interested participants provided preference for screening type. Participants received follow-up calls from patient navigators. Navigators provided encouragement to complete screening and collected information about barriers. Results: N = 612 patients received PN for CRC. 72% of the population (n = 442) were Black. 47% (n = 290) chose colonoscopy, and n = 322 chose FIT. 44% (n = 263) completed a screening. 19% (n = 55) of those choosing colonoscopy completed screening. 66% (n = 213) choosing FIT completed screening. Women who chose FIT were more likely than men who chose FIT to complete screening (86% vs. 45%, p < 0.001). Barriers to screening included appointment coordination, transportation, and insurance. Conclusions: When offered PN and choice of CRC screening, community members in Cleveland equally chose colonoscopy vs. FIT. Those that chose FIT were more likely to complete screening (p < 0.001). Barriers suggest access and use of healthcare remain challenging for underserved communities. The simplicity of FIT paired with PN may remove barriers for this population and increase screening uptake. More research needs to be done to understand the impact of PN on sustained rate of completion.