Management of pain and cachexia in pancreatic cancer: Protocol for two systematic reviews, network meta-analysis, surveys and focus groups

BACKGROUND:  Approximately 75% of people with pancreatic cancer experience pain, and >50% of them have cachexia (weakness and wasting of the body). However, there is considerable uncertainty regarding the management of these distressing symptoms. OBJECTIVE:  Our primary objectives are to compare the relative benefits and harms of different interventions for pain in people with unresectable pancreatic cancer and for prevention and treatment of cachexia due to pancreatic cancer, through systematic reviews and network meta-analysis. Our secondary objectives are to develop an evidence-based clinical care pathway to manage pain and prevent and treat cachexia in people with pancreatic cancer through surveys and focus groups involving patients, carers, and health care professionals. METHODS:  We will perform 2 systematic reviews of the literature related to pain and cachexia in people with pancreatic cancer using searches from Cochrane Library, MEDLINE, Embase, Science Citation Index, and trial registries. Two researchers will independently screen for eligibility and identify randomized controlled trials (no language or publication status restriction), comparing interventions for pain or cachexia based on full-texts for articles shortlisted during screening. We will assess risk of bias in the trials using the Cochrane risk of bias tool (version 2.0) and obtain data related to baseline prognostic characteristics, potential effect modifiers and outcome data related to overall survival, health-related quality of life, treatment-related complications, and resource utilisation. We aim to conduct network meta-analysis on outcomes with multiple treatment comparisons where possible, otherwise, meta-analysis with direct comparisons, or narrative synthesis. We will perform various subgroup and sensitivity analyses. Using information obtained from both systematic reviews, we will conduct 2 surveys: one directed to patients or carers to assess acceptability of interventions, and the other to health care professionals to assess feasibility of delivery in the National Health Service. Four mixed focus groups will be conducted to evaluate findings and foster consensus in the development of the care pathway. RESULTS:  Funding was awarded from April 2022 (NIHR202727). Both systematic review protocols were prospectively registered on PROSPERO in May 2022. Formal searches began thereafter. Approval by the University College London Research Ethics Committee (23563/001) was received in December 2022. Data collection began in January 2023; data analysis will begin in May 2023 (completion expected by October 2023). CONCLUSIONS:  This study will comprehensively encompass major interventions for management of pain in people with unresectable pancreatic cancer, and prevention and treatment of cachexia in people with pancreatic cancer. Key stakeholders will facilitate the development of an evidence-based care pathway, ensuring both acceptability and feasibility. The project ends in April 2024 and published results are expected within 12 months of completion. We aim to present the findings through patient group websites, conferences, and publications, irrespective of the findings, in a peer-reviewed journal. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46335

A comprehensive database of quality-rated fossil ages for Sahul\u27s Quaternary vertebrates

The study of palaeo-chronologies using fossil data provides evidence for past ecological and evolutionary processes, and is therefore useful for predicting patterns and impacts of future environmental change. However, the robustness of inferences made from fossil ages relies heavily on both the quantity and quality of available data. We compiled Quaternary non-human vertebrate fossil ages from Sahul published up to 2013. This, the FosSahul database, includes 9,302 fossil records from 363 deposits, for a total of 478 species within 215 genera, of which 27 are from extinct and extant megafaunal species (2,559 records). We also provide a rating of reliability of individual absolute age based on the dating protocols and association between the dated materials and the fossil remains. Our proposed rating system identified 2,422 records with high-quality ages (i.e., a reduction of 74%). There are many applications of the database, including disentangling the confounding influences of hypothetical extinction drivers, better spatial distribution estimates of species relative to palaeo-climates, and potentially identifying new areas for fossil discovery

Wildfire and Rehabilitation History Effects on Artemisia tridentata subsp. wyomingensis Communities Invaded by Bromus tectorum

Currently, ~50% of the sagebrush steppe in the Great Basin, USA, has been lost to land-use change, plant invasions, and fire. These threats warrant potential rehabilitation treatments in order to maintain native plant communities; however, little research exists on the effects of rehabilitation treatment and fire history on native communities or sites with a history of rehabilitation across landscapes. To fill this gap we used a combination of fieldwork and spatial analysis to examine the effect of fire history, rehabilitation history, and environmental variables on plant community assembly, Bromus tectorum invasion, and changes in fire regime characteristics. Environmental variables explained 41% of the variation in plant communities while fire and rehabilitation history explained 44% of the variation in plant cover. Native species richness increased with elevation, but nonnative species richness did not. Bromus tectorum cover and density were inhibited by diverse native bunchgrass communities. Bromus tectorum decreased as the number rehabilitation treatments or time since treatment increased which was attributed to native bunchgrass establishment success and population growth, respectively. Fire regimes were in part determined by site moisture with more xeric sites burning more overall and more frequently at shorter intervals in the last twenty years. The type of vegetation treatment prior to the most recent fire played a role in fire regimes with sites that were aerially seeded prior to a fire having shorter fire turn intervals and more frequent fires in the last twenty years. The number of fires increased as sites became drier for aerially seeded sites, but not those with drill seeding. When the most recent treatment was drill seeding, it could increase the fire return interval and decrease frequency even when sites had a history of aerial seeding. This suggests increasing the number of drill seeding treatments can be used to establish diverse native plant communities that are resistant to Bromus tectorum and resilient to fire. Drill seeding can also reduce the numbers and frequency of fires and increase fire return intervals which may assist in Artemisia tridentata recruitment.doctoral, Ph.D., Natural Resources -- University of Idaho - College of Graduate Studies, 2019-1

Marketing and destination growth: A symbiotic relationship or simple coincidence?

This paper examines the relationship between destination growth and destination marketing by investigating the relationship between destination marketing organisations and local government authorities. A case study approach is adopted to explore this issue using two Queensland destinations, the Gold Coast and the Sunshine Coast. The findings of this research suggest that the manner in which private and public sector stakeholder organisations work together through a recognised destination marketing organisation will influence the overall rate of growth of destinations, particularly when origin markets are located in another state or overseas. In particular the study supports previous research findings that the role of local government authorities is essential if destination marketing authorities are to operate effectively

Progress in tourism and hospitality research conference, Gold Coast, Australia, 11-14 February 1998

Bruce Prideaux, Chris Ryan and David Simmons from the universities of Queensland, Waikato and Lincoln respectively, not only presented papers at the 1998 Australian Tourism and Hospitality Research Conference, but between them tried to cover most of the sessions in order to identify some highlights of the conference

The Effect of Seeding Treatments and Climate on Fire Regimes in Wyoming Sagebrush Steppe

Wildfire size and frequency have increased in the western United States since the 1950s, but it is unclear how seeding treatments have altered fire regimes in arid steppe systems. We analyzed how the number of fires since 1955 and the fire return interval and frequency between 1995 and 2015 responded to seeding treatments, anthropogenic features, and abiotic landscape variables in Wyoming big sagebrush ecosystems. Arid sites had more fires than mesic sites and fire return intervals were shortest on locations first treated between 1975 and 2000. Sites drill seeded before the most recent fire had fewer, less frequent fires with longer fire return intervals (15–20 years) than aerially seeded sites (intervals of 5–8 years). The response of fire regime variables at unseeded sites fell between those of aerial and drill seeding. Increased moisture availability resulted in decreased fire frequency between 1994 and 2014 and the total number of fires since 1955 on sites with unseeded and aerially pre-fire seeding, but fire regimes did not change when drill seeded. Greater annual grass biomass likely contributed to frequent fires in the arid region. In Wyoming big sagebrush steppe, drill seeding treatments reduced wildfire risk relative to aerial seeded or unseeded sites

Assessment for selection for the health care professions and specialty training: Consensus statement and recommendations from the Ottawa 2010 Conference

Assessment for selection in medicine and the health professions should follow the same quality assurance processes as in-course assessment. The literature on selection is limited and is not strongly theoretical or conceptual. For written testing, there is evidence of the predictive validity of Medical College Admission Test (MCAT) for medical school and licensing examination performance. There is also evidence for the predictive validity of grade point average, particularly in combination with MCAT for graduate entry but little evidence about the predictive validity of school leaver scores. Interviews have not been shown to be robust selection measures. Studies of multiple mini-interviews have indicated good predictive validity and reliability. Of other measures used in selection, only the growing interest in personality testing appears to warrant future work. Widening access to medical and health professional programmes is an increasing priority and relates to the social accountability mandate of medical and health professional schools. While traditional selection measures do discriminate against various population groups, there is little evidence on the effect of non-traditional measures in widening access. Preparation and outreach programmes show most promise. In summary, the areas of consensus for assessment for selection are small in number. Recommendations for future action focus on the adoption of principles of good assessment and curriculum alignment, use of multi-method programmatic approaches, development of interdisciplinary frameworks and utilisation of sophisticated measurement models. The social accountability mandate of medical and health professional schools demands that social inclusion, workforce issues and widening of access are embedded in the principles of good assessment for selection