scholarly journals Variability in Synoptic Reporting of Colorectal Cancer pT4a Category and Lymphovascular Invasion

2020 ◽  
Author(s):  
Julia R. Naso ◽  
Hui-Min Yang ◽  
David F. Schaeffer
Keyword(s):  
Colorectal Carcinoma ◽  
Real World ◽  
Large Scale ◽  
Lymphovascular Invasion ◽  
Interobserver Agreement ◽  
Interobserver Variability ◽  
Prognostic Significance ◽  
Large Scale Assessment ◽  
Before And After ◽  
The Impact

Context.— Serosal involvement (pT4a category) and lymphovascular invasion have prognostic significance in colorectal carcinoma, but are subject to interobserver variation in assessment. Objectives.— To provide the first large-scale assessment of interobserver variability in pT4a category and lymphovascular invasion reporting in real-world practice and to explore the impact of information from guidelines on variability in reporting these features. Design.— Analysis of 1555 consecutive synoptic reports of colorectal carcinoma was performed using multivariate logistic regression. Interobserver variability before and after the presentation of guideline information was assessed using an image-based survey. Results.— Significant differences in the odds of reporting pT4a versus pT3 category, detecting lymphovascular invasion of any type, and detecting large vessel invasion were identified among hospital sites and for individual pathologists compared with the median pathologist at the same site. Consistent with these results, interobserver agreement was only moderate in the image-based survey regarding T4a staging and lymphovascular invasion (all κ ≤ 0.57). The provision of information from guidelines did not tend to increase interobserver agreement in the survey, though responses in favor of using an elastic stain increased following recommendations for their use. However, when observers were provided with elastic-stained images, interobserver agreement remained only moderate (κ = 0.55). Conclusions.— Real-world reporting of pT4a category and lymphovascular invasion shows substantial variability at both local and regional levels. Our study underscores the need to address these features in quality initiatives, and provides a novel method through which existing synoptic data can be harnessed to monitor reporting patterns and provide individualized feedback.

scholarly journals POS1121 DEMOGRAPHICS, COMORBIDITIES, AND RENAL FUNCTION OF UNCONTROLLED GOUT PATIENTS WHO RECEIVED PEGLOTICASE: FINDING FROM A LARGE US CLAIMS DATABASE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 839.2-840
Author(s):  
C. Vesel ◽  
A. Morton ◽  
M. Francis-Sedlak ◽  
B. Lamoreaux
Keyword(s):  
Kidney Function ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Small Subset ◽  
Phase 3 ◽  
Claims Database ◽  
Medical Diagnoses ◽  
Ckd Stage ◽  
Before And After ◽  
The Impact

Background:NHANES data indicate that approximately 9.2 million Americans have gout,1 with a small subset having uncontrolled disease.2 Pegloticase is a PEGylated recombinant uricase enzyme indicated for treating uncontrolled gout that markedly reduces serum uric acid levels (sUA)3 and resolves tophi in treatment responders.4 Despite pegloticase availability in the US for many years, real world demographics of pegloticase users in the treatment of uncontrolled gout have not been previously reported in a population-based cohort.Objectives:This study utilized a large US claims database to examine demographics and co-morbidities of uncontrolled gout patients treated with pegloticase. Kidney function before and after pegloticase treatment and concomitant therapy with immunomodulators were also examined.Methods:The TriNetX Diamond database includes de-identified data from 4.3 million US patients with gout (as of September 2019), including demographics, medical diagnoses, laboratory values, procedures (e.g. infusions, surgeries), and pharmacy data. Patients who had received ≥1 pegloticase infusion were included in these analyses. The number of infusions was evaluated for a subgroup of patients who were in the database ≥3 months before and ≥2 years after the first pegloticase infusion (i.e. first infusion prior to September 2017) to ensure only complete courses of therapy were captured. In this subpopulation, kidney function before and after pegloticase therapy was examined, along with the presence of immunomodulation prescriptions (methotrexate, mycophenolate mofetil, azathioprine, leflunomide) within 60 days prior to and 14 days after the first pegloticase infusion.Results:1494 patients treated with pegloticase were identified. Patients were 63.1 ± 14.0 years of age (range: 23–91), mostly male (82%), and white (76%). Mean sUA prior to pegloticase was 8.7 ± 2.4 mg/dL (n=50), indicating uncontrolled gout in the identified population. The most commonly reported comorbidities were chronic kidney disease (CKD, 48%), essential hypertension (71%), type 2 diabetes (39%), and cardiovascular disease (38%), similar to pegloticase pivotal Phase 3 trial populations. In patients with pre-therapy kidney function measures (n=134), pre-treatment eGFR averaged 61.2 ± 25.7 ml/min/1.73 m2, with 44% having Stage 3-5 CKD. In patients with complete therapy course capture and pre- and post-therapy eGFR measures (n=48), kidney function remained stable (change in eGFR: -2.9 ± 18.2 ml/min/1.73 m2) and CKD stage remained the same or improved in 81% of patients. In 791 patients with complete treatment course capture, patients had received 8.7 ± 13.8 infusions (median: 3, IQR: 2-10). Of these, 189 (24%) patients received only 1 pegloticase infusion and 173 (22%) received ≥12 infusions. As the data cut-off for this analysis pre-dated emerging data on the use of immunomodulation as co-therapy, only 19 of 791 (2%) patients received immunomodulation co-therapy with pegloticase.Conclusion:This relatively large group of patients with uncontrolled gout treated with pegloticase had similar patient characteristics of those studied in the phase 3 randomized clinical trials. Patients with uncontrolled gout are significantly burdened with systemic co-morbid diseases. The majority of patients had stable or improved kidney function following pegloticase treatment. As these results reflect patients initiating treatment prior to 2018, before co-treatment with immunomodulation was introduced, this cohort only included a small percentage of patients who were co-treated with an immunomodulator. Future studies using more current datasets are needed to evaluate real world outcomes in patients treated with pegloticase/immunomodulator co-therapy and to evaluate the impact of systemic co-morbid diseases.References:[1]Chen-Xu M, et al. Arthritis Rheumatol 2019 71:991-999.[2]Fels E, Sundy JS. Curr Opin Rheumatol 2008;20:198-202.[3]Sundy J, et al. JAMA 2011;306:711-720.[4]Mandell BF, et al. Arthritis Res Ther 2018;20:286.Disclosure of Interests:Claudia Vesel Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Allan Morton Speakers bureau: Sanofi, Amgen, and Horizon, Megan Francis-Sedlak Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Brian LaMoreaux Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc.

The Importance of Similarity: How Gender Congruence Matters for the Impact of Leadership Training

2021 ◽  
pp. 009539972110642
Author(s):  
Trine H. Fjendbo ◽  
Christian B. Jacobsen ◽  
Seung-Ho An
Keyword(s):  
Leadership Training ◽  
Large Scale ◽  
Leadership Behaviors ◽  
Leadership Behavior ◽  
Female Gender ◽  
Perceived Leadership ◽  
Scale Field ◽  
Before And After ◽  
Large Scale Field ◽  
The Impact

Leadership training is key to promoting more active leadership, but the effects of leadership training can depend on the gender context. Gender congruence between manager and employee can affect how the manager employs leadership behaviors adapted from training and how employees perceive leadership behavior. Quantitative data on 474 managers’ 4,833 employees before and after a large-scale field experiment with leadership training enable us to examine changes in employee-perceived leadership following training. The results show that gender congruence between manager and employee is associated with stronger leadership training effects on employee-perceived leadership behaviors. Female gender congruence shows the most pronounced effects.

scholarly journals Impact of the first COVID-19 shelter-in-place order in the United States on emergency department utilization, Marin County, California

2020 ◽  
Author(s):  
Brett R. Bayles ◽  
Michaela F George ◽  
Haylea Hannah ◽  
Patti Culross ◽  
Rochelle R. Ereman ◽  
...  
Keyword(s):  
United States ◽  
San Francisco ◽  
Large Scale ◽  
Temporal Dynamics ◽  
The United States ◽  
Emergency Department Utilization ◽  
Marin County ◽  
Before And After ◽  
Ed Visits ◽  
The Impact

Background: The first shelter-in-place (SIP) order in the United States was issued across six counties in the San Francisco Bay Area to reduce the impact of COVID-19 on critical care resources. We sought to assess the impact of this large-scale intervention on emergency departments (ED) in Marin County, California. Methods: We conducted a retrospective descriptive and trend analysis of all ED visits in Marin County, California from January 1, 2018 to May 4, 2020 to quantify the temporal dynamics of ED utilization before and after the March 17, 2020 SIP order. Results: The average number of ED visits per day decreased by 52.3% following the SIP order compared to corresponding time periods in 2018 and 2019. Both respiratory and non-respiratory visits declined, but this negative trend was most pronounced for non-respiratory admissions. Conclusions: The first SIP order to be issued in the United States in response to COVID-19 was associated with a significant reduction in ED utilization in Marin County.

scholarly journals Energy conservation by retrofitting of dwellings

2019 ◽  
Vol 111 ◽  
pp. 03010
Author(s):  
Imrich Sánka ◽  
Dušan Petráš
Keyword(s):  
Large Scale ◽  
Thermal Environment ◽  
Winter Season ◽  
Residential Building ◽  
Indoor Environmental Quality ◽  
Air Exchange Rate ◽  
Energy Auditing ◽  
Before And After ◽  
The Impact

This article investigates the impact of energy renovation on the indoor environmental quality of apartment building during heating season. The study was performed in one residential building before and after its renovation. Energy auditing and classification of the selected building into energy classes were carried out. Additionally, evaluation of indoor air quality was performed using objective measurements and subjective survey. Thermal environment and concentration of CO2 was measured in bedrooms. Higher concentrations of CO2 was observed in the residential building after its renovation. The concentrations of CO2, in some cases exceeded the recommended maximum limits, especially after implementing of energy saving measures on the building. The average air exchange rate was visible higher before renovation of the building. The current study indicates that large-scale of renovations may reduce the quality of the indoor environment in many apartments, especially in the winter season.

Cigarette and cigar sales in Hawaii before and after implementation of a Tobacco 21 Law

2020 ◽  
Vol 30 (1) ◽  
pp. 98-102 ◽  
Author(s):  
Rebecca Glover-Kudon ◽  
Doris G Gammon ◽  
Todd Rogers ◽  
Ellen M Coats ◽  
Brett Loomis ◽  
...  
Keyword(s):  
Large Scale ◽  
Geographical Area ◽  
Upward Trend ◽  
Food Stores ◽  
The Us ◽  
Before And After ◽  
Youth And Young Adults ◽  
The Usa ◽  
Product Sales ◽  
The Impact

IntroductionOn 1 January 2016, Hawaii raised the minimum legal age for tobacco access from 18 to 21 years (‘Tobacco 21 (T21)’) statewide, with no special population exemptions. We assessed the impact of Hawaii’s T21 policy on sales of cigarettes and large cigars/cigarillos in civilian food stores, including menthol/flavoured product sales share.MethodsCigarette and large cigar/cigarillo sales and menthol/flavoured sales share were assessed in Hawaii, California (implemented T21 in June 2016 with a military exemption), and the US mainland using the only Nielsen data consistently available for each geographical area. Approximate monthly sales data from large-scale food stores with sales greater than US$2 million/year covered June 2012 to February 2017. Segmented regression analyses estimated changes in sales from prepolicy to postpolicy implementation periods.ResultsFollowing T21 in Hawaii, average monthly cigarette unit sales dropped significantly (−4.4%, p<0.01) coupled with a significant decrease in menthol market share (−0.8, p<0.01). This combination of effects was not observed in comparison areas. Unit sales of large cigars/cigarillos decreased significantly in each region following T21 implementation. T21 policies in Hawaii and California showed no association with flavoured/menthol cigar sales share, but there was a significant increase in flavoured/menthol cigar sales share in the USA (7.1%, p<0.01) relative to Hawaii’s implementation date, suggesting T21 may have attenuated an otherwise upward trend.ConclusionsAs part of a comprehensive approach to prevent or delay tobacco use initiation, T21 laws may help to reduce sales of cigarette and large cigar products most preferred by US youth and young adults.

scholarly journals V2Karst V1.0: A parsimonious large-scale integrated vegetation-recharge model to simulate the impact of climate and land cover change in karst regions

2018 ◽  
Author(s):  
Fanny Sarrazin ◽  
Andreas Hartmann ◽  
Francesca Pianosi ◽  
Thorsten Wagener
Keyword(s):  
Land Cover ◽  
Groundwater Recharge ◽  
Land Cover Change ◽  
Large Scale ◽  
Synthetic Data ◽  
Temporal Distribution ◽  
Soil Parameters ◽  
Large Scale Assessment ◽  
Karst Areas ◽  
The Impact

Abstract. Karst aquifers are an important source of drinking water in many regions of the world. Karst areas are highly permeable and produce large amounts of groundwater recharge, while surface runoff is typically negligible. As a result, recharge in these systems may have a different sensitivity to climate and land cover changes compared to other less permeable systems. However, little effort has been directed toward assessing the impact of climate and land cover change in karst areas at large-scales. In this study, we address this gap by (1) introducing the first large-scale hydrological model including an explicit representation of both karst and land cover properties, and by (2) analysing the model's recharge production behaviour. To achieve these points, we first improve the evapotranspiration estimation of a previous large-scale karst recharge model (VarKarst). The new model (V2Karst V1.0) includes a parsimonious representation of relevant ET processes for climate and land cover change impact studies. We demonstrate the plausibility of V2Karst simulations at carbonate rock FLUXNET sites using soft rules and global sensitivity analysis. Then, we use virtual experiments with synthetic data to assess the sensitivity of simulated recharge to precipitation characteristics and land cover. Results reveal how both vegetation and soil parameters control the model behaviour, and they suggest that simulated recharge is sensitive to both precipitation (overall amount and temporal distribution) and land cover. Large-scale assessment of future karst groundwater recharge should therefore consider the combined impact of changes in land cover and precipitation properties, if it is to produce realistic projections of future change impacts.

Impact of a Large-Scale Coach Education Program from a Lifelong-Learning Perspective

2013 ◽  
Vol 6 (1) ◽  
pp. 23-42 ◽  
Author(s):  
Diana Deek ◽  
Penny Werthner ◽  
Kyle J. Paquette ◽  
Diane Culver
Keyword(s):  
Lifelong Learning ◽  
Education Program ◽  
Large Scale ◽  
Learning Experience ◽  
Coach Education ◽  
Coach Learning ◽  
Before And After ◽  
Coaching Certification ◽  
The Impact ◽  
Depth Interviews

This study examines the impact of a coach education program on coach learning and perceived changes to coaching practices, while situating this episodic learning experience within a lifelong-learning perspective. Three sets of in-depth interviews were conducted with 10 coaches taking part in one of three competition-development modules within Canada’s National Coaching Certification Program (Coaching and Leading Effectively, Managing Conflict, and Psychology of Performance). It was found that (a) the coaches’ biographies varied widely, (b) all of the coaches reported learning from the modules, (c) eight of ten coaches reported a change in their coaching practices as a result of participation in one of the modules, and (d) the coaches credited a combination of mediated, unmediated, and internal learning situations for their learning before and after the modules. These findings suggest that a large-scale coach education program can have an impact on coaches when the program takes a lifelong-learning perspective and integrates constructivist principles into its design and delivery.

scholarly journals Did Students Learn Less During the COVID-19 Pandemic? Reading and Mathematics Competencies Before and After the First Pandemic Wave

2021 ◽  
Author(s):  
Johannes Schult ◽  
Nicole Mahler ◽  
Benjamin Fauth ◽  
Marlit Annalena Lindner
Keyword(s):  
Large Scale ◽  
Learning Loss ◽  
School Closures ◽  
Large Scale Assessment ◽  
Low Achieving Students ◽  
Before And After ◽  
And Mathematics ◽  
Future Education ◽  
Regular Classes ◽  
Reading And Mathematics

The first wave of the COVID-19 pandemic disrupted regular classes in spring 2020. Temporary school closures supposedly led to a considerable learning loss, particularly for low-achieving students. Schools in Baden-Württemberg, Germany, were closed for two months. Although distance learning was implemented, students spent less time learning. Additionally, teachers were faced with organizational and technological challenges of remote learning environments. The present study investigates the competencies of fifth-graders, using large-scale assessment results in reading and mathematics from annual mandatory tests in September (each n &gt; 80,000). In line with studies from other countries, competence scores were slightly lower in 2020 compared with the three previous years (–0.07 standard deviations for reading comprehension, –0.09 for operations, and –0.03 for numbers). Low-achieving readers managed to attain pre-pandemic competence levels. On the other hand, low-achieving students seem to have a learning backlog regarding mathematics competencies (such as operations) that deserves attention in future education.

Sign in / Sign up

Export Citation Format

Share Document