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Background There exists scant evidence on the optimal approaches to integrating patient-reported outcomes (PROs) in clinical practice. This study gathered oncology practitioners’ experiences with implementing PROs in cancer care. Methods Between December 2019 and June 2020, we surveyed practitioners who reported spending > 5% of their time providing clinical care to cancer patients. Respondents completed an online survey describing their experiences with and barriers to using PROs in clinical settings. Results In total, 362 practitioners (physicians 38.7%, nurses 46.7%, allied health professionals 14.6%) completed the survey, representing 41 countries (Asia–Pacific 42.5%, North America 30.1%, Europe 24.0%, others 3.3%). One quarter (25.4%) identified themselves as “high frequency users” who conducted PRO assessments on > 80% of their patients. Practitioners commonly used PROs to facilitate communication (60.2%) and monitor treatment responses (52.6%). The most commonly reported implementation barriers were a lack of technological support (70.4%) and absence of a robust workflow to integrate PROs in clinical care (61.5%). Compared to practitioners from high-income countries, more practitioners in low-middle income countries reported not having access to a local PRO expert (P

On-chip lasers are a key component for the realization of silicon photonics. The performance of silicon-based quantum dot (QD) devices is approaching equivalent QDs on native substrates. To drive forward design optimization we investigated the temperature and pressure dependence of intrinsic and modulation p-doped 1.3 μm InAs dot-in-well (DWELL) laser diodes on on-axis silicon substrates for comparison with devices on GaAs substrates. The silicon-based devices demonstrated low room temperature (RT) threshold current densities ( Jth ) of 192 Acm−2 (538 Acm−2) intrinsic (p-doped). Intrinsic devices exhibited temperature stable operation from 170–200 K. Above this, Jth increased more rapidly due to increased non-radiative recombination. P-doping increased the temperature at which Jth(T) started to increase to 300 K with a temperature insensitive region close to RT, but with a higher Jth . A strong correlation was found between the temperature dependence of gain spectrum broadening and the radiative component of threshold Jrad(T) . At low temperature this is consistent with strong inhomogeneous broadening of the carrier distribution, which is more pronounced in the p-doped devices. At higher temperatures Jth increases due to homogeneous thermal broadening coupled with non-radiative recombination. Hydrostatic pressure investigations indicate that while defect-related recombination dominates, radiative and Auger recombination also contribute to Jth .

Background Telemedicine services have been increasingly used to facilitate post-treatment cancer survivorship care, including improving access; monitoring health status, health behaviors, and symptom management; enhancing information exchange; and mitigating the costs of care delivery, especially since the COVID-19 pandemic. To inform guidance for the use of telemedicine in the post-COVID era, the aim of this overview of systematic reviews (SRs) was to evaluate the efficacy of, and survivor engagement in, telemedicine interventions in the post-treatment survivorship phase, and to consider implementation barriers and facilitators. Methods PubMed, Cochrane CENTRAL, CINAHL, Embase, and Web of Science databases were searched. SRs that examined the use of telemedicine in the post-treatment phase of cancer survivorship, published between January 2010 and April 2021, were included. Efficacy data were synthesized narratively. Implementation barriers and facilitators were synthesized using the Consolidated Framework for Implementation Research. Results Twenty-nine SRs were included. A substantive body of evidence found telemedicine to benefit the management of psychosocial and physical effects, particularly for improving fatigue and cognitive function. There was a lack of evidence on the use of telemedicine in the prevention and surveillance for recurrences and new cancers as well as management of chronic medical conditions. This overview highlights a range of diverse barriers and facilitators at the patient, health service, and system levels. Conclusions This review highlights the benefits of telemedicine in addressing psychosocial and physical effects, but not in other areas of post-treatment cancer survivorship care. This large review provides practical guidance for use of telemedicine in post-treatment survivorship care.

This publication addresses the limited use of qualitative methods in neglected tropical disease (NTD) programmes. It describes a scoping literature review conducted to inform the development of a guide to inform the use of rapid qualitative assessments to strengthen NTD mass drug administration (MDA) programmes. The review assessed how qualitative methods are currently used by NTD programmes and identified qualitative approaches from other health and development programmes with the potential to strengthen the design of MDA interventions. Systematic review articles were reviewed and searched using key terms conducted on Google Scholar and PubMed. Results show that methods used by NTD programmes rely heavily on focus group discussions and in-depth interviews, often with time-consuming analysis and limited information on how results are applied. Results from other fields offered insight into a wider range of methods, including participatory approaches, and on how to increase programmatic uptake of findings. Recommendations on how to apply these findings to NTD control are made. The topic of human resources for qualitative investigations is explored and a guide to improve MDAs using qualitative methods is introduced. This guide has direct applicability across the spectrum of NTDs as well as other public health programmes.

Sensitized kidney transplant recipients experience high rates of antibody-mediated rejection due to the presence of donor-specific antibodies and immunologic memory. Here we show that transient peri-transplant treatment with the central complement component C3 inhibitor Cp40 significantly prolongs median allograft survival in a sensitized nonhuman primate model. Despite donor-specific antibody levels remaining high, fifty percent of Cp40-treated primates maintain normal kidney function beyond the last day of treatment. Interestingly, presence of antibodies of the IgM class associates with reduced median graft survival (8 vs. 40 days; p = 0.02). Cp40 does not alter lymphocyte depletion by rhesus-specific anti-thymocyte globulin, but inhibits lymphocyte activation and proliferation, resulting in reduced antibody-mediated injury and complement deposition. In summary, Cp40 prevents acute antibody-mediated rejection and prolongs graft survival in primates, and inhibits T and B cell activation and proliferation, suggesting an immunomodulatory effect beyond its direct impact on antibody-mediated injury. Donor-specific antibodies in sensitized recipients may cause kidney transplant rejection. Here the authors show that complement component C3 inhibition prolongs graft survival by inhibiting T and B cell proliferation/activation and hence tissue injury, despite antibody levels remaining unaffected.

Previous research has highlighted both psychological and structural risk factors as correlates of condomless anal sex, a key pathway to HIV acquisition in men who have sex with men (MSM). Fewer studies have focused on positive psychobehavioral factors, which may be associated with more consistent condom use. This study hypothesized that positive psychobehavioral factors would be associated with more frequent condom use over and above psychological and structural risk factors. MSM with histories of childhood sexual abuse in Boston, MA and Miami, FL (N = 108) completed cross-sectional assessments of psychosocial, structural, and positive psychobehavioral factors. These factors were entered simultaneously in a linear regression model to examine their association with frequency of condomless sex. More recent seroadaptive behavior (B = 0.323, 95% CI = 0.055–0.590, p = .019) and receipt of government benefits to supplement income (B = 0.892, 95% CI = 0.171–1.612, p = .016) were independently associated with higher frequency of condomless sex over and above all other psychosocial, structural, and positive psychobehavioral factors. R2 for the final model was 0.270. Ancillary analyses including participants taking and adherent to biomedical HIV prevention suggested an association between higher distress tolerance and lower frequency of condomless sex. Positive psychobehavioral factors may potentially lower risk for HIV in high-risk MSM; however, left unaddressed, structural disadvantage is a potent influence which may limit potential benefits.

BackgroundMyalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a serious multifactorial disorder. The origin remains ambiguous, however reduced natural killer (NK) cell cytotoxicity is a consistent immunological feature of ME/CFS. Impaired transient receptor potential melastatin 3 (TRPM3), a phosphatidylinositol dependent channel, and impaired calcium mobilisation have been implicated in ME/CFS pathology. This investigation aimed to examine the localisation of TRPM3 at the NK cell plasma membrane and co-localisation with phosphatidylinositol 4,5-bisphosphate (PIP2). The effect of IL-2 priming and treatment using pregnenolone sulfate (PregS) and ononetin on TRPM3 co-localisation and NK cell cytotoxicity in ME/CFS patients and healthy controls (HC) was also investigated.MethodsNK cells were isolated from 15 ME/CFS patients and 15 age- and sex-matched HC. Immunofluorescent technique was used to determine co-localisation of TRPM3 with the NK cell membrane and with PIP2of ME/CFS patients and HC. Flow cytometry was used to determine NK cell cytotoxicity. Following IL-2 stimulation and treatment with PregS and ononetin changes in co-localisation and NK cell cytotoxicity were measured.ResultsOvernight treatment of NK cells with PregS and ononetin resulted in reduced co-localisation of TRPM3 with PIP2and actin in HC. Co-localisation of TRPM3 with PIP2in NK cells was significantly reduced in ME/CFS patients compared with HC following priming with IL-2. A significant increase in co-localisation of TRPM3 with PIP2was reported following overnight treatment with ononetin within ME/CFS patients and between groups. Baseline NK cell cytotoxicity was significantly reduced in ME/CFS patients; however, no changes were observed following overnight incubation with IL-2, PregS and ononetin between HC and ME/CFS patients. IL-2 stimulation significantly enhanced NK cell cytotoxicity in HC and ME/CFS patients.ConclusionSignificant changes in co-localisation suggest PIP2-dependent TRPM3 function may be impaired in ME/CFS patients. Stimulation of NK cells with IL-2 significantly enhanced cytotoxic function in ME/CFS patients demonstrating normal function compared with HC. A crosstalk exists between IL-2 and TRPM3 intracellular signalling pathways which are dependent on Ca2+influx and PIP2. While IL-2R responds to IL-2 binding in vitro, Ca2+dysregulation and impaired intracellular signalling pathways impede NK cell function in ME/CFS patients.

Background: Cervical cancer is the third most common cancer attacking women globally, and the second in Eastern Africa where Rwanda is located. Regular screening is an effective prevention approach for cervical cancer. Despite that, the screening rate for cervical cancer in Africa is estimated between 10% and 70%, with a number of barriers. This is especially the case in sub-Saharan Africa. In Rwanda, there is limited literature on the rate of use of screening services or the barriers to cervical screening. Objective: To assess knowledge, utilization, and barriers of cervical cancer screening among women attending selected district hospitals in Kigali, Rwanda. Methods: A descriptive cross-sectional study with a structured questionnaire was used to collect data. Nominal ‘yes’ or ‘no’ questions were used to gather data on knowledge and utilisation of cervical cancer and its screening. Likert-type scale questions were used to identify different barriers to screening services. Data were analysed using descriptive and inferential statistics. Respondents were selected by systematic random sampling from the database of women attending gynaecology services at three district hospitals in Kigali, Rwanda. Results: Three hundred and twenty-nine women responded to the survey. Half of the respondents (n = 165) had high knowledge level scores on cervical cancer screening. The cervical cancer screening rate was 28.3%. Utilization of screening was associated with knowledge (P = 0.000, r = -0.392) and selected demographic factors (P = 0.000). Individual barriers included poor knowledge on availability of screening services, community barriers included living in a rural area, and health provider and systems barriers included lack of awareness campaigns, negative attitudes of healthcare providers toward clients, and long waiting times; all barriers limit the access to screening services. Conclusion: A low rate of cervical cancer screening was identified for women attending selected district hospitals in Kigali-Rwanda due to various barriers. On-going education on cervical cancer and its screening is highly recommended. It is important that trained health providers encourage their clients to have cervical cancer screening and work to reduce related barriers.

Background: Although estimates of suboptimal adherence to oral corticosteroids in asthma range from 30% to 50%, no ideal method for measurement exists; the impact of poor adherence in severe asthma is likely to be particularly high. Research Questions: What is the prevalence of suboptimal adherence detected by self-reporting and direct measures? Is suboptimal adherence associated with disease activity? Study Design and Methods: Data were included from individuals with severe asthma taking part in the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes) study and prescribed daily oral corticosteroids. Participants completed the Medication Adherence Report Scale, a five-item questionnaire used to grade adherence on a scale from 1 to 5, and provided a urine sample for analysis of prednisolone and metabolites by liquid chromatography-mass spectrometry. Results: Data from 166 participants were included in this study: mean (SD) age, 54.2 (± 11.9) years; FEV 1, 65.1% (± 20.5%) predicted; female, 58%; 37% completing the Medication Adherence Report Scale reported suboptimal adherence; and 43% with urinary corticosteroid data did not have detectable prednisolone or metabolites in their urine. Good adherence by both methods was detected in 49 of the 142 (35%) of participants in whom both methods were performed; adherence detection did not match between methods in 53%. Self-reported high adherers had better asthma control and quality of life, whereas directly measured high adherers had lower blood eosinophil levels. Interpretation: Low adherence is a common problem in severe asthma, whether measured directly or self-reported. We report poor agreement between the two methods, suggesting some disassociation between self-assessment of medication adherence and regular oral corticosteroid use, which suggests that each approach may provide complementary information in clinical practice.

Background: Prenatal immune development may play an important role in the etiology of childhood acute lymphoblastic leukemia (ALL). Methods: Seven cytokines, IL1β, IL4, IL6, IL8, GM-CSF, TNFα, and VEGF, were analyzed in blood spots collected at birth from 1,020 ALL cases and 1,003 controls participating in the California Childhood Leukemia Study. ORs and 95% confidence intervals (95% CI) associated with an interquartile range increment in cytokine levels were calculated using logistic regression, adjusting for sociodemographic and birth characteristics. Results: We found that patients with ALL were born with higher levels of a group of correlated cytokines than controls [IL1β: OR of 1.18 (95% confidence interval [CI], 1.03–1.35); IL8: 1.19 (1.03–1.38); TNFα: 1.15 (1.01–1.30); VEGF: 1.16 (1.01–1.33)], especially among children of Latina mothers (ORs from 1.31 to 1.40) and for ALL with high hyperdiploidy (ORs as high as 1.27). We found that neonatal cytokine levels were correlated with neonatal levels of endogenous metabolites which had been previously associated with ALL risk; however, there was no evidence that the cytokines were mediating the relationship between these metabolites and ALL risk. Conclusions: We posit that children born with altered cytokine levels are set on a trajectory towards an increased risk for subsequent aberrant immune reactions that can initiate ALL. Impact: This is the first study to evaluate the interplay between levels of immunomodulatory cytokines at birth, prenatal exposures, and the risk of childhood ALL.

BACKGROUND: Selection of the optimal treatment modality for primary liver cancers remains complex, balancing patient condition, liver function, and extent of disease. In individuals with preserved liver function, liver resection remains the primary approach for treatment with curative intent but may be associated with significant mortality. The purpose of this study was to establish a simple scoring system based on Model for End-stage Liver Disease (MELD) and extent of resection to guide risk assessment for liver resections. METHODS: The 2005–2015 NSQIP database was queried for patients undergoing liver resection for primary liver malignancy. We first developed a model that incorporated the extent of resection (1 point for major hepatectomy) and a MELD-Na score category of low (MELD-Na =6, 1 point), medium (MELD-Na =7–10, 2 points) or high (MELD-Na >10, 3 points) with a score range of 1–4, called the Hepatic Resection Risk Score (HeRS). We tested the predictive value of this model on the dataset using logistic regression. We next developed an optimal multivariable model using backwards sequential selection of variables under logistic regression. We performed K-fold cross validation on both models. Receiver operating characteristics were plotted and the optimal sensitivity and specificity for each model were calculated to obtain positive and negative predictive values. RESULTS: A total of 4,510 patients were included. HeRS was associated with increased odds of 30-day mortality [HeRS =2: OR =3.23 (1.16–8.99), P=0.025; HeRS =3: OR =6.54 (2.39–17.90), P

We present the case of a 41-year-old female who underwent bilateral lung transplantation after the donor lungs were placed on a normothermic ex vivo lung perfusion and ventilation device and flown nearly 5000 miles from Honolulu, Hawaii to Durham, North Carolina. The patient experienced no primary graft dysfunction. One year after transplantation she has remained rejection-free and exhibits excellent pulmonary function. This case highlights the challenge that active organ preservation systems pose to questions of organ allocation and geographic sharing.

Obesity is a chronic disease associated with many complications. Weight loss of 5–15% can improve many obesity-related complications. Despite the benefits of weight reduction, there are many challenges in losing weight and maintaining long-term weight loss. Pharmacotherapy can help people with obesity achieve and maintain their target weight loss, thereby reducing the risk of obesity-related complications. The prevalence of obesity in the USA has been increasing over the past few decades, and despite the availability of approved anti-obesity medications (AOMs), people with obesity may not be accessing or receiving treatment at levels consistent with the disease prevalence. Reasons for low levels of initiation and long-term use of AOMs may include reluctance of public health and medical organizations to recognize obesity as a disease, lack of reimbursement, provider inexperience, and misperceptions about the efficacy and safety of available treatments. This article aims to inform primary care providers about the mechanism of action of one class of AOMs, glucagon-like peptide 1 receptor agonists (GLP-1RAs), in weight loss and longer-term maintenance of weight loss, and the efficacy and safety of this treatment class. GLP-1RA therapy was initially developed to treat type 2 diabetes. Owing to their effectiveness in reducing body weight, once-daily subcutaneous administration of liraglutide 3.0 mg has been approved, and once-weekly subcutaneous administration of semaglutide 2.4 mg is being investigated in phase III trials, for obesity management. Considerations regarding adverse effects and contraindications for different drug classes are provided to help guide treatment decision-making when considering pharmacotherapy for weight management in patients with obesity. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01710-0., Plain Language Summary Obesity is a growing public health issue that increases the risk of developing heart disease, type 2 diabetes, and osteoarthritis. Weight loss can reduce the risk of developing these health problems but, despite this, levels of obesity remain high. Achieving and maintaining weight loss is challenging for many individuals. There is therefore a need for some patients to take medications to help them lose weight and prevent weight regain. Glucagon-like peptide 1 receptor agonists (GLP-1RAs) are a type of medication originally developed to treat type 2 diabetes, but are now being used for the treatment of obesity because they are effective at helping people to lose weight. One GLP-1RA, liraglutide, has been approved to treat obesity, and another, semaglutide, is in clinical trials. GLP-1RAs work by reducing the appetite and feelings of hunger, slowing the release of food from the stomach, and increasing feelings of fullness after eating. Most people can tolerate GLP-1RAs well. The most common side effects (nausea, vomiting, and diarrhea) are usually mild and occur in the first few weeks of treatment, reducing over time. Because of the difficulties many people face in maintaining weight loss, lifelong treatment may be needed. In clinical trials, GLP-1RAs were well tolerated and effective at helping people prevent weight regain, and may be a good option for long-term weight control and lowering patients’ chances of serious health problems. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01710-0.

A novel Family of Origin as Supervisory Resource Model that harnesses the family of origin of the therapist-in-training as a cultural supervisory resource in the training paradigm is presented. The format of the model comprises three phases: supervisor’s exploration of the trainee’s professional dilemmas, supervisor’s exploration of the same dilemma through stories narrated by the supervisee’s family of origin members, and supervisee’s presentation of a case that is an example of the dilemma. The application of this training model during supervision strengthens the trainee’s flexibility in divergent family systems and enhances the ability to handle dilemmas and to form a healthy therapeutic alliance.

People with HIV (PWH) are at an increased risk of developing nonalcoholic fatty liver disease (NAFLD). Interleukin (IL)-18 is regulated by inflammasomes in response to pathogens and danger signals and has been implicated in both the pathogenesis of NAFLD and HIV disease progression. We hypothesized that increased IL-18 may be associated with NAFLD and liver injury in PWH. This was an observational study of 125 PWH and 59 individuals without HIV in the Boston area. Participants with known hepatitis B, hepatitis C, and excessive alcohol use were excluded. IL-18 was measured in serum by enzyme-linked immunosorbent assay. Liver lipid content was assessed by liver-to-spleen computed tomography (CT) attenuation ratio. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and IL-18 levels were higher in PWH than in controls. In PWH, log(10) IL-18 was associated with log(10)AST (r = 0.34, p = .0001), log(10)ALT (r = 0.33, p = .0002), log(10)HIV RNA (r = 0.29, p = .002), and inversely associated with liver-to-spleen ratio (r = −0.24, p = .02). In addition, log(10) IL-18 was associated with log(10) triglycerides (r = 0.26, p = .003), log(10) MCP-1 (monocyte chemoattractant protein-1; r = 0.33, p = .0004), log(10)caspase-1 (r = 0.35, p

Objectives To describe main challenges experienced by older adults (75+ years) following primary cancer treatment as a basis for development of age-appropriate survivorship care. Material and Methods A national survey was conducted across ten Canadian provinces to identify experiences with follow-up for cancer survivors one to three years post-treatment. The survey included open-ended questions for respondents to add details that offered deeper insight into their experiences. This publication presents analysis of responses from older adults (75+ years) about the main challenge they faced in transitioning to survivorship. Results In total, 3274 older adults (75+ years) responded to the survey and 2057 responded to the main challenge question. Fifty-five percent were male, 72% had not experienced metastatic disease and 75% reported comorbid conditions. The 1571 (48.0%) respondents reporting at least one main challenge described 2426 challenges categorized as physical, emotional, practical, lifestyle adjustments, health care delivery, and relationships/support. Physical challenges were identified most frequently (68.2%, n = 1655) including physical capacity (35.8%), symptoms/side effects (32.7%), and changes in bodily function/appearance (31.3%). Thematic analysis revealed three themes: ‘getting back on my feet’, ‘adjusting to the changes’, and ‘finding the support I needed’. Conclusion This work highlights gaps in early cancer survivorship for older adults and raises concerns about unexamined ageism within the Canadian cancer care system. A need for comprehensive geriatric assessments is evident before and toward the end of primary treatment to individualize care plans. Proactive provision of information about managing changes from treatment, offered in meaningful multi-modal ways, is important.

With the COVID pandemic impacting our current business networks, discussing spirituality in the workplace has become the forefront of how we do business. The need for human connectivity in current times plays an even more significant role in the makeup of how people work. Workplace spirituality is a reasonably new paradigm that has gained an amplified interest in the past two decades with academics and the corporate world [1]. Blau [2] has advocated that even before COVID, social exchanges could create an enhanced work dynamic by suggesting that companies are concerned with material gain and nonmaterial social experiences such as humanitarian ideals and spiritual values. Burack [3] suggested that there has been a rapid growth of spirituality in the workplace and organization in recent times as we have increased social chaos. This growth is mainly because of the changing nature of work and the realization that employees' spiritual level has been neglected for many years [4]. The current challenges have only accelerated the interest in spirituality as a workplace practice. This article will explore recent definitions of spirituality as they relate to religion and counseling in the workplace. Since spirituality is an abstract expression of self, it is not easy to define in its entirety. The paper's focus will converge on a review of the point of view of spirit that gives way to spirituality as defined through the lens of individuals and organizations' relationship to self and others and the world. With the current struggles related to the pandemic and changing times, the integration of spirituality at work can enhance people's connectivity within a business. According to Chopra [5], both leadership and spirituality have a powerful influence on an organization's overall performance. As we continue to move forward into the post-pandemic, the need to have a strong sense of spirit will continue to grow. The article will then introduce three identified behaviors that create a robust spiritual interconnectedness model that can play a role in a business's effectiveness. This spiritual model is introduced to improve relationships at work and integrate spiritual tenants into business processes. Introduction: Human connectivity is an essential aspect of any business. Ashmos and Duchon [6] suggested that there is increasing evidence that a significant transformation occurs in many organizations. With society's changes, especially related to technological advances and the global pandemic, individuals' interactions take on a more significant meaning for a business's success. The connectivity of people intersects with the disconnection of employees. Conclusion: “As rightly pointed out by Martin and Cullen [42], promoting a climate of trust in the organizational environment depends on adherence to a set of rules and principles of conduct, which advocates ethical values shared by the company's members. Based on the information reviewed in this article, there is a place for spirituality in the workplace related to the definition of spirituality as our connection to self, others, and the world.

Objective: To seek understanding of financial burden from the perspective of cancer patients, in a largely publicly funded health care system, about the impacts of financial hardship on their lives. Methods: A qualitative descriptive analysis was completed for comments written in response to an open-ended, free-text item on a pan-Canadian survey about costs incurred during cancer treatment and follow-up and the impact of financial difficulties. Results: A total 378 of the 901 survey respondents provided comments about their financial situations during cancer treatment. Forty percent of those individuals indicated experiencing financial struggles and resulting emotional distress. Themes were identified as follows: cost incurred, reduced income and reserves, impact of costs and reduced financial income/reserve, and managing financial distress. Conclusion: Even within a universal health care system, a significant proportion of cancer patients experienced financial struggle and resulting emotional distress. Practice implications: Regular monitoring of financial and emotional distress and its sources can facilitate the identification of those who are experiencing financial difficulty and the provision of appropriate interventions.

The number of older adults with cancer is growing but little is known about healthcare professionals' (HCPs) perceptions of their readiness to care for older adults with cancer. The Canadian Network on Aging and Cancer together with the Canadian Association of Nurses in Oncology, Oncology and Aging Special Interest Group, conducted a survey to assess geriatric oncology learning needs of Canadian HCPs and explore any differences in needs between nurses and physicians.An online survey was distributed to Canadian HCP, which assessed respondent confidence and desire to learn about domains related to geriatric oncology, current clinical practice and sociodemographic information. Descriptive statistics and chi-square tests were used to characterize participant characteristics, learning needs and compare learning needs of physicians vs. nurses.Respondents (n = 154) were mostly physicians (n = 78, 51%) or nurses (n = 56, 36%). Respondents reported not being confident addressing mental health issues (75%), polypharmacy (71%), geriatric oncology care models (69%), and return to baseline function post-treatment (67%). Physicians reported more confidence than nurses in managing comorbidities (72% vs. 49%, p 0.05), having difficult conversations (90% vs. 68%, p 0.001), and addressing ageism (76% vs. 58%, p 0.05), while nurses reported more confidence with managing mobility limitations (64% vs 42%, p 0.05), fall prevention (72% vs. 26%, p 0.01) and supporting caregivers (74% vs 52%, p 0.05). Nurses wanted to learn more about geriatric oncology than physicians for 10 domains (p 0.05).There is a need for interprofessional educational initiatives that address differences between nurses and physicians in clinical areas of confidence and learning needs.

Purpose of review The number of individuals aged 65+ with cancer will double in the next decade. Attention to quality of life (QOL) is imperative to identify relevant endpoints/outcomes in research and provide care that matches individual needs. This review summarizes recent publications regarding QOL measurement in older adults with cancer, considering implications for research and practice. Recent findings QOL is a complex concept and its measurement can be challenging. A variety of measurement tools exist, but only one specific to older adults with cancer. QOL is frequently measured as functional health, adverse symptoms, and global QOL, thus only capturing a portion of this concept. Yet successful QOL intervention for older adults requires drawing from behavioral and social dimensions.Growing interest in comprehensive geriatric assessment (CGA) and patient-reported outcomes (PROs) provides important opportunities for measuring QOL. Recommendations for use of CGAs and PROs in clinical practice have been made but widespread uptake has not occurred. Summary QOL is important to older adults and must be central in planning and discussing their care. It is modifiable but presents measurement challenges in this population. Various domains are associated with decline, survival, satisfaction with life, coping, and different interventions. Measurement approaches must fit with intention and capacity to act within given contexts.

Goal To determine patient-reported financial and family burden associated with treatment of cancer in the previous 28 days across Canada. Methods A self-administered questionnaire (P-SAFE v7.2.4) was completed by 901 patients with cancer from twenty cancer centres nationally (344 breast, 183 colorectal, 158 lung, 216 prostate) measuring direct and indirect costs related to cancer treatment and foregone care. Monthly self-reported out-of-pocket-costs (OOPCs) included drugs, homecare, homemaking, complementary/ alternative medicines, vitamins/supplements, family care, accommodations, devices, and “other” costs. Travel and parking costs were captured separately. Patients indicated if OOPC, travel, parking, and lost income were a financial burden. Results Mean 28-day OOPCs were CA$518 (US Purchase Price Parity [PPP] $416), plus CA$179 (US PPP $144) for travel and CA$84 (US PPP $67) for parking. Patients self-reporting high financial burden had total OOPCs (33%), of CA$961 (US PPP $772), while low-burden participants (66%) had OOPCs of CA$300 (US PPP $241). “Worst burden” respondents spent a mean of 50.7% of their monthly income on OOPCs (median 20.8%). Among the 29.4% who took time off work, patients averaged 18.0 days off. Among the 26.0% of patients whose caregivers took time off work, caregivers averaged 11.5 days off. Lastly, 41% of all patients had to reduce spending. Fifty-two per cent of those who reduced spending were families earning Conclusions In our Canadian sample, high levels of financial burden exist for 33% of patients, and the severity of burden is higher for those with lower household incomes.

Rationale: Host inflammatory responses have been strongly associated with adverse outcomes in critically ill patients, but the biologic underpinnings of such heterogeneous responses have not been d...

Regulatory agencies have derived noncancer toxicity values for 2,3,7,8-tetrachlorodibenzo-p-dioxin based on reduced sperm counts relying on single studies from a large body of evidence. Techniques such as meta-regression allow for greater use of the available data while simultaneously providing important information regarding the uncertainty associated with the underlying evidence base when conducting risk assessments. The objective herein was to apply systematic review methods and meta-regression to characterize the dose-response relationship of gestational exposure and epididymal sperm count. Twenty-three publications (20 animal studies consisting of 29 separate rat experimental data sets, and 3 epidemiology studies) met inclusion criteria. Risk of bias evaluation was performed to critically appraise study validity. Low to very low confidence precluded use of available epidemiological data as candidate studies for dose-response due to inconsistencies across the evidence base, high risk of bias, and general lack of biological coherence, including lack of clinical relevance and dose-response concordance. Experimental animal studies, which were found to have higher confidence following the structured assessment of confidence (eg, controlled exposure, biological consistency), were used as the basis of a meta-regression. Multiple models were fit; points of departure were identified and converted to human equivalent doses. The resulting reference dose estimates ranged from approximately 4 to 70 pg/kg/day, depending on model, benchmark response level, and study validity integration approach. This range of reference doses can be used either qualitatively or quantitatively to enhance understanding of human health risk estimates for dioxin-like compounds.

Electric-assisted bicycles (e-bikes) may encourage commuters to shift from car to bike by improving perceptions of bicycling safety and increasing destination accessibility. Awareness of e-bikes is...

Background: This study examined the feasibility, burden and acceptability of a legacy-making intervention in adults with cancer and preliminary effects on patient quality-of-life (QOL) measures. Method: We conducted a Stage IB pilot, intervention study. The intervention was a digital video legacy-making interview of adults with advanced cancer to create a digital video of their memories and experiences. Baseline and post-video QOL assessments included: Functional Assessment of Cancer Therapy—General (FACT-G), Patient Dignity Inventory (PDI), Hospital Anxiety and Depression Scale (HADS), and Emotional Thermometers for distress, anxiety, anger, help and depression. Participants received a final copy of the digital video for distribution to their families. Results: Adults (n = 16) ages 38-83 years old with an advanced or life-limiting cancer diagnosis completed an intervention. Feasibility and acceptability was strong with 0% attrition. While the pilot study was not powered for quantitative significance, there were changes from baseline to post-intervention in the participants’ total or subscale FACT-G scores, PDI, HADS anxiety or depression scores, and Emotional Thermometer scores. Conclusions: A digital video legacy-making intervention is feasible for adults with cancer without significant negative outcomes for individuals completing the study. It remains unclear whether this intervention contributes to positive quality of life outcomes.

Objectives: The purpose of this systematic review is to examine ways a resilience framework might inform social workers’ understanding about how to mitigate risks for youth who use Internet and Communication Technologies (ICTs). Eligibility criteria: This review identified original research published between January 2006 and December 2019 that used a resilience framework to assess outcomes of youth, ages 10–19, who use ICTs. Methods of synthesis: A narrative synthesis grouped articles based on conceptualizations of resilience, risk, and protection; methods; and populations. Results: A search identified 13 peer-reviewed studies that used resilience and its relationship to outcomes. Most studies identified resilience as a mediator or moderator that buffers the effect of harm. Conclusions: Social workers who wish to mitigate risks for youth who use ICTs might focus on interventions that strengthen resilience. Currently, resilience is inconsistently conceptually defined, and more robust research is needed regarding ICT use by marginalized youth.

PurposeThe aim of this paper is to begin a conversation about historicising the public relations (PR) curriculum in universities.Design/methodology/approachThe paper discusses PR history and historiography to identify the underlying ideological and methodological influences. It considers scholarship on PR education, and the inclusion or, more often, the exclusion of history except where it serves to reinforce a narrative of steady, and apparently unproblematic, professional development. The paper reviews the presentation of history in textbooks and discusses the authors' experiences of teaching PR history. The paper concludes with a discussion of how the inclusion of history in the PR curriculum offers an important critical intervention in PR education.FindingsThe PR curriculum tends to meet industry expectations around practice and skills in order to develop students as future practitioners. But this paper argues that a more historical and historiographical understanding of PR can develop in students important skills in research, analysis and interpretation. It can also introduce students to working with ambiguity and alternate perspectives. Foregrounding new histories and challenging existing histories introduce students to richer and more complex understandings of PR. It also introduces students to epistemology and ethics, and therefore offers a way to introduce critical thinking into the curriculum.Originality/valueA more historical understanding of PR develops student skills in research, analysis and interpretation as well as critical thinking.

Retrospective cohort study. To investigate radiographic sagittal and spinopelvic parameters of patients with adolescent idiopathic scoliosis (AIS) treated with bracing and assess differences among those treated successfully and unsuccessfully. AIS is a three-dimensional deformity of the spine, sharing an intricate relationship with pelvic morphology. However, the most relevant predictors of curve progression have historically been coronal parameters and skeletal maturity. Sagittal and spinopelvic parameters have not been thoroughly investigated as predictors of curve progression and brace treatment success. Retrospective review of AIS patients who underwent brace treatment. Coronal Cobb angles (CC), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), lumbar lordosis (LL), and thoracic spinopelvic angles (T1SP, T9SP) were measured prior to initiation of bracing. The sagittal and spinopelvic parameters of patients requiring surgical treatment due to curve progression were compared to those treated successfully with bracing. No significant differences were found for age, race, gender, Risser category (0/1 vs 2/3), initial CC, TK, LL, T1SP, or T9SP between cohorts. The cohort requiring surgery had significantly lower PI (p < 0.001, 42.0 v. 54.6), SS (p < 0.001, 37.0 v. 44.5), and PT (p = 0.003, 5.0 v. 10.2) compared to those successfully treated with bracing. Multivariable models controlling for Risser stage and Initial CC revealed the odds for successful brace treatment increases with an increase in PI (OR = 1.47, CI 1.18–1.83, p < 0.001), SS (OR = 1.26, CI 1.07–1.48, p = 0.006), and PT (OR = 1.43, CI 1.09–1.86, p = 0.006) (Table 3). The odds of successful brace treatment is given per one-unit increase for each radiographic measure after adjusting for Initial CC and Risser sign which were forced into each multivariable model. Spinopelvic parameters may indicate potential spine adaptability and skeletal maturity. For these reasons, we proposed that spinopelvic parameters may be a potential predictor of curve progression and brace treatment success. Our results demonstrated a higher risk of curve progression with lower PI, PT, or SS which support this hypothesis, however, given the small sample size and high variability, the magnitude of this effect should be viewed with caution and should serve as an impetus to further, larger scale studies to investigate the value spinopelvic parameters in curve progression and bracing efficacy. IV.

Financial toxicity related to cancer diagnosis and treatment is a common issue in developed countries. We seek to systematically summarize the extent of the issue in very high development index countries with publicly funded healthcare. We identified articles published Jan 1, 2005, to March 7, 2019, describing financial burden/toxicity experienced by cancer patients and/or informal caregivers using OVID Medline Embase and PsychInfo, CINAHL, Business Source Complete, and EconLit databases. Only English language peer-reviewed full papers describing studies conducted in very high development index countries with predominantly publicly funded healthcare were eligible (excluded the USA). All stages of the review were evaluated in teams of two researchers excepting the final data extraction (CJL only). The searches identified 7117 unique articles, 32 of which were eligible. Studies were undertaken in Canada, Australia, Ireland, UK, Germany, Denmark, Malaysia, Finland, France, South Korea, and the Netherlands. Eighteen studies reported patient/caregiver out-of-pocket costs (range US$17–US$506/month), 18 studies reported patient/caregiver lost income (range 17.6–67.3%), 14 studies reported patient/caregiver travel and accommodation costs (range US$8–US$393/month), and 6 studies reported financial stress (range 41–48%), strain (range 7–39%), or financial burden/distress/toxicity among patients/caregivers (range 22–27%). The majority of studies focused on patients, with some including caregivers. Financial toxicity was greater in those with early disease and/or more severe cancers. Despite government-funded universal public healthcare, financial toxicity is an issue for cancer patients and their families. Although levels of toxicity vary between countries, the findings suggest financial protection appears to be inadequate in many countries.

Because persons who identify across the transgender spectrum (PATS) are a key population in human immunodeficiency virus (HIV) yet are underreported in HIV and cardiovascular research, we aimed to characterize this population within the REPRIEVE global clinical trial (n = 7770). Acceptance of gathering gender identity was high (96%). Participation by PATS was 1.7% overall, 2.4% among natal males, 0.3% among natal females, and varied across geographic regions (from 0% in sub-Saharan Africa to 2.3% in High Income Region). Thirty percent of natal male PATS identified other than transgender. Some characteristics differed by gender. Most notably, 38% of natal male PATS receiving gender-affirming treatment had waist circumference >102 cm (compared with ≤25% in other groups). Given that PATS is a key population, HIV research should routinely report trial participation and outcomes by gender in addition to natal sex, to provide the results needed to optimize medical care to PATS.

Background People with human immunodeficiency virus (PWH) face increased risks for heart failure and adverse heart failure outcomes. Myocardial steatosis predisposes to diastolic dysfunction, a heart failure precursor. We aimed to characterize myocardial steatosis and associated potential risk factors among a subset of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) participants. Methods Eighty-two PWH without known heart failure successfully underwent cardiovascular magnetic resonance spectroscopy, yielding data on intramyocardial triglyceride (IMTG) content (a continuous marker for myocardial steatosis extent). Logistic regression models were applied to investigate associations between select clinical characteristics and odds of increased or markedly increased IMTG content. Results Median (Q1, Q3) IMTG content was 0.59% (0.28%, 1.15%). IMTG content was increased (> 0.5%) among 52% and markedly increased (> 1.5%) among 22% of participants. Parameters associated with increased IMTG content included age (P = .013), body mass index (BMI) ≥ 25 kg/m2 (P = .055), history of intravenous drug use (IVDU) (P = .033), and nadir CD4 count Conclusions A substantial proportion of antiretroviral therapy–treated PWH exhibited myocardial steatosis. Age, BMI ≥ 25 kg/m2, low nadir CD4 count, and history of IVDU emerged as possible risk factors for myocardial steatosis in this group. Clinical Trials Registration NCT02344290; NCT03238755.

Background People with human immunodeficiency virus (PWH) are at risk for accelerated development of physical function impairment and frailty; both associated with increased risk of falls, hospitalizations, and death. Identifying factors associated with physical function impairment and frailty can help target interventions. Methods The REPRIEVE trial enrolled participants 40–75 years of age, receiving stable antiretroviral therapy with CD4+ T-cell count >100 cells/mm3, and with low to moderate cardiovascular disease risk. We conducted a cross-sectional analysis of those concurrently enrolled in the ancillary study PREPARE at enrollment. Results Among the 266 participants, the median age was 51 years; 81% were male, and 45% were black, and 28% had hypertension. Body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was 25 to Conclusions Physical function impairment was common among middle-aged PWH; greater BMI and physical inactivity are important modifiable factors that may prevent further decline in physical function with aging. Clinical Trials Registration NCT02344290.

Background Pain management is an essential component of care for pediatric patients following surgery. Massage reduces self-reported postoperative pain in adults with heart disease but has received little attention in postoperative pediatric patients with complex congenital heart disease (CCHD). Objectives The aim of the study was to evaluate the effectiveness of massage compared to a rest period on postoperative pain scores and physiological responses in infants with CCHD. Methods We used a two-group randomized clinical trial design with a sample of 60 infants with CCHD between 1 day and 12 months of age following their first cardiothoracic surgery. Both groups received standard postoperative care. Group 1 received a daily 30-minute restriction of nonessential caregiving (quiet time), and Group 2 received a daily 30-minute massage. Interventions continued for seven consecutive days. Pain was measured six times daily using the Face, Legs, Activity, Cry, Consolability Pain Assessment Tool (FLACC). Average daily doses of analgesics were recorded. Heart rates (HRs), respiratory rates (RRs), and oxygen saturations (SpO2) were recorded continuously. Daily averages, pre- and postintervention FLACC scores, and physiological responses were analyzed using descriptive statistics, generalized linear mixed models repeated measures, latent growth models, and/or regression discontinuity analysis. Fentanyl-equivalent narcotic values were used as a time-varying covariate. Results Adjusted pain scores were lower for the massage group on all days except Day 7. Overall, there were no group effects on level of pain or differential rate of change in pain. However, the massage group had lower daily pain scores with small to medium effect size differences, largest at Days 4, 5, and 6, and lower average daily HR and RR. There was little difference between groups in SpO2. Infants demonstrated immediate effects of massage, with HR and RR decreasing and oxygen saturations increasing. Discussion This study provides beginning evidence that postoperative massage may reduce pain and improve physiological parameters in infants with congenital heart disease. This nonpharmacological adjunct to pain management may provide a particular benefit for this population by reducing demand on the cardiorespiratory system.

Background This study aimed to compare the microbiota of pediatric patients with chronic rhinosinusitis (CRS) who are undergoing adenoidectomy to treat their disease with that of healthy control patients. Methods Patients undergoing adenoidectomy-only for obstructive sleep apnea (n = 50) and CRS (n = 37) were recruited. Preoperative 22-item Sino-Nasal Outcome Test (SNOT-22) or Sinus and Nasal Quality of Life Survey (SN-5) were collected. Each patient had samples collected from their nasopharynx (adenoid bed) and nasal cavity (sinus) at the onset of surgery. 16S ribosomal ribonucleic acid (rRNA) gene sequencing was subsequently performed to obtain per sample taxonomic abundances. Statistical analyses included permutational multivariate analysis of variance (PERMANOVA), alpha (within sample) diversity measures, and changes in taxonomic abundance. Results Moraxella was the most abundant organism. Nasopharyngeal swabs demonstrated higher alpha diversity compared to the nasal cavity. The diversity was not different based on CRS vs obstructive history. There was an increase in diversity with increasing age, and eczema contributed to a greater difference in diversity between the nasopharynx and nasal cavity. Diversity was not affected by adenoid size; however, use of nasal steroids, inhaled steroids, and antihistamines influenced diversity in both the nasopharynx and nasal cavity. Nasopharyngeal samples were higher in relative abundance for Fusobacterium, Prevotella, Porphyromonas, and Campylobacter compared to the nasal cavity. Conclusion The nasopharynx and nasal cavity differed in both microbiota composition and diversity. In contrast, no significant difference in composition or diversity were found in CRS vs control patients. Ecological changes in the nasopharyngeal and sinus site may contribute to the etiology for adenoid hypertrophy in both healthy controls and CRS patients.

Background: Pain following autograft harvest has been studied; however, published literature has typically focused on the iliac crest with follow-up limited to only a few years. It remains unknown if pain continues or improves over time. The purpose of this study was to evaluate long-term pain associated with autograft harvest to supplement hindfoot or ankle arthrodesis. Methods: Subjects in the control arm of a previously conducted trial comparing autograft with a synthetic bone graft for hindfoot or ankle arthrodesis were invited back for a single visit at a minimum of 5 years following their initial surgery. Harvest site, fusion site, and weight-bearing pain were evaluated using a 100-point visual analog scale (VAS). Of the 130 invited subjects, 60 (46.1%) returned for assessment, 58 of whom completed pain assessments. Results: At a mean follow-up of 9.0 years (range, 7.8-10.5), more than a third (36.6%) of subjects had some level of harvest site pain. Using VAS greater than 20 mm as a threshold of clinical significance, pain remained clinically significant in 5.2% of subjects. There was a significant correlation between harvest site pain and both weight-bearing and fusion site pain. There was not a significant correlation between harvest site pain and volume of graft harvested. Conclusion: Autograft harvest can result in chronic, clinically significant pain that can last up to 10 years. In the era of shared decision making, this information will help surgeons and patients quantify the risks of chronic pain after arthrodesis procedures that include a secondary operative incision for graft harvest. Level of Evidence: Level II, prospective comparative study.

PURPOSE: The role of mobile health (mHealth) technology in cancer care has evolved alongside the rapid development in digital technology. Its use can come with significant potential benefits; however, such use may also be associated with risks. This paper summarizes the latest developments around mHealth use in cancer care presented by a panel of experts at the 2019 Annual Meeting of the Multinational Association of Supportive Care in Cancer. METHODS: Through lectures, case studies, and panel discussions, speakers and participants (including cancer specialist doctors, nurses, and allied health professionals) evaluated current and emerging mHealth methods for supportive care in cancer survivorship. Focus areas and special considerations were agreed upon by consensus. RESULTS: Three focus areas for the use of mHealth in cancer care were identified: activation and support of self-management, exercise oncology, and enablement of survivorship care delivery. In addition to these focus areas, two special considerations were highlighted: technology-enhanced supportive cancer care for disparate populations, and ethical considerations relevant to the use of technology in supportive care. CONCLUSION: mHealth has the potential to revolutionize and transform cancer care delivery. Future research should guide further advances in the use of technology in supportive cancer care and carefully explore the safety, efficacy, cost-effectiveness, and implementation of interventions delivered through mHealth platforms.

Background Chronic Fatigue Syndrome/Myalgic Encephalomyelitis/Systemic Exertion Intolerance Disease (CFS/ME/SEID) is a complex illness that has an unknown aetiology. It has been proposed that metabolomics may contribute to the illness pathogenesis of CFS/ME/SEID. In metabolomics, the systematic identification of measurable changes in small molecule metabolite products have been identified in cases of both monogenic and heterogenic diseases. Therefore, the aim of this systematic review was to evaluate if there is any evidence of metabolomics contributing to the pathogenesis of CFS/ME/SEID. Methods PubMed, Scopus, EBSCOHost (Medline) and EMBASE were searched using medical subject headings terms for Chronic Fatigue Syndrome, metabolomics and metabolome to source papers published from 1994 to 2020. Inclusion and exclusion criteria were used to identify studies reporting on metabolites measured in blood and urine samples from CFS/ME/SEID patients compared with healthy controls. The Joanna Briggs Institute Checklist was used to complete a quality assessment for all the studies included in this review. Results 11 observational case control studies met the inclusion criteria for this review. The primary outcome of metabolite measurement in blood samples of CFS/ME/SEID patients was reported in ten studies. The secondary outcome of urine metabolites was measured in three of the included studies. No studies were excluded from this review based on a low-quality assessment score, however there was inconsistency in the scientific research design of the included studies. Metabolites associated with the amino acid pathway were the most commonly impaired with significant results in seven out of the 10 studies. However, no specific metabolite was consistently impaired across all of the studies. Urine metabolite results were also inconsistent. Conclusion The findings of this systematic review reports that a lack of consistency with scientific research design provides little evidence for metabolomics to be clearly defined as a contributing factor to the pathogenesis of CFS/ME/SEID. Further research using the same CFS/ME/SEID diagnostic criteria, metabolite analysis method and control of the confounding factors that influence metabolite levels are required.

Background The prevalence of urinary symptoms and infections among female garment factory workers in Bangladesh - a large developing country - is largely unknown. Garment sector is this country's main economic growth engine. Objectives This paper focuses on garment industry workers and compares the findings with another group of low socioeconomic status working women. Methods Urinary tract symptoms (UTS) were determined by self-reported survey including International Consultation on Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and urinary tract infection (UTI) was determined among a subset population by urine dipstick tests. Results Data were collected from 310 garment workers and 297 comparison workers. About one third of garment workers (31.94%) and comparison workers (29.97%) could take up to 3 toilet breaks in a day. Garment workers reported to be more sexually active and menstruation was more common among them compared to comparison workers. They reported a significantly higher prevalence of malodorous urine and vaginal discharge. Garment workers were found to have a significantly higher ICIQ-FLUTS score of voiding than comparison workers (0.44 vs. 0.27; p-value = 0.0167).Among the study respondents, 148 garment workers and 134 other workers provided urine samples and 21 (7.45%) were found to have UTI. After considering all the risk factors in multivariate model, garment work had a significant impact on the probability of having UTI with Odds Ratio of 5.46 (p-value = 0.0374; 95% CI = 1.10, 26.97) compared to other workers. Conclusions This study highlights the prevalence and burden of urinary symptoms and infections among female worker populations in Bangladesh.