bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers to providing palliative care to patients with advanced cancer: A province-wide survey of oncology clinicians’ perceptions.
Authors: Watanabe Sharon , Dunn Sharlette , Earp Madalene , Shirt Lisa , Biondo Patricia , Cheung Winson , Kerba Marc , Tang Patricia A. , Sinnarajah Aynharan , Simon Jessica 
Published: November 2018

88 Background: Despite known benefits, cancer care systems struggle to provide early, integrated palliative care (PC). Previously, we identified barriers to providing early PC as perceived by gastrointestinal oncology clinicians in Alberta, Canada (top barrier: time/competing priorities). Here, we expand on the previous study to better understand barriers to early PC for clinicians working with all tumor groups across Alberta. Methods: A 33-item survey was emailed to oncology clinicians in Alberta between November 2017 - January 2018. Questions were informed by Michie’s Theoretical Domains Framework (TDF) and Behaviour Change Wheel (BCW) and queried (a) providing PC in oncology clinics, (b) referral to specialist PC consultation, and (c) working with PC consultants and homecare. Results: Respondents (n = 268) were nurses (42%), physicians (25%), and allied health professionals (20%). Barriers most frequently identified were "patients’ negative perceptions of PC” (68%), “my limited time/competing priorities” (66%), and "capability to manage patients’", social (65%) and spiritual (63%) concerns. These factors map to all three BCW domains: motivation, opportunity, and capability. In contrast, least frequently identified barriers were in clinician’s own motivation, e.g. perceived benefits of PC. There were few significant differences in response by tumor group or profession (χ2 test, responses coded: disagree [1-3], neutral [4], agree [5-7]). Most notably, tumor groups differed in their perception that “the criteria for PC services are too restrictive” (p = 0.003), while nurses and allied staff reported that patients’ negative perception of PC is a barrier more frequently than physicians (p = 0.003). Conclusions: Surveying across clinicians and tumor groups using Michie’s TDF/BCW revealed that the challenges to an early integrated PC approach include all three sources of behavior, though not equally for all clinicians. Determining this has allowed us to tailor multifaceted interventions, e.g. tip sheets to enhance capability, re-framing PC with patients, and earlier secondary PC nursing access, to enhance clinicians use and patients benefit from an early PC approach.
Residents' attitudes and beliefs towards palliative care in a community teaching hospital.
Authors: Shikdar Sufana , Medeiros Noel , Kelly Erin , Ghionni Nicholas , Cassidy Deborah , Green Eric 
Published: November 2018

89 Background: Early integrated palliative care improves the quality of life in patients with cancer. Wong et al. (2016) recently demonstrated that residents and fellows in a university hospital-based large comprehensive cancer center believed palliative care services to be beneficial for patient care. However, there are substantial differences between the clinical learning environments of a university and community teaching hospital. We aim to assess residents' attitudes and beliefs towards palliative care in the oncologic population in a community teaching hospital. Methods: We surveyed all residents (n = 90) in Mercy Catholic Medical Center's internal medicine, transitional year, and general surgery residencies about their knowledge, training, attitudes and beliefs regarding palliative care using a survey modified from Wong et al. (2015). Mercy Catholic Medical Center is a conglomeration of two community teaching hospitals in greater Philadelphia. The factors associated with awareness were analyzed using chi square or fisher exact test and logistic regression. Results: A total of 57 (63%) residents participated. The differences between the knowledge of residents from other specialties were not statistically significant. The awareness was reported more among residents who are American medical graduates (p = 0.03). The majority of the residents believed palliative care was beneficial to patients and families (98%), reduce health care costs (91%), decrease overall symptom burden (86%) and symptomatic management in newly diagnosed cancer (81%). Residents who reported having palliative care training during residency had significantly higher awareness (OR = 2.99, p = 0.04). Conclusions: Our study shows that the attitude and belief of residents at community teaching hospital is similar to the trainees at university teaching hospital. The implementation of palliative care rotation for all residents from clinical specialties can be effective in improving trainee’s attitude and belief regarding increased and early referral to palliative care.
The patient specific functional scale in outpatient cancer rehabilitation.
Authors: Sangermano Sarah , Pugh Terrence , Raj Vishwa 
Published: November 2018

94 Background: Cancer rehabilitation is an underutilized service within the oncology care spectrum. Approximately 65% of survivors have functional impairments, while only 6% receive services. The effectiveness of cancer rehabilitation must be demonstrated to increase access to care, however there are no nationally recognized outcome tools for use with the oncology population across therapy disciplines. The Patient Specific Functional Scale (PSFS) is validated for use in many traditional rehabilitation populations, and has been referenced in one study with breast cancer patients. The purpose of this quality improvement project was to investigate the utility of the PSFS with cancer patients seen in an outpatient therapy setting. Methods: The PSFS was selected for its comprehensiveness and the ability to use across rehabilitation therapy disciplines. The PSFS measures patient perception of functional improvement during rehabilitation. Patients select up to three limiting activities and rate them on an 11-point scale. An average score is computed. Occupational, physical, and speech therapists were trained on administration, scoring, and reporting of the PSFS. The initial score was obtained at evaluation and the final score was collected during the last treatment session. PSFS scores were collected over a one-year period. Results: 307 new patients were evaluated in the outpatient clinic and 65 of those patients completed the PSFS at both the initial and final visits. Most patients had breast, prostate, and brain cancers. Barriers to completion of PSFS included patients not being appropriate for treatment, therapist compliance with the tool, and patients not returning for their final therapy appointment. Of the 65 patients, 86% reported the minimal clinically important change of 2-points or greater. The average increase in PSFS score was 3.7 points. Conclusions: The PSFS was successfully utilized in the outpatient rehabilitation setting with oncology patients. Therapists perceived the tool as quick, patient-centered, and easy to use. Patients showed functional improvement using the PSFS. Further research is necessary to understand the psychometric properties of the PSFS with the oncology population.
Palliative care physicians' beliefs toward hematology and the care of patients with hematologic diseases: Results of a nationwide survey.
Authors: Santivasi Wil Leonard , Wu Kelly , Litzow Mark Robert , LeBlanc Thomas William , Strand Jacob J 
Published: November 2018

95 Background: Palliative care (PC) specialists provide supportive care for patients with hematologic diseases (HD). However, the degree of engagement by PC physicians may be limited by the views of both PC physicians & hematologists. Prior studies have surveyed hematologists to identify barriers to delivery of PC, however PC physician views are unclear. This study aimed to examine views of PC physicians toward hematology. Methods: A survey was mailed to a random sample of the AAHPM physician contact list in 2017. Items focused on perceptions of their understanding of HD, comfort providing care, opinions regarding PC & hospice involvement, & beliefs about hematologists. Anonymized responses were assessed on a Likert scale. Statistical testing was based on logistic regression models with generalized estimating equations to account for correlated data within respondents. Results: 538 of 1000 surveys were completed. 51.9% of respondents were male. Community (37.2%), academic (36.7%) & hospice (26.2%) physicians were represented. Respondents were likelier to believe they understand the trajectories of lymphoma & myeloma than leukemia or patients undergoing hematopoietic stem cell transplantation (HSCT) (p < 0.001). They were more comfortable discussing prognosis (p < 0.001) & managing symptoms (p < 0.001) in lymphoma & myeloma than leukemia & HSCT. They were likelier to believe that hematologists’ perceptions of PC physicians limit collaboration rather than their own views of hematologists (p < 0.001). 80.2% agreed that hospice referrals are not made early enough. Conclusions: PC physicians’ understanding of trajectories & comfort caring for patients varies by hematologic disease. They perceive that hematologists’ perceptions are a larger barrier than their own & hospice referrals are delayed. These results provide insights into opportunities for better collaboration with hematologists.
Effect of dietary additives on intestinal permeability in both Drosophila and a human cell co-culture
Authors: Pereira Matthew T. , Malik Mridu , Nostro Jillian A. , Mahler Gretchen J. , Musselman Laura Palanker 
Published: November 2018

ABSTRACT
Increased intestinal barrier permeability has been correlated with aging and disease, including type 2 diabetes, Crohn's disease, celiac disease, multiple sclerosis and irritable bowel syndrome. The prevalence of these ailments has risen together with an increase in industrial food processing and food additive consumption. Additives, including sugar, metal oxide nanoparticles, surfactants and sodium chloride, have all been suggested to increase intestinal permeability. We used two complementary model systems to examine the effects of food additives on gut barrier function: a Drosophila in vivo model and an in vitro human cell co-culture model. Of the additives tested, intestinal permeability was increased most dramatically by high sugar. High sugar also increased feeding but reduced gut and overall animal size. We also examined how food additives affected the activity of a gut mucosal defense factor, intestinal alkaline phosphatase (IAP), which fluctuates with bacterial load and affects intestinal permeability. We found that high sugar reduced IAP activity in both models. Artificial manipulation of the microbiome influenced gut permeability in both models, revealing a complex relationship between the two. This study extends previous work in flies and humans showing that diet can play a role in the health of the gut barrier. Moreover, simple models can be used to study mechanisms underlying the effects of diet on gut permeability and function.
This article has an associated First Person interview with the first author of the paper.
Mobile money and branchless banking regulations affecting cash-in, cash-out networks in low- and middle-income countries
Authors: Reynolds Travis W. , Klawitter Marieka , Biscaye Pierre E. , Anderson C. Leigh 
Published: November 2018

Background: We examined recent trends in mobile money and branchless banking regulations related to cash-in, cash-out (CICO) networks (physical access points allowing users to exchange physical cash and electronic money) in low- and middle-income countries, and reviewed evidence on the impacts of CICO regulations on markets and financial inclusion. Methods: Regulation and literature searches began in August 2017 and concluded in June 2018. For the regulatory search we compiled an original database of regulations targeting CICO networks in Bangladesh, India, Indonesia, Kenya, Nigeria, Pakistan, Tanzania, and Uganda. To review evidence of impacts of regulations we conducted additional global searches on Scopus, Google Scholar, and Google using keywords for specific regulatory approaches (e.g., regulation of CICO agents) or hypothesized impacts (e.g., financial inclusion). Results: The resulting database of CICO regulations in the eight focus countries includes 127 regulatory documents, which we coded for four groups of regulations, namely: Business Channel Requirements; Agent Requirements; Regulations on Caps, Fees and Charges; and Customer Identification Requirements. Early CICO regulations focused on agent selection rules, limits on fees, and know-your-customer requirements. More recent waves of regulation have expanded or restricted services CICO agents provide, and also imposed reporting requirements on service providers in an effort to prevent fraud or enhance financial inclusion. Our search for evidence of impacts of CICO regulations resulted in a sample of 90 documents published since 2005, of which only 31 provided evidence on CICO regulation impacts, with most limited in scope—suggesting rigorous policy analysis remains lacking in this quickly expanding sector. Conclusions: Many low- and middle-income countries have introduced regulations that may affect CICO networks, with regulatory approaches differing across geographies and over time. While anecdotal reports of regulatory impacts exist, we found limited evidence of impacts of regulations on CICO networks or on CICO-related financial inclusion.
Molecular characterization of rotavirus group A strains circulating prior to vaccine introduction in rural coastal Kenya, 2002-2013
Authors: Owor Betty E. , Mwanga Mike J. , Njeru Regina , Mugo Robert , Ngama Mwanajuma , Otieno Grieven P. , Nokes D.J. , Agoti C.N. 
Published: November 2018

Background: Kenya introduced the monovalent Rotarix® rotavirus group A (RVA) vaccine nationally in mid-2014. Long-term surveillance data is important prior to wide-scale vaccine use to assess the impact on disease and to investigate the occurrence of heterotypic strains arising through immune selection. This report presents baseline data on RVA genotype circulation patterns and intra-genotype genetic diversity over a 7-year period in the pre-vaccine era in Kilifi, Kenya, from 2002 to 2004 and from 2010 to 2013. Methods: A total of 745 RVA strains identified in children admitted with acute gastroenteritis to a referral hospital in Coastal Kenya, were sequenced using the di-deoxy sequencing method in the VP4 and VP7 genomic segments (encoding P and G proteins, respectively). Sequencing successfully generated 569 (76%) and 572 (77%) consensus sequences for the VP4 and VP7 genes respectively. G and P genotypes were determined by use of BLAST and the online RotaC v2 RVA classification tool. Results: The most common GP combination was G1P[8] (51%), similar to the Rotarix® strain, followed by G9P[8] (15%) , G8P[4] (14%) and G2P[4] (5%). Unusual GP combinations—G1P[4], G2P[8], G3P[4,6], G8P[8,14], and G12P[4,6,8]—were observed at frequencies of <5%. Phylogenetic analysis showed that the infections were caused by both locally persistent strains as evidenced by divergence of local strains occurring over multiple seasons from the global ones, and newly introduced strains, which were closely related to global strains. The circulating RVA diversity showed temporal fluctuations both season by season and over the longer-term. None of the unusual strains increased in frequency over the observation period. Conclusions: The circulating RVA diversity showed temporal fluctuations with several unusual strains recorded, which rarely caused major outbreaks. These data will be useful in interpreting genotype patterns observed in the region during the vaccine era.
Cytogenetic features of sexual and asexual Limonium taxa (Plumbaginaceae)
Authors: Caperta Ana D. , Conceição Sofia I.R. , Rõis Ana S. , Loureiro João , Castro Sílvia 
Published: November 2018

AbstractThe genus Limonium (sea lavenders) is characterized by various taxonomically challenging complexes with great karyological diversity, and chromosomes ranging in size from diminutive to large. In this biosystematic study, our goal was to investigate cytogenetic features of twelve sexual and asexual taxa in a particular part of their distribution range. Genome size, chromosome number variation, and other cytological features were investigated in a representative set of sea lavenders with distinct leaf venation, present in the coastal areas of the Iberian Peninsula, Morocco, France, and the Channel Islands. Flow cytometric genome size determinations were made in plants from natural populations. Cell and nuclear areas of epidermal cells, as well as, chromosome numbers and length were measured in plants from ex situ collections. Our findings revealed positive and significant correlations between holoploid genome size and cell size, nuclei area and chromosome total length. Tetraploid taxa with pinnately veined leaves had significant lower holoploid and monoploid genome sizes along with lower cell and nuclei areas and chromosome sizes than tetraploid taxa with parallel‐veined leaves. The results obtained are discussed in the context of breeding relationships known or suspected among these taxa. In conclusion, our results provide a basis for future evolutionary studies, and support that pollen‐stigma dimorphisms and genome size allied with chromosome counts might be important taxonomic traits in Limonium in apomictic/sexual groups.
Mathematical Programming Algorithms for Spatial Cloaking
Authors: Ceselli Alberto , Damiani Maria Luisa , Righini Giovanni , Valorsi Diego 
Published: November 2018

We consider a combinatorial optimization problem for spatial information cloaking. The problem requires computing one or several disjoint arborescences on a graph from a predetermined root or subset of candidate roots, so that the number of vertices in the arborescences is minimized but a given threshold on the overall weight associated with the vertices in each arborescence is reached. For a single arborescence case, we solve the problem to optimality by designing a branch-and-cut exact algorithm. Then we adapt this algorithm for the purpose of pricing out columns in an exact branch-and-price algorithm for the multiarborescence version. We also propose a branch-and-price-based heuristic algorithm, where branching and pricing, respectively, act as diversification and intensification mechanisms. The heuristic consistently finds optimal or near optimal solutions within a computing time, which can be three to four orders of magnitude smaller than that required for exact optimization. From an application point of view, our computational results are useful to calibrate the values of relevant parameters, determining the obfuscation level that is achieved. The online supplement is available at https://doi.org/10.1287/ijoc.2018.0813 .
UNIFORMIDADE DE DISTRIBUIÇÃO DE LÍQUIDO E DE AR AO LONGO DA BARRA DE PULVERIZAÇÃO
Authors: Baesso Murilo Mesquita , Teixeira Mauri Martins , Vieira Rogério Faria , De Paula Junior Trazilbo José , Cecon Paulo Roberto 
Published: November 2018

O desenvolvimento de novas tecnologias de aplicação de fitossanitários visa à redução da contaminação ambiental, da deriva, do volume de calda com aumento da segurança do aplicador e melhoria da deposição da calda, para melhorar a qualidade da pulverização. O objetivo deste trabalho foi avaliar a uniformidade de distribuição de ar ao longo da barra de pulverização com assistência de ar, bem como avaliar a uniformidade de distribuição de líquido de bicos de pulverização
hidráulica de jato cônico vazio, modelo JA-4, marca Jacto, além de bicos de jato leque, modelo AXI-110-04, marca Jacto, trabalhando com quatro velocidades de rotação do ventilador e três alturas da barra de pulverização em relação à bancada de ensaios. A rotação do eixo do ventilador que apresentou os melhores resultados foi a de 2.100 rpm. Os perfis de distribuição do ar foram irregulares, e as distribuições do vento a 0,5 m da barra apresentaram coeficientes de variação menores que as obtidas quando a barra estava a 0,3 m do ponto de leitura.
NOTA TÉCNICA: DESENVOLVIMENTO DE DISPOSITIVO ELETRÔNICO PARA MARCAÇÃO AUTOMÁTICA DO PONTO DE TRAÇAMENTO DA MADEIRA POR UMA GARRA TRAÇADORA
Authors: Fernandes Haroldo Carlos , Lopes Sebastião Eudes , Teixeira Mauri Martins , Minette Luciano José , Rinaldi Paula Cristina Natalino 
Published: November 2018

Este trabalho foi conduzido em povoamentos de eucalipto de uma empresa florestal do Estado de Goiás, com o objetivo de desenvolver dispositivo eletrônico para marcação automática do ponto de traçamento da madeira. O trator utilizado neste trabalho foi uma escavadora hidráulica, modelo 320 CL, fabricante caterpillar, com 103 kW de potência nominal do motor. Para o controle do ponto de traçamento dos toretes, foram utilizados um contador
controlador programável, um gerador de pulsos e um sensor de proximidade do tipo indutivo. De acordo com os resultados, conclui-se que os valores encontrados para os comprimentos dos toretes quando medidos pelo dispositivo eletrônico e pela tora padrão ficaram próximos do desejado. O sensor utilizado não foi capaz de zerar automaticamente os valores quando o operador ultrapassou a medida desejada. O dispositivo ainda necessita de ajustes principalmente quanto ao tempo de traçamento.
NOTA TÉCNICA: ISOTERMA DE ADSORÇÃO DE FÓSFORO EM PÓ COLETADO NO SISTEMA DE TRATAMENTO DE EFLUENTES ATMOSFÉRICOS GERADOS EM INDÚSTRIA SIDERÚRGICA
Authors: Matos Antonio Teixeira de , Costa Neto André M. , Martins Marcio Arêdes , Matos Mateus Pimentel de 
Published: November 2018

O pó coletado no sistema de tratamento dos efluentes atmosféricos do alto-forno é considerado um resíduo de difícil disposição final, em decorrência das grandes quantidades produzidas e de seu potencial poluente para o meio ambiente. Objetivou-se, com a realização deste trabalho, caracterizar física, química e mineralogicamente o pó coletado no sistema de tratamento dos efluentes atmosféricos de alto-forno em indústria siderúrgica, avaliar sua capacidade em adsorver fósforo, e obter a isoterma de adsorção que melhor ajuste proporcionar aos dados obtidos. A concentração total de Cd, Cr, Cu, Mn, Ni, Pb, Zn, Fe, Al, Mg, Ca, K e P foi obtida após digestão nítrico-perclórico da amostra e quantificação da
concentração em solução utilizando-se espectrometria de absorção atômica. A análise mineralógica foi feita utilizando-se um Difratômetro de raio X. O resíduo apresentou altos teores de Fe, Ca, Cr e Mg, além de alto pH, sendo constituído predominantemente por hematita e magnetita, além de grande capacidade de adsorção de fósforo. Os modelos de Langmuir e Freundlich se ajustaram razoavelmente bem aos dados para representar a isoterma de adsorção.