An immunotherapy survivor population: health-related quality of life and toxicity in patients with metastatic melanoma treated with immune checkpoint inhibitors

© The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Purpose The immune checkpoint inhibitors (ICIs) have resulted in subgroups of patients with metastatic melanoma achievinghigh-quality durable responses. Metastatic melanoma survivors are a new population in the era of cancer survivorship. The aimofthis study was to evaluate metastatic melanoma survivors in terms of health-related quality of life (HRQoL), immune-relatedadverse events (irAEs) and exposure to immunosuppressive agents in a large single centre in the UK.Methods We defined the survivor population as patients with a diagnosis of metastatic melanoma who achieved a durableresponse to an ICI and had been followed-up for a minimum of 12 months from initiation of ICI without disease progression.HRQoL was assessed using SF-36. Electronic health records were accessed to collect data on demographics, treatments, irAEsand survival. HRQoL data was compared with two norm-based datasets.Results Eighty-four metastatic melanoma survivors were eligible and 87% (N = 73) completed the SF-36. ICI-related toxicity ofany grade occurred in 92%of patients and 43%had experienced a grade 3 or 4 toxicity. Almost half (49%) of the patients requiredsteroids for the treatment of ICI-related toxicity, whilst 14% required treatment with an immunosuppressive agent beyondsteroids.Melanoma survivors had statistically significant lower HRQoL scores with regard to physical, social and physical rolefunctioning and general health compared with the normative population. There was a trend towards inferior scores in patientswith previous exposure to ipilimumab compared with those never exposed to ipilimumab.Conclusions Our results show that metastatic melanoma survivors have potentially experienced significant ICI-related toxicityand experience significant impairments in specific HRQoL domains. Future service planning is required to meet this population’sunique survivorship needs.Peer reviewe

Involving patients and families in a social robot study

Innovative research in care practice for older people can benefit from the active involvement of patient and family partners. Involvement may begin with identifying priorities, then move to formulate research questions and to plan the research methods, to data collection, and finally to analysis and knowledge dissemination. However, in the field of dementia care, actively engaging patients and families in co-research is a novel practice that needs exploration. This paper describes the experiences and perspectives of two patient researchers and three family researchers, along with four clinicians (two physicians, a nurse, and an occupational therapist) within a social robot project in dementia care. Meeting notes, team reflection focus groups, follow–up interviews, and a research journal were used to document the research process. The results are presented in three themes: (a) identify challenges and lessons learned, (b) co-inquire enriched learning, (c) co-produce knowledge for care improvement. All team members agreed that an inclusive environment was important to facilitate meaningful partnerships for undertaking research together. Trust and respect were seen as vital for a rewarding and productive experience in the co-inquiry journey. Some of the challenges to sustaining participant engagement were competing priorities and a risk of tokenism. This article provides a rich description as well as practical details of the research experiences among team members. We offer examples of lessons learned and practical tips to help others increase the engagement of patients and families in research. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this len

Master Formula Approach to Chiral Symmetry Breaking: Pi-Pi scattering

The master formula approach to chiral symmetry breaking is used to analyze the phase shifts for $\pi\pi$ scattering in the elastic region. The results are in excellent agreement with the data for the phase shifts up to the K-K bar threshold. Our analysis shows that the pi-pi data near threshold in the scalar channel favors a large quark condensate in the vacuum, i.e. \sim -(240 MeV)^3.Comment: 17 pages, LaTeX, 1 postscript file of 12 figures in addition. Equation 2 is changed, the rest is the sam

Expectations from relative clauses:Real-time coherence updates in discourse processing

Contains fulltext : 233081.pdf (Publisher’s version ) (Open Access)10 p

Bayesian system identification of a nonlinear dynamical system using a novel variant of Simulated Annealing

This work details the Bayesian identification of a nonlinear dynamical system using a novel MCMC algorithm: 'Data Annealing'. Data Annealing is similar to Simulated Annealing in that it allows the Markov chain to easily clear 'local traps' in the target distribution. To achieve this, training data is fed into the likelihood such that its influence over the posterior is introduced gradually - this allows the annealing procedure to be conducted with reduced computational expense. Additionally, Data Annealing uses a proposal distribution which allows it to conduct a local search accompanied by occasional long jumps, reducing the chance that it will become stuck in local traps. Here it is used to identify an experimental nonlinear system. The resulting Markov chains are used to approximate the covariance matrices of the parameters in a set of competing models before the issue of model selection is tackled using the Deviance Information Criterion. © 2014

Coherent amplification of classical pion fields during the cooling of droplets of quark plasma

In the framework of the linear sigma model, we study the time evolution of a system of classical $\sigma$ and pion fields coupled to quarks. For this purpose we solve numerically the classical transport equation for relativistic quarks coupled to the nonlinear Klein-Gordon equations for the meson fields. We examine evolution starting from variety of initial conditions corresponding to spherical droplets of hot quark matter, which might mimic the behaviour of a quark plasma produced in high-energy nucleus-nucleus collisions. For large droplets we find a strong amplification of the pion field that oscillates in time. This leads to a coherent production of pions with a particular isospin and so would have similar observable effects to a disoriented chiral condensate which various authors have suggested might be a signal of the chiral phase transition. The mechanism for amplification of the pion field found here does not rely on this phase transition and is better thought of as a "pion laser" which is driven by large oscillations of the $\sigma$ field.Comment: 12 TeX pages + 20 postscript figures, psfig styl

Detection of low-frequency tones and whale predator sounds by the American sand lance Ammodytes americanus

Author Posting. © The Author(s), 2012. This is the author's version of the work. It is posted here by permission of John Wiley & Sons for personal use, not for redistribution. The definitive version was published in Journal of Fish Biology 81 (2012): 1646-1664, doi:10.1111/j.1095-8649.2012.03423.x.Auditory evoked potentials (AEPs) were used to measure the hearing range and auditory sensitivity of the American sand lance Ammodytes americanus. Responses to amplitude modulated tone pips indicated that the hearing range extended from 50 to 400 Hz. Sound pressure thresholds were lowest between 200 and 400 Hz. Particle acceleration thresholds showed an improved sensitivity notch at 200 Hz but not substantial differences between frequencies and only a slight improvement in hearing abilities at lower frequencies. The hearing range was similar to Pacific sand lance A. personatus and variations between species may be due to differences in threshold evaluation methods. AEPs were also recorded in response to pulsed sounds simulating humpback whale Megaptera novaeangliae foraging vocalizations termed ‘megapclicks’. Responses were generated with pulses containing significant energy below 400 Hz. No responses were recorded using pulses with peak energy above 400 Hz. These results show that A. americanus can detect the particle motion component of low frequency tones and pulse sounds, including those similar to the low frequency components of megapclicks. Ammodytes americanus hearing may be used to detect environmental cues and the pulsed signals of mysticete predators.We also thank the Mountlake Research Fund, the Provost’s Fund for Senior Thesis Research and the Horton Elmer Fund, all of which provided the support for this study through Princeton University. A. Mooney was supported through a Woods Hole Postdoctoral Scholar award and the Andrew W. Mellon Fund for Innovative Research.2014-09-0

Classical and Quantum Gravity in 1+1 Dimensions, Part I: A Unifying Approach

We provide a concise approach to generalized dilaton theories with and without torsion and coupling to Yang-Mills fields. Transformations on the space of fields are used to trivialize the field equations locally. In this way their solution becomes accessible within a few lines of calculation only. In this first of a series of papers we set the stage for a thorough global investigation of classical and quantum aspects of more or less all available 2D gravity-Yang-Mills models.Comment: 24 pages, no figures, some sign errors in Eqs. 52--59 have been corrected (according to the Erratum

The Benefits of and Barriers to Using Social Robot PARO in Care Settings: A Scoping Review

Background Given the complexity of providing dementia care in hospitals, integrating technology into practice is a high challenge and an important opportunity. Although there are a growing demand and interest in using social robots in a variety of care settings to support dementia care, little is known about the impacts of the robotics and their application in care settings, i.e., what worked, in which situations, and how.   Methods Scientific databases and Google Scholar were searched to identify publications published since 2000. The inclusion criteria consisted of older people with dementia, care setting, and social robot PARO.   Results A total of 29 papers were included in the review. Content analysis identified 3 key benefits of and 3 barriers to the use of PARO. Main benefits include: reducing negative emotion and behavioral symptoms, improving social engagement, and promoting positive mood and quality of care experience. Key barriers are: cost and workload, infection concerns, and stigma and ethical issues. This review reveals 3 research gaps: (a) the users’ needs and experiences remain unexplored, (b) few studies investigate the process of how to use the robot effectively to meet clinical needs, and (c) theory should be used to guide implementation.   Conclusions Most interventions conducted have been primarily researcher-focused. Future research should pay more attention to the clinical needs of the patient population and develop strategies to overcome barriers to the adoption of PARO in order to maximize patient benefits

The Benefits of and Barriers to Using Social Robot PARO in Care Settings: A Scoping Review

Background Given the complexity of providing dementia care in hospitals, integrating technology into practice is a high challenge and an important opportunity. Although there are a growing demand and interest in using social robots in a variety of care settings to support dementia care, little is known about the impacts of the robotics and their application in care settings, i.e., what worked, in which situations, and how.   Methods Scientific databases and Google Scholar were searched to identify publications published since 2000. The inclusion criteria consisted of older people with dementia, care setting, and social robot PARO.   Results A total of 29 papers were included in the review. Content analysis identified 3 key benefits of and 3 barriers to the use of PARO. Main benefits include: reducing negative emotion and behavioral symptoms, improving social engagement, and promoting positive mood and quality of care experience. Key barriers are: cost and workload, infection concerns, and stigma and ethical issues. This review reveals 3 research gaps: (a) the users’ needs and experiences remain unexplored, (b) few studies investigate the process of how to use the robot effectively to meet clinical needs, and (c) theory should be used to guide implementation.   Conclusions Most interventions conducted have been primarily researcher-focused. Future research should pay more attention to the clinical needs of the patient population and develop strategies to overcome barriers to the adoption of PARO in order to maximize patient benefits