bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subcutaneous administration at home for symptom management in palliative care.
Authors: Rodriguez Luisa Fernanda , Consuegra Pareja Cesar Antonio , Bastidas Alirio , Leon Marta Ximena , Umbacia Alejandra , Garcia Andrea , Moreno Juan Pablo , Bruera Eduardo 
Published: November 2018

49 Background: Patients who require home-based palliative care have advanced complex illnesses with functional limitations and decline. Subcutaneous administration of drugs and hydration is a possible alternative when oral intake is hampered. This observational study characterized the use of subcutaneous catheters at a home based palliative care program in Bogotá, Colombia. Methods: Consecutive medical records from September 1, 2017 to February 28, 2018 were reviewed for 272 patients at a home based palliative care program who received subcutaneous administration of drugs and/ or hydration. Statistical analysis was performed to describe the characteristics of the population and its relation to the use of subcutaneous catheters using SPSS tool. Results: The mean age was 72 years (SD: 18), 163 (60%) were females, with a mean in Barthel Index 20 (SD:22), Karnofsky Performance Status Scale 36 (SD: 9.6), PPS of 36 (SD: 11), and PPI 6 (SD: 3.4). The mean time for subcutaneous use was of 34 days (SD: 52). The main indication for the subcutaneous route was poor symptom control in 162 (60%), and because of reduced oral intake in 107 (39%). The administration of drugs was done by a family member in 207 (76%), all trained by a nurse (spouse 14%, offspring 52%, others 34%). The mean number of drugs used per catheter was 3,7 (SD: 1,7). The most common opioid was hydromorphone (57%) followed by morphine (35%). Other medications used were haloperidol (59%) and midazolam (23%). The most common site of application was the upper right extremity. The change of the catheter due to dysfunction was made in 98 (36%) subjects, due to infection in 9 (3.3%) of the 272 patients and 1.5% of 594 catheter insertions. An association with catheter dysfunction was found after multivariate analysis of the time of catheter use and the number of medications. 240 patients (88.2%) died with the catheter in place. Conclusions: Subcutaneous administration of hydration and drugs when used with proper education, training, and followed up by home care programs is a useful strategy for delivering care at home for optimal symptom control for patients receiving palliative care.
The impact of emergency general surgery on end-of-life care among older patients with metastatic cancer.
Authors: Lee Katherine C , Lilley Elizabeth J. , Sturgeon Daniel , Lipsitz Stuart R. , Havens Joaquim M , Roeland Eric , Cooper Zara 
Published: November 2018

56 Background: Despite high post-discharge mortality among older patients with metastatic cancer who undergo emergency general surgery (EGS), little is known about the impact of EGS on the type of end-of-life care received. We sought to examine the association between EGS and established markers of high intensity or poor quality end-of-life care for cancer patients. Methods: This retrospective cohort study used 2001-2013 Surveillance, Epidemiology, and End Results-Medicare to identify beneficiaries 65 years or older, diagnosed initially with stage IV cancer (lung, colorectal, breast, ovarian, pancreatic, or melanoma), who received one of the seven highest-burden EGS operations, and died within 180 days of surgery. Non-EGS controls were exact-matched by age, sex, race, cancer type, and cancer diagnosis date then assigned a pseudo-exposure date corresponding to the EGS date. Conditional logistic regression adjusting for region and Charlson score was performed among pairs discharged alive to compare location of death (facility or home/hospice), healthcare utilization (hospitalization, intensive care unit (ICU) stay, emergency department (ED) visit) in the last 30 days of life, and hospice use (death in hospice, hospice enrollment less than three days from death). Results: Among 1,129 matched pairs, EGS patients had higher odds of death in facility (OR [95% CI]: 1.29 [1.05 - 1.58]) as well as hospitalization (1.83 [1.54 - 2.18]), ICU stay (2.05 [1.66 - 2.53]) or ED visit (1.76 [1.47 - 2.10]) in the last 30 days of life compared to non-EGS patients. EGS patients had higher odds of dying in hospice (1.22 [1.02 - 1.45]), but also experienced higher odds of hospice enrollment less than three days from death (1.72 [1.20 - 2.46]). Conclusions: Older patients with metastatic cancer who survive EGS experienced higher intensity end-of-life care than similar non-EGS patients. Such EGS patients may benefit from targeted interventions during the emergent hospitalization to improve the end-of-life care received.
When is the best time to transfer terminally ill cancer patients from hospitals to palliative hospice home care? Analysis of a questionnaire survey of 1,055 surviving families.
Authors: Nakajima Maria Michiko , Nakajima Shuhei James , Horikoshi Noboru , Isogawa Akihiro , Kondo Yurin , Nakajima Go , Takeshita Nobuhiro , Kawakami Kazuyuki , Suga Shigehiro , Nakajima Michiko , Hayashi Kazuhiko 
Published: November 2018

61 Background: It is difficult to know when the best timing is to transfer terminally ill cancer patients from hospitals to palliative hospice home care for their quality of life to death. This study aimed to articulate the best time for medical teams working in hospitals to refer their terminally ill cancer patients to palliative home care. Methods: A statistical analysis of a survey was conducted with 1,055 surviving families whose members had died with palliative home care from 1995 to 2014. The questionnaire included the following 8 contents: 1. transfer timing from hospitalization to the home care; A. appropriate, B. too late, C. too early; and the contextual items ware, 2. peacefulness of patient at dying, 3. peacefulness of patient all through the care, 4. physical pain, 5. mental pain, 6. spiritual pain, 7. alleviation of family sufferings, 8. satisfaction of family as care-givers. The response rate is 31% (311 persons). However, we excluded responses without names on the questionnaire, of non-cancer patients, with death location out of home, and without answer to question 1, resulting in 166 responses for analysis. Results: Focusing on the question 1, number of responders are A; 113 (68%), B; 52 (31%), C; 1 (0.6%). The medians of home care days to death are A; 66, B; 23, C; analysis impossible. Comparison of respondents’ satisfaction according to number of days of palliative home care revealed that 89.4% people with two months or more before their patients’ death were satisfied (A), while 10.6% of those who had less than two month were unsatisfied (B+C). Conclusions: Most surviving families were satisfied if they had two months or more for palliative home care. This survey suggests the relevancy to start preparation for discharge that enables the patients to stay home with their family members for two months or more. [Table: see text]
Patterns of anti-cancer therapy use in the last 14 days of life in a community cancer institute.
Authors: McNaughton Caitlyn , Lynch Selah , Newport Kristina Braine , Wong Riley , Svetec Sarah , Moore Jason , Holliday Rachel , Oyer Randall A. , Sivendran Shanthi 
Published: November 2018

66 Background: Studies have shown that aggressive cancer care at end of life is associated with decreased quality of life, decreased median survival, and increased cost of care. This study describes the patients most likely to receive aggressive anti-cancer therapy at the end of life in a community cancer institute. Methods: We performed a retrospective review of 213 patients who received anti-cancer therapy in our institution and died between July 2016-April 2017. Data collected included primary malignancy, death date, date of last anti-cancer treatment, hospice enrollment, healthcare utilization, Oncology Care Model (OCM) enrollment, and clinical assessments at last office visit prior to a treatment decision before death. Data were analyzed using univariate logistic regression to determine feature importance. Results: Of the 201 patients who died of cancer, 36 (17%) received anti-cancer therapy within the last 14 days of life. Several factors were significantly positively correlated with receiving anti-cancer therapy at end of life, including enrollment in OCM (p < 0.001), frequency of hospital utilization (p < 0.001), death in hospital (p<0.001), referral to hospice (p<0.001), and hematologic malignancy (p = 0.014). Conclusions: In our community cancer institute, enrollment in OCM, frequency of hospitalizations, death in a hospital, referral to hospice, and hematologic malignancy diagnosis were predictive of receiving aggressive anticancer therapy at the end of life, suggesting that these factors should have greater importance in our clinic. Taken as a whole, these data will help inform clinicians and patients in choices regarding care near the end of life.
Goals of care and advanced care planning in phase I trials.
Authors: Ferrell Betty R. , Borneman Tami R. , Williams Anna Cathy , Chung Vincent , Koczywas Marianna , Smith Thomas J. 
Published: November 2018

80 Background: Cancer patients participating in phase 1 clinical trials often represent a population with advanced disease, symptoms and QOL impact from disease and treatment. This analysis was conducted using data from a randomized trial in progress testing a palliative care intervention for solid tumor patients on phase 1 trials to evaluate goals of care and advance care planning. Methods: In this analysis, the investigators evaluated chart audit data from patients at baseline and six months after initiating a phase 1 trial. Results: Patients (N = 284) were at a mean age of 60, 56% were female and 32% were ethnic minorities. Predominant diagnoses were lung cancer (18%), colon (15%), and pancreatic (12%) cancers. Thirty six percent (36%) of these patients died within six months of initiating the phase 1 trial. At six months post trial initiation, forty four percent (44%) had no advanced care plan and 58% remained full code status. Forty four percent of those who died were full code status. Forty five percent had no documented goals of care conversation and 32% had no proxy decision maker. Thirteen percent (13%) of those who died received chemotherapy in the last two weeks of life. Only forty four percent (44%) of those who died received hospice care and only fifty seven percent (57%) had received palliative care referrals. Conclusions: This data supports the need for palliative care for cancer patients on phase 1 cancer trials. There are important opportunities to integrate palliative care with cancer clinical trials for best supportive care of these patients.
A simple system for symptom assessment in pediatric palliative care patients with cancer: A preliminary report.
Authors: Madden Kevin , Charone Maira , Dibaj Seyedeh , Mills Sarah , Williams Janet L. , Liu Diane D. , Bruera Eduardo 
Published: November 2018

81 Background: Systematic symptom assessment is not a standard of care in children with cancer. Many well-known symptom assessment tools are lengthy or difficult to integrate into a daily pediatric palliative care practice. We created a series of brief and simple questions to be systematically given to children and their caregivers. The primary objective was to determine the percentage of eligible children and caregivers exposed to the questions that were able to complete the assessment. Secondary objectives included documenting the symptom burden at time of consultation, evaluating the level of agreement in symptom reporting between children and caregivers, as well as between children/caregivers and the referring medical team. Methods: A series of systematic questions were presented to all caregivers (if present) and children who were 7 years of age or older at time of initial consultation with pediatric palliative care. Results: 122 consecutive children and caregivers were given the survey. 107/108 (99%) of eligible caregivers and 83/97 (86%) of eligible children successfully completed the survey. Lack of appetite (child – 72/83, 87%; caregiver – 89/107, 83%) and pain (child – 71/83, 86%; caregiver – 86/107, 80%) were the most commonly reported symptoms. Caregivers reported irritability (p = 0.005) and nervousness (p < 0.0001) more frequently than children. Referring medical teams significantly under-diagnosed psychological and other less clinically evident symptoms such as anorexia, fatigue, and insomnia (p < 0.0001). Conclusions: Our series of questions is easy to complete by children and caregivers. Systematic symptom assessment of children with cancer needs to become a true standard of care.
Preparing oncology advanced practice nurses (OAPRNs) to provide primary palliative care (PC).
Authors: Ferrell Betty R. , Malloy Pam , Mazanec Polly , Paice Judith A. , Coyne Patrick J. , Thaxton Cheryl , Virani Rose 
Published: November 2018

84 Background: A major public health concern is the recognition of the growing demand for PC in oncology practice. Despite proven benefits, there is often no system in place to provide concurrent palliative and oncology care. Oncology patients and families often report psychological and social stress from cancer care impacted by unmet information and care coordination needs. OAPRNs within cancer centers can provide models of leadership which facilitate systems and organizational changes to provide the best quality PC for oncology patients. Methods: This unique skills-based innovative program/curriculum, supported by R25 funding from NCI, is designed to educate OAPRNs to provide primary PC in oncology practice. Five national workshops will be conducted 2018 - 2021. The participants are competitively selected from NCI designated and community cancer centers depending on goals and the commitment to partner with a specialty palliative care team. All participants will be followed at 6 and 12 months regarding challenges and opportunities in developing/instituting primary palliative care in their oncology practice/institution. Results: The first national workshop was held April 2018, N = 69 representing 23 states, with post course evaluations rating [on a scale of 1 = low to 5 = high] that the materials and resources were applicable to their practice as 4.94, and information stimulating and thought provoking regarding palliative care issues as 4.95. This presentation will report on the OAPRNs’ 6 month post-course outcomes, which will reflect on the challenges and opportunities in implementing skills as primary PC providers within their institutions. This presentation will also report on monthly webinars that reinforce content and enable the OAPRNs to share experiences in implementing primary PC, in order to foster professional networking. Conclusions: This unique educational offering will provide practicing OAPRNs with the knowledge and skills to provide primary palliative care to facilitate systems and organizational changes for quality PC within oncology settings.
Perspectives and attitudes toward the integration of oncology and palliative care in Japan: Qualitative analysis of a nationwide survey.
Authors: Uneno Yu , Nishimura Mayumi , Ito Satoko , Morita Tatsuya , Sato Kazuki , Mori Masanori , Shimizu Chikako , Horie Yoshiki , Hirakawa Mami , Nakajima Takako Eguchi , Tsuneto Satoru , Muto Manabu 
Published: November 2018

96 Background: The integration of oncology and palliative care (IOP) is an emerging issue that has been encouraged by several agencies, including the American Society of Clinical Oncology. Despite such efforts, clinical implementation of IOP is evolving slowly. One key barrier to implementation is the lack of institutional support; however, recognition of IOP by the heads of hospitals has rarely been investigated. Methods: This was a secondary qualitative analysis of a nationwide survey, which was performed in November 2017 to clarify the current status of IOP in Japan. The questionnaires were distributed to all designated cancer hospitals (DCHs) (n = 399) and randomly sampled non-DCHs (n = 478). This survey included a free text query asking executives or directors of oncology departments at cancer hospitals to describe their opinions about encouragement of IOP in Japan (i.e., importance or challenges of IOP). In total, 174 hospitals (20.2%) responded to the free text query (106 DCHs and 68 non-DCHs). Contents analysis was performed using the free text data. Results: Three major categories emerged from the descriptive data: (1) perceptions and attitudes toward IOP, (2) perceived barriers to IOP, and (3) perceived facilitators of IOP, which possessed two, nine, and eight minor categories, respectively. Of these minor categories, there were both affirmative and contradictory opinions toward IOP. Reluctant attitudes of patients, caregivers, health care professionals, and hospital heads; limited clinical resources, process, and political support; and specific clinical circumstances in Japan were identified as perceived barriers. Education, improvement of clinical resources and process, and political initiatives were identified as perceived facilitators. Conclusions: Comprehensive perceptions, attitudes, challenges, and solutions regarding IOP were proposed. Such data may provide healthcare professionals and policymakers with greater understanding of how to encourage IOP in Japan.
The male gamete membrane protein DMP9/DAU2 is required for double fertilization in flowering plants
Authors: Takahashi Taro , Mori Toshiyuki , Ueda Kenji , Yamada Lixy , Nagahara Shiori , Higashiyama Tetsuya , Sawada Hitoshi , Igawa Tomoko 
Published: November 2018

ABSTRACT
All flowering plants exhibit a unique type of sexual reproduction called ‘double fertilization’ in which each pollen tube-delivered sperm cell fuses with an egg and a central cell. Proteins that localize to the plasma membrane of gametes regulate one-to-one gamete pairing and fusion between male and female gametes for successful double fertilization. Here, we have identified a membrane protein from Lilium longiflorum generative cells using proteomic analysis and have found that the protein is an ortholog of Arabidopsis DUF679 DOMAIN MEMBRANE PROTEIN 9 (DMP9)/DUO1-ACTIVATED UNKNOWN 2 (DAU2). The flowering plant DMP9 proteins analyzed in this study were predicted to have four transmembrane domains and be specifically expressed in both generative and sperm cells. Knockdown of DMP9 resulted in aborted seeds due to single fertilization of the central cell. Detailed imaging of DMP9-knockdown sperm cells during in vivo and semi-in vitro double fertilization revealed that DMP9 is involved in gamete interaction that leads to correct double fertilization.
Limonium homoploid and heteroploid intra‐ and interspecific crosses unveil seed anomalies and neopolyploidy related to sexual and/or apomictic reproduction
Authors: Conceição Sofia I.R. , Rõis Ana Sofia , Caperta Ana D. 
Published: November 2018

AbstractApomixis is a form of asexual reproduction that consists in cloning through seeds. In Limonium (Plumbaginaceae) species present a pollen–stigma dimorphism linked to a sporophytic self‐incompatibility system associated with sexual and/or apomictic reproductive modes. Previous work in other genera suggests that the emergence of apomixis is associated with hybridization and/or polyploidy. In this study, our goal was to test the ability of diploid and tetraploid species to hybridize and to evaluate the variate outcomes from these crosses. To achieve this, sexual diploid (L. nydeggeri, L. ovalifolium) and facultative apomict tetraploid (L. binervosum, L. dodartii) plants from cultivated material, previously cytogenetically and reproductively characterized, were used for experimental intra‐ and interspecific crosses. Genome sizes, ploidy levels and morphology were examined in the resulting progenies. Results showed a high production of viable seeds in particular in plants from tetraploid × diploid (heteroploid) crosses. In these crosses, some seedlings exhibited pleiocotyly (tricotyl, tetracotyl), while others showed polyembryony. In both homoploid (diploid × diploid) and heteroploid (tetraploid × diploid) crosses, most of the offspring plants were morphologically and in their ploidy similar to the female receiver, although some morphological abnormalities were found. Molecular progeny tests using the nrDNA ITS1‐ITS2 sequence demonstrated an astounding range of diploid offspring plants originated from diploid × diploid crosses that were either genetically similar or distinct from parental plants. Although in intraspecific crosses most of the resulting progeny was diploid, one triploid plant was formed. Moreover, in homoploid interspecific crosses, neopolyploids (two tetraploid plants) were produced. Progeny plants from heteroploid crosses always showed nrDNA ITS1‐ITS2 sequences identical to the parental plant used as female receiver. In conclusion, diploid homoploid crosses presented genetically diverse offspring arising from sexual reproduction. By contrast, heteroploid crosses generated clonal, maternal (apomictic) offspring.
POTENCIAL HIDRÁULICO EM BACIAS HIDROGRÁFICAS I: IDENTIFICAÇÃO DE QUEDAS DE ÁGUA PARA GERAÇÃO DE ENERGIA ELÉTRICA
Authors: Faria Filho Reynaldo Furtado , Silva João Batista Lopes da , Ferreira Paulo Afonso , Euclydes Humberto Paulo , Oliveira Filho Delly 
Published: November 2018

Neste trabalho foram utilizados os Sistemas de Informações Geográficas, a fim de desenvolver uma metodologia para identificar, em sub-bacias, seções com potencial para geração de energia hidrelétrica. O estudo foi desenvolvido na sub-bacia do rio Turvo Sujo, bacia do rio Doce. Para obter o modelo digital de elevação hidrologicamente consistente (MDEHC), utilizaram-se dados de altimetria e hidrografia do IBGE (Instituto Brasileiro de Geografia e Estatística), pontos cotados por levantamento topográfico e dados digitais de altimetria SRTM (Shuttle Radar Topography Mission). Com
esses dados, foram gerados oito MDEHC’s, com duas resoluções espaciais de células, com 5 e 10 m. Os resultados foram satisfatórios para os MDEHC’s obtidos com os pontos cotados e os dados do IBGE, para ambas as resoluções. Utilizando os dados do IBGE e o SRTM, os MDEHC’s obtidos para ambas as resoluções, não apresentaram resultados satisfatórios.
CONFORMIDADE DO POSTO DE OPERAÇÃO DE PULVERIZADORES AUTOPROPELIDOS
Authors: Casali André Luis , Farias Marcelo Silveira de , Schlosser José Fernando , Romano Leonardo Nabaes , Uhry Daniel 
Published: November 2018

As operações com pulverizadores autopropelidos exigem um grande esforço físico e mental dos operadores. A correta disposição dos comandos aumenta, consideravelmente, a eficiência da operação. Em vista disso, este trabalho teve como objetivo identificar e comparar a localização dos comandos de uso frequentes e raros pelo operador em cinco pulverizadores autopropelidos, segundo a norma ISO 15077. Foram medidas as coordenadas dos principais comandos de operação em relação ao SIP (Seat Index Point). A análise revelou que o número de comandos decresce à medida que o nível tecnológico do pulverizador aumenta. Entre os comandos de acionamento frequentes, presentes em todos os pulverizadores, destacam-se os modelos 4730 e Patriot 350, que obtiveram 100% dos comandos dentro da Zona de Conforto nos dois perfis analisados. Os pulverizadores Impactus 2750, Patriot 350 e Gladiador 3000 não obtiveram comandos localizados na zona inacessível em nenhum dos dois perfis analisados. Desta forma, podemos concluir que
os modelos avaliados apresentam grande variação no número dos comandos, que se encontram, na maioria dos casos, dentro da zona de conforto para pulverizadores com maior nível tecnológico e em menor expressão em pulverizadores com menor nível tecnológico.