Plan Selection Research Articles

“Pick a Plan and Roll the Dice”: A qualitative study of consumer experiences selecting a health plan in the non-group market

BackgroundFor consumers without access to employer-sponsored or public insurance, health plan choices in the non-group (individual) insurance market that do not meet consumer needs have the potential for negative downstream implications for health and financial well-being. ObjectiveThis qualitative interview study sought to understand consumers’ experiences and challenges with choosing a non-group health plan, among those who later had negative experiences with the plan they chose. MethodsWe conducted semi-structured telephone interviews with a purposive sample of 36 participants from a large regional health insurance carrier in three states who enrolled in non-group plans in 2017 (21 in Affordable Care Act (ACA) Marketplace plans and 15 enrolled off-Marketplace). Participants were included if they reported negative experiences using their plan after enrollment, such as higher-than-expected medical costs. Interviews explored challenges choosing a plan; information needed for choosing; usefulness of available tools; and preferred format for interventions to improve plan choice experiences. We analyzed interview transcripts using thematic content analysis. ResultsStudy participants reported experiencing substantial challenges to choosing an insurance plan. Key barriers included understanding insurance terms, finding relevant information, and making comparisons across plans. Participants valued the ability to make comparisons across carriers when using the Marketplace websites but were less satisfied with customer service. Suggestions for improvement included greater standardization of plans and language and availability of customized one-on-one assistance. ConclusionFindings from this study suggest that health plan selection in the non-group market presents challenges to consumers that may be addressed through enrollment assistance and improved presentation of information. Personalized assistance to find and choose coverage may lead to plan choices that better meet consumer needs and increase confidence choosing a plan in subsequent enrollment periods.

Factors Affecting Patient and Caregiver Preferences for Treatment of Myeloma and Indolent Lymphoma.

Treatment options for myeloma and indolent lymphoma are increasing exponentially, with distinct efficacy, side effects, and cost. We aim to determine the factors influencing patient and caregiver treatment preferences. Patients and caregivers of patients with myeloma and indolent lymphoma were recruited from two cancer centers in Singapore. Preferences were elicited using a discrete choice experiment. Attributes and levels were selected based on a previous qualitative study. The relative preference for levels within each attribute (part worth utility values) and the extent to which an attribute would influence decision making (relative importance) were calculated. Patient and caregiver participation in the treatment plan selection process were assessed using the Control Preference Scale. One hundred ninety-nine patients and 169 caregivers were recruited. Patients placed the highest importance on out-of-pocket costs (relative importance = 35%), followed by efficacy (25%), persistent side effects (19%), administration route (8%), treatment duration (7%), and short-term side effects (5%). Caregivers ranked efficacy (27%) as the most important attribute, over out-of-pocket costs (24%). Most patients preferred a collaborative role in the shared decision-making process, while similar proportions of caregivers favored active and collaborative roles. Our study demonstrates that both patients and caregivers consider cost seriously when making treatment decisions. Furthermore, as patient and caregiver preferences may differ, there are implications for treatment selection and counseling, especially in cultures where caregivers have more prominent roles in treatment planning.

The Development of Flashcard Media to Improve Narrative Writing Skills for Elementary School

The focus of the research was to produce flashcard media to improve 2nd grade narrative writing skills at SDIT Ar Ruhul Jadid Jombang. There are 7 stages to go through 1) potential and problems which include problem analysis, 2) research and data collection which includes activities to collect information, 3) planning which includes product design planning and material selection, 4) design validation which includes validation by experts, 5 ) design revisions according to input and assessment by experts, 6) product trials, and 7) product revisions. Based on the results of the data during the research 1) the developed flashcard media was stated to be very valid for use in learning to write narratives. This is based on the validation results of media experts of 91.25% and material experts 93.13% of the percentage of criteria that have been set. 2) the developed flashcard media is stated to be very feasible to use in learning to write narratives. This is based on the results of the teacher response questionnaire 93.75% and 83% of the student response questionnaire. 3) the results of trials for the development of flashcard learning media obtained a value from the results of t count 11.284 > t table 2.056 so that it could be declared effective in improving narrative writing skills. This is supported by a significance value of 0.000 which is smaller than the significance of 0.05 (0.000 <0.05). This means that there is a significant increase in students' writing skills in writing narratives before and after using flashcard learning media.

Why higher copayments for opioids did not reduce use among Medicare beneficiaries.

To examine whether higher cost-sharing deterred prescription opioid use. Medicare Part D claims from 2007 to 2016 for a 20% random sample of Medicare enrollees. We obtain estimates of the effect of cost-sharing on prescription opioid use using ordinary least squares and instrumental variables methods. In both, we exploit the variation (change) in cost-sharing within plans over time for a sample of beneficiaries who remain in the same plan. Focusing on changes in cost-sharing within a plan for a constant sample of beneficiaries mitigates potential bias from plan selection and using a constant set of weights derived from use in year (t) eliminates changes in the cost-sharing indexes due to (endogenous) consumer choice in year (t+1). Part D plans adopted benefit changes designed to reduce opioid use, including moving opioids to higher cost-sharing tiers. Increasing plan copayments for hydrocodone or oxycodone was associated with reductions in plan-paid claims and offsetting increases in cash claims. Widespread availability of low-cost generics combined with the anti-clawback provision in Part D mediated the effect of higher cost sharing to curb opioid use. As plans moved generic opioids to higher cost-sharing tiers, beneficiaries simply paid cash prices and aggregate use remained largely unchanged. The anti-clawback provision in Part D, intended to protect beneficiaries from price gouging, limited plans' ability to constrain opioid use through typical demand-side measures such as increased cost-sharing.

Anti-infective therapy durations predict psychological stress and laparoscopic surgery quality in pelvic abscess patients

BACKGROUND The degree of psychological stress and the difficulty and efficacy of laparoscopic surgery differ in patients with pelvic abscesses after different durations of anti-infection treatment. AIM To compare and analyse the effects of different durations of anti-infective therapy on patients’ preoperative psychological stress level and the clinical efficacy of laparoscopic surgery in patients with pelvic abscesses to offer a reference for the selection of therapy plans. METHODS A total of 100 patients with pelvic abscesses who were admitted to the Department of Gynecology of Suzhou Ninth Hospital affiliated to Soochow University (Suzhou Ninth People's Hospital) from January 2018 to December 2022 were retrospectively enrolled. According to the different durations of anti-infective therapy, they were divided into Group S (50 patients, received anti-infective therapy for 24-48 h) and Group L (50 patients, received anti-infective therapy for 48-96 h). Baseline data, state-trait anxiety score at admission and before surgery, self-rating anxiety scale (SAS) + self-rating depression scale (SDS) score, surgery time, adhesion grading score, intraoperative blood loss, presence or absence of intraoperative intestinal injury, ureteral injury or bladder injury, postoperative body temperature, length of hospital stay, and presence or absence of recurrence within 3 mo after surgery, chronic pelvic pain, incision infection, dysmenorrhea, menstrual disorder or intestinal obstruction were compared between the S group and the L group. RESULTS There was no significant difference in the background data between the S group and the L group (P < 0.05). There was no significant difference in the state-trait anxiety score or SAS + SDS score between the S group and the L group on admission (P < 0.05). The state-trait anxiety score and SAS + SDS score of the S group were lower than those of Group L after receiving different durations of anti-infective therapy (P < 0.05). There was no significant difference in the incidence of intestinal, ureteral or bladder injury between the S group and the L group (P < 0.05). The surgery time of Group S was shorter than that of Group L, and the adhesion score and intraoperative blood loss volume were lower than those of Group L (P < 0.05). There was no significant difference in the incidence of incision infection, dysmenorrhea, menstrual disorder or intestinal obstruction between the S group and the L group (P < 0.05). The postoperative body temperature of Group S was lower than that of Group L (P < 0.05), and the hospital stay was shorter than that of Group L (P < 0.05). The incidences of recurrence and chronic pelvic pain within 3 mo after surgery were lower than that of Group L (P < 0.05). CONCLUSION Twenty-four to forty-eight hours of anti-infective therapy is better than 48-96 h of anti-infective therapy for patients with pelvic abscesses because the degree of psychological stress is lower, which is more conducive to achieving better outcomes after laparoscopic surgery.

Research on the Impact of Smart City Development Taking Amsterdam as an Example

The Smart City is the highest stage of urban information development and an emerging model of sustainable urban development. Currently, the predominant focus of smart city research lies in the domain of construction, while there exists a dearth of discourse and theoretical underpinning pertaining to the sustainable development of smart cities with regards to conceptual standards and practical necessities. This insufficiency in comprehensive discussion and theoretical support may hinder the progress of Smart City research and impede the long-term effectiveness of implementation strategies. In order to address these concerns, this study chooses the most typical Amsterdam Smart City and investigates viable options for sustainable urban growth. A comprehensive definition of a smart city is formulated through a thematic study, this study adopting a prototype theory as the basis. The study also presents reference strategies for establishing a sustainable development model for smart cities in China, utilizing case studies. The findings indicate that the continued development of the Smart City model can contribute to the progress of urban intelligence, information systems, and modernization in the long run. Besides, this paper provides a case study of smart cities for in-depth investigation, with development factors influencing the selection of subsequent urban development plans.

A novel approach to three-way decision model under fuzzy soft dominance degree relations and emergency situation

In this study, we attempt to present a three-way multi criteria decision-making (MCDM) technique with fuzzy soft dominance degree relation based on additive consistency to simultaneously choose the best alternative, rank alternatives, and classify alternatives, which would aid decision-makers in making better decisions. First, we provide the additive consistency based fuzzy soft dominance degree relation. Then, based on the fuzzy soft dominance degree relation, we build the idea of the θ-similarity class and define new relative loss functions with unknown risk coefficient vectors and unknown weights of the alternatives. Further, using θ-similarity classes based conditional probability, we offer a theoretical approach for finding total decision cost to attain the best cost-sensitive granularity selection. Furthermore, we also discuss in detail about the newly proposed three-way MCDM method’s decision making mechanisms. We further check the method’s viability using the emergency plan selection problem. Comparative assessments demonstrate that the proposed approach has a better decision-making function than several other methods available in the literature. Experimental evaluations demonstrate that the proposed technique consistently rank the considered object and chooses the best one. Furthermore, the suggested technique can satisfy the decision-makers’ preferences in the classification choice in addition to offering suitable ranking decision recommendation for decision-makers.

States' racial resentment correlates with administrative distancing and lower rates of health plan selection in affordable care act marketplaces: a cross sectional analysis.

In the United States, the Affordable Care Act (ACA) pursued equity in healthcare access and treatment, but ACA implementation varied, especially limiting African Americans' gains. Marketplaces for subsidized purchase of coverage were sometimes implemented with limited outreach and enrollment assistance efforts. Reflecting state's ACA receptivity or reluctance, state's implementation may rest on sociopolitical stances and racial sentiments. Some states were unwilling to provide publicly supported healthcare to nonelderly, non-disabled adults- "the undeserving poor" -who evoke anti-black stereotypes. The present study assessed whether some states shunned Affordable Care Act (ACA) marketplaces and implemented them less vigorously than other states, leading to fewer eligible persons selecting insurance plans. It assessed if states' actions were motivated by racial resentment, because states connote marketplaces to be government assistance for unworthy African Americans. Using marketplace and plan selection data from 2015, we rated states' marketplace structures along a four-level continuum indicating greater acceptance of marketplaces, ranging from states assuming sole responsibility to minimal responsibility. Using national data from a four-question modern racism scale, state-wide racial resentment estimates were estimated at the state level. Analysis assessed associations between state levels of racial resentment with states' marketplace structure. Further analysis assessed relationships between both state levels of racial resentment and states' marketplace structure with states' consumer plan selection rates-representing the proportion of persons eligible to enroll in insurance plans who selected a plan. Racial resentment was greater in states with less responsibility for the administration of the marketplaces than actively participating states. States higher in racial resentment also showed lower rates of plan selection, pointing to less commitment to implementing marketplace provisions and fulfilling the ACA's coverage-improvement mission. Differences persisted after controlling for differences in conservatism, uninsurance, poor health, and rejection of Medicaid expansion. Resentment of African Americans' purported irresponsibility and entitlement to government assistance may interfere with states structuring and operating marketplaces to maximize health insurance opportunities for everyone available under the ACA. N/A.

Maintaining Task Performance Levels Under Cognitive Load While Walking Requires Widespread Reallocation of Neural Resources.

This study elucidates the neural mechanisms underlying increasing cognitive load while walking by employing 2 versions of a response inhibition task, the '1-back' version and the more cognitively demanding '2-back' version. By using the Mobile Brain/Body Imaging (MoBI) modality, electroencephalographic (EEG) activity, three-dimensional (3D) gait kinematics and task-related behavioral responses were collected while young adults (n=61) performed either the 1-back or 2-back response inhibition task. Interestingly, increasing inhibitory difficulty from 1-back to 2-back during walking was not associated with any detectable costs in response accuracy, response speed, or gait consistency. However, the more difficult cognitive task was associated with distinct EEG component changes during both successful inhibitions (correct rejections) and successful executions (hits) of the motor response. During correct rejections, ERP changes were found over frontal regions, during latencies related to sensory gain control, conflict monitoring and working memory storage and processing. During hits, ERP changes were found over left-parietal regions during latencies related to orienting attention and subsequent selection and execution of the motor plan. The pattern of attenuation in walking-related EEG amplitude changes, during 2-back task performance, is thought to reflect more effortful recalibration of neural processes, a mechanism which might be a key driver of performance maintenance in the face of increased cognitive demands while walking. Overall, the present findings shed light on the extent of the neurocognitive capacity of young adults and may lead to a better understanding of how factors such as aging or neurological disorders could impinge on this capacity.

Increasing Young Entrepreneurs Through the WMP DISPORA Program

The aim of this service activity is to encourage economic growth in the Garut Regency community through young entrepreneurs in the fields of finance, education and training. The method used is the mentoring method. The Youth and Sports Service (Dispora) carries out entrepreneurial assistance activities by opening the Young Youth Entrepreneurship (WMP) program. Beginner Young Entrepreneurs (WMP) is a form of appreciation from the government to young people who are active in the business world, and have shown results and have the potential to develop. This WMP program provides opportunities for young entrepreneurs who have been running a business for at least three months who pass the business plan criteria and selection to receive assistance in the form of capital, education and soft skills training. Capital assistance can be in the form of money or goods, while to increase entrepreneurial knowledge capacity, one way is by holding soft skills training and WMP comparative studies. The result of this service activity is strengthening education and capital skills for young business actors in Garut Regency which encourages community economic growth through the WMP program. This WMP program contributes to the creation of new jobs, increases economic growth and is one component in supporting a healthy business environment and encouraging the vision of the Garut Regency government 2019-2024.

Multi-objective optimization for through train service integrating train operation plan and type selection

ABSTRACT Providing effective Through Train Services (TTSs) faces challenges due to complex infrastructure conditions, train performances and passenger demands. To enhance TTSs between two different classes of urban rail transit lines with variations in train speed and capacity, we propose a multi-objective Integer Non-Linear Programming (INLP) model. This model maximizes passenger travel time savings and average train load utilization, and develops an integrated approach to simultaneously optimize the frequencies of through express trains and local trains, as well as the operation zones, stopping patterns and type selection of through trains. Additionally, a Non-Dominated Sorting Genetic Algorithm II is designed to solve the INLP model based on a simple test network and a real-world case from the Nanjing Subway. The unique benefits of our proposed method are demonstrated by a comprehensive compared with the Single Line Operation Mode and the all-stop plans under Through Operation Mode.

Inter-observer variability in library plan selection on iterative CBCT and synthetic CT images of cervical cancer patients.

In the Library-of-Plans (LoP) approach, correct plan selection is essential for delivering radiotherapy treatment accurately. However, poor image quality of the cone-beam computed tomography (CBCT) may introduce inter-observer variability and thereby hamper accurate plan selection. In this study, we investigated whether new techniques to improve the CBCT image quality and improve consistency in plan selection, affects the accuracy of LoP selection in cervical cancer patients. CBCT images of 12 patients were used to investigate the inter-observer variability of plan selection based on different CBCT image types. Six observers were asked to individually select a plan based on clinical X-ray Volumetric Imaging (XVI) CBCT, iterative reconstructed CBCT (iCBCT) and synthetic CTs (sCT). Selections were performed before and after a consensus meeting with the entire group, in which guidelines were created. A scoring by all observers on the image quality and plan selection procedure was also included. For plan selection, Fleiss' kappa (κ) statistical test was used to determine the inter-observer variability within one image type. The agreement between observers was significantly higher on sCT compared to CBCT. The consensus meeting improved the duration and inter-observer variability. In this manuscript, the guidelines attributed the overall results in the plan selection. Before the meeting, the gold standard was selected in 76% of the cases on XVI CBCT, 74% on iCBCT, and 76% on sCT. After the meeting, the gold standard was selected in 83% of the cases on XVI CBCT, 81% on iCBCT, and 90% on sCT. The use of sCTs can increase the agreement of plan selection among observers and the gold standard was indicated to be selected more often. It is important that clear guidelines for plan selection are implemented in order to benefit from the increased image quality, accurate selection, and decrease inter-observer variability.

When architecture meets RL+EA: A hybrid intelligent optimization approach for selecting combat system-of-systems architecture

In recent decades, various domains such as military, aerospace and supply chain are becoming increasingly complex, forming system-of-systems (SoSs). The effectiveness of SoSs is mainly determined by their architecture, thus selecting proper architecture for SoSs is crucial to maximize their effectiveness. While most studies focus on specific issues, such as mission planning and SoSs meta-architecture selection, few papers deal with the two issues together. This paper introduces the task oriented SoSs architecture selection problem (TSASP) and proposes an combination of reinforcement learning (RL) and evolutionary algorithm (EA) (CRE) to address this problem. CRE comprises two layers: the inner layer utilizes a DQN-based algorithm to solve the mission planning problem, and the outer layer with improved genetic algorithm optimizes the SoSs architecture selection based on the output of inner one. A synthetic air and missile defense (AMD) example is conducted to test the effectiveness of proposed method, and results show that CRE can improve the mission planning effect by select a feasible architecture.

Optimization of Village Budget Plan Selection Based on Priorities Using Method Promethee and Borda

The rapid information technology that is happening now
 has a significant impact on human life, including various
 activities that occur at the village office. The village head
 is responsible for managing funds at the village level
 including the collection and accountability of funds in
 accordance with the provisions of law no.33 of 2004
 concerning the balance of central and regional
 governments. This study aims to implement a decision
 support system by combining two methods, namely the
 promethee and borda methods in selecting village budget
 plans in Tegal Sari village based on priority. The method
 used in this research is the Research and Development
 (R&D) method. The method used for calculations is the
 PROMETHEE and Borda methods. The PROMETHEE
 method is used to manage individual decisions from each
 decision maker, while the Borda method is used to
 manage group decisions resulting from the PROMETHEE
 ranking method. The criteria in this study are Cost,
 Completion Time, Impact on Regions/Society, Profits
 from Sustainable Investment, Factors of Interest. The
 results obtained from this research are Pemb. Health
 Sarpras as an alternative priority for the village budget.

Assessment and optimization of co-firing power plant in Thailand: Seasonal effects and dust emission concerns

In this work, the industrial-scale co-fired power plant in Thailand was analyzed and the optimization model was proposed to provide a proper fuel selection for the feedstock seasonal planning to minimize the cost of electricity generation. Also, the dust emission model was introduced in this work to investigate the environmental concern of the proposed fuel formula. The seasonal effects including feed price, properties, and availability were also included in the optimization model. The optimum solution reported a set of fuel formulas for each season that is capable of maintaining power production stability and minimizing fuel costs. Although, the global demand for coal was at its peak in the winter season, using biomass (wood chip, wood bark, and fiber) could increase the production to achieve its minimum requirement. The optimization could reduce the cost of electricity (COE) production by up to 14% (in the winter season). Also, the emission model indicated that to increase the steam production rate to meet the requirement in the summer season, a larger amount of mixed fuel consumption rate was needed. This led to an increase in dust emissions in the summer season. However, in the winter season, the result from optimization could decrease dust emissions by up to 50%. In conclusion, increasing biomass utilization is a favorable option in both economic and environmental aspects.

Design and Incentives of Equity Incentives in Chinese SOEs in Response to Environmental Uncertainty -- Case study of Hikvision based on grounded theory

High-tech companies are the most affected by restrictions on their ability to innovate. As the epitome of high-tech enterprise development in China, Hikvision actively explores and boldly innovates the equity incentive method and is always adapting to cope with internal and external environmental instability. This paper analyzes and compares the first four equity incentives based on the uncertainty factors and motivations of the internal and ex-ternal environment of the enterprise, takes this as the starting point, starts from the environmental motivations, and according to the constructively-rooted theory proposed by Glaser and Strauss, carries out programmed coding for the three dimensions of environmental factors, equity incentive plan selection and overall enterprise value enhancement. In this paper, we investigate the rationality of Hikvision's equity incentive policy setting, evaluate the effectiveness of the equity incentive policy, and predict the likelihood of equity lock-up under future environmental trends through tools such as excess return and return on equity. Based on the advantages and disadvantages, this paper puts forward the improvement of the equity incentive policy already implemented, and puts forward the universal suggestions on the application of equity incentive to deal with the environmental uncertainty, and establishes the equity incentive model for enterprises to deal with the uncertain environment to help enterprises make better management decisions.

An integrated optimization model for planning supply chains' resilience and business continuity under interrelated disruptions: a case study

PurposeThe adverse interactions between disruptions can increase the supply chain's vulnerability. Accordingly, establishing supply chain resilience to deal with disruptions and employing business continuity planning to preserve risk management achievements is of considerable importance. The aforementioned idea is discussed in this study.Design/methodology/approachThis study proposes a multi-objective optimization model for employing business continuity management and organizational resilience in a supply chain for responding to multiple interrelated disruptions. The improved augmented e-constraint and the scenario-based robust optimization methods are adopted for multi-objective programming and dealing with uncertainty, respectively. A case study of the automotive battery manufacturing industry is also considered to ensure real-world conformity of the model.FindingsThe results indicate that interactions between disruptions remarkably increase the supply chain's vulnerability. Choosing a higher fortification level for the supply chain and foreign suppliers reduces disruption impacts on resources and improves the supply chain's resilience and business continuity. Facilities dispersion, fortification of facilities, lateral transshipment, order deferral policy, dynamic capacity planning and direct transportation of products to markets are the most efficient resilience strategies in the under-study industry.Originality/valueApplying resource allocation planning and portfolio selection to adopt preventive and reactive resilience strategies simultaneously to manage multiple interrelated disruptions in a real-world automotive battery manufacturing industry, maintaining the long-term achievements of supply chain resilience using business continuity management and dynamic capacity planning are the main contributions of the presented paper.

Machine learning-identified stemness features and constructed stemness-related subtype with prognosis, chemotherapy, and immunotherapy responses for non-small cell lung cancer patients

AimThis study aimed to explore a novel subtype classification method based on the stemness characteristics of patients with non-small cell lung cancer (NSCLC).MethodsBased on the Cancer Genome Atlas database to calculate the stemness index (mRNAsi) of NSCLC patients, an unsupervised consensus clustering method was used to classify patients into two subtypes and analyze the survival differences, somatic mutational load, copy number variation, and immune characteristics differences between them. Subsequently, four machine learning methods were used to construct and validate a stemness subtype classification model, and cell function experiments were performed to verify the effect of the signature gene ARTN on NSCLC.ResultsPatients with Stemness Subtype I had better PFS and a higher somatic mutational burden and copy number alteration than patients with Stemness Subtype II. In addition, the two stemness subtypes have different patterns of tumor immune microenvironment. The immune score and stromal score and overall score of Stemness Subtype II were higher than those of Stemness Subtype I, suggesting a relatively small benefit to immune checkpoints. Four machine learning methods constructed and validated classification model for stemness subtypes and obtained multiple logistic regression equations for 22 characteristic genes. The results of cell function experiments showed that ARTN can promote the proliferation, invasion, and migration of NSCLC and is closely related to cancer stem cell properties.ConclusionThis new classification method based on stemness characteristics can effectively distinguish patients' characteristics and thus provide possible directions for the selection and optimization of clinical treatment plans.

Adverse pathologic features impact survival outcomes for small renal masses following nephrectomy.

While most small renal masses (SRM) < 4 cm have an excellent prognosis following resection, the impact of adverse T3a pathologic features on oncologic outcomes of SRMs remains unclear. We sought to compare clinical outcomes for surgically resected pT3a versus pT1a SRMs at our institution. We retrospectively reviewed records of patients who underwent radical or partial nephrectomy (RN, PN) for renal tumors <4 cm at our institution between 2010 and 2020. We compared features and outcomes of pT3a vs pT1a SRMs. Continuous and categorical variables were compared using Student's t and Pearson's chi-squared tests, respectively. Postoperative outcomes of interest including overall, cancer-specific, and recurrence-free survival (OS, CSS, and RFS) were analyzed using Kaplan-Meier method, Cox proportional hazard regression, and competing risk analysis. Analyses were performed using R statistical package (R Foundation, v4.0). We identified 1,837 patients with malignant SRMs. Predictors of postoperative pT3a upstaging included higher renal score, larger tumor size, and presence of radiologic features concerning for T3a disease (odds ratio [OR] = 5.45, 95% confidence interval [CI] 3.92-7.59, P < 0.001). On univariable modeling, pT3a SRMs had higher positive margin rates (9.6% vs 4.1%, P < 0.001), worse OS (hazard ratio [HR] = 2.9, 95% CI 1.6-5.3, P = 0.002), RFS (HR 9.32, 95% CI 2-40.1, P = 0.003), and CSS (HR = 3.6, 95% CI 1.5-8.2, P = 0.003). On multivariable modeling, pT3a status remained associated with worse RFS (HR = 2.7, 95% CI 1.04-7, P = 0.04), but not OS (HR 1.6, 95% CI = 0.83-3.1, P = 0.2); multivariable modeling was deferred for CSS due to low event rates. Adverse T3a pathologic features portend worse outcomes for SRMs, highlighting the crucial role of pre-operative planning and case selection. These patients have relatively poor prognosis, and should be monitored more closely and counseled for consideration of adjuvant therapy or clinical trials.

CIPP모형을 활용한 R&amp;D과제기획 선정평가 도구 개발 연구 : K연구원 중심으로

CIPP모형을 활용한 R&amp;D과제기획 선정평가 도구 개발 연구 : K연구원 중심으로