Symptom Experience of Patients with Advanced Melanoma Undergoing Immune Checkpoint Inhibitor Therapy

Background: Immune checkpoint inhibitors (ICIs) are novel therapeutic agents utilized in the management of advanced melanoma. Though generally well-tolerated, patients receiving ICIs experience treatment-related toxicities at varying onset and intensity. Assessment and evaluation of these toxicities and their impact on a quality of life is essential to comprehensive cancer care. Patient-reported outcomes (PRO) contribute vital data to a clinical assessment, supporting clinicians in their ability to improve outcomes. To date, there is no melanoma-specific or ICI-specific PRO measure of symptom burden available. Purpose: The purpose of this study was to describe the symptom experience from the patient\u27s perspective and how it relates to the quality of life among patients undergoing ICIs for advanced melanoma across the treatment trajectory. In addition, this study assessed the concordance between symptoms communicated to clinicians during a follow-up visit and those reported via PRO instruments. Methods: This was a cross-sectional, mixed-methods evaluation of the symptom experience of patients with advanced melanoma within their first year of ICI therapy. Participants completed two PRO instruments: the FACT-M and a modified version of the MDASI. The clinical review of systems was captured from the electronic health record following the visit in which the PRO instruments were completed to assess degree of matching. A subset of participants completed semi-structured, qualitative interviews to enrich the quantitative data. Interpretive description informed the inductive and iterative analysis approach. Results: All 60 participants reported at least one symptom on the PRO instruments. Most commonly reported on the modified MDASI were lack of energy (N=43, 72%), fatigue (n=42, 71%), feeling drowsy (n=35, 60%), joint stiffness/soreness (n=34, 57%), disturbed sleep (n=33, 56%), dry mouth (n=32, 53%), and itching (n=30, 50%). Most commonly reported on the FACT-M were fatigue (n=49, 82%), lack of energy (n=46, 77%), worry that the disease would get worse (n=38, 63%), worry about dying (n=32, 54%), and feeling sad (n=32, 54%). More than 50% of participants reported interference with working (n=32, 53%) and general activity (n=33, 55%). Participants reported three or more symptoms on the PRO instruments when compared to the number of symptoms documented in the clinician ROS in the EHR. The participants (n=19) who completed the qualitative interviews had a heterogenous experience of ICI and melanoma-related symptoms. The most commonly reported symptoms in qualitative interviews included distress (n= 16, 84%), fatigue (n=13, 68%), and rash (n=10, 53%). Uncertainty was a pervasive theme (n=13, 68%), despite the majority having positive thoughts about ICI therapy (n=11, 58%) and expectations of the success of therapy (n=10, 53%). Conclusion: The physical and emotional burden of a melanoma diagnosis and related therapy and the uncertainty of outcomes are common themes described by patients. Communication surrounding the diagnosis, prognosis, treatment options, and outcomes needs to be clear and acknowledge that there are unknowns. Providers may benefit from utilizing a validated PRO instrument to evaluate and understand patients\u27 symptom experiences while undergoing ICI therapy. Further research is needed to finalize a melanoma ICI-specific instrument

Intensity Weighted Ranking: A Methodology for Understanding What Clients Tell Us

Although rank ordering of issues for needs assessment provides some information, this method does not capture the intensity of respondents concerns. This article presents a method of going beyond rank ordering to study both the intensity of response and uncover priorities for more than a few aggregated issues. Results from a survey of attendees of the Indiana State fair are utilized to illustrate the methodology

Natalie Carroll and Jessica Hardy in Senior Recitals

This is the program for the joint senior recital of pianist Natalie Carroll and mezzo-soprano of Jessica Hardy. Ms. Hardy was accompanied on the piano by Mary Worthen. This recital took place on April 15, 2011, in the McBeth Recital Hall in the Mabee Fine Arts Center

Using Technology to Survey New Audiences

A touch screen computer was set up at a state fair to assess citizen water quality concerns. Over 500 people took the survey. The researchers were able to reach citizens from both urban and rural areas. Respondents were aged from 18 to over 75. Most respondents (41%) felt that clean drinking water the most important water quality issue

The development of a new sport-specific classification of coping and a meta-analysis of the relationship between different coping strategies and moderators on sporting outcomes

There is an ever growing coping and sports performance literature, with researchers using many different methods to assess performance and different classifications of coping. As such, it makes it difficult to compare studies and therefore identify how coping is related to performance. Furthermore, there are no quantitative syntheses of the results from these studies. A quantitative synthesis would facilitate a more comprehensive understanding of how coping is associated with athletic performance. In order to accurately compare studies, our first aim was to develop a new coping classification that would make this possible. Firstly, we reviewed the strengths and limitations of the different coping classifications and then identified the commonalities and differences between such classifications. We opted for a three-factor classification of coping, because the evidence suggests that a three-factor classification provides a superior model fit to two-factor approaches. Our new classification of coping was based on an existing model from the developmental literature, which received an excellent model fit. We made some adaptations, however, as our classification was intended for an athletic population. As such, we classified coping as mastery (i.e., controlling the situation and eliminating the stressor), internal regulation (i.e., managing internal stress responses), or goal withdrawal (i.e., ceasing efforts towards goal attainment). Undertaking a meta-analysis, our second aim was to identify which coping strategies correlated with sports performance and whether this relationship varied according to moderator variables. Articles were sourced from online electronic databases and manual journal searches. PRISMA guidelines were used to search, select, and synthesize relevant studies. Random effects meta-analyses were performed to identify associations between coping classification and sport performance. Q, I2, and R2 values assessed heterogeneity. Eighteen published investigations, including 3900 participants and incorporating fifty-nine correlations, indicated an overall positive effect for mastery coping, a negligible negative effect for internal regulation coping, and a negative effect for goal withdrawal strategies. The findings of this meta-analysis could be used by sports practitioners to help them deliver effective coping interventions. In order to maximize performance, practitioners could encourage the use of mastery coping, but advise their athletes not to use goal withdrawal strategies

Theoretical descriptions of electron transport through single molecules: developing design tools for molecular electronic devices

There are vast numbers of organic compounds that could be considered for usein molecular electronics. Hence there is a need for efficient and economicalscreening tools. Here we develop theoretical methods to describe electrontransport through individual molecules, the ultimate goal of which is to establish design tools for molecular electronic devices. To successfully screen a compound for its use as a device component requires a proper representation ofthe quantum mechanics of electron transmission. In this work we report the development of tools for the description of electron transmission that are: Charge self-consistent, valid in the presence of a finite applied potential field and (in some cases) explicitly time-dependent. In addition, the tools can be extended to any molecular system, including biosystems, because they are free of restrictive parameterizations. Two approaches are explored: (1) correlation of substituent parameter values (σ), (commonly found in organic chemistry textbooks) to properties associated with electron transport, (2) explicit tracking of the time evolution of the wave function of a nonstationary electron. In (1) we demonstrate that the σ correlate strongly with features of the charge migration process, establishing them as useful indicators of electronic properties. In (2) we employ a time-dependent description of electron transport through molecular junctions. To date, the great majority of theoretical treatments of electron transport in molecular junctions have been of the time-independent variety. Time dependence, however, is critical to such properties as switching speeds in binary computer components and alternating current conductance, so we explored methods based on time-dependent quantum mechanics. A molecular junction is modeled as a single molecule sandwiched between two clusters of close-packed metal atoms or other donor and acceptor groups. The time dependence of electron transport is investigated by initially localizing an electron on the donor and following the time development of the corresponding non-stationary wavefunction of the time-independent Hamiltonian. We demonstrate that the time-dependent treatment of electron transport predicts physically intuitive results, while providing insights not available from time-independent methods.Ph.D., Chemistry -- Drexel University, 200

The effects of exercise to promote quality of life in individuals with traumatic brain injuries: a systematic review

© 2020 Taylor & Francis Group, LLC. Objective: To systematically review the effects of exercise interventions that may enhance quality of life (QOL) in individuals with traumatic brain injury (TBI). Methods: A systematic search was conducted using five databases up to April 2018. Studies were included if QOL was quantified following an exercise programme for people with a TBI. Methodological quality was assessed using a validated scoring checklist. Two independent reviewers assessed study inclusion and methodological quality. Results: Thirteen studies met the inclusion criteria (seven RCTs, six non-RCTs). The median total scores for the quality assessment tool were 26.1 (RCTs), and 21.3 (non-RCTs), out of 33. Eight out of the 13 studies reported improved QOL following an exercise programme. The duration of the interventions varied from 8-12weeks. The most common programmes involved moderate to vigorous exercise; with a frequency and duration of 3–5 times/week for 30–60minutes. Conclusion: Due to the diversity of the exercise training interventions, heterogeneity of patient characteristics, multitude of QOL instruments and outcome domains assessed, it was not possible to draw any definitive conclusion about the effectiveness of exercise interventions. However, this review identified positive trends to enhance various aspects of QOL measured using a range of assessment tools

Day Re-construction: Understanding How College Students Manage Their Time Through Self-monitoring

With a plethora of possibilities for new social experiences, activities, and other prospects, college students may find it challenging to balance their time. To facilitate their awareness of and reflection upon time expenditures regarding the three pillars of a balanced life: work, personal maintenance and leisure. We designed and evaluated a web app called LifeLogger. This application harnesses semi-automated, self-tracking, and visualization features to support awareness and reflection of time use. We invited 13 participants to interact with the prototype for a week, and followed up with semi-structured interviews to understand their experiences of the application. We find that LifeLogger increases participants awareness and encourages self-reflection on time use, which could facilitate participants in comprehend- ing their time expenditures. We conclude by discussing potential design strategies for time management

Physical Activity Measures in the Healthy Communities Study

The risk of obesity is reduced when youth engage in recommended levels of physical activity (PA). For that reason, public health organizations in the U.S. have encouraged communities to implement programs and policies designed to increase PA in youth, and many communities have taken on that challenge. However, the long-term effects of those programs and policies on obesity are largely unknown. The Healthy Communities Study is a large-scale observational study of U.S. communities that is examining the characteristics of programs and policies designed to promote healthy behaviors (e.g., increase PA and improve diet) and determining their association with obesity-related outcomes. The purpose of this paper is to describe the methods used to measure PA in children and the personal and community factors that may influence it. The study used both self-reported and objective measures of PA, and measured personal, family, and home influences on PA via three constructs: (1) PA self-schema; (2) parental support; and (3) parental rules regarding PA. Neighborhood and community factors related to PA were assessed using three measures: (1) child perceptions of the neighborhood environment; (2) availability of PA equipment; and (3) attributes of the child’s street segment via direct observation. School influences on children’s PA were assessed via three constructs: (1) school PA policies; (2) child perceptions of the school PA environment; and (3) school outdoor PA environment. These measures will enable examination of the associations between characteristics of community PA programs and policies and obesity-related outcomes in children and youth