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Background: In community-acquired pneumonia (CAP), the role of biomarkers to shorten duration of antibiotic treatment has not been firmly established. We assessed the effectiveness of active feedback of treatment algorithms based on procalcitonin (PCT) and C-reactive protein (CRP), compared to standard care, on the duration of antibiotic treatment in patients hospitalized with community-acquired pneumonia (CAP) in non-ICU wards. Methods and findings: We performed a randomised, open label, parallel group, multi-centre trial in 3 Dutch teaching hospitals. Treatment was guided by a PCT algorithm, CRP algorithm or standard care. Participants were recruited by a member of the study team and randomised at day 2–3 of admission in a 1:1:1 ratio. Treatment was discontinued upon predefined thresholds of biomarkers that were assessed on admission, day 4 and days 5–7 if indicated. The primary outcome was total days on antibiotic treatment until day 30. In total 468 participants were included in this study. The median days on antibiotics (IQR) was 7 (IQR 7–10) in the control group, 4 (IQR 3–7) in the CRP group (rate ratio (RR) of 0.70, 95% CI 0.61–0.82 compared to standard care; p <0.001), and 5.5 (IQR 3–9) in the PCT group (RR of 0.78, 95% CI 0.68–0.89 compared to standard care; p <0.001). New antibiotics within the first 30 days were prescribed to 24, 23 and 35 patients in standard care, CRP and PCT groups, respectively. The hazard ratio for a new prescription in patients in the PCT group compared to standard care 1.63 (CI 0.97–2.75; p = 0.06). No difference in time to clinical stability or length of stay was found. Conclusions: A strategy of feedback of CRP-guided and PCT-guided treatment algorithms reduced the number of days on antibiotic in the first 30 days after hospital admission in non-ICU wards for CAP. The study was not powered to determine safety of shortening duration of antibiotic treatment. (NCT01964495). [ABSTRACT FROM AUTHOR]

Integrating evolutionary partial differential equations (PDEs) is an essential ingredient for studying the dynamics of the solutions. Indeed, simulations are at the core of scientific computing, but their mathematical reliability is often difficult to quantify, especially when one is interested in the output of a given simulation, rather than in the asymptotic regime where the discretization parameter tends to zero. In this paper we present a computer-assisted proof methodology to perform rigorous time integration for scalar semilinear parabolic PDEs with periodic boundary conditions. We formulate an equivalent zero-finding problem based on a variation of constants formula in Fourier space. Using Chebyshev interpolation and domain decomposition, we then finish the proof with a Newton–Kantorovich type argument. The final output of this procedure is a proof of existence of an orbit, together with guaranteed error bounds between this orbit and a numerically computed approximation. We illustrate the versatility of the approach with results for the Fisher equation, the Swift–Hohenberg equation, the Ohta–Kawasaki equation and the Kuramoto–Sivashinsky equation. We expect that this rigorous integrator can form the basis for studying boundary value problems for connecting orbits in partial differential equations. [ABSTRACT FROM AUTHOR]

The predominant approach to understand dynamic risk factors of sexual reoffending has been referred to as the Propensities Model (Thornton, 2016). According to this model, dynamic risk factors can be conceptualized as latent constructs whose change alters the risk of sexual reoffending. Despite its strengths and contributions to research, this model does not offer answers to the question of how dynamic risk factors contribute to the risk of sexual reoffending, or of how sustained change in risk might take place. In this paper we introduce the Network-Based Model of Risk of Sexual Reoffending (NBM-RSR), which addresses several limitations and constraints of the Propensities Model and offers empirically testable propositions regarding the nature and development of the risk of sexual reoffending. The NBM-RSR considers risk of sexual reoffending to involve a self-sustaining network of causally connected dynamic risk factors. Consistent with this, an increased risk of sexual reoffending is characterized through a network that contains more and stronger interconnected dynamic risk factors with a higher strength. Sustained change in risk of sexual reoffending occurs when activity in the network exceeds a critical point resulting in a new self-sustaining network. Propositions based on the NBM-RSR are introduced and translated into testable hypotheses. These propositions revolve around (a) risk of sexual reoffending resulting from the construction of a network of causally connected dynamic risk factors, (b) network stability, sudden changes, and critical transitions, and (c) dynamic risk factors' relative influence on risk of sexual reoffending. [ABSTRACT FROM AUTHOR]

Background: This study assesses the incidence of gastrointestinal symptoms in the first year after resection of esophageal or gastric cancer and its association with health-related quality of life (HRQoL), functioning, work productivity, and daily activities. Patients and Methods: Patients diagnosed with esophageal or gastric cancer between 2015 and 2021, who underwent a resection, and completed ≥ 2 questionnaires from the time intervals prior to resection and 0–3, 3–6, 6–9, and 9–12 months after resection were included. Multivariable generalized linear mixed models were used to assess changes in gastrointestinal symptoms over time and the impact of the number of gastrointestinal symptoms on HRQoL, functioning, work productivity, and daily activities for patients who underwent an esophagectomy or gastrectomy separately. Results: The study population consisted of 961 (78.8%) and 259 (21.2%) patients who underwent an esophagectomy and gastrectomy, respectively. For both groups, the majority of gastrointestinal symptoms changed significantly over time. Most clinically relevant differences were observed 0–3 after resection compared with prior to resection and included increased diarrhea, appetite loss, and eating restrictions, and specifically after esophagectomy dry mouth, trouble with coughing, and trouble talking. At 9–12 after resection one or more severe gastrointestinal symptoms were reported by 38.9% after esophagectomy and 33.7% after gastrectomy. A higher number of gastrointestinal symptoms was associated with poorer functioning, lower HRQoL, higher impairment in daily activities, and lower work productivity. Conclusions: This study shows that gastrointestinal symptoms are frequently observed and burdensome after esophagectomy or gastrectomy, highlighting the importance to address these sequelae for high quality survivorship. [ABSTRACT FROM AUTHOR]

Ground state solutions of elliptic problems have been analysed extensively in the theory of partial differential equations, as they represent fundamental spatial patterns in many model equations. While the results for scalar equations, as well as certain specific classes of elliptic systems, are comprehensive, much less is known about these localised solutions in generic systems of nonlinear elliptic equations. In this paper we present a general method to prove constructively the existence of localised radially symmetric solutions of elliptic systems on R d . Such solutions are essentially described by systems of non-autonomous ordinary differential equations. We study these systems using dynamical systems theory and computer-assisted proof techniques, combining a suitably chosen Lyapunov–Perron operator with a Newton–Kantorovich type theorem. We demonstrate the power of this methodology by proving specific localised radial solutions of the cubic Klein–Gordon equation on R 3 , the Swift–Hohenberg equation on R 2 , and a three-component FitzHugh–Nagumo system on R 2 . These results illustrate that ground state solutions in a wide range of elliptic systems are tractable through constructive proofs. [ABSTRACT FROM AUTHOR]

Objective. We aimed to gain consensus on HCPs' perspectives on self-management support information needs of patients with esophageal cancer during the preoperative phase. Methods. Based on the literature, observations of clinical consultations, and hospital patient information leaflets, a survey was created. HCPs were surveyed twice about their opinion on importance of information, from "not essential" to "absolutely essential," using Delphi methods. Topics were included in the second round if predetermined criteria were met. To be included in the final list, topics had to meet criteria for consensus and stability. Results. 64 information items and 6 sources of support were identified. Survey response rates were 59% (68 out of 116, first round) and 75% thereafter. The final list included 33 topics, including logistical information, expectations for future health condition, complications, follow-up care, nutrition during treatment, and nutrition during recovery as topics with 100% agreement. Consensus on the source of support was reached for face-to-face contact, written information, information video, and a case manager. Conclusion. This study provides a list of important topics, from the perspectives of HCPs, to guide the systematic provision of education to support EC patients' self-management during the preoperative phase. Additionally, the most preferred sources of support were face-to-face contact and a case manager. [ABSTRACT FROM AUTHOR]

In this paper, we study travelling front solutions for nonlocal equations of the type ∂ t u = N ∗ S (u) + ∇ F (u) , u (t , x) ∈ R d. Here, N ∗ denotes a convolution-type operator in the spatial variable x ∈ R , either continuous or discrete. We develop a Morse-type theory, the Conley–Floer homology, which captures travelling front solutions in a topologically robust manner, by encoding fronts in the boundary operator of a chain complex. The equations describing the travelling fronts involve both forward and backward delay terms, possibly of infinite range. Consequently, these equations lack a natural phase space, so that classic dynamical systems tools are not at our disposal. We therefore develop, from scratch, a general transversality theory, and a classification of bounded solutions, in the absence of a phase space. In various cases the resulting Conley–Floer homology can be interpreted as a homological Conley index for multivalued vector fields. Using the Conley–Floer homology, we derive existence and multiplicity results on travelling front solutions. [ABSTRACT FROM AUTHOR]

Although retrogressive flow slides in subaqueous sandy slopes can be very large and cause substantial damage, the failure mechanisms of such slides are not very clear yet. This study analyses two well-monitored flow slides in a shoal margin in the Western Scheldt estuary in the Netherlands: a natural flow slide that eroded 300 m into the edge of the shoal and an artificially induced flow slide that was triggered by dredging and eroded only 30 m of the shoal margin. Both slides were simulated with a newly developed numerical model that describes the physics of slow retrogressive breaching and the much faster retrogression of statically liquefied fine to medium (silty) sands. The simulations show that the differences in trigger and size can be explained by assuming that in the larger slide both retrogressive breaching and static liquefaction took place, while in the smaller one only breaching occurred. The main contribution of retrogressive liquefaction to the larger slide was the generation of a temporary high-erosive density flow that proved sufficient to create such a high, near-vertical slope that the breaching process could continue over a long period and distance. It is therefore likely that both breaching and static liquefaction play a role in large natural flow slides. [ABSTRACT FROM AUTHOR]

Background: Accurate restoration of joint line height and posterior offset in primary Total Knee Arthroplasty (TKA) have been shown to be important factors in post-operative range of movement and function. The aim of this study was to assess the accuracy of joint line and posterior offset restoration in a group of patients that underwent robotic-assisted TKA (raTKA). A matched cohort of patients that underwent a TKA using a conventional jig-based technique was assessed for comparison. The null hypothesis was that there would be no difference between groups. Methods: This study was a retrospective analysis of a cohort of 120 patients with end-stage knee osteoarthritis that received a TKA using the Navio Surgical System (n = 60), or Conventional manual TKA (n = 60). Procedures were performed between 1 January 2019 and 1 October 2019 at six different centres. Joint line height and posterior offset was measured pre-operatively and post-operatively on calibrated weight bearing plain radiographs of the knee. Two observers performed measurements using validated measuring tools. A BMI and age-matched cohort of patients that underwent TKA using a conventional technique in the same six centres were assessed for comparison. Mean values, standard deviations and confidence intervals are presented for change and absolute change in joint line height and posterior offset. Student's t-test was used to compare the changes between techniques. Results: Patients that underwent robotic-assisted TKA had joint line height and posterior offset restored more accurately than patients undergoing TKA using a conventional technique. Average change from pre-operative measurement in joint line height using raTKA was -0.38mm [95% CI: -0.79 to 0.03] vs 0.91 [0.14 to 1.68] with the conventional technique. Average absolute change in joint line height using raTKA was 1.96mm [1.74 to 2.18] vs 4.00mm [3.68 to 4.32] with the conventional technique. Average change in posterior offset using raTKA was 0.08mm [-0.40 to 0.56] vs 1.64mm [2.47 to 0.81] with the conventional technique. Average absolute change in posterior offset with raTKA was 2.19mm [1.92 to 2.46] vs 4.24mm [3.79 to 4.69] with the conventional technique. There was a significant difference when comparing absolute change in joint line height and posterior offset between groups (p<0.01). Conclusion: Robotic-assisted primary TKA restores the joint line height and posterior offset more accurately than conventional jig-based techniques. [ABSTRACT FROM AUTHOR]

In this paper we develop a general computer-assisted proof method for periodic solutions to delay differential equations. The class of problems considered includes systems of delay differential equations with an arbitrary number of (forward and backward) delays. When the nonlinearities include nonpolynomial terms we introduce auxiliary variables to first rewrite the problem into an equivalent polynomial one. We then apply a flexible fixed point technique in a space of geometrically decaying Fourier coefficients. We showcase the efficacy of this method by proving periodic solutions in the well-known Mackey–Glass delay differential equation for the classical parameter values. [ABSTRACT FROM AUTHOR]

Background: Refractory dyspnea or breathlessness is a common symptom in patients with advanced chronic obstructive pulmonary disease (COPD), with a high negative impact on quality of life (QoL). Low dosed opioids have been investigated for refractory dyspnea in COPD and other life-limiting conditions, and some positive effects were demonstrated. However, upon first assessment of the literature, the quality of evidence in COPD seemed low or inconclusive, and focused mainly on morphine which may have more side effects than other opioids such as fentanyl. For the current publication we performed a systematic literature search. We searched for placebo-controlled randomized clinical trials investigating opioids for refractory dyspnea caused by COPD. We included trials reporting on dyspnea, health status and/or QoL. Three of fifteen trials demonstrated a significant positive effect of opioids on dyspnea. Only one of four trials reporting on QoL or health status, demonstrated a significant positive effect. Two-thirds of included trials investigated morphine. We found no placebo-controlled RCT on transdermal fentanyl. Subsequently, we hypothesized that both fentanyl and morphine provide a greater reduction of dyspnea than placebo, and that fentanyl has less side effects than morphine.Methods: We describe the design of a robust, multi-center, double blind, double-dummy, cross-over, randomized, placebo-controlled clinical trial with three study arms investigating transdermal fentanyl 12 mcg/h and morphine sustained-release 10 mg b.i.d. The primary endpoint is change in daily mean dyspnea sensation measured on a numeric rating scale. Secondary endpoints are change in daily worst dyspnea, QoL, anxiety, sleep quality, hypercapnia, side effects, patient preference, and continued opioid use. Sixty patients with severe stable COPD and refractory dyspnea (FEV1 < 50%, mMRC ≥ 3, on optimal standard therapy) will be included.Discussion: Evidence for opioids for refractory dyspnea in COPD is not as robust as usually appreciated. We designed a study comparing both the more commonly used opioid morphine, and transdermal fentanyl to placebo. The cross-over design will help to get a better impression of patient preferences. We believe our study design to investigate both sustained-release morphine and transdermal fentanyl for refractory dyspnea will provide valuable information for better treatment of refractory dyspnea in COPD. Trial registration NCT03834363 (ClinicalTrials.gov), registred at 7 Feb 2019, https://clinicaltrials.gov/ct2/show/NCT03834363 . [ABSTRACT FROM AUTHOR]

Upper‐flow‐regime bedforms, including upper‐stage‐plane beds, antidunes, chutes‐and‐pools and cyclic steps, are ubiquitous in glacigenic depositional environments characterized by abundant meltwater discharge and sediment supply. In this study, the depositional record of Froude near‐critical and supercritical flows in glacigenic settings is reviewed, and similarities and differences between different depositional environments are discussed. Upper‐flow‐regime bedforms may occur in subglacial, subaerial and subaqueous environments, recording deposition by free‐surface flows and submerged density flows. Although individual bedform types are generally not indicative of any specific depositional environment, some observed trends are similar to those documented in non‐glacigenic settings. Important parameters for bedform evolution that differ between depositional environments include flow confinement, bed slope, aggradation rate and grain size. Cyclic‐step deposits are more common in confined settings, like channels or incised valleys, or steep slopes of coarse‐grained deltas. Antidune deposits prevail in unconfined settings and on more gentle slopes, like glacifluvial fans, sand‐rich delta slopes or subaqueous (ice‐contact) fans. At low aggradation rates, only the basal portions of bedforms are preserved, such as scour fills related to the hydraulic‐jump zone of cyclic steps or antidune‐wave breaking, which are common in glacifluvial systems and during glacial lake‐outburst floods and (related) lake‐level falls. Higher aggradation rates result in increased preservation potential, possibly leading to the preservation of complete bedforms. Such conditions are met in sediment‐laden jökulhlaups and subaqueous proglacial environments characterized by expanding density flows. Coarser‐grained sediment leads to steeper bedform profiles and highly scoured facies architectures, while finer‐grained deposits display less steep bedform architectures. Such differences are in part related to stronger flows, faster settling of coarse clasts, and more rapid breaking of antidune waves or hydraulic‐jump formation over hydraulically rough beds. [ABSTRACT FROM AUTHOR]

In this paper we present a general approach to rigorously validate Hopf bifurcations as well as saddle-node bifurcations of periodic orbits in systems of ODEs. By a combination of analytic estimates and computer-assisted calculations, we follow solution curves of cycles through folds, checking along the way that a single nondegenerate saddle-node bifurcation occurs. Similarly, we rigorously continue solution curves of cycles starting from their onset at a Hopf bifurcation. We use a blowup analysis to regularize the continuation problem near the Hopf bifurcation point. This extends the applicability of validated continuation methods to the mathematically rigorous computational study of bifurcation problems. [ABSTRACT FROM AUTHOR]

In this paper, a general method to obtain constructive proofs of existence of periodic orbits in the forced autonomous Navier–Stokes equations on the three-torus is proposed. After introducing a zero finding problem posed on a Banach space of geometrically decaying Fourier coefficients, a Newton–Kantorovich theorem is applied to obtain the (computer-assisted) proofs of existence. The required analytic estimates to verify the contractibility of the operator are presented in full generality and symmetries from the model are used to reduce the size of the problem to be solved. As applications, we present proofs of existence of spontaneous periodic orbits in the Navier–Stokes equations with Taylor–Green forcing. [ABSTRACT FROM AUTHOR]

The article reports on the development of modern Deism, the philosophical position that rejects revelation as a source of religious knowledge and asserts that reason and observation of the natural world can establish the existence of a Supreme Being.

Purpose: While there is a significant proportion of people with a mild intellectual disability (MID) or borderline intellectual functioning (BIF) who commit sexual offenses, little research has focused on the risk factors for sexual recidivism in people with MID-BIF. The purpose of this paper is to compare the scores on the STATIC-99R and STABLE-2007 between persons with sexual offense histories with and without MID-BIF. Design/methodology/approach: Data using the STATIC-99R and STABLE-2007 were collected in 85 male patients divided into an MID-BIF group (IQ 50–85, n=50) and comparison group (IQ>95, n=35). Findings: The MID-BIF group and comparison group did not differ significantly on the static risk factors and total score of the STATIC-99R. However, of the 13 dynamic risk factors of the STABLE-2007, the MID-BIF group scored significantly higher on the items Impulsive acts, Poor problem solving skills and Lack of concern for others, while the comparison group scored significantly higher on the item Deviant sexual preference. Originality/value: The higher score on a number of dynamic risk factors for patients with MID-BIF could partly be explained by the characteristics associated with MID-BIF. Although dynamic criminogenic risk factors which are usually identified as targets for treatment appear the same for people with and without MID-BIF who commit sexual offenses, adaptations to the modality of treatment will still need to be made for people with MID-BIF. [ABSTRACT FROM AUTHOR]

In this paper we develop a symmetry preserving method for the rigorous computation of stationary states of the Ohta-Kawasaki partial differential equation in three space dimensions. By preserving the relevant symmetries we achieve an enormous reduction in computational cost. This makes it feasible to construct computer-assisted proofs of complex three-dimensional structures. In particular, we provide the first existence proofs for both the double gyroid and body centered cubic packed sphere solutions to this problem. [ABSTRACT FROM AUTHOR]

Traveling waves form a prominent feature in the dynamics of scalar reaction-diffusion equations on unbounded cylinders. The traveling waves can be identified with the bounded solutions of the elliptic PDE{∂2tu-c∂tu + Δu + f(x,u)= 0, t ϵ R, X ϵ Ω, B(u) = 0, t ϵ R, x ϵ ∂Ω where c ≠ 0 is the wave speed, Ω ⊂ Rd d is a bounded domain, Δ is the Laplacian on \Omega, and B denotes Dirichlet, Neumann, or periodic boundary data. We develop a new homological invariant for the dynamics of the bounded solutions of the above elliptic PDE. Restrictions on the nonlinearity f are kept to a minimum; for instance, any nonlinearity exhibiting polynomial growth in u can be considered. In particular, the set of bounded solutions of the traveling wave PDE may not be uniformly bounded. Despite this, the homology is invariant under lower order (but not necessarily small) perturbations of the nonlinearity f, thus making the homology amenable for computation. Using the new invariant we derive lower bounds on the number of bounded solutions of our PDE, thus obtaining existence and multiplicity results for traveling wave solutions of reaction-diffusion equations on unbounded cylinders. [ABSTRACT FROM AUTHOR]

Background: Delayed diagnosis of pulmonary embolism (PE) is common because symptoms can be non-specific. The few studies that have investigated diagnostic delay have not taken into account the role of primary care physicians in the diagnostic process.Aim: To document and quantify the stages of diagnostic delay of PE and to identify clinical factors associated with this delay.Design and Setting: A retrospective cohort study conducted in Zwolle and its surroundings in the Netherlands.Method: Primary and secondary care records of all patients diagnosed with PE between January 2008 and December 2009 were reviewed for dates of symptom onset, date of presentation and diagnosis, and for clinical findings. Relationships between delay and clinical parameters were tested using multivariate regression analysis.Results: The 261 patients enrolled in the study had an average total delay of 8.6 days. Patient delay (4.2 days average) and delay in primary care (3.9 days) were the major contributors to this delay. Chest pain (odds ratio [OR] 0.51, 95% confidence interval [CI] = 0.28 to 0.92, P = 0.03) and symptoms of deep venous thrombosis (calf pain) (OR 0.49, 95% CI = 0.24 to 0.98, P = 0.05) were associated with an early diagnosis. Patient delay was shorter in patients with chest pain (OR 0.49, 95% CI = 0.25 to 0.95, P = 0.03) and longer in patients with dyspnoea (OR 2.95, 95% CI = 0.99 to 8.85, P = 0.05). In primary care, chest pain (OR 0.37, 95% CI = 0.17 to 0.84, P = 0.02) and rales (OR 0.22, 95% CI = 0.06 to 0.83, P = 0.03) were associated with an early referral, whereas comorbidity led to a delayed referral.Conclusion: This study shows that the diagnostic delay of PE is substantial, especially patient delay and delay in primary care. There is room to reduce this delay by increasing the awareness of both patients and GPs. Further research is needed on clinical factors that raise suspicion of PE in primary care. [ABSTRACT FROM AUTHOR]

Objective We examined the costs and benefits of introducing migraine nurses into primary care. Background Migraine is one of the most costly neurological diseases. Methods We analyzed data from our earlier nonrandomized cohort study comparing an intervention group of 141 patients, whose care was supported by nurses trained in migraine management, and a control group of 94 patients receiving usual care. Estimates of per-person direct costs were based on nurses' salaries and referrals to neurologists. Indirect costs were estimated as lost productivity, including numbers of days of absenteeism or with <50% productivity at work due to migraine, and notional costs related to lost days of household activities or days of <50% household productivity. Analysis was conducted from the payer's perspective. Results After 9 months the direct costs were €281.11 in the control group against €332.23 in the intervention group (mean difference −51.12; 95% CI: −113.20-15.56; P = .134); the indirect costs were €1985.51 in the control group against €1631.75 in the intervention group (mean difference 353.75; 95% CI: −355.53-1029.82; P = .334); and total costs were €2266.62 in the control group, against €1963.99 in the intervention group (mean difference 302.64; 95% CI: −433.46-1001.27; P = .438). When costs attributable to lost household productivity were included, total costs increased to €6076.62 in the control group and €5048.15 in the intervention group (mean difference 1028.47; 95% CI: −590.26-2603.67; P = .219). Conclusion Migraine nurses in primary care seemed in this study to increase practice costs but decrease total societal costs. However, it was a nonrandomized study, and the differences did not reach significance. For policy-makers concerned with headache-service organization and delivery, the important messages are that we found no evidence that nurses increased overall costs, and investment in a definitive study would therefore be worthwhile. [ABSTRACT FROM AUTHOR]

The author discusses the diffusion of the works of the English deist Thomas Morgan in the U.S. He mentions that numerous intellectuals and deists report on seeing copies of Morgan's works in libraries and personal collections, as well as discussing the spread of deism throughout the country.

In this work we introduce a rigorous computational method for finding heteroclinic solutions of a system of two second order differential equations. These solutions correspond to standing waves between rolls and hexagonal patterns of a two-dimensional pattern formation PDE model. After reformulating the problem as a projected boundary value problem (BVP) with boundaries in the stable/unstable manifolds, we compute the local manifolds using the parameterization method and solve the BVP using Chebyshev series and the radii polynomial approach. Our results settle a conjecture by Doelman et al. [European J. Appl. Math., 14 (2003), pp. 85-110] about the coexistence of hexagons and rolls. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to investigate the feasibility of completing an exercise program in patients with advanced cancer and to obtain preliminary data of its impact on physical and quality of life (QoL) outcomes. Methods: We conducted a nonrandomized pilot study. Participants were 26 palliative care patients with advanced cancer (mean age=54.5 years; standard deviation [SD] 8.9 years) of the outpatient clinic of the medical oncology and the urology departments of a medical center in The Netherlands. Participants followed an individually graded group exercise program, consisting of resistance training and aerobic exercise, twice a week during 6 weeks. Feasibility of the training program, muscle strength, aerobic fitness, body composition, QoL, fatigue, and physical role, social, and activities of daily living (ADL) functioning were assessed at baseline and immediately after the intervention. Results: Dropout rate during the training period was 35% due to disease progression. After the training period, based on intention to treat analysis, muscle strength and aerobic functional fitness had increased significantly ( p≤0.01). A significant decrease in fat percentage ( p≤0.02) was observed. QoL had increased significantly ( p≤0.02), as well as social ( p≤0.04), physical role ( p≤0.01), and ADL functioning ( p≤0.05). Fatigue decreased significantly on the Checklist Individual Strength (CIS) and RAND-36 questionnaires ( p≤0.02), however not on the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 ( p=0.48). No change in physical functioning was observed with the EORTC QLQ-C30 and RAND-36 (respectively, p=0.33 and p=0.09). Conclusions: These preliminary results show that physical exercise in patients with advanced cancer is feasible. A significant impact was observed on physical and QoL outcomes. These findings need to be confirmed with a larger-scale, randomized controlled trial. [ABSTRACT FROM AUTHOR]