Background
Chemotherapy-induced peripheral neuropathy (CIPN) is a troublesome chronic symptom that has no proven pharmacologic treatment. The purpose of this double-blind randomized ...placebo-controlled trial was to evaluate a novel compounded topical gel for this problem.
Methods
Patients with CIPN were randomized to baclofen 10 mg, amitriptyline HCL 40 mg, and ketamine 20 mg in a pluronic lecithin organogel (BAK-PLO) versus placebo (PLO) to determine its effect on numbness, tingling, pain, and function. The primary endpoint was the baseline-adjusted sensory subscale of the EORTC QLQ-CIPN20, at 4 weeks.
Results
Data in 208 patients reveal a trend for improvement that is greater in the BAK-PLO arm over placebo in both the sensory (
p
= 0.053) and motor subscales (
p
= 0.021). The greatest improvements were related to the symptoms of tingling, cramping, and shooting/burning pain in the hands as well as difficulty in holding a pen. There were no undesirable toxicities associated with the BAK-PLO and no evidence of systemic toxicity.
Conclusion
Topical treatment with BAK-PLO appears to somewhat improve symptoms of CIPN. This topical gel was well tolerated, without evident systemic toxicity. Further research is needed with increased doses to better clarify the clinical role of this treatment in CIPN.
While deduplication and cross-validation protocols have been recommended for large Web-based studies, protocols for survey response validation of smaller studies have not been published.
This paper ...reports the challenges of survey validation inherent in a small Web-based health survey research.
The subject population was North American, gay and bisexual, prostate cancer survivors, who represent an under-researched, hidden, difficult-to-recruit, minority-within-a-minority population. In 2015-2016, advertising on a large Web-based cancer survivor support network, using email and social media, yielded 478 completed surveys.
Our manual deduplication and cross-validation protocol identified 289 survey submissions (289/478, 60.4%) as likely spam, most stemming from advertising on social media. The basic components of this deduplication and validation protocol are detailed. An unexpected challenge encountered was invalid survey responses evolving across the study period. This necessitated the static detection protocol be augmented with a dynamic one.
Five recommendations for validation of Web-based samples, especially with smaller difficult-to-recruit populations, are detailed.
Prostate cancer is the second most common cancer in gay, bisexual, and other men who have sex with men (GBM). Few studies have assessed the effects of treatment on GBM’s sexual behavior. For an ...online survey, 193 gay and bisexual men with prostate cancer were recruited from the North American’s largest online cancer support group. Sexual functioning was measured using the Expanded Prostate Cancer Index Composite (EPIC) and a tailored Gay Sexual Functioning Inventory (GSFI). GBM have worse EPIC urinary and hormonal function and worse hormonal bother, but better sexual function and bother scores than published norms. In the GSFI, two-thirds of participants described their sexual functioning, post-treatment, as fair to poor. Only 22% reported erections sufficient for insertive anal sex. For receptive anal sex, one-third met criteria for anodyspareunia. Over half reported urination problems during sex or at orgasm. Erectile difficulties were common, severe, and a reason cited for not using condoms. Three men HIV seroconverted post-prostate cancer treatment. Differences in function and bother scores were observed by type of treatment, age, race/ethnicity, sexual orientation, but not relationship status. Sexual functioning significantly predicted long-term mental and physical health. GBM scored significantly worse on mental health and better on physical health than published norms. Sexual recovery after prostate cancer treatment is problematic for most GBM. Research to develop more effective sexual recovery, tailored to the needs of GBM treated for prostate cancer, is needed. Six implications for clinicians treating GBM with prostate cancer are identified.
The sex education made available to transgender youth has rarely been studied empirically. In this study, we sought to explore the sex education experiences of transgender young people and summarise ...their recommendations for transgender-inclusive curricula. Qualitative data from 14 transgender youth in the upper-Midwest USA were collected by means of an online questionnaire and group interview. Data was analysed using a consensual qualitative approach. Three themes emerged: (1) sources and reactions to sex education, (2) the importance of trust, and (3) missing information and recommendations. Sources and reactions to sex education included sexual health information sources and the strategies participants employed to supplement the sex education they received. Trust included trustworthy information sources and strong qualities of sexual health resources. Missing information and recommendations included unmet sex education needs, including the scope of information and from whom the information is delivered. Findings suggest that important curricular considerations include the diversity of content, but also the diversity of voices delivering it.
The suboptimal rate of viral suppression among persons aged 13 years and older and residing in 37 states and the District of Columbia leaves considerable opportunities for onward transmission and ...contributes to poor health outcomes. Men who have sex with men (MSM) represent one of the most at-risk groups in the United States. There is a clear and continued need for innovative adherence support programs to optimize viral suppression. To address this gap, we designed and are implementing a randomized controlled trial (RCT) to test the efficacy of the Thrive with Me intervention for MSM living with HIV. Critical components of the protocol are presented.
The aim of this study is to describe the protocol for rigorously testing the efficacy of Thrive with Me to improve antiretroviral therapy (ART) adherence among HIV-positive MSM residing in New York City.
A community advisory board and beta testing were used to obtain feedback from HIV-positive MSM on the overall look and feel of Thrive with Me and problems with navigation to finalize intervention components and content. We will enroll 400 HIV-positive MSM residing in the New York City area into a two-arm prospective RCT and follow them for 17 months. Men in the Thrive with Me experimental intervention arm will have access to Thrive with Me for 5 months. Thrive with Me has three primary components: (1) a private social networking feature; (2) tailored HIV and ART adherence information; and (3) medication reminders, self-monitoring, and reflection. Gamification components include badges and leveling up to increase intrinsic motivation to engage with the intervention. Men randomized to the control condition will view a weekly newsletter for 5 months. The newsletter will be delivered via email and contains information on topics related to HIV with the exception of ART adherence. Study assessments will occur at enrollment and 5, 11, and 17 months post enrollment. The primary study outcome is HIV viral load, which is considered an objective indicator of ART adherence.
Participant recruitment for the RCT began in October 2016, and the data collection period is anticipated to end in the Fall of 2019.
The efficacy trial of Thrive with Me will help to fill gaps in understanding about the utility of multicomponent, technology-based interventions to improve ART adherence among HIV-positive MSM. Of importance is the ability for the results of the Thrive with Me trial to inform best practices for conducting technology-based interventions that incorporate social media features.
ClinicalTrials.gov NCT02704208; https://clinicaltrials.gov/ct2/show/NCT02704208 (Archived by WebCite at http://www.webcitation.org/6zQ8WPra6).
RR1-10.2196/10182.
Foraging is a crucial and remarkably complex behavior that is key to survival. For social insects such as bumblebees, successful foraging depends on a combination of individual traits (e.g. ...physiological and biomechanical performance of individual workers) and collective behavioral strategies for regulating food intake at the colony level. Here, I use foraging behavior in bumblebees as a lens to explore how insects cope with challenging, natural environments, scaling from individual performance to group dynamics. First, I explore how bumblebee foragers cope with structural clutter, with particular emphasis on the allometry of maneuverability and flight performance (Chapter 1). Next, I investigate how the variable, turbulent wind flows that characterize natural environments affect flight stability (Chapter 2) and landing behavior (Chapter 3) of bumblebee foragers. Moving from the individual to the colony level, I then develop an automated, high throughput behavioral tracking system (Chapter 4) capable of following uniquely identified individuals in visually complex environments, and use this system to explore the distribution and regulation of foraging activity across entire bumblebee colonies (Chapter 5). Finally, I use this same tracking system to examine the effects of exposure to a common neonicotinoid pesticide (imidacloprid) encountered during foraging, and show that it disrupts aspects of social behavior and communication in bumblebee colonies (Chapter 6).
Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, 2016. In conjunction with the Leaders for Global Operations Program at MIT.
Thesis: S.M. in Engineering Systems, ...Massachusetts Institute of Technology, School of Engineering, Institute for Data, Systems, and Society, 2016. In conjunction with the Leaders for Global Operations Program at MIT.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 105-107).
In 2003 Kiva Systems (now Amazon Robotics) introduced a new type material handling automation to the world. The system is based on the principle that the physical infrastructure that contains inventory should be mobile. Kiva achieved this remarkable advancement by employing a fleet of robots to move shelving to human operators. Broadly, these types of systems are defined in the literature as multi-agent robotic systems. Amazon acquired Kiva Systems in 2012 to incorporate the technology into their operations. The goal of this thesis is to optimize the throughput of warehouses employing multi-agent robotic automation. It is assumed that extracting inventory from the automated system is the limiting factor in maximizing throughput (i.e. downstream process are unconstrained). Two strategies are advocated: 1) performing velocity segregation of inventory within the automation via a bifurcation between fast selling and slow selling inventory, 2) maximizing pick rates through policies that increase worker retention. It will be shown that velocity segregation increases machine efficiency by increasing the efficiency of delivering inventory to human operators. This assertion will be investigated by developing a theoretical understanding of how inventory velocity impacts machine efficiency and simulating different types of stow strategies impact on system efficiency. It is estimated that some stow strategies can increase machine efficiency by as much as 30%. It will also be shown that the number of man-hours worked by inexperienced pickers explains practically all of the variability of aggregate pick cycle times and hence pick rates, which motivates the argument for worker retention. Together, these two modifications are estimated to increase throughput by 10% over current baseline.
by James DeWitt Stowe.
M.B.A.
S.M. in Engineering Systems
PDF
