Web-based patient-reported outcome measures for personalized treatment and care (PROMPT-Care) : multicenter pragmatic nonrandomized trial

Background: Despite the acceptability and efficacy of e–patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. Objective: This pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a diverse population of patients with cancer. Methods: Adult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. Results: From April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33% (P=.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39%), tiredness (38.4%), worry (32.9%), general wellbeing (32.9%), and sleep (24.1%), aligning with the most frequently accessed self-management domain pages of physical well-being (36%) and emotional well-being (23%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82%), largely in response to the automated clinical alerts (n=877). Conclusions: Algorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a diverse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records; (2) the instrumental role nurses play in managing alerts; and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care

Surface Chemistry of Perfluoropolyethers and Hydrogenated Analogs: Are Studies of Model Compounds Useful?

We have studied adsorption, desorption, and decomposition of ethers on Ru(001), an atomically-smooth metal surface. We have compared diethers with monoethers, and fluorinated ethers with hydrogenated ethers. The number of ether linkages does not strongly influence adsorption bond strength, nor the extent of decomposition. Fluorination does weaken the adsorption bond strength and prevents decomposition. These studies suggest that the surface properties of monomeric ethers can be used to predict properties of oligomeric, and perhaps even polymeric, ethers

Profiling the anti-protozoal activity of anti-cancer HDAC inhibitors against Plasmodium and Trypanosoma parasites

Histone deacetylase (HDAC) enzymes work together with histone acetyltransferases (HATs) to reversibly acetylate both histone and non-histone proteins. As a result, these enzymes are involved in regulating chromatin structure and gene expression as well as other important cellular processes. HDACs are validated drug targets for some types of cancer, with four HDAC inhibitors clinically approved. However, they are also showing promise as novel drug targets for other indications, including malaria and other parasitic diseases. In this study the in vitro activity of four anti-cancer HDAC inhibitors was examined against parasites that cause malaria and trypanosomiasis. Three of these inhibitors, suberoylanilide hydroxamic acid (SAHA; vorinostat (R)), romidepsin (Istodax (R)) and belinostat (Beleodaq (R)), are clinically approved for the treatment of T-cell lymphoma, while the fourth, panobinostat, has recently been approved for combination therapy use in certain patients with multiple myeloma. All HDAC inhibitors were found to inhibit the growth of asexual-stage Plasmodium falciparum malaria parasites in the nanomolar range (IC50 10-200 nM), while only romidepsin was active at sub-mu M concentrations against bloodstream form Trypanosoma brucei brucei parasites (IC50 35 nM). The compounds were found to have some selectivity for malaria parasites compared with mammalian cells, but were not selective for trypanosome parasites versus mammalian cells. All compounds caused hyperacetylation of histone and non-histone proteins in P. falciparum asexual stage parasites and inhibited deacetylase activity in P. falciparum nuclear extracts in addition to recombinant PfHDAC1 activity. P. falciparum histone hyperacetylation data indicate that HDAC inhibitors may differentially affect the acetylation profiles of histone H3 and H4. (C) 2015 The Authors. Published by Elsevier Ltd on behalf of Australian Society for Parasitology

Observation of Two Narrow States Decaying into Ξc+γ\Xi_{c}^{+}\gamma and Ξc0γ\Xi_{c}^{0}\gamma

We report the first observation of two narrow charmed strange baryons decaying to $\Xi_c^+\gamma$ and $\Xi_c^0\gamma$, respectively, using data from the CLEO II detector at CESR. We interpret the observed signals as the $\Xi_c^{+\prime}(c{su})$ and $\Xi_c^{0\prime}(c{sd})$, the symmetric partners of the well-established antisymmetric $\Xi_c^+(c[su])$ and $\Xi_c^0(c[sd])$. The mass differences $M(\Xi_c^{+\prime})-M(\Xi_c^+)$ and $M(\Xi_c^{0\prime})-M(\Xi_c^0)$ are measured to be $107.8\pm 1.7\pm 2.5$ and $107.0\pm 1.4\pm 2.5 MeV/c^2$, respectively.Comment: 11 pages, postscript file also available through http://w4.lns.cornell.edu/public/CLN

Investigation of Semileptonic BB Meson Decay to P-Wave Charm Mesons

We have studied semileptonic $B$ meson decays with a P-wave charm meson in the final state using 3.29 x 10^6 B\bar{B} events collected by the CLEO~II detector at the Cornell Electron-positron Storage Ring. We find a value for the exclusive semileptonic product branching fraction: Br(B^- -> D_1^0 l^- \bar{\nu}) x Br(D_1^0 -> D^{*+}\pi^-) = (0.373 \pm 0.085 \pm 0.052 \pm 0.024)% and an upper limit for Br(B^- -> D_2^{*0} l^- \bar{\nu}) x Br(D_2^{*0} -> D^{*+}\pi^-) < 0.16%$ (90% C.L.). These results indicate that at least 20% of the total B^- semileptonic rate is unaccounted for by the observed exclusive decays, B^- -> D^0 l^- \bar{\nu}, B^- -> D^{*0} l^- \bar{\nu}, B^- -> D_1^0 l^- \bar{\nu}, and B^- -> D_2^{*0} l^- \bar{\nu}.Comment: 10 page postscript file, postscript file also available through http://w4.lns.cornell.edu/public/CLN

Measurements of the Ratios B(Ds+→ηℓ+ν)/B(Ds+→ϕℓ+ν){\cal B}(D_s^+\to \eta\ell^+\nu)/{\cal B}(D_s^+\to \phi\ell^+\nu) and B(Ds+→η′ℓ+ν)/B(Ds+→ϕℓ+ν){\cal B}(D_s^+\to \eta'\ell^+\nu)/{\cal B}(D_s^+\to \phi\ell^+\nu)

Using the CLEO~II detector we measure ${\cal B}(D_s^+\to \eta e^+\nu)/{\cal B}(D_s^+\to \phi e^+\nu) =1.24\pm0.12\pm0.15$, ${\cal B}(D_s^+\to \eta' e^+\nu)/{\cal B}(D_s^+\to \phi e^+\nu) =0.43\pm0.11\pm0.07$ and ${\cal B}(D_s^+\to \eta' e^+\nu)/{\cal B}(D_s^+\to \eta e^+\nu) =0.35\pm0.09\pm0.07$. We find the vector to pseudoscalar ratio, ${\cal B}(D_s^+\to \phi e^+\nu)/{\cal B}(D_s^+\to (\eta+\eta') e^+\nu) =0.60\pm0.06\pm0.06$, which is similar to the ratio found in non strange $D$ decays.Comment: 11 page uuencoded postscript file, postscript file also available through http://w4.lns.cornell.edu/public/CLN

Observation of a New Charmed Strange Meson

Using the CLEO-II detector, we have obtained evidence for a new meson decaying to $D^0 K^+$. Its mass is $2573.2^{+1.7}_{-1.6}\pm 0.8\pm 0.5$ {}~MeV/$c^2$ and its width is $16^{+5}_{-4}\pm 3$~MeV/$c^2$. Although we do not establish its spin and parity, the new meson is consistent with predictions for an $L=1$, $S=1$, $J_P=2^+$ charmed strange state.Comment: 9 pages uuencoded compressed postscript (process with uudecode then gunzip). hardcopies with figures can be obtained by sending mail to: [email protected]

Measurement of the Branching Fractions of Λc+→pKˉn(π)\Lambda_{c}^{+}\to p\bar{K}n(\pi)

Using data recorded by the CLEO-II detector at CESR, we report new measurements of the branching fractions for the decays of the charmed baryon $\Lambda_c^+$ into $pK^-\pi^+\pi^0$, $p\bar{K}^0$, $p\bar{K}^0\pi^+\pi^-$, and $p\bar{K}^0\pi^0$, all measured relative to $pK^-\pi^+$. The relative branching fractions are $0.67\pm0.04\pm0.11, 0.46\pm0.02\pm0.04,0.52\pm0.04\pm0.05$, and $0.66\pm0.05\pm0.07$ respectively.Comment: 7 page postscript file, postscript file also available through http://w4.lns.cornell.edu/public/CLN

Observation of the Isospin-Violating Decay Ds∗+→Ds+π0D_s^{*+}\to D_s^+\pi^0

Using data collected with the CLEO~II detector, we have observed the isospin-violating decay $D_s^{*+}\to D_s^+\pi^0$. The decay rate for this mode, relative to the dominant radiative decay, is found to be $\Gamma(D_s^{*+}\to D_s^+\pi^0)/\Gamma(D_s^{*+}\to D_s^+\gamma)= 0.062^{+0.020}_{-0.018}\pm0.022$.Comment: 8 page uuencoded postscript file, also available through http://w4.lns.cornell.edu/public/CLN

Semileptonic Branching Fraction of Charged and Neutral B Mesons

An examination of leptons in ${\Upsilon (4S)}$ events tagged by reconstructed $B$ decays yields semileptonic branching fractions of $b_-=(10.1 \pm 1.8\pm 1.4)\%$ for charged and $b_0=(10.9 \pm 0.7\pm 1.1)\%$ for neutral $B$ mesons. This is the first measurement for charged $B$. Assuming equality of the charged and neutral semileptonic widths, the ratio $b_-/b_0=0.93 \pm 0.18 \pm 0.12$ is equivalent to the ratio of lifetimes. A postscript version is available through World-Wide-Web in http://w4.lns.cornell.edu/public/CLNS/1994Comment: 9 pages (in REVTEX format) Preprint CLNS94-1286, CLEO 94-1