(Cost-)effectiveness of an individualised risk prediction tool (PERSARC) on patient’s knowledge and decisional conflict among soft-tissue sarcomas patients:protocol for a parallel cluster randomised trial (the VALUE-PERSARC study)

Introduction Current treatment decision-making in high-grade soft-tissue sarcoma (STS) care is not informed by individualised risks for different treatment options and patients’ preferences. Risk prediction tools may provide patients and professionals insight in personalised risks and benefits for different treatment options and thereby potentially increase patients’ knowledge and reduce decisional conflict. The VALUE-PERSARC study aims to assess the (cost-)effectiveness of a personalised risk assessment tool (PERSARC) to increase patients’ knowledge about risks and benefits of treatment options and to reduce decisional conflict in comparison with usual care in high-grade extremity STS patients. Methods The VALUE-PERSARC study is a parallel cluster randomised control trial that aims to include at least 120 primarily diagnosed high-grade extremity STS patients in 6 Dutch hospitals. Eligible patients (≥18 years) are those without a treatment plan and treated with curative intent. Patients with sarcoma subtypes or treatment options not mentioned in PERSARC are unable to participate. Hospitals will be randomised between usual care (control) or care with the use of PERSARC (intervention). In the intervention condition, PERSARC will be used by STS professionals in multidisciplinary tumour boards to guide treatment advice and in patient consultations, where the oncological/ orthopaedic surgeon informs the patient about his/her diagnosis and discusses benefits and harms of all relevant treatment options. The primary outcomes are patients’ knowledge about risks and benefits of treatment options and decisional conflict (Decisional Conflict Scale) 1 week after the treatment decision has been made. Secondary outcomes will be evaluated using questionnaires, 1 week and 3, 6 and 12 months after the treatment decision. Data will be analysed following an intention-to-treat approach using a linear mixed model and taking into account clustering of patients within hospitals. Ethics and dissemination The Medical Ethical Committee Leiden-Den Haag-Delft (METC-LDD) approved this protocol (NL76563.058.21). The results of this study will be reported in a peer-review journal.</p

(Cost-)effectiveness of an individualised risk prediction tool (PERSARC) on patient’s knowledge and decisional conflict among soft-tissue sarcomas patients:protocol for a parallel cluster randomised trial (the VALUE-PERSARC study)

Introduction Current treatment decision-making in high-grade soft-tissue sarcoma (STS) care is not informed by individualised risks for different treatment options and patients’ preferences. Risk prediction tools may provide patients and professionals insight in personalised risks and benefits for different treatment options and thereby potentially increase patients’ knowledge and reduce decisional conflict. The VALUE-PERSARC study aims to assess the (cost-)effectiveness of a personalised risk assessment tool (PERSARC) to increase patients’ knowledge about risks and benefits of treatment options and to reduce decisional conflict in comparison with usual care in high-grade extremity STS patients. Methods The VALUE-PERSARC study is a parallel cluster randomised control trial that aims to include at least 120 primarily diagnosed high-grade extremity STS patients in 6 Dutch hospitals. Eligible patients (≥18 years) are those without a treatment plan and treated with curative intent. Patients with sarcoma subtypes or treatment options not mentioned in PERSARC are unable to participate. Hospitals will be randomised between usual care (control) or care with the use of PERSARC (intervention). In the intervention condition, PERSARC will be used by STS professionals in multidisciplinary tumour boards to guide treatment advice and in patient consultations, where the oncological/ orthopaedic surgeon informs the patient about his/her diagnosis and discusses benefits and harms of all relevant treatment options. The primary outcomes are patients’ knowledge about risks and benefits of treatment options and decisional conflict (Decisional Conflict Scale) 1 week after the treatment decision has been made. Secondary outcomes will be evaluated using questionnaires, 1 week and 3, 6 and 12 months after the treatment decision. Data will be analysed following an intention-to-treat approach using a linear mixed model and taking into account clustering of patients within hospitals. Ethics and dissemination The Medical Ethical Committee Leiden-Den Haag-Delft (METC-LDD) approved this protocol (NL76563.058.21). The results of this study will be reported in a peer-review journal.</p

First Stars. II. Evolution with mass loss

The first stars are assumed to be predominantly massive. Although, due to the low initial abundances of heavy elements the line-driven stellar winds are supposed to be inefficient in the first stars, these stars may loose a significant amount of their initial mass by other mechanisms. In this work, we study the evolution with a prescribed mass loss rate of very massive, galactic and pregalactic, Population III stars, with initial metallicities $Z=10^{-6}$ and $Z=10^{-9}$, respectively, and initial masses 100, 120, 150, 200, and 250$\,M_{\odot}$ during the hydrogen and helium burning phases. The evolution of these stars depends on their initial mass, metallicity and the mass loss rate. Low metallicity stars are hotter, compact and luminous, and they are shifted to the blue upper part in the Hertzprung-Russell diagram. With mass loss these stars provide an efficient mixing of nucleosynthetic products, and depending on the He-core mass their final fate could be either pair-instability supernovae or energetic hypernovae. These stars contributed to the reionization of the universe and its enrichment with heavy elements, which influences the subsequent star formation properties.Comment: Accepted for publication in Astrophysics & Space Science. 15 pages, 18 figure

Changes in Health-Related Quality of Life following Surgery in Patients with High-Grade Extremity Soft-Tissue Sarcoma: A Prospective Longitudinal Study

Introduction: Changes in health-related quality of life (HRQoL) during the diagnostic and treatment trajectory of high-grade extremity soft-tissue sarcoma (eSTS) has rarely been investigated for adults (18–65 y) and the elderly (aged ≥65 y), despite a potential variation in challenges from diverse levels of physical, social, or work-related activities. This study assesses HRQoL from time of diagnosis to one year thereafter among adults and the elderly with eSTS. Methods: HRQoL of participants from the VALUE-PERSARC trial (n = 97) was assessed at diagnosis and 3, 6 and 12 months thereafter, utilizing the PROMIS Global Health (GH), PROMIS Physical Function (PF) and EQ-5D-5L. Results: Over time, similar patterns were observed in all HRQoL measures, i.e., lower HRQoL scores than the Dutch population at baseline (PROMIS-PF:46.8, PROMIS GH-Mental:47.3, GH-Physical:46.2, EQ-5D-5L:0.76, EQ-VAS:72.6), a decrease at 3 months, followed by an upward trend to reach similar scores as the general population at 12 months (PROMIS-PF:49.9, PROMIS GH-Physical:50.1, EQ-5D-5L:0.84, EQ-VAS:81.5), except for the PROMIS GH-Mental (47.5), where scores remained lower than the general population mean (T = 50). Except for the PROMIS-PF, no age-related differences were observed. Conclusions: On average, eSTS patients recover well physically from surgery, yet the mental component demonstrates no progression, irrespective of age. These results underscore the importance of comprehensive care addressing both physical and mental health

Models for the circumstellar medium of long gamma-ray burst progenitor candidates

Long gamma-ray bursts are highly energetic events that are thought to occur when certain massive stars, that end their lives as Wolf-Rayet stars, collapse at the end of their evolution. We present models of the circumstellar medium around those massive stars that are thought to be possible progenitors of long gamma-ray bursts. During their evolution such stars lose a significant amount of mass in the form of stellar wind, a flow of low density material that leaves the star at high velocity. This stellar wind creates a bubble around the star. We make computational hydrodynamical models of the interactions between the stellar wind and the surrounding medium and between the different phases of the stellar wind. The results of our simulations can be compared to the observations of gamma-ray bursts in order to investigate which massive stars are in fact the progenitors of long gamma-ray bursts. In the afterglows of some gamma-ray bursts, absorption features appear that are blue-shifted relative to the source, indicating that matter is moving away from the gamma-ray burst progenitor at discrete velocities. We conclude that this is the result of hydrodynamical interactions in the circumstellar medium that result from changes in the stellar wind. This leads us to the conclusion that these stars had only a short final Wolf-Rayet phase since otherwise the blue-shifted absorption features would have disappeared. Observations of other gamma-ray burst afterglows indicate that the surrounding medium has a constant density, rather than a profile corresponding to a stellar wind. Our models show hat this can be explained by several external influences, combined with a comparatively weak stellar wind. This indicates that these stars most likely had a low initial metallicity

The influence of a variable mass loss rate on the dust and gas dynamics in the bow-shock of

We present hydrodynamical simulations of the interaction between the stellar wind of α-Orionis and the interstellar gas. In particular we focus our efforts on reproducing the multiple arc structure of the bow-shock that was observed with Herschel. We do this by varying the mass loss rate of the star over a period of 10 000 years, representing the effect of thermal pulses. We find that the effect of repeated collisions between high density shells and the wind termination shock can create multiple arc-like structures in the inner part of the bow-shock region. This may explain the arcs seen in the observations. Unlike the observed bow-shock of α-Orionis, our simulations show strong instabilities at the contact discontinuity between the shocked wind and the shocked interstellar medium. This can be an indication of the age of the bow-shock, which may be to young to have formed the instabilities

Radiative cooling in numerical astrophysics: The need for adaptive mesh refinement

Energy loss through optically thin radiative cooling plays an important part in the evolution of astrophysical gas dynamics and should therefore be considered a necessary element in any numerical simulation. Although the addition of this physical process to the equations of hydrodynamics is straightforward, it does create numerical challenges that have to be overcome in order to ensure the physical correctness of the simulation. First, the cooling has to be treated (semi-)implicitly, owing to the discrepancies between the cooling timescale and the typical timesteps of the simulation. Secondly, because of its dependence on a tabulated cooling curve, the introduction of radiative cooling creates the necessity for an interpolation scheme. In particular, we will argue that the addition of radiative cooling to a numerical simulation creates the need for extremely high resolution, which can only be fully met through the use of adaptive mesh refinement. (C) 2010 Elsevier Ltd. All rights reserved