Comprehension Scores Research Articles

Longitudinal outcomes after financial toxicity and health-related social risks screening and referral.

17 Background: Financial toxicity (FT) is associated with delayed/omitted care, reduced quality of life, and worse mortality. Routine screening for FT and health-related social risks (HRSR) is recommended during clinical care, but there is limited longitudinal evidence on outcomes after patients screen positive and are referred for assistance. Methods: FT and HRSR screening for patients with breast, gynecologic, gastrointestinal, or thoracic cancers was implemented at an urban comprehensive cancer center. Screening included the Comprehensive Score for Financial Toxicity (COST) tool (0-44, lower scores=worse FT) and a HRSR checklist to identify food, housing, and transportation insecurity. COST score ≤16-20 or reported HRSR was a “positive” screen and counseling referral was offered: patients could accept the referral by identifying their current concerns. Analysis sample was limited to receiving chemotherapy, radiotherapy, or surgery 120 days prior to baseline survey and had a follow-up survey 4-12 months later. Data were collected 10/2022-12/2023. Results: 2196 patients met inclusion criteria, median time between surveys was 5.5 months (IQR 4.4, 6.9). 20% (n=438) screened positive and accepted referral; 11% (n=246) screened positive and declined referral; the remaining 69% (n=1512) screened negative. Sociodemographic factors of age (median 58 vs 62, p<.001), sex (82% vs 74% female, p =.015), and race (31% vs 17% racial/ethnic minority, p<.001) were associated with accepting vs declining referral. Those who accepted referral had lower COST scores (median 10 vs 19) and more HRSR (39% vs 20% housing; 32% vs 18% food; 37% vs 17% transportation) at baseline (all p≤.001). At follow-up, both cohorts had COST decrease, indicating worsened FT [mean difference (95% CI): accepted referral -2.0 (-2.8, -1.2) vs declined referral -2.8 (-4.0, 1.5)]. Across all collected HRSR, those who accepted referral had small benefits in previously reported HRSR, however were more likely to have newly designated HRSR (Table shows changes). Conclusions: Screening for FT and HRSR identified one-third of patients on recent cancer treatment with financial or social needs. Those who accepted financial assistance referral had significantly higher FT and more reported HRSR. Although referral did appear to have some benefit on initial needs, new HRSR were identified at follow-up. Future work will focus on optimizing available assistance to meet ongoing patient needs during and after cancer treatment. Accepted Referraln = 438 (%) Declined Referraln = 246 (%) Housing Resolved need 67 (15) 31 (13) New need 54 (12) 15 (6.1) Stable unmet need 102 (23) 18 (7.3) Stable no need 215 (49) 182 (74) Food Resolved need 64 (15) 31 (13) New need 69 (16) 16 (6.5) Stable unmet need 77 (18) 14 (5.7) Stable no need 228 (52) 185 (75) Transportation Resolved need 73 (17) 34 (14) New need 56 (13) 20 (8.1) Stable unmet need 87 (20) 8 (3.3) Stable no need 222 (51) 184 (75)

Validating a simplified financial toxicity screening tool for patients with cancer.

318 Background: Medical-related financial hardship (called financial toxicity) can negatively impact patient clinical outcomes and overall well-being. Routine financial toxicity screening is recommended to facilitate referrals to resources for patients experiencing, or at risk for, financial toxicity. The validated Comprehensive Score for Financial Toxicity (COST) tool is widely used in research to measure financial toxicity; however, its 11-question length and lack of standardized screening threshold make it challenging to implement in clinical practice. This analysis sought to develop and validate an abbreviated version of the tool, suitable for routine screening in clinical practice. Methods: The full COST was administered as part of clinical care from June 2022-August 2023. Patients receiving treatment for breast, gynecologic, thoracic, or gastrointestinal cancer at an urban comprehensive cancer center were queried via patient portal or in clinic. Using 38,330 observations, we calculated the correlation of abbreviated tools of varying length with the full COST score (0-44, lower scores=higher FT). We then used a validation dataset of 19,196 observations to assess the positive and negative predictive values (PPV, NPV) of an abbreviated tool against the full COST score, when compared to thresholds for risk previously used in the literature (score ≤15, ≤20). Results: Including two questions (Q3: “I worry about the financial problems I will have in the future as a result of my illness or treatment”; Q6: “I am satisfied with my current financial situation”) yielded r=0.922 correlation with the full COST. For this 2-item tool, PPV ranged from 74-91%, and NPV ranged from 91-98% when compared to the full COST tool. Table 1 shows the PPV and NPV of varying score thresholds for the abbreviated COST against full scores ≤15 and ≤20. Conclusions: Using a large and clinically diverse sample of patients with cancer,we demonstrate the predictive value of an abbreviated COST tool and show its approximate accuracy when compared to the full tool. Simplified, clinically integratedscreening for financial hardship can efficiently ensure appropriate intervention for patients experiencing medical-related financial hardship and can also be a first step toward mitigating hardship among those at risk for developing it. Predictive value of 2-item COST vs. full COST score in the validation set. Full COST score ≤ 15 Yes No 2-question, COST score ≤ 1 Yes 2337 (14%) 253 (1.5%) PPV = 90% No 822 (4.8%) 13844 (80%) 1-NPV = 5.6% Full COST score ≤ 15 Yes No 2-question, COST score ≤ 2 Yes 2924 (17%) 1045 (6.1%) PPV = 74% No 235 (1.4%) 13052 (76%) 1-NPV = 1.8% Full COST score ≤ 20 Yes No 2-question, COST score ≤ 2 Yes 3626 (21%) 343 (2.0%) PPV = 91% No 1199 (6.9%) 12088 (70%) 1-NPV = 9.0% Full COST score ≤ 20 Yes No 2-question, COST score ≤ 3 Yes 4359 (25%) 1272 (7.4%) PPV = 77% No 466 (2.7%) 11159 (65%) 1-NPV = 4.0%

Longitudinal changes in patient-reported outcomes (PROs) among early phase clinical trial (EP-CT) participants.

243 Background: Little research has explored associations of longitudinal changes in PROs and clinical outcomes among EP-CT participants. We sought to describe changes in PROs over the first month of EP-CT participation and examine associations of changes with clinical outcomes. Methods: We prospectively enrolled adults participating in EP-CTs at Massachusetts General Hospital from 04/2021-01/2023. We assessed quality of life (QOL) (Functional Assessment of Cancer Therapy-General, with subdomains: physical wellbeing [PWB], emotional wellbeing [EWB], social wellbeing [SWB], functional wellbeing [FWB]); hope (Herth Hope Index); symptom burden (Edmonton Symptom Assessment System); and financial wellbeing (Comprehensive Score for Financial Toxicity) at time of EP-CT enrollment and one month later (1-month). We used descriptive statistics and regression models to describe 1-month changes in PROs and explore associations of patient-reported QOL, hope, symptom burden, and financial wellbeing with patient factors (age, diagnosis, performance status) and clinical outcomes (time on trial [TOT], treatment response, ED visits, hospitalizations, and survival). Results: Of 205 enrolled patients, 159 (77.9%) had baseline and 1-month data evaluable for analysis (median age: 63.0 [range 33.0 – 88.6], 59.8% female, 93.6% metastatic cancer, ECOG 0= 46.2% and ECOG 1=53.8%). Most common cancer types were gastrointestinal (31.5%) and breast (22.0%). There was no significant change from baseline to 1-month in mean QOL (75.2 to 76.2), hope (27.1 to 26.7), ESAS total symptom burden (20.4 to 20.9), ESAS physical symptoms (13.3 to 13.7), and financial wellbeing (28.5 to 28.0). There was no significant change in overall QOL and in each subdomain with the exception of EWB (16.2 to 17.0, p<.001). Older age was associated with increased hope (B=1.29, p=.008) and increased QOL (B=3.02, p=0.024). Increasing EWB at 1-month was associated with longer TOT (HR=0.93, p=.011). Increased symptom burden at 1-month was associated with greater risk of ED visits (HR=1.04, p=.005) and hospitalizations (HR=1.03, p=.012). Improving financial wellbeing at 1-month was associated with lower risk of hospitalization (HR=0.96, p=.046). We found no other significant associations of 1-month changes in PROs with treatment response or survival. Conclusions: We described changes in PROs from baseline to 1-month and identified factors associated with these changes. Despite the rigors and intensity associated with EP-CT initiation, most PROs did not worsen, with significantly improved EWB after 1-month of participation. Results demonstrate changes in physical symptoms predicted for greater risk of ED visits and hospitalizations. Future studies should build upon this work and measure PROs throughout trial participation to identify factors associated with changes and guide intervention development.

Financial toxicity and unmet social needs in adolescents and young adults (AYA) with cancer.

13 Background: Cancer incidence is rising in adolescents and young adults (AYA) (age 18-39), a population that faces durable financial challenges during and after treatment. Although AYA cancer survivors face unique risks for poor outcomes due to financial toxicity (FT), best practices for FT and social needs screening (i.e. food, housing, transportation insecurity) are unknown. Further, the relationship between FT and social needs is largely unexplored in AYA. Methods: A FT and social needs screening quality improvement project was conducted at a comprehensive cancer center. The Comprehensive Score for Financial Toxicity (COST) assessed FT, and patients reported unmet social needs and treatment payment methods. Quality of life (QOL) was assessed via a visual analog scale. Multivariate linear and logistic regression tested for associations with FT and unmet social needs, adjusting for demographic and clinical characteristics. Results: Of 70,983 requests, 38,249 patients completed the screening (54% response rate): 2,519 were AYA. Mean age of AYA was 33.7 years (SD 4.7), and most (65%) were non-Hispanic white. Disease sites included 41% breast, 20% gastrointestinal, and 19% gynecologic. Over one-half (54%) had active cancer treatment (chemotherapy, radiation, or surgery) within 120 days of assessment. Mean COST was 23.2 (SD 10.8; 0-44, with lower scores indicating worse FT), and 54% had COST <26, suggesting FT. Racial/ethnic minority patients (β -4.37, p<0.001) and those who had recent treatment (β -3.21, p<0.001) had worse FT. Of those who screened positive for FT, only 44% accepted a referral for financial assistance. About one-quarter of the sample (28%) were unable to afford at least one social need, with 16% facing housing, 14% transportation, and 13% food insecurity. Patients who are a racial/ethnic minority (OR 2.98, 95% CI 2.35-3.79, p<0.001) and those with metastatic disease (OR 2.45, 95% CI 1.10-5.45, p=0.028) were more likely to have at least one unmet social need. One-quarter of the sample (24%) used at least some of their savings to pay for treatment, with 7% reporting they did not have any savings. 25% borrowed money or took on new loans to pay for treatment: of those, 58% borrowed from friends/family. 10% did not have enough money for medications, and 7% took less medications than prescribed due to cost. Mean QOL was 7.3 [(SD 1.8) 0 “as bad as it can be”-10 “as good as it can be”]. Increased FT was associated with reduced QOL (β -0.10, p<0.001), using more savings to pay for treatment (β 0.52, p<0.001), and taking less medications due to cost (β 0.01, p<0.001). Conclusions: Routine FT and social needs screening is feasible for AYA patients and uncovers high rates of FT and unmet social needs. Given lower QOL and decreased adherence to treatment associated with FT, future research should focus on interventions to support the specific needs of AYA and increase acceptance of financial assistance and navigation.

Implementing a financial toxicity screening program.

275 Background: Financial toxicity (FT) is a well-documented negative side effect of cancer treatment. Routine screening can mitigate FT by proactively connecting at-risk patients to resources and counseling. Herein, we describe implementation of a FT screening quality improvement (QI) program. Methods: At a comprehensive cancer center, an interdisciplinary team explored options for implementation, with consideration for screening content, mechanism for delivery, and clinical workflow. Through consensus, the team agreed to use the 12-item COmprehensive Score for Financial Toxicity (COST) tool, a health-related social risk checklist, patient-self report of cost-related medication non-adherence, and a visual analog quality of life scale. Surveys were sent via portal every four months to patients on active treatment. The QI project was implemented on the breast, gastrointestinal, gynecologic, and thoracic services. COST scores ≤20 or any endorsed social risk (e.g., food, transportation) yielded a positive screen, and nurses placed a financial counseling referral, with counseling dispositions tracked. In March 2023, due to an influx of “unproductive” counseling dispositions (e.g., patient could not be contacted, patient no longer wanted help), machine learning models suggested reducing the screening threshold to COST scores ≤16 and limiting the social risk checklist to four items (food, transportation, medication, and housing insecurity). Results: From 06/2022-12/2023, 196,675 financial toxicity surveys were assigned to 78,289 unique patients: 38% (n=75,526) were completed by 45,003 patients. Of these, 56% have completed one survey, 26% have completed two surveys, and 18% have completed three or more. Since implementation, 9612 financial counseling referrals have been placed, yielding assistance with insurance selection and applications for assistance with co-payments, non-medical expenses, and out-of-pocket costs. During the QI project, several real-time workflow changes were made. On day 1, 519/1811 patients screened positive, yielding an overflow of counseling referrals: an additional question to allow patients to opt into referral, rather than generating an automatic referral, was then added: the following week, 136 referrals were generated. In September 2022, this opt-in was modified to allow patients to directly identify the areas in which they were seeking assistance (e.g., insurance counseling, out-of-pocket expenses). In 2024, the screening was reduced to two COST questions that had a 0.92 correlation with the full-tool. Conclusions: Routine FT screening is feasible during active treatment, although attention is needed to clinical workflows to ensure patients have access to the screening, nurses and other clinical staff are involved in the implementation, and referrals to resources are available for patients who screen positive. Future work will address cadence of delivery and outcomes of interventions.

Correlation of a single-item measure of financial toxicity with overall score.

351 Background: Financial toxicity (FT) refers to the financial burden experienced by patients due to direct and indirect costs associated with their medical care. It has been linked to higher symptom burden, poorer clinical outcomes, quality of life, and psychological well-being and has been shown to extend beyond diagnosis and treatment. Despite the availability of validated tools to measure FT, no single-item screening measure has been validated yet. In the context where time constraints are the most cited reason for patients declining FT surveys, it is crucial to develop efficient tools that allow us to routinely screen patients for FT at different stages of their care. We, therefore, sought to establish item 12 (“My illness has been a financial hardship to my family and me”) of the Comprehensive Score for Financial Toxicity (COST) measure as a well-functioning screening item for FT. Methods: In this secondary analysis of 579 patients who completed a survey on financial toxicity screening preferences, items 1-11 were scored (including reversing 7 items per the version 2 scoring guidelines), with lower scores indicating worse FT. Analyses focused on establishing a correlation with the total score as well as examining item properties. Item 12 was also reverse scored, so lower scores mean greater hardship. Results: Item 12 had an item-total correlation of r = 0.63 (adjusted item-total correlation = .531). Similarly, a linear model with item 12 score as a predictor and total score as the outcome showed that increases of 1 point on item 12 is associated with around 3 total points on the full scale (b = 3.35, p < .001, adjusted R 2 = 0.28. Finally, item analysis with the graded-response item response theory (IRT) model showed very good discrimination (a = 2.10) for item 12, indicating that it can reliably distinguish between low and high FT in patients. IRT results also showed that the item functions as a nearly binary item with responses of “quite a bit” and “very much” corresponding to a high probability of high FT, while responses of “somewhat,” “a little bit,” and “not at all” corresponding to a high probability of low FT. Conclusions: This is the first validation of a single-item screening measure for RT. Overall, these results illustrate that item 12 is a good candidate for a single-item screener, with “quite a bit” and “very much” responses indicating a high likelihood of high FT.

Financial toxicity screening in an urban underserved patient population with cancer.

169 Background: Cancer-related financial hardship is associated with treatment delays, non-adherence and adverse survival outcomes. Racial/ethnic minorities and low-income households are disproportionately impacted by financial toxicity. The Comprehensive Score for Financial Toxicity (COST) measure is used to measure financial toxicity in research but has not been validated in low-income, racially diverse cancer patient populations. Methods: We conducted this study at a large urban medical center from January-August 2023. We included cancer patients on systemic therapy for at least 2 months with ECOG performance status 0-2. Participants completed the COST measure, the Functional Assessment of Cancer Therapy: General (FACT-G) and the European Organization for Research and Treatment of Cancer (EORTC) QOL to assess health-related quality of life (HRQOL). Cancer diagnosis/stage, demographic data, and social work/financial counseling interventions were abstracted. Factor analyses were conducted to determine the underlying factor structure of the COST measure responses and bivariate analyses were conducted to identify relationships between COST scores and other data. Results: 100 patients participated in the study; the average age was 65 and both sexes were equally represented. Most patients reported African American (67%) race/ethnicity. 72% of patients held less than a 4-year college degree, 22 % were unemployed and 55% reported a yearly household income of less than $35,000. Lung (46%) and gastrointestinal (38%) cancers were the most represented. 73% were enrolled in a government sponsored insurance program (Medicare, Medicaid). The average COST score among participants was 22 [range 0-44] and mean FACT-G and EORTC scores were 16.5 [range 0-28] and 59.6 [ range 0 – 100] respectively. Fifty-eight patients were referred to social work or financial counseling for financial interventions. Factor analysis revealed three predominant factors among the COST responses (Eigenvalues > 1) including Factor 1: items 3, 7, 8, 9, 10, 11; Factor 2: item 4; Factor 3: item 5. COST was weakly associated with FACT-G and EORTC (Pearson range 0.27 – 0.37). The most highly correlated value was between the COST and EORTC physical wellbeing subscale (Pearson 0.38). The COST score was significantly associated with income, with higher incomes reporting less financial toxicity (p = 0.004). No significant differences in COST scores were noted across gender, race, or level of education. Conclusions: Low levels of financial toxicity were detected using the COST measure in a diverse, low-income cancer patient population despite many patients being referred to social work/financial counseling. Compared to similar studies, we found a weaker correlation between the COST measure and HRQOL. These findings suggest that the COST measure may need to be further adapted for use in underserved populations and patients with government sponsored insurance.

A scoping review capturing financial experiences of cancer survivors: Are we on the same page?

348 Background: There is great variation in how post-treatment financial consequences have been conceptualized and measured. This scoping review characterized the terms and measures used to capture the financial experiences of post-treatment cancer survivors. Methods: Reported according to PRISMA-ScR, electronic searches for published literature were conducted using Ovid MEDLINE, Embase.com, Web of Science Core Collection, Cochrane Central via Ovid, and ClinicalTrials.gov in March 2024. Eligible articles were U.S.-based empirical studies conducted with adult (≥18 years) cancer survivors (≥ 6 months post-treatment). Studies were managed using Covidence systematic review software. Results: Two coders screened 2452 titles and abstracts; 502 met inclusion criteria. Initial full-text review identified 127 articles for co-investigator assessment. Each article was evaluated for eligibility and quality by two investigators; 84 met criteria. Many terms were used, including financial hardship, burden, toxicity, stress/distress, worry, problems, impact, economic burden, difficulty, strain, and perceived financial security. Financial hardship and burden were most prevalent and often used interchangeably, categorized within material, psychological, and behavioral domains. Financial stress/distress , and financial worry , were consistently conceived as the psychological aspect of financial burden/hardship. Financial problems , strain , difficulty , impact , and economic burden were mainly measured using items pertaining to material/behavioral domains of financial consequences. Financial toxicity typically described the totality of effect of direct and indirect costs of cancer/treatment on one’s quality of life. Terms and definitions likely differed due to wide variation in the measures used; 47 measures were used. The most common tools included items from the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement (N= 20), the Comprehensive Score for Financial Toxicity (N= 13), and the National Health Interview Survey (N= 11). Conclusions: Findings suggest a general lack of consensus regarding the conceptualization and measurement of the financial experiences of cancer survivors. Financial hardship and burden were often used interchangeably, with financial toxicity capturing the greater encompassing effect of financial consequences of cancer. Future work is needed to arrive at a consensus that distinguishes between these critical outcomes.

Patient engagement in a community-partnered hybrid health-related social needs navigation intervention for adolescents and young adults with cancer (AYA-NAV).

173 Background: Adolescent and young adult (AYAs) cancer survivors experience high rates of financial toxicity (FT), which is associated with poorer health outcomes. FT may disproportionately affect AYAs with unmet health-related social needs (HRSN), such as food or housing insecurity. Needs navigation may be an effective intervention to reduce financial distress, however, engagement has been a challenge in prior adult-directed interventions. We hypothesize that a hybrid navigation delivery model with community organization support and digital delivery will reduce financial distress and improve health outcomes. In a pilot study of AYA-NAV, an AYA-directed needs navigation intervention, we report patient engagement among participants. Methods: Eligible AYAs were 15-39 years old, Spanish- or English-speaking, receiving curative-intent treatment for cancer, and screened positive for FT (Comprehensive Score of Financial Toxicity < 22) or unmet HRSN (food, housing, transportation, or utilities insecurity). Participants were referred for a consultation with the Patient Advocate Foundation (PAF), a national organization that provides case management and navigation support for people facing life limiting illness. At month 1, participants were referred to findhelp.org, a digital platform of comprehensive resources to facilitate resolution of unmet HRSN. Monthly check-ins were conducted by the study team to assess acceptability, intervention fidelity, and provide additional navigation support. We plan to enroll 30 participants on this study. Results: Of 19 AYAs that completed screening to date, 13 met criteria for FT or unmet HRSN; 13 (100%) agreed to AYA-NAV participation. To date, of 46 check-ins initiated by the study team, 33 (72%) were completed. All AYAs connected with the study team at least once during the 6-month duration of the study by text, phone, and/or in-clinic. Ten out of 13 (77%) participants reported that they spoke with a PAF case manager, and 7 (70%) of those said it was helpful. If the patient was unable to connect with PAF, more than half (55%) requested to be reconnected during a monthly check-in. Eight of the 13 (62%) participants visited findhelp.org; 6 (75%) of those found the digital platform to be helpful. Most patients referenced the high usability of findhelp.org, and 55% stated they connected to community resources via findhelp.org. Patients qualitatively reported challenges to intervention participation including medical complications, scheduling conflicts, and work commitments. Conclusions: Preliminary data demonstrate high patient engagement and intervention fidelity during a pilot feasibility study of AYA-NAV. Flexible modes for data collection and intervention delivery are important to inclusion of and retention of AYAs in hybrid navigation delivery models. Clinical trial information: NCT06072833 .

Water resource safety assessment of the Hexi inland river of China based on the PSR model

ABSTRACT The Hexi Corridor is located in northwest China, and its water resources mainly rely on meltwater from the Qilian Mountains and limited precipitation. The Hexi Corridor is an important regional population center and grain production area. However, limited rainfall restricts regional development due to inadequate water resources. Assessing water resource security in the Hexi region and providing targeted recommendations are crucial for rational planning and utilization of water resources, protecting the ecological environment, and promoting development. This study employs the entropy weight method to construct a pressure-state-response (PSR) system, assessing the water resource security of various river basins in the Hexi inland area. The evaluation results indicate that since the 21st century, the comprehensive water resource security scores of the three river basins have shown an upward trend. Specifically, the economic and social systems of the Shule River Basin and Heihe River Basin are improving, while their natural systems are declining; all three systems in the Shiyang River Basin are improving. Based on these results, targeted recommendations for different areas are proposed, providing a basis for enhancing water resource security in the region.

Study on the Performance Evaluation Method and Application of Drainage Nonwoven Geotextile in the Yellow River Sediment Filling Reclamation Area

Technical challenges associated with drainage and filling efficacy confront the Yellow River sediment filling reclamation, a novel approach to reclaiming coal-mined subsided lands. This study proposes an improved geotextile performance evaluation method to address the shortcomings of current geotextile screening methodologies in the drainage of the Yellow River sediment. This method comprehensively considers essential characteristics under working conditions, such as permeability, soil conservation, and blockage prevention properties, including indicators such as the permeability coefficient and sediment retention rate of geotextiles under pressure. Indoor flume filling and drainage experiments were implemented to verify the efficacy of geotextile drainage. The improved method identified thermal-bonded nonwoven geotextiles of 200 and 250 g·m−2 as having the highest comprehensive evaluation scores. The experimental results showed that these geotextiles significantly improved their drainage efficiency and better met the specific requirements of the Yellow River sediment filling reclamation. Traditional screening methods may be unsuitable for sediment drainage conditions, necessitating sediment interception and rapid drainage due to the streaming water–sediment mixture. Therefore, the newly established performance evaluation method is more appropriate for the specific requirements. It is recommended that a simple vibrating device be installed to maintain 20 vibrations per minute to keep drainage channels clear and provide stable drainage performance in engineering applications.

Task complexity effects on L2 speech rhythm in spontaneous speech production

Task-based pronunciation teaching studies have shown that the cognitive complexity of a task affects different aspects of second language (L2) speech, such as vowel accuracy and comprehensibility. However, its impact on L2 speech rhythm is still under-researched, especially in spontaneous pronunciation-unfocused tasks. In this study, we first investigated how task complexity influences L2 speech rhythm, and we then explored how L2 speech rhythm metrics might predict global pronunciation proficiency (comprehensibility and accentedness). Eighty-two Spanish/Catalan bilingual learners of English and a control group of eight native speakers (NSs) completed a simple and a complex version of an adapted monologic decision-making task. Oral production data were analysed using well-established rhythm metrics (%V, VarcoV, nPVI-V, and VarcoC), novel distance measures (Euclidean and Mahalanobis distance scores) and ratings from 13 English NSs. Results showed differential task complexity effects on L2 speech rhythm depending on the rhythm metrics and distance measures considered. Additionally, the %V rhythm metric and the Mahalanobis distance measure accounted for a modest amount of variance in both comprehensibility and accentedness scores, with Mahalanobis distances having a more reliable predicting power. The outcomes of this study point to the importance of further examining the role of task complexity in L2 speech rhythm in spontaneous speech and to what extent L2 speech rhythm is related to global measures of L2 pronunciation proficiency. These findings also highlight the need for identifying which rhythm metrics are more suitable to depict L2 speech elicited through different methods, particularly spontaneous speech.

Immediate and distant results of liver and bile duct resections for portal cholangiocarcinoma in elderly and senile patients

Aim. Evaluation of surgical outcomes in elderly and senile patients with portal cholangiocarcinoma.Materials and methods. The immediate and long-term results of surgical treatment of 170 patients with portal cholangiocarcinoma performed in 2013–2023 were analyzed. A comparison of the outcomes in patients aged below 60, 60–74, and over 74 years old was carried out. Factors prognostically associated with a high risk of fatal outcome in elderly and senile patients were determined by multivariate logistic regression analysis.Results. The senile patient group was more likely to develop severe complications (p = 0.089) and had a higher 90-day mortality (p = 0.042). The combination of such factors as the Charlson comorbidity index, Comprehensive Risk Score (CRS), resection volume, and surgery duration showed high prognostic significance with respect to hospital mortality, with an area under the ROC curve (AUC) of 0.895 (p < 0.001). The overall and recurrence-free survival of patients did not differ among all age groups (p = 0.886).Conclusion. In the absence of appropriate patient selection based on risk factors, the surgical outcomes in senile patients deteriorate. When planning a surgical intervention in senile patients, attention should be paid to minimizing surgical trauma and surgery duration, especially in patients with a high comorbidity index.

An Evaluation of Patient Profiles and Outcomes in an Off-Site Rehabilitation Unit in 2023 Compared to 2019

Abstract Background Our off-site inpatient rehabilitation unit accepts patients from many different referral centres. Demographic shifts have occurred in the last 4 years with the Covid-19 pandemic resulting in several practice changes and frailty admissions increasing at our primary referral centre by 11%. We compared the number of patients, their demographics and dependency in 2023 in comparison with 2019 and hypothesised a longer length of stay could be explained by increased dependency as defined by Barthel score on admission. Methods Data regarding patients’ age, admission and discharge dates, referral source and discharge destination were extracted from the rehabilitation unit's database. Weekly MDT records were examined to identify the patients’ presentation and dependency level. Presentations were categorised as stroke, hip fracture, other fracture, acute medical and surgical presentations, and elective surgical procedures. Results Discharges decreased to 89 in 2023 compared to 125 in 2019. Mean length of stay increased to 35.1 from 29.5. Mean age reduced from 85 to 83. Mean Barthel on admission was unchanged at 10. 21 Patients were admitted following elective orthopaedic surgery in 2019 compared to 2 in 2023 with a mean length of stay of 16 days. Length of stay for stroke patients increased from 33 to 50. Excluding both led to a length of stay of 32 in both years. Conclusion The reduction of bed days could be explained by increased frequency of outbreaks and more robust isolation strategies reducing total bed availability. A significant reduction in patients admitted following elective orthopaedic surgery impacted the average length of stay as did an increase in length of stay for stroke patients. Patient dependency defined by Barthel score was not increased and did not explain the increased length of stay. A more comprehensive score such as the Rehabilitation Complexity Score may be more predictive of complexity and thus length of stay.

A direct immersion-solid-phase microextraction method for the automated determination of 3- to 6-ring polycyclic aromatic hydrocarbons in saliva by gas-chromatography-tandem mass spectrometry

This work presents a novel method for the analysis of polycyclic aromatic hydrocarbons (PAHs) in saliva samples using solid phase microextraction (SPME) coupled with gas chromatography-triple quadrupole mass spectrometry (GC-QqQ-MS). The protocol utilizes the latest commercially available overcoated fiber (PDMS/DVB/PDMS) for direct immersion extraction of the target analytes, enabling the determination of thirteen PAHs, including low-volatile compounds. The SPME extraction method was optimized using a central composite design (CCD). The evaluation of the fiber coating's robustness over time demonstrated excellent extraction performance with no significant degradation. The validation procedure confirmed good performance for all parameters, with LOQ values (100 ng/L for ten analytes and 500 ng/L for three analytes) comparable to other chromatographic methods. The environmental impact of the protocol was objectively assessed using two recently proposed metrics: the Green Analytical Procedure Index (GAPI) and the Analytical Greenness metric for sample preparation (AGREEprep). Both metrics indicated good overall environmental friendliness, with AGREEprep providing a satisfactory comprehensive score despite the use of highly impactful instrumentation. These characteristics make the developed method suitable for routine analysis in environmental and epidemiological monitoring.

Clinical prognostication in acute necrotizing encephalopathy of childhood: the role of magnetic resonance imaging severity assessment.

Acute necrotizing encephalopathy of childhood is a unique entity with bilateral gray and white matter involvement. The aim of this study is to explore whether the severity of findings on imaging scans is indicative of the prognosis and clinical outcomes for pediatric patients with acute necrotizing encephalopathy. A retrospective cross-sectional study was conducted on 42 patients diagnosed with acute necrotizing encephalopathy. A severity score based on MR imaging was computed for each patient, utilizing a point system determined by the existence of factors such as hemorrhage, cavitation, enhancement, diffusion restriction, and lesion location. The scoring was categorized into mild, moderate, and severe. Clinical outcomes were determined at the time of discharge and at follow-ups as mild disability, moderate disability, severe disability, and death according to the modified Rankin Scale. Associations were determined by Fisher's exact test, chi-square test, and one-way ANOVA. The study included 21 boys and 21 girls with a mean age of 71.5months. A statistically significant connection (P=0.027) was found between the severity score from MR imaging and the clinical outcome. A statistically significant relationship was also observed between diffusion restriction (P=0.008), cerebellar involvement (P=0.048), and an unfavorable clinical outcome. Additionally, individuals who experienced shock exhibited a correlation with adverse outcomes (P=0.01). In predicting the outcome of acute necrotizing encephalopathy, cerebellar involvement and presence of diffusion restriction were associated with worse clinical outcomes in our study. Developing a comprehensive MR-based severity score is crucial for improving diagnostic accuracy and patient outcomes. Our findings underscore the importance of including diffusion restriction and cerebellar involvement in the scoring system.

A comprehensive scoring system for the diagnosis and staging of adhesive capsulitis: development, application, and implications.

Adhesive capsulitis (AC), often referred to as frozen shoulder, presents a diagnostic challenge due to its insidious onset and progressive nature. The condition is characterized by pain and restricted motion in the shoulder, with a predilection for individuals between 40 and 60years of age. A novel scoring system was developed to enhance the accuracy of diagnosing AC and distinguishing between its stages, aiming to streamline clinical decision-making and treatment planning. A cohort of patients with symptoms suggestive of AC was assessed using the new scoring system, which integrates clinical, radiological, and patient history factors. Parameters included comorbidities like diabetes mellitus, recent immobility, rotator cuff tears, and specific ultrasound findings. Patients were scored and categorized into definitive AC, uncertain diagnosis, or exclusion from AC, with scores > 7, 6-2, and < 2, respectively. The scoring system effectively categorized patients, with those scoring > 7 demonstrating pronounced symptoms and ultrasound changes consistent with Phase 2 AC. Patients with scores between 6 and 2 were classified into uncertain Phase 1 or Phase 3, necessitating further observation. Scores < 2 effectively excluded AC, indicating a need to explore alternative diagnoses. The structured scoring system demonstrated potential as a comprehensive tool for diagnosing AC. By quantitatively assessing a range of contributory factors, it allowed for the stratification of the disease into distinct stages. This system is anticipated to improve early diagnosis and the precision of treatment interventions, although further validation in larger cohorts is warranted. II-III.

Animal Models of Autistic-like Behavior in Rodents: A Scoping Review and Call for a Comprehensive Scoring System

Appropriate animal models of human diseases are a cornerstone in the advancement of science and medicine. To create animal models of neuropsychiatric and neurobehavioral diseases such as autism spectrum disorder (ASD) necessitates the development of sufficient neurobehavioral measuring tools to translate human behavior to expected measurable behavioral features in animals. If possible, the severity of the symptoms should also be assessed. Indeed, at least in rodents, adequate neurobehavioral and neurological tests have been developed. Since ASD is characterized by a number of specific behavioral trends with significant severity, animal models of autistic-like behavior have to demonstrate the specific characteristic features, namely impaired social interactions, communication deficits, and restricted, repetitive behavioral patterns, with association to several additional impairments such as somatosensory, motor, and memory impairments. Thus, an appropriate model must show behavioral impairment of a minimal number of neurobehavioral characteristics using an adequate number of behavioral tests. The proper animal models enable the study of ASD-like-behavior from the etiologic, pathogenetic, and therapeutic aspects. From the etiologic aspects, models have been developed by the use of immunogenic substances like polyinosinic-polycytidylic acid (PolyIC), lipopolysaccharide (LPS), and propionic acid, or other well-documented immunogens or pathogens, like Mycobacterium tuberculosis. Another approach is the use of chemicals like valproic acid, polychlorinated biphenyls (PCBs), organophosphate pesticides like chlorpyrifos (CPF), and others. These substances were administered either prenatally, generally after the period of major organogenesis, or, especially in rodents, during early postnatal life. In addition, using modern genetic manipulation methods, genetic models have been created of almost all human genetic diseases that are manifested by autistic-like behavior (i.e., fragile X, Rett syndrome, SHANK gene mutation, neuroligin genes, and others). Ideally, we should not only evaluate the different behavioral modes affected by the ASD-like behavior, but also assess the severity of the behavioral deviations by an appropriate scoring system, as applied to humans. We therefore propose a scoring system for improved assessment of ASD-like behavior in animal models.

Pulsed lighting for adults with Dyslexia: very limited impact, confined to individuals with severe reading deficits

The goal of this study is to evaluate the impact of pulsed lighting on the reading performance of young adults with dyslexia. A total of 42 participants were recruited, including individuals diagnosed with developmental dyslexia and adults without reported reading difficulties. The severity of each participant’s reading deficit was assessed on a continuous scale using a reading impairment score, derived from four reading tests: an isolated-word reading test, a pseudoword reading test, and two reading fluency tests. The impairment score ranged from 0 (no impairment) to 4 (severe impairment across all tests). To examine the potential effect of pulsed lighting, we measured (1) sentence reading speed, expressed as a reading accessibility index (ACC), and (2) text comprehension, expressed as a comprehension score. These measures were taken under three lighting conditions: standard lighting, pulsed lighting, and a combination of the two. Linear mixed-effects models were applied to assess the effects of lighting on ACC and comprehension, controlling for the reading impairment score. We found no effect of lighting conditions on either ACC or comprehension, except in the most impaired readers, who showed a small but significant increase of 7% in ACC. However, even with pulsed lighting, impaired readers did not reach the performance level of skilled adult readers. In conclusion, the study did not demonstrate a clear positive impact of pulsed lighting on the reading skills of adults with dyslexia.

MEDIA VIDEO ANIMASI MINDFUL EATING DAPAT DIGUNAKAN UNTUK MEMBANTU MENGATASI DISORDERED EATING PADA MAHASISWA

Disordered Eating (DE) or eating behavior problems are one of the issues that are increasingly significant among college students. Academic pressures and cultural changes influence the concept of the ideal body, leading to unhealthy eating behaviors. Mindful Eating (ME), which emphasizes awareness and appreciation of eating behaviors, effectively addresses disordered eating behaviors. However, there are still many cases of DE among collage students, especially women. This research aimed to develop a canvas-based animation video to help college students overcome DE. The type research method in this study used Research and Development (R&amp;D) with the ADDIE (Analyze, Design, Development, Implementation, and Evaluation) model, but only up to the development stage in this study. Canva-based animation video validation involves three experts: expert materials, linguists, and media experts, with an average result of 80.3 (decent category, revised as necessary). Next, it was tested on prospective users (n = 37) who were selected by simple random sampling. The results of product assessment by prospective users amounted to 91.1 (very feasible category, no need to revise). The ME Knowledge Questionnaire measured the impact of video use (reliability = 0.621). The results of the comprehension score based on the pre-test and post-test on students obtained an average N-Gain score of 0.84 with an average score of 0.84 with a high category. Based on the analysis results, it can be concluded that ME video products are feasible to use as learning media to increase ME knowledge and overcome ED problems in collage students.