bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing the Bereaved Family Survey for an advanced cancer population.
Authors: Kaltman Jessica , Walling Anne Margaret , Wenger Neil 
Published: November 2017

76 Background: Despite being endorsed as a National Quality Forum measure, the Bereaved Family Survey (BFS), a tool to assess a patient’s end-of-life (EOL) experience, has not been broadly used outside the Veteran’s Affairs Health System or in the outpatient setting. We adapted the BFS for an advanced cancer population and implemented it at an academic health system to identify areas for quality improvement in EOL care. Methods: Between August 2016 and May 2017, we surveyed caregivers of advanced cancer decedents. We included English-speaking decedents > 18 years of age who were continuity patients of a health system oncologist and had documentation of metastatic disease in either problem list, oncology notes, or advanced imaging. Death was verified in the chart or by obituary found via internet search. Caregivers surveyed were the appointed healthcare agent in an advance directive or the first listed contact. Scoring was done via the top-box approach. Surveys were mailed 3 months after death with a follow-up post-card reminder and phone-call at 2 and 4 weeks, respectively. Results: Of 285 eligible decedents, 242 caregivers were mailed surveys with 83 completed (34% response rate) of whom 28% died in the hospital. Mean overall BFS score was 75 out of 100. Ratings were high for overall care quality (78% Always/Usually) and staff caring (74% Always) with lower ratings for communication (58% Always), emotional/spiritual support (37% Always with 30% not wanting support) and pain control (56% Always/Usually uncomfortable). Nearly 84% of respondents felt their loved one died in the right place and 67% felt staff caring for the patient provided a dignified death. 74% of patients were referred to hospice with 64% of caregivers stating the hospice referral was timely. Write-in responses mentioned concerns about caregiver support, the quality and timeliness of hospice care and communication between physician and patient/caregiver. Over half of statements were positive remarks about a physician or ancillary staff member. Conclusions: A post-mortem survey implemented for an advanced cancer population received a modest response rate but collected valuable information regarding gaps in care quality to drive quality improvement.
Polypharmacy and out-of-pocket medication costs in the last month of life among commercially insured patients with advanced cancer: Insights from linking a regional cancer registry and insurance claims.
Authors: McDermott Cara L. , Fedorenko Catherine R. , Greenwood-Hickman Mikael Anne , Kreizenbeck Karma L. , Conklin Ted , Smith Bruce , Curtis J. Randall , Lyman Gary H. , Ramsey Scott David 
Published: November 2017

79 Background: Polypharmacy, defined as the concurrent use of multiple medications, may expose patients to drug-drug interactions and excessive medication costs. Patients with advanced cancer may benefit from medication discontinuation when faced with life-limiting illness. While polypharmacy prevalence has been explored in older patients, there are limited data for younger patients with advanced malignancy. To better understand medication use in this population, we characterized medication use and associated out-of-pocket (OOP) costs in the last month of life among commercially insured subjects under age 65 who did not enroll in hospice. Methods: We linked enrollment and claims records from two regional commercial insurers to Surveillance, Epidemiology, and End Results (SEER) Cancer Surveillance System and Washington State Cancer Registry records for patients diagnosed with a stage IV solid tumor malignancy in Washington state between January 1, 2007-December 31, 2016. We excluded patients who did not incur at least 1 claim in their last month. We calculated OOP costs as the difference between allowed and paid claim amounts, adjusted to 2016 dollars. Results: See Table. Among 369 patients, the average age was 56 years (range 23-64) and 51% (n=189) were male. Patients most frequently had lung (n=149, 40%), pancreatic (n=36, 10%) or colorectal cancer (n=32, 9%). Patients had an average of 7 medication claims (range 1-26) in the last month of life; the most commonly observed non-chemotherapy claims were for opioids, benzodiazepines and anti-emetics. Conclusions: A majority of subjects incurred at least 5 medication claims in their last 30 days; almost one-third had 10 or more. Frequent claims were for medication for pain or other symptoms. OOP costs ranged considerably. Future research will focus on developing interventions to assure effective medication use congruent with patient and family preferences and goals of care. [Table: see text]
A communication strategy using a video support tool and structured family meetings for relatives of patients dying in the ICU.
Authors: Sedhom Ramy , Bajaj Jasmet , Finklestein Vadim , Tanpiengco Mindy , Barile David 
Published: November 2017

81 Background: Death in the ICU is an extraordinarily stressful event. Qualitative and quantitative studies have identified effective communication between caregivers and families to be important throughout the decision making process. In many ICUs, the end-of-life family conference is an opportunity to ask questions, express concerns, and confront painful emotions with the help of compassionate professionals. Methods: A prospective study in a single ICU center. The ICU physician, palliative care team, and research nurse interviewed surrogate decision makers. The only criterion for inclusion in the study was anticipated death in one year. Patients younger than 18 were excluded from the study, as were those unable to speak English. Prior to the family meeting, families were offered an opportunity to watch a video on EOL decision-making made by the research team. The meeting itself followed a script, guided by four steps:establish diagnosis, share prognosis, elicit goals of care, recommend treatment. The investigators recorded ICU and patient characteristics on standardized forms. Results: 22 families were included. A decision to forego life-sustaining treatment and transition to comfort care or hospice was pursued by 77% of families. There were few non-beneficial interventions, such as CRRT or use of artificial nutrition; withdrawal of mechanical ventilation and vasopressors was common. Qualitative commentary suggested that time spent by providers were sufficient and the video support tool was clear and easy to understand. Conclusions: EOL family conferences improve communication between ICU staff and family members and assist families in decision making, especially for cancer syndromes. The structured family meetings offered opportunities to discuss patient’s wishes, alleviate feelings of guilt, and understand the goals of care. Patients received few non-beneficial treatments and families were likely to accept realistic goals of care. This highlights the potential role for video-support tools in advance care planning. Future studies reporting overall LOS and bereavement data are important quality markers and pending in a future report.
Quality matters: Patterns of palliative interventions in metastatic colorectal cancer (mCRC) patients.
Authors: Prince Rebecca M. , Liang Shuyin , Brar Mantaj , Ramkumar Stephanie , Scheer Adena , Wong Rebecca , Hallet Julie I. , Zimmermann Camilla , Easson Alexandra Maria 
Published: November 2017

83 Background: Increasing recognition that high-quality end of life care is essential has resulted in internationally endorsed metrics allowing assessment of interventions at the end of life. Median survival for mCRC patients has improved to more than 24 months resulting in increased opportunity to undergo interventions for symptom relief at the end of life. We explored patterns of palliative interventions (chemotherapy, radiotherapy, surgery, endoscopy, drainage procedures) and outcomes in mCRC patients. Methods: A retrospective review was undertaken of all mCRC patients referred to the palliative care service from 2000 to 2010 at a tertiary cancer center in Toronto, Canada. Descriptive statistics, survival analysis and regression were employed. Results: A total of 542 patients were included of whom 52.8% were male, mean age was 62.8 years and 44.6% had stage 4 disease at diagnosis. Over the course of their disease 93.9% had an intervention at any time after their diagnosis including 27.5% of patients undergoing palliative surgery, 77% of patients had an intervention in the last year of life and 19.1% had an intervention in the last 30 days of life. The percentage of patients receiving interventions within the last 14 days of life were 1.23% for chemotherapy, 4.6% for radiotherapy, 0.5% for surgery, 10.4% for endoscopy and 23% drainage procedures. The mean time between referral to palliative care and death was 7 months (SD 10.4). For patients who received chemotherapy, the mean time between last chemotherapy and death was 9.5 months (SD 14.9). Overall survival for patients who did not receive chemotherapy was 28 months (SD 33) compared with 40 months (SD 32) for those who received chemotherapy. Regression analysis for risks of dying within 30 days of chemotherapy was limited by a low event rate. Increasing age was significantly associated with a lower risk of dying within 30 days of chemotherapy. Conclusions: In their final months of life, palliative mCRC patients undergo a significant number of interventions aiming to improve quality of life. These require considerable multi-disciplinary input with ramifications for quality care, planning for service provision and funding.
Factors associated with palliative radiotherapy in the last 30 days of life.
Authors: Wu Susan Y. , Singer Lisa , Garcia Michael A , Fogh Shannon E. , Braunstein Steve E. 
Published: November 2017

84 Background: A significant proportion of patients will undergo radiotherapy (RT) within their last 30 days of life. Identifying patients who may not benefit from RT is difficult and use of predictive models for life expectancy is not routine (Chow et al., JCO 2008; Krishnan et al., Cancer 2013). Methods: Patients treated with external beam RT to a site of metastatic disease between 2012-2016 at a single institution prior to death were included in this analysis. Mann-Whitney U and chi-squared tests were used to compare patients who received RT within 30 days of death (D30RT) and those who did not. Multivariate analysis was used to identify factors associated with D30RT. Results: 518 patients accounting for 922 palliative RT courses were included. Median age at treatment was 63 yrs (IQR 54-71 yrs), median survival time was 28 months (IQR 11-53 mos) and median time from RT to death was 74 days (IQR 33-174 days). 49% of patients were metastatic at diagnosis. The most common primary sites were lung (26%), breast (19%) and prostate (10%). The most common treatment sites were bone (56%) and brain (28%). 125 patients (24%) died within 30 days of RT. D30RT was associated with older median age at treatment (64 vs. 62 yrs, p = 0.04), shorter interval since diagnosis (14 vs. 31 months, p < 0.001), liver but not brain or lung metastasis (p = 0.02, 0.43, and 0.06 respectively), lower median KPS scores (50 vs. 70, p < 0.001), lower median BMI (22 vs. 24, p = 0.001), and inpatient status at consult (56% vs. 26%, p < 0.001). Despite poor outcomes, patients who died within 30 days of RT were less likely to have hospice involved in their care (44% vs. 71%, p = 0.001). The only factor associated with hospice was longer time since diagnosis (28 months vs. 21 months, p = 0.04). D30RT was associated with higher Chow and TEACHH scores at the time of consult (p < 0.001 for both). Conclusions: A high frequency of patients received palliative RT at the end of life in our cohort. Earlier integration of palliative care or hospice services may allow patients and physicians to optimally direct treatment at the end of life. Existing life-expectancy prediction models may allow physicians to identify patients who could benefit from short treatment courses or alternative interventions to maximize quality at the end of life.
Economic impact of palliative care among elderly cancer patients.
Authors: Lebrett Wendi G. , Roeland Eric , Bruggeman Andrew , Yeung Heidi , Murphy James Don 
Published: November 2017

91 Background: Randomized trials among advanced cancer patients demonstrate that early palliative care integration into usual oncology care reduces symptom burden, improves quality of life and caregiver outcomes, and may improve survival. The impact of palliative care on health economics remains poorly defined and reported cost savings are an unintentional consequence of providing care aligned with patient goals. This study determined the impact of palliative care on healthcare costs among elderly patients with advanced cancer. Methods: We conducted a matched case-control study among Medicare beneficiaries with metastatic lung, colorectal, breast and prostate cancers. We matched patients who received a palliative care consultation to similar patients who did not receive a palliative care consultation. To determine the economic impact of a palliative care consultation we compared costs between cases and controls before and after the palliative care intervention. Costs included inpatient, outpatient, home health care, hospice, and medical equipment, and were adjusted to 2011 dollars. Results: Among the 2,576 patients in this study the total healthcare costs per patient in the 30 days before palliative care consultation was balanced between palliative care ($12,881) and non-palliative care control patients ($12,335). Palliative care intervention reduced total healthcare costs after the intervention. The total cost of care per patient in the 120 days after palliative care exposure was $6,880 compared to $9,604 for controls (28% decrease; p < 0.001). The economic effect of palliative care depended on timing of the consult. Palliative care consultation within 7 days of death decreased healthcare costs by $975, whereas palliative care consultation more than 4 weeks from death decreased costs by $5,362. Conclusions: This study demonstrates that palliative care has the capacity to substantially reduce healthcare expenditures among advanced cancer patients. Furthermore, the cost reduction depends on timing of the palliative care consult.
Expression of collagens in the damage area at abdominal adhesions
Authors: Shurygina Irina , Shurygina Irina , Shurygin Mikhail , Shurygin Mikhail , Rodionova Lyubov , Rodionova Lyubov , Chepurnykh Elena , Chepurnykh Elena , Ayushinova Natalia , Ayushinova Natalia 
Published: November 2017

Background. Postoperative adhesions are a serious problem in surgery. However, at the present time molecular
mechanisms of the adhesion process are insufficiently studied.
Aim. To study the dynamics of expression of genes encoding the synthesis of collagen in case of damage to the serosa
on the example of the peritoneum in conditions of aseptic inflammation.
Materials and methods. Aseptic inflammatory process in the abdominal cavity was modeled (Wistar rats, n = 40).
A micro- and macroscopic picture of the damage area was studied. Immunofluorescent staining for Type I collagen
(Col 1A1) was performed. The expression of genes encoding collagen of different types was evaluated using the RT 2 -
Profiler PCR kit Array Rat Wound Healing.
Results. It has been established that the adhesion process with peritoneal damage in aseptic conditions reaches its
maximum by the 30 th day of observation. The same period coincides with the maximum of collagen synthesis in fibro-
blasts in the repair area, revealed by immunofluorescence study. The interrelation of synthesis of type I and III collagens
went as expected – the onset of expression of type III collagen (from day 3) is ahead of the expression of collagen type I
(from day 7). Peak gene expression of collagens type I, Alpha-1 and -2; type III Alpha-1, type IV Alpha-1 and -3, type V
Alpha-1, -2 and -3; type XIV Alpha-1 (Col14a1) falls on the 14th day. For the first time, active involvement of type V
alpha-3 collagen in the adhesion process was noted - we detected both early (from day 1) and maximum intensive (up
to 166.96 times increase in comparison with intact animals).
Conclusion. Perhaps, the hyperexpression of collagen V alpha-3 that we revealed is an important link in the pathogenesis
of adhesion in the abdominal cavity.
Integer Programming Formulations and Benders Decomposition for the Maximum Induced Matching Problem
Authors: Ahat Betül , Ekim Tınaz , Taşkın Z. Caner 
Published: November 2017

We investigate the maximum induced matching problem (MIM), which is the problem of finding an induced matching having the largest cardinality on an undirected graph. The problem is known to be NP-hard for general graphs. We first propose a vertex-based integer programming formulation for MIM, which is more compact compared to an edge-based formulation found in the literature. We also introduce the maximum weight induced matching problem (MWIM), which generalizes MIM so that vertices and edges have weights. We adapt the edge-based formulation to MWIM, and propose a quadratic programming formulation of MWIM based on our vertex-based formulation. We then linearize our quadratic programming formulation, and devise a Benders decomposition algorithm that exploits a special structure of the linearized formulation. We also propose valid inequalities and formulation tightening procedures to improve the efficiency of our approach. Our computational tests on a large suite of randomly generated graphs show that our vertex-based formulation and decomposition approach significantly improve the solvability of MIM and MWIM, especially on dense graphs. The online appendix and data are available at https://doi.org/10.1287/ijoc.2017.0764 .
An asymptotic analysis for Hamilton–Jacobi equations with large Hamiltonian drift terms
Authors: Kumagai Taiga 
Published: November 2017

Abstract
We investigate the asymptotic behavior of solutions of Hamilton–Jacobi equations with large Hamiltonian drift terms in an open subset of the two-dimensional Euclidean space.
The drift is given by

ε

-
1

⁢

(

H

x
2

,

-

H

x
1

)

{{\varepsilon}^{-1}(H_{x_{2}},-H_{x_{1}})}

of a Hamiltonian H, with

ε
>
0

{{\varepsilon}>0}

.
We establish the convergence, as

ε
→

0
+

{{\varepsilon}\to 0+}

, of solutions of the Hamilton–Jacobi equations and identify the limit of the solutions as the solution of systems of ordinary differential equations on a graph.
This result generalizes the previous one obtained by the author to the case where the Hamiltonian H admits a degenerate critical point and, as a consequence, the graph may have more than four segments at a node.
Reconstructing ‘John Lelamour’s’ Herbal: The Linguistic Evidence
Authors: Olalla David Moreno 
Published: November 2017

AbstractTwenty years ago, George R. Keiser showed that the mutilated last quire of Lincoln Cathedral, Dean and Chapter Library, MS 91 had once contained a herbal written in Middle English. He discovered moreover that passages parallel to those reconstructable for the Lincoln manuscript appear in other texts, including an important work called John Lelamour’s Herbal after a name mentioned in its explicit, and concluded that Lelamour, an otherwise unknown fourteenth-century schoolmaster from Hereford, was the author of the original treatise that Thornton and other scribes used for the composition of their own herbals. The present article will present ample evidence which will demonstrate that Keiser’s hypothesis on a Herefordian pedigree for this textual family cannot be sustained any longer, and that the origins of this textual family should in fact be sought not too far from Scotland. A linguistic approach based on a collection of scribal modifications, both unconscious and conscious ones (i. e. copy mistakes and changes made on purpose by the several copyists), will be used for the task. This will reveal how linguistic variation between the several manuscripts can be profitably used to reconstruct the dialect of the original translation, which will here consequently be named Northern Middle English Translation of Macer Floridus’s De Viribus Herbarum (or Northern Macer for short).
Changes of photochemical efficiency and epidermal polyphenols content of Prosopis glandulosa and Prosopis juliflora leaves exposed to cadmium and copper
Authors: Gonzalez-Mendoza Daniel , Mendez-Trujillo Vianey , Grimaldo-Juarez Onecimo , Ceceña-Duran Carlos , Tzintzun-Camacho Olivia , Gutierrez-Miceli Federico , Sanchez-Viveros Gabriela , Aviles Marin Monica 
Published: November 2017

AbstractThe effect of metals on the photosynthetic activities and epidermal polyphenol content of Prosopis glandulosa and Prosopis juliflora leaves was investigated by the tissue tolerance test. Foliar tissues of Prosopis glandulosa and Prosopis juliflora were incubated with Cd2+ (0.001 M) or Cu2+ (0.52 M) concentrations for 96 h. The results showed that significant reductions (p < 0.05) of photochemical efficiency in P. juliflora leaves were found after 96 h of exposure to 0.52 M Cu2+ compared with Cd-treatments and controls. In contrast, P. glandulosa leaves showed a progressive increase on photochemical efficiency at 72 h after Cu-treatment. The results also showed a significant decrease (p < 0.05) of epidermal polyphenols in P. juliflora leaves after 24 h of exposure to 0.52 M Cu2+ compared with Cd-treatments and control leaves. On the other hand, the values of leaf epidermal polyphenols observed in P. glandulosa exposed to copper and cadmium did not show any difference with respect to control. These findings are very important and suggest that these compounds could be considered as a protection mechanism of P. glandulosa when is treated with these heavy metals. Finally, the results of bioaccumulation showed that the copper concentration in P. glandulosa was higher than the values detected in P. juliflora Nevertheless, the cadmium concentration in foliar tissues of P. juliflora was significantly higher than P. glandulosa after 96 h of exposure to Cu2+ or Cd2+. Therefore, future studies are necessary to elucidate the effects of heavy metals on the biosynthesis of flavonoids and participation of these compounds in the reduction of metal toxicity in Prosopis species.
Software design and implementation concepts for an interoperable medical communication framework
Authors: Besting Andreas , Bürger Sebastian , Kasparick Martin , Strathen Benjamin , Portheine Frank 
Published: November 2017

AbstractThe new IEEE 11073 service-oriented device connectivity (SDC) standard proposals for networked point-of-care and surgical devices constitutes the basis for improved interoperability due to its independence of vendors. To accelerate the distribution of the standard a reference implementation is indispensable. However, the implementation of such a framework has to overcome several non-trivial challenges. First, the high level of complexity of the underlying standard must be reflected in the software design. An efficient implementation has to consider the limited resources of the underlying hardware. Moreover, the frameworks purpose of realizing a distributed system demands a high degree of reliability of the framework itself and its internal mechanisms. Additionally, a framework must provide an easy-to-use and fail-safe application programming interface (API). In this work, we address these challenges by discussing suitable software engineering principles and practical coding guidelines. A descriptive model is developed that identifies key strategies. General feasibility is shown by outlining environments in which our implementation has been utilized.
Multi-Type Branching Processes Modeling of Nosocomial Epidemics
Authors: Mohamed Zeinab , Oraby Tamer 
Published: November 2017

AbstractNosocomial epidemics are infectious diseases which spread among different types of susceptible individuals in a health-care facility. To model this type of epidemics, we use a multi-type branching process with a multivariate negative binomial offspring distribution. In particular, we estimate the basic reproduction number