Performance status and trial site-level factors are associated with missing data in palliative care trials: An individual participant-level data analysis of 10 phase 3 trials

BACKGROUND: Missing data compromise the internal and external validity of trial findings, however there is limited evidence on how best to reduce missing data in palliative care trials. AIM: To assess the association between participant and site level factors and missing data in palliative care trials. DESIGN AND SETTING: Individual participant-level data analysis of 10 phase 3 palliative care trials using multi-level cross-classified models. RESULTS: Participants with missing data at the previous time-point and poorer performance status were more likely to have missing data for the primary outcome and quality of life outcomes, at the primary follow-up point and end of follow-up. At the end of follow-up, the number of site randomisations and number of study site personnel were significantly associated with missing data. Trial duration and the number of research personnel explained most of the variance at the trial and site-level respectively, except for the primary outcome where the amount of data requested was most important at the trial-level. Variance at the trial level was more substantial than at the site level across models and considerable variance remained unexplained for all models except quality of life at the end of follow-up. CONCLUSION: Participants with a poorer performance status are at higher risk of missing data in palliative care trials and require additional support to provide complete data. Performance status is a potential auxiliary variable for missing data imputation models. Reducing trial variability should be prioritised and further factors need to be identified and explored to explain the residual variance

Global Ultrasound Elastography Using Convolutional Neural Network

Displacement estimation is very important in ultrasound elastography and failing to estimate displacement correctly results in failure in generating strain images. As conventional ultrasound elastography techniques suffer from decorrelation noise, they are prone to fail in estimating displacement between echo signals obtained during tissue distortions. This study proposes a novel elastography technique which addresses the decorrelation in estimating displacement field. We call our method GLUENet (GLobal Ultrasound Elastography Network) which uses deep Convolutional Neural Network (CNN) to get a coarse time-delay estimation between two ultrasound images. This displacement is later used for formulating a nonlinear cost function which incorporates similarity of RF data intensity and prior information of estimated displacement. By optimizing this cost function, we calculate the finer displacement by exploiting all the information of all the samples of RF data simultaneously. The Contrast to Noise Ratio (CNR) and Signal to Noise Ratio (SNR) of the strain images from our technique is very much close to that of strain images from GLUE. While most elastography algorithms are sensitive to parameter tuning, our robust algorithm is substantially less sensitive to parameter tuning.Comment: 4 pages, 4 figures; added acknowledgment section, submission type late

Ethnicity and palliative care - we need better data: five key considerations

Good quality data on ethnicity is crucial for demonstrating the extent and impact of ethnic disparities within healthcare. However, data must be collected well and used responsibly. We outline five key considerations: (1) Improvement of ethnic group categories. (2) Sensitive, proportionate and timely data collection. (3) Support for staff collecting data. (4) Building public trust in data. (5) Responsible and contextualised use of ethnicity data. Palliative care seeks to adopt a holistic approach to the person and their total pain. By extending this ethos to ethnicity data collection and use, comprehensive and high-quality data could facilitate monitoring practice and disparities

Temporal changes in rock uplift rates of folds in the foreland of the Tian Shan and the Pamir from geodetic and geologic data

Understanding the evolution of continental deformation zones relies on quantifying spatial and temporal changes in deformation rates of tectonic structures. Along the eastern boundary of the Pamir‐Tian Shan collision zone, we constrain secular variations of rock uplift rates for a series of five Quaternary detachment‐ and fault‐related folds from their initiation to the modern day. When combined with GPS data, decomposition of interferometric synthetic aperture radar time series constrains the spatial pattern of surface and rock uplift on the folds deforming at decadal rates of 1–5 mm/yr. These data confirm the previously proposed basinward propagation of structures during the Quaternary. By fitting our geodetic rates and previously published geologic uplift rates with piecewise linear functions, we find that gradual rate changes over >100 kyr can explain the interferometric synthetic aperture radar observations where changes in average uplift rates are greater than ~1 mm/yr among different time intervals (~10¹, 10⁴‾⁵, and 10⁵‾⁶ years)

Role of optimization algorithms based fuzzy controller in achieving induction motor performance enhancement.

Three-phase induction motors (TIMs) are widely used for machines in industrial operations. As an accurate and robust controller, fuzzy logic controller (FLC) is crucial in designing TIMs control systems. The performance of FLC highly depends on the membership function (MF) variables, which are evaluated by heuristic approaches, leading to a high processing time. To address these issues, optimisation algorithms for TIMs have received increasing interest among researchers and industrialists. Here, we present an advanced and efficient quantum-inspired lightning search algorithm (QLSA) to avoid exhaustive conventional heuristic procedures when obtaining MFs. The accuracy of the QLSA based FLC (QLSAF) speed control is superior to other controllers in terms of transient response, damping capability and minimisation of statistical errors under diverse speeds and loads. The performance of the proposed QLSAF speed controller is validated through experiments. Test results under different conditions show consistent speed responses and stator currents with the simulation results

Biomarker Changes Associated with Tuberculin Skin Test (TST) Conversion: A Two-Year Longitudinal Follow-Up Study in Exposed Household Contacts

Background:A high prevalence (50-80%) of Tuberculin Skin Test Positivity (TST+ \u3eor=10 mm indurations) has been reported in TB endemic countries. This pool forms a huge reservoir for new incident TB cases. However, immune biomarkers associated with TST conversion are largely unknown. The objective of this study was to identify immune biomarkers associated with TST conversion after acute Mycobacterium tuberculosis (MTB) Methodology/Principal Findings:A 24 month longitudinal study was carried out in a recently MTB exposed cohort of household contacts (HC = 93, 75% TST+). Control group consisted of unexposed community controls (EC = 59, 46%TST+). Cytokine secretion was assessed in whole blood cultures in response to either mycobacterial culture filtrate (CF) antigens or mitogens (PHA or LPS) using Elisa methodology. Compared to the EC group, the HC group at recruitment (Kruskal-Wallis Test) showed significantly suppressed IFN gamma (p = 0.0001), raised IL-10 (p = 0.0005) and raised TNF alpha (p = 0.001) in response to CF irrespective of their TST status. Seventeen TST-HC, showed TST conversion when retested at 6 months. Post TST conversion (paired t tests) significant increases were observed for CF induced IFN gamma (p = 0.038), IL-10 (p = 0.001) and IL-6 (p = 0.006). Cytokine responses were also compared in the exposed HC group with either recent infection [(TST converters (N = 17)] or previous infection [TST+ HC (N = 54)] at 0, 6, 12 and 24 months using ANOVA on repeated measures. Significant differences between the exposed HC groups were noted only at 6 months. CF induced IFN gamma was higher in previously infected HC group (p = 0.038) while IL-10 was higher in recently infected HC group (p = 0.041). Mitogen induced cytokine secretion showed similar differences for different group.Conclusions/Significance:Our results suggest that TST conversion is associated with early increases in IFN gamma and IL-10 responses and precedes latency by several months post exposure

Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive bladder cancer.

We conducted a phase I/II study investigating synchronous chemoradiotherapy with mitomycin C and infusional 5-fluorouracil (5-FU) in muscle invasive bladder cancer. Early dose escalation results were previously published. We report the long-term toxicity and efficacy results with the optimised regimen. Patients with muscle invasive bladder cancer with glomerular filtration rate >25 ml min(-1) were eligible. Mitomycin (12 mg m(-2) on day 1 only) and infusional 5-FU (500 mg m(-2) day(-1)) for 5 days were administered during weeks 1 and 4 of radiotherapy of 55 Gy in 20 fractions. A total of 41 patients were enrolled, median age was 68 years, 33 were male and eight female patients. Out of the 41 patients, 20 (49%) had hydronephrosis at presentation and 25 (62%) had T3b or T4 disease. Four patients experienced Grade III thrombocytopenia and three patients had Grade III neutropenia. There were no episodes of febrile neutropenia. Four patients experienced Grade III diarrhoea and 1 Grade III urgency and dysuria. Six patients did not undergo cystoscopic evaluation due to early metastatic spread although there was no clinical suggestion of bladder failure. In all, out of 35 evaluable patients, 25 (71%) had macroscopic complete response at 3-month cystoscopy, and biopsy confirmed in 24 out of 25. A total of 16 (39%) patients remain alive with a median follow-up of 50.7 (range 23.5-68.8) months, 14 with a functioning bladder with no reported long-term treatment-related bladder or bowel toxicity. Five out of 41 patients have undergone salvage cystectomy: two for persistent CIS, two T1 and one muscle invasive recurrence. Four patients have received intravesical chemotherapy, of whom two remain alive with a functioning bladder. Overall 12-, 24- and 60-month (m) survival rates were 68, 49 and 36%. Local and distant progression free rates were 82 and 86% at 12-m and 79 and 75% at 24-m. Organ preservation using multimodality therapy is feasible and safe, even in patients with poor renal reserve, and does not compromise salvage therapies. A national phase III trial BC2001 (www.bc2001.org.uk) exploring the effects of synchronous chemoradiotherapy with this regimen is currently recruiting

Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases

PURPOSE: Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients' pain, analgesic use, and pain interference with daily functioning. METHODS: Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials (N = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. RESULTS: The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. CONCLUSIONS: SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning

Systematic analysis of disease-specific immunological signatures in patients with febrile illness from Saudi Arabia

10.1002/cti2.1163Clinical and Translational Immunology98e116