Pilot implementation of ICoPE: An innovative model to support patients with glioma and their carers across key care transitions

The current study aims to conduct a pilot implementation and evaluation of an innovative model designed to support patients and their carers through transitions of care. The model involves the provision of Information, Coordination, Preparation and Emotional support (I-CoPE) over 3 key identified care transitions, for people newly diagnosed with primary malignant glioma (PMG) and their carers. I-CoPE is based on prior research conducted by our team which identified gaps in the early disease stages associated around times of care transition, when support was inadaquete. From these gaps in care, I-CoPE was defined which specifically aims to: 1) Provide remote monitoring and management for PMG patients who are likely to resort to acute hospital services for ongoing support; 2) Effectively institute a key care worker who can appropriately support the transition of the patient through acute hospital, ambulatory care and primary care settings; and 3) Focus and tailor support, information and education for patients’ carers to ensure they are able to engage in the primary health care process, enabling patients to remain in the community. The study will collect key patient/carer outcome and health service utilisation data to assess the effectiveness of this innovative model which targets care transitions. If successful, the model has important implications for broader implementation into other patient groups with end stage diseases who also have complex care needs. Indeed general practitioners in primary care settings face the difficult challenge of supporting complex care needs of palliative care patients and their families, often with minimal support and sometimes nil prior exposure to rare disease trajectories such as in the case of PMG. Having strategic and focused communication with a care transition manager throughout the patients' care process, including individualised patient screening results which identify unmet care needs, is likely to enhance primary care management.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Audit committee strength and auditors' risk assessments:The moderating role of CEO narcissism

This paper examines the impact of two elements of the client's control environment on auditor's assessment of the risk of material misstatement: audit committee strength and CEO narcissism, the latter of which is a component of management philosophy, operating style, and tone at the top. We predict and find that auditors' risk assessments are adequately responsive to both elements; however, importantly, a strong audit committee decreases perceived risk assessments only when the client has a CEO with less narcissistic characteristics. In other words, our findings suggest that the presence of narcissistic CEOs' attitudes weakens the perceived audit committee effectiveness, leading auditors to rely less on a strong audit committee. Our findings contribute to the auditing literature by exploring auditors' responses to the complex dynamics between management boards and those charged with governance. From a practical perspective, our results suggest that auditing standards and practice guidance should consider making such complexities and the role of management attitudes and styles even more explicit

The Effect of Audit Standards on Fraud Consultation and Auditor Judgment

We investigate how the strictness of a requirement to consult on potential client fraud affects auditor assessments of fraud risk and the propensity to consult with firm experts. We test two specific forms of guidance about fraud consultations: (1) relatively strict (i.e., mandatory and binding) and (2) relatively lenient (i.e., advisory and non-binding). We predict that a strict consultation requirement will lead to greater propensity to consult and higher fraud risk assessments. We further investigate potentially amplifying effects of a client attribute (underlying fraud risk) and an engagement attribute (deadline pressure). Results from two experiments with 208 Dutch audit managers and partners demonstrate that fraud risk and the consultation propensity are both assessed higher under a strict consultation requirement. For near-partners and partners, this effect is compounded when a client exhibits significant red flags; for managers, it is compounded when deadline pressure is tight. This study demonstrates that the formulation of a standard, such as the consultation requirement, may create adverse incentives that bias risk assessment, which should be considered by regulators and audit firms when developing, formulating and implementing such procedures

A Major Role for the Lateral Habenula in Depressive Illness: Physiologic and Molecular Mechanisms

Emerging preclinical and clinical evidence indicate that the lateral habenula plays a major role in the pathophysiology of depressive illness. Aberrant increases in neuronal activity in the lateral habenula, an anti-reward center, signals down-regulation of brainstem dopaminergic and serotonergic firing, leading to anhedonia, helplessness, excessive focus on negative experiences, and, hence, depressive symptomatology. The lateral habenula has distinctive regulatory adaptive role to stress regulation in part due to its bidirectional connectivity with the hypothalamic–pituitary–adrenal (HPA) axis. In addition, studies show that increased lateral habenula activity affects components of sleep regulation including slow wave activity and rapid eye movement (REM), both disrupted in depressive illness. Lack of perceived reward experienced during the adverse outcomes also precipitates lateral habenula firing, while outcomes that meet or exceed expectations decrease lateral habenula firing and, in turn, increase midbrain dopaminergic and serotonergic neurotransmission. The ability to update expectations of the environment based on rewards and aversive stimuli reflects a potentially important survival mechanism relevant to the capacity to adapt to changing circumstances. What if one lives in a continuously aversive and invalidating environment or under the conditions of chronic stress? If there is a propensity of the habenula to release many burst discharges over time, an individual could habitually come to perceive the world as perpetually disappointing. Conceivably, the lateral habenula could learn to expect an adverse outcome systematically and communicate it more easily. Thus, if the lateral habenula fires more frequently, it may lead to a state of continuous disappointment and hopelessness, akin to depression. Furthermore, postmortem studies reveal that the size of the lateral habenula and total number of neurons are decreased in patients who had depressive illness. Novel research in the field shows that ketamine induces rapid and sustained antidepressant effect. Intriguingly, recent preclinical animal models show that ketamine abolishes N-methyl-D-aspartate receptor (NMDAR)-dependent lateral habenula bursting activity, leading to rapid resolution of depressive symptoms

Differential Effects of Emotional Information on Interference Task Performance Across the Life Span

While functioning in multiple domains declines with age, emotional regulation appears to remain preserved in older adults. The Emotion Inhibition (Emotional Stroop) Test requires participants to name the ink color in which neutrally and emotionally valenced words are printed. It was employed in the current investigation as a measure of affective regulation in the context of an interference task in relation to age. Results demonstrated that while participants ranging from 20 to 50 years of age performed significantly worse on the emotion Stroop Inhibition relative to the neutral Stroop Inhibition condition, subjects over 60 years of age displayed the converse of this pattern, performing better on the emotion than the neutral condition, suggesting that they are less affected by the emotional impact of the positive and negative words used in the former condition. This pattern of age-related change in the ability to manage emotion may be related to blunting of affective signaling in limbic structures or, at the psychological level, focusing on emotional regulation

Randomized, phase II selection study of ramucirumab and paclitaxel versus FOLFIRI in refractory small bowel adenocarcinoma: SWOG S1922

Background: Small bowel adenocarcinoma is a rare malignancy with limited evidence to support the choice of systemic chemotherapy beyond the frontline setting. Though second-line therapy has historically been extrapolated from colorectal cancers, recent molecular data has demonstrated small bowel adenocarcinoma to be genomically unique when compared to either colon or gastric cancer. Retrospective analyses of irinotecan- and taxane-based therapies and one prospective phase II clinical trial of nab-paclitaxel have demonstrated clinical activity in this cancer. Ramucirumab/paclitaxel represents an active combination in the management of gastric cancer. SWOG 1922 evaluates the use of FOLFIRI or ramucirumab/paclitaxel in the second- and later-line setting for small bowel adenocarcinoma. Methods: This is randomized, phase II, selection design clinical trial of FOLFIRI (5-fluorouracil, leucovorin and irinotecan) every two weeks or ramucirumab D1,15 and paclitaxel D1,8,15 every 4 weeks with the primary endpoint of progression-free survival (PFS). Secondary endpoints include response rate, overall survival, and safety. Archived paraffin tumor tissue collection and serial blood collections are included for correlative analyses. Key eligibility criteria include having mismatch repair proficient/microsatellite stable small bowel adenocarcinoma (ampullary location excluded); metastatic or locally advanced unresectable disease; prior fluoropyrimidine and/or oxaliplatin therapy; no prior treatment with irinotecan, ramucirumab, or taxanes; no recent bleeding, blood clots, or bowel perforation/fistula; and Zubrod performance status of 0/1. Measurable disease is not required. The null hypothesis is median PFS of 2.5 months. If a median PFS of at least 3.5 months is observed in one or both arms, the goal is to choose the better regimen with respect to this endpoint. The design provides a 90% probability of selecting the more active arm, assuming a hazard ratio of 1.4, if both arms meet this threshold. This trial is open and, as of September 1, 2021, 21 of 94 planned patients have been enrolled

Cetuximab as Second-Line Therapy in Patients with Metastatic Esophageal Adenocarcinoma: A Phase II Southwest Oncology Group Study (S0415)

IntroductionEsophageal adenocarcinomas commonly express the epidermal growth factor receptor. This trial assessed the 6-month overall survival probability in metastatic esophageal cancer patients treated with cetuximab as second-line therapy.MethodsThis was a multicenter, open-label phase II study of single-agent cetuximab for metastatic esophageal adenocarcinoma patients who failed one prior chemotherapy regimen. Adequate organ function and Zubrod performance status of 0 to 2 were required. Patients received cetuximab 400 mg/m2 intravenously (IV) on week 1 and 250 mg/m2 IV weekly thereafter. The primary objective was to determine 6-month overall survival. Secondary end points included progression-free survival, response rate, and toxicity. Tumor tissue was collected for correlative studies.ResultsSixty-three patients were registered, with eight ineligible or never treated. Fifty-five eligible patients (49 men, 6 women; median age = 61.2 years [range, 30.7–88.5]) were enrolled. Twenty patients survived more than 6 months for a 6-month overall survival rate of 36% (95% confidence interval [CI]: 24–50%). The median overall survival was 4.0 months (95% CI: 3.2–5.9). Median progression-free survival was 1.8 months (95% CI: 1.7–1.9). One partial response and two unconfirmed partial responses were observed. Two patients experienced grade 4 fatigue. There was one treatment-related death due to pneumonitis. Germline polymorphisms of epidermal growth factor receptor, epidermal growth factor, interleukin (IL)-8, cyclooxygenase (COX)-2, vascular epidermal growth factor receptor (VEGF), CCND1, neuropilin 1 (NRP1), and K-ras mutational status were not associated with response or survival.ConclusionsThe 6-month overall survival rate of 36% observed on this study failed to meet the primary survival objective. Thus, cetuximab alone cannot be recommended in the second-line treatment of metastatic esophageal cancer

KSU Student Anxiety around Mass Shootings

This research will examine the relationships among generalized anxiety, social anxiety, and fear of mass shootings, particularly for members of minority and low socioeconomic status (SES) groups. Previous research has examined the various types of mass public shootings and which ones receive more media attention. Previous research has also examined potential causes of mass shootings, ways to prevent them, and areas where mass shootings are common. There is little research on different types of anxiety (generalized and social) and how those correlate to fear of mass shootings, especially for minority groups in college. To examine this relationship, we will administer an online questionnaire with demographic questions, questions that examine generalized and social anxiety levels, and questions on fears of mass shootings on campus and off campus. We hypothesize that stronger correlations among generalized anxiety, social anxiety, and fear of mass shootings will emerge amongst participants who belong to minority groups rather than majority groups. Through this research we hope to find trends in anxiety levels amongst these student groups and use the findings to implement effective intervention programs at KSU. The purpose of this study is ultimately to ease anxiety levels among all students, especially those of minority status.This research will examine the relationships among generalized anxiety, social anxiety, and fear of mass shootings, particularly for members of minority and low socioeconomic status (SES) groups. Previous research has examined the various types of mass public shootings and which ones receive more media attention. Previous research has also examined potential causes of mass shootings, ways to prevent them, and areas where mass shootings are common. There is little research on different types of anxiety (generalized and social) and how those correlate to fear of mass shootings, especially for minority groups in college. To examine this relationship, we will administer an online questionnaire with demographic questions, questions that examine generalized and social anxiety levels, and questions on fears of mass shootings on campus and off campus. We hypothesize that stronger correlations among generalized anxiety, social anxiety, and fear of mass shootings will emerge amongst participants who belong to minority groups rather than majority groups. Through this research we hope to find trends in anxiety levels amongst these student groups and use the findings to implement effective intervention programs at KSU. The purpose of this study is ultimately to ease anxiety levels among all students, especially those of minority status