bluuebunny/crossref_metadata_2025_split huggingface dataset:
Egg rejection and egg recognition mechanisms in Oriental Reed Warblers
Authors: Ma Laikun , Liang Wei 
Published: September 2021

Abstract
Background
Nest parasitism by cuckoos (Cuculus spp.) results in enormous reproductive failure and forces hosts to evolve antiparasitic strategies, i.e., recognition of own eggs and rejection of cuckoo eggs. There are often sexual conflicts between male and female individuals in the expression of antiparasitic behavior due to the differences in reproductive inputs and division of labor.

Methods
By adding a foreign egg made of blue soft clay to the host nest during early incubation period in the field, and by removing several host eggs and adding experimental eggs to control the proportion of two egg types in the nest, we examined egg rejection ability, egg recognition mechanism and sexual difference in egg rejection of the Oriental Reed Warbler (Acrocephalus orientalis), one of the major hosts of Common Cuckoos (Cuculus canorus).

Results
Our results indicated that Oriental Reed Warblers can recognize and reject nearly 100% (73/75) of the non-mimetic eggs made of blue soft clay, and they could reject foreign eggs with 100% accuracy, regardless of the ratio of experimental eggs and its own eggs in the nest. Furthermore, all cases of egg rejections recorded by videos were only carried out by females.

Conclusions
Oriental Reed Warblers have a high egg recognition ability and show a true recognition mechanism. Only female warblers perform egg rejection, suggesting that the sex for host egg incubation seems to play an important role in the evolution of egg recognition mechanisms.
Application of fuzzy evaluation technique and grey clustering method for water quality assessment of the coastal and estuaries of selected rivers in Sarawak
Authors: Asare Ebenezer Aquisman , Assim Zaini Bin , Wahi Rafeah Binti , Tahir Rajuna Bin , Droepenu Eric Kwabena 
Published: September 2021

Abstract
Background
Estuarine and marine water quality has remarkable importance because these water resources are used for multiple reasons for instance: transportation, tourism, recreation, and other human or economic ways to use water. The objective of the study was to assess the water quality of the coastal and estuaries of the Rambungan, Sibu, Salak, and Santubong rivers in Sarawak, Malaysia. Water samples were collected from 10 locations and analyzed by employing standard techniques. A fuzzy comprehensive evaluation, grey clustering evaluation methods, Thailand Marine Water Classification System, and the Malaysian Marine Water Quality Index (MMWQI) and its classification system were applied to compute the index of each water quality parameter.

Results
The results showed that all the analyzed water quality parameters were within the allowable threshold levels. The results obtained by the application of fuzzy comprehensive evaluation and grey clustering evaluation methods proved that the coastal and the estuaries waters were clean with exception of coastal location CZ9 and the estuary of Salak river which showed slight pollution. Based on the Malaysian Marine Water Quality Index, it was observed that all the locations were in the classification group of moderate (i.e. 50–79%). This suggests that the estuaries of selected rivers can be used for natural resource conservation, while the coastal regions are good for fish farming.

Conclusion
It can be deduced that the suggested techniques were workable and logical. The method developed and the information in this study can serve as a reference and decision support for scientists and policymakers of concern.
Landscape Analysis of Breast Cancer and Acute Myeloid Leukemia Trials Using the My Cancer Genome Clinical Trial Data Model
Authors: Jain Neha M. , Holt Marilyn , Micheel Christine , Levy Mia 
Published: September 2021

PURPOSE The field of oncology is expanding rapidly. New trials are opening as an increasing number of therapeutic agents are being investigated before they can become approved therapies. Aggregate views of these data, particularly data associated with diseases, biomarkers, and drugs, can be helpful in understanding the trends in current research as well as existing gaps in cancer care. METHODS In this paper, we performed a landscape analysis for breast cancer and acute myeloid leukemia related trials with structured, curated data from clinical trials using the My Cancer Genome clinical trial knowledgebase. RESULTS We have performed detailed analytics on breast cancer (N = 1,128) and acute myeloid leukemia trial sets (N = 483) to highlight the top biomarkers, drug classes, and drugs—thereby supporting a full view of biomarkers, biomarker groups, and drugs that are currently being explored in these respective diseases. CONCLUSION Analysis and data visualization of the cancer clinical trial landscape can inform strategic planning for new trial designs and trial activation at a particular site.
Transportation barriers to health care and mortality risk among the U.S. adults with history of cancer.
Authors: Jiang Changchuan , Deng Lei , Wang Qian , Perimbeti Stuthi , Han Xuesong 
Published: September 2021

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

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

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

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

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

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

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