Testing minimum energy with powerful radio sources in clusters of galaxies

We analyze ROSAT data for cluster gas surrounding powerful radio galaxies, which is well fitted by a ``beta-model'' gas distribution, after allowing for a compact central source. The cluster thermal pressure at the distance of the radio lobes is typically an order of magnitude larger than the lobe minimum pressure. Since radio lobes are sharply-bounded, the missing pressure is not simply entrained intra-cluster gas. Thus the minimum energy in the lobes is a severe underestimate of the actual energy content. We argue that the extra energy is mostly in the form of particles, so that the magnetic field is below equipartition and thus not a major factor in the lobe dynamics. The large departure from minimum energy has far-reaching implications for the nature of AGN central engines and the supply of mechanical energy to the cluster gas.Comment: 6 pages, including 2 figures, to appear in `Life Cycles of Radio Galaxies', ed. J. Biretta et al., New Astronomy Review

Reporting Standards for Patient-Reported Outcomes in Clinical Trial Protocols and Publications

Over the past 20 years, interest has grown to include patient-reported outcomes (PRO) in cancer clinical trials, evidenced by guidance documents from international regulatory authorities and a steady increase of PRO-based endpoints in protocols (eg, pain improvement). But is inclusion of PRO endpoints rigorous and systematic? Concerns have been raised previously about incomplete reporting of PRO results in clinical trial publications, which may reflect underlying design weaknesses. These concerns have prompted recent international collaborative efforts to standardize expectations for describing PRO endpoints in protocols and publications

Commentary on King-Kallimanis et al.: Inadequate measurement of symptomatic adverse events in immunotherapy registration trials

Symptomatic adverse events are common with cancer therapies, and provide key information about tolerability during development and regulatory review. After a therapy becomes available on the market, information about these adverse events is essential for patient and clinician decision-making. Historically, the standard approach for collecting symptomatic adverse events in trials depended on clinician reporting via the National Cancer Institute’s (NCI) Common Terminology Criteria for Adverse Events (CTCAE)—but this process was found to be unreliable and to miss about half of patients’ symptoms

Symptom Monitoring in Pediatric Oncology Using Patient-Reported Outcomes: Why, How, and Where Next

Symptom monitoring using patient-reported outcomes (PROs) is not common in pediatric oncology, despite interest from stakeholders—including patients, families, clinicians, and regulatory organizations—and proven clinical benefit in adult oncology. This article examines the foundational data for patient-reported symptom reporting in this population and posits the next investigative steps toward the implementation of patient-reported symptom monitoring in the care and research of pediatric oncology patients. The reasoning behind, and feasibility of, monitoring symptoms in pediatric oncology patients using PRO measures are discussed, as well as specific tools that have been developed to track symptoms in this population, including innovative electronic self-reporting platforms built to engage children in the symptom reporting process. Aspects of engaging both patients and clinicians in the symptom self-report process are reviewed, as are the experiences of “early adopters” of this process in pediatric oncology and across pediatrics. It is clear that there are key issues that remain regarding the use of PROs for symptom monitoring, including selection of specific outcomes to monitor, how to resolve discrepant reports, and determination of benefit. The next steps for investigation of these issues are discussed. Unanswered questions notwithstanding, work should continue to make patient-reported symptom monitoring an established, evidence-based part of routine and research practice in pediatric oncology

Benefits of Digital Symptom Monitoring with Patient-Reported Outcomes during Adjuvant Cancer Treatment

Digital symptom monitoring via electronic patient-reported outcomes (PROs) has been demonstrated in prospective randomized trials and population research to improve outcomes for adults with metastatic cancer receiving systemic treatment, including symptom control, quality of life, emergency department visits, time on treatment, and survival. Catching symptoms early via this strategy enables care teams to intervene early and avert preventable downstream complications. It is well-established that up to half of patients’ symptoms go undetected by providers, and digital monitoring bridges this gap

On the origin and acceleration of cosmic rays: Cooling flow clusters and AGN hosts

We are looking for radio `relics' and `halos' in an X-ray selected sample of clusters of galaxies. These radio features are not a product of the Active Galactic Nuclei (AGN)-mechanism, but more likely are associated with past cluster merger events. AGN hosts of cooling flow clusters contain particle bubbles that show non-thermal radio emission. These bubbles could explain the presence of radio relics and halos if they can restrict cosmic rays efficiently. Intracluster magnetic fields and cluster environments can reveal the acceleration mechanisms of cosmic rays. Using radio/X-ray data and analytical methods we examine three AGN hosts out of our 70 clusters, namely Hercules A, 3C310 and 3C388. We found that none of these clusters contain relics and/or halos.Comment: 5 pages, 2 tables; NIMA, 201

On the extragalactic jet asymmetry and composition, and the production of high energy cosmic rays

We probe the role of the directional asymmetry between relativistic outflows to kilo-parsec scale jets in the propagation and acceleration of cosmic rays. Our sample contains powerful AGN hosting dense cluster environments. We attempt a thorough description of where and when ultra high energy cosmic ray production and acceleration takes place also using radio observations of the large scale stucture of the AGNs and X-ray data of the hot dense gas in which the AGNs are situated. As far as the cosmic ray primaries are concerned, the presence of relativistic protons or mildly relativistic electrons/positrons contributes substantially to the energy budget of the jets enabling them to heat efficiently the intracluster gas.Comment: 4 page

Electronic symptom monitoring in pediatric patients hospitalized for chemotherapy

Background: Using patient-reported outcomes for symptom monitoring in oncology has resulted in significant benefits for adult patients with cancer. The feasibility of this approach has not been established in the routine care of children with cancer. Methods: The Pediatric Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (Ped-PRO-CTCAE) is an item library that enables children and caregivers to self-report symptoms. Ten symptom items from the Ped-PRO-CTCAE were uploaded to an online platform. Patients at least 7 years old and their caregivers were prompted by text/email message to electronically self-report daily during a planned hospitalization for chemotherapy administration. Symptom reports were emailed to the clinical team caring for the patient, but no instructions were given regarding the use of this information. Rates of patient participation and clinician responses to reports were systematically tracked. Results: The median age of the participating patients (n = 52) was 11 years (range, 7-18 years). All patients and caregivers completed an initial login, with 92% of dyads completing at least 1 additional symptom assessment during hospitalization (median, 3 assessments; range, 0-40). Eighty-one percent of participating dyads submitted symptom reports on at least half of hospital days, and 54% submitted reports on all hospital days. Clinical actions were taken in response to symptom reports 21% of the time. Most patients felt that the system was easy (73%) and important (79%). Most clinicians found symptom reports easy to understand and useful (97%). Conclusions: Symptom monitoring using patient-reported outcome measures for hospitalized pediatric oncology patients is feasible and generates data valued by clinicians and patients

Use of Patient-Reported Outcomes to Understand & Measure the Patient Experience of Novel Cell and Gene Therapies

Patient reported outcomes (PROs) are the gold standard for assessing patients’ experience of treatment in oncology, defined in the 21st Century Cures Act as information about patients’ experiences with a disease or condition, including the impact of a disease or condition, or a related therapy or clinical investigation on patients’ lives; and patient preferences with respect to treatment of their disease or condition [1]. PROs provide a comprehensive assessment of the benefits and risks of new medical products, as well as essential data to inform real-world use. Although RCTs are the ultimate source for information for evaluating products in development, they are not always feasible for rare diseases with few or no effective treatment options available. Thus, it is important to consider other measures that can help to improve the strength of evidence for cell and gene therapies targeting rare indications. While collection of PROs and other patient experience endpoints does not resolve the difficulty of conducting trials in small populations, doing so contributes empirical evidence that informs both product development and patient access. Additionally, including routine collection of PROs in registries may provide supplemental data to further characterize the benefit:risk profile of cell and gene therapies at follow-up times that would be infeasible to operationalize in a clinical trial setting

Comparing Presenting Clinical Features in 48 Children With Microscopic Polyangiitis to 183 Children Who Have Granulomatosis With Polyangiitis (Wegener's) : an ARChiVe Cohort Study

OBJECTIVE: To uniquely classify children with microscopic polyangiitis (MPA), to describe their demographic characteristics, presenting clinical features, and initial treatments in comparison to patients with granulomatosis with polyangiitis (Wegener's) (GPA). METHODS: The European Medicines Agency (EMA) classification algorithm was applied by computation to categorical data from patients recruited to the ARChiVe (A Registry for Childhood Vasculitis: e-entry) cohort, with the data censored to November 2015. The EMA algorithm was used to uniquely distinguish children with MPA from children with GPA, whose diagnoses had been classified according to both adult- and pediatric-specific criteria. Descriptive statistics were used for comparisons. RESULTS: In total, 231 of 440 patients (64% female) fulfilled the classification criteria for either MPA (n\u2009=\u200948) or GPA (n\u2009=\u2009183). The median time to diagnosis was 1.6 months in the MPA group and 2.1 months in the GPA group (ranging to 39 and 73 months, respectively). Patients with MPA were significantly younger than those with GPA (median age 11 years versus 14 years). Constitutional features were equally common between the groups. In patients with MPA compared to those with GPA, pulmonary manifestations were less frequent (44% versus 74%) and less severe (primarily, hemorrhage, requirement for supplemental oxygen, and pulmonary failure). Renal pathologic features were frequently found in both groups (75% of patients with MPA versus 83% of patients with GPA) but tended toward greater severity in those with MPA (primarily, nephrotic-range proteinuria, requirement for dialysis, and end-stage renal disease). Airway/eye involvement was absent among patients with MPA, because these GPA-defining features preclude a diagnosis of MPA within the EMA algorithm. Similar proportions of patients with MPA and those with GPA received combination therapy with corticosteroids plus cyclophosphamide (69% and 78%, respectively) or both drugs in combination with plasmapheresis (19% and 22%, respectively). Other treatments administered, ranging in decreasing frequency from 13% to 3%, were rituximab, methotrexate, azathioprine, and mycophenolate mofetil. CONCLUSION: Younger age at disease onset and, perhaps, both gastrointestinal manifestations and more severe kidney disease seem to characterize the clinical profile in children with MPA compared to those with GPA. Delay in diagnosis suggests that recognition of these systemic vasculitides is suboptimal. Compared with adults, initial treatment regimens in children were comparable, but the complete reversal of female-to-male disease prevalence ratios is a provocative finding