Duloxetine (DL) in treatment of oxaliplatin-induced peripheral neuropathy (PN).

195 Background: Oxaliplatin is commonly used to treat many GI cancers, especially colorectal (CRC), pancreatic (PC), and gastric (GC); however, peripheral neuropathy (PN) is the dose-limiting toxicity. Duloxetine (DL) is a second-generation selective serotonin and norepinephrine reuptake inhibitor (SNRI) used for the treatment of depression, anxiety, PN-associated with diabetes or ongoing pain due to medical conditions such as fibromyalgia. In this retrospective study, we evaluated the role of DL in reduction of oxaliplatin-induced neuropathy. Methods: Patients with GI cancers receiving oxaliplatin-based chemotherapy regimens from Nov 2016 to Nov 2019 were included. Patients with pre-existing PN from other etiologies such as diabetes, alcoholism, autoimmune disease, infections, hereditary, etc. were excluded. Neurological evaluations were performed serially before initiating DL and every 4 weeks thereafter according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0. DL was given at 30 mg by mouth (PO) once daily and if tolerated after 3 days, was escalated to 60 mg once daily. Response was calculated to include number of patients with stable PN, improved PN, or no benefit. Adverse toxicities were graded. Results: 53 patients with median age of 53 years (range: 38 – 72) received DL for oxaliplatin-induced PN during treatment of GI cancers (CRC: 40%, PC:30%, GC: 10%, others: 10%). Improvement in PN from higher to lower grades was witnessed at 2 weeks in only 4 patients. At 4 week of DL, 3/53 (6%) patients improved from G3 PN to G2, 6/53 (11%) from G3 to G1, and 28/53 (52.8%) from G2 to G1, 14/53 (26%) and 2/53 (4%) had stable G3 and G2 PN respectively. At 8 week of DL, 10/53 (19%) of patients improved from G3 to G2, 3/53 (6%) from G2 to G1, 23/53 (43%) from G1 to G0, while 11/53 (21%), 2/53 (4%) and 4/53 (8%) remained stable at G1, G2 and G3 respectively. Overall DL resulted in a response rate of 89% and stable PN in 11%. 5 patients had to stop DL due to G3 drowsiness, insomnia, dry mouth and headache. Overall, DL was well-tolerated with majority of toxicities in G1-2 grade: dizziness (15%), drowsiness (11%), sexual side effects (11%), dry mouth (11%), insomnia (8%), headache (8%). In addition to PN, DL helped in improving depression in 50% of these patients and decreased the pain score in an additional 23%. Conclusions: DL resulted in a clinically significant improvement in PN-induced by oxaliplatin with manageable toxicity profile. Additionally, DL also improved depression and pain score. DL may be considered as an option in ameliorating PN in these patients, however, caution must be taken about DL and other drugs interaction. Our study warrants a prospective randomized trial to study the effectiveness of DL in treating oxaliplatin-induced PN. Moreover, cost effectiveness of DL in concurrently improving PN, depression and pain needs to be studied as well.

A data-driven approach to monitoring data collection in an online panel

Longitudinal or panel surveys suffer from panel attrition which may result in biased estimates. Online panels are no exceptions to this phenomenon, but offer great possibilities in monitoring and managing the data-collection phase and response-enhancement features (such as reminders), due to real-time availability of paradata. This paper presents a data-driven approach to monitor the data-collection phase and to inform the adjustment of response-enhancement features during data collection across online panel waves, which takes into account the characteristics of an ongoing panel wave. For this purpose, we study the evolution of the daily response proportion in each wave of a probability-based online panel. Using multilevel models, we predict the data-collection evolution per wave day. In our example, the functional form of the data-collection evolution is quintic. The characteristics affecting the shape of the data-collection evolution are those of the specific wave day and not of the panel wave itself. In addition, we simulate the monitoring of the daily response proportion of one panel wave and find that the timing of sending reminders could be adjusted after 20 consecutive panel waves to keep the data-collection phase efficient. Our results demonstrate the importance of re-evaluating the characteristics of the data-collection phase, such as the timing of reminders, across the lifetime of an online panel to keep the fieldwork efficient.

Skills to Enhance Positivity in Suicidal Adolescents: Results From an Open Development Trial

“Skills to Enhance Positivity” (STEP) is a two-part positive affect program designed to decrease recurrent suicidal behavior in adolescents hospitalized due to suicide risk. Here, we describe the initial pilot phase in which the intervention was developed and modified based on a sample of 20 adolescent participants, aged 12 to 18 years old ( Mage = 15.9, SD = 1.5). STEP consisted of an in-person phase (four sessions) and a remote delivery phase (text messaging and phone calls). The inpatient sessions focused on psychoeducation of positive affect, mindfulness meditation, gratitude, and savoring. The remote delivery phase comprised of weekly phone calls and daily text messages to enhance mood monitoring and skills practice reminders. Average session attendance was 81%, and mean daily response rate to text messages was 73.6%, demonstrating high engagement. STEP was described as good or excellent by over 90% of parents and 100% of adolescents. Only one participant had a suicide attempt, and five were readmitted for suicidality in the following 6 months, fewer than comparable naturalistic studies. Although preliminary results are promising, larger randomized trials are needed to determine the efficacy of STEP in reducing suicidal behaviors.

Pastoral care and healing in Africa: Towards an Adamic Christological practical theology imagination for pastoral healing

This article argues that the challenge and need for relevant ministry models is critical for effective Christian ministry and pastoral ministry as practical life ministry. It establishes an Adamic Christological model as a paradigm that provides a practical effective ministerial approach in Africa, particularly within the context of pastoral care and healing. This framework reveals Christ’s complete identification with African Christians in their contextual sufferings as the New Adam without compromising authentic gospel reality. In employing the Adamic Christological framework as the anchor for African pastoral and healing ministry, a model for African Christians’ daily response to their various contextual sufferings is constructed. This responsive model bridges the gap between the ascension of Christ and the interim period of Christianity by instituting God’s ongoing personal presence in believers’ suffering through the Holy Spirit (pneumatology) as an encouraging and comforting reality that should enable Christians to cope in their suffering. It is argued that this Adamic Christological framework provides a practical theological model that contributes to healing and hope in pastoral care through practical knowing that impacts and imparts meaning in life.

Skriving i et digitalt triadisk refleksjonsfellesskap i lærerutdanninga

Artikkelen tar utgangspunkt i et intervensjonsprosjekt i grunnskolelærerutdanninga. SKRIVUT-prosjektet svarer på en nasjonal og internasjonal etterspørsel etter gode møte­plasser for samarbeidet i lærerutdanninga. Møteplassen er et diskusjonsforum i It’s learning knyttet til praksisopplæringa der andreårsstudentene daglig skriver og får respons av medstudenter, praksislærer og faglærere i norsk og i pedagogikk og elevkunnskap. Studien som presenteres i artikkelen, bygger på kvalitativ analyse av loggdiskusjoner og intervjuer fra prosjektets andre år. Studien viser en faglig orientering i studentenes loggskriving og at det er mulig å etablere en samspillsarena. Den skriftlige dialogen i det digitale rommet viste seg å være drivende både for teoristudier og utvikling av fagspråk. Samtidig løftes praksislærers lokale og erfaringsbaserte kunnskap fram og settes i dialog med den teoribaserte kunnskapen. I diskusjonen tolkes karakteristiske trekk ved dialogen i det triadiske refleksjonsfellesskapet i lys av tenkning om behovet for situasjonsavgrensende og situasjonsoverskridende prosesser i læringskontekster. Funnene diskuteres opp mot studier som peker på at lærerstudenter og lærere har et mangelfullt fagspråk og er lite orientert mot etablert kunnskap.Nøkkelord: lærerutdanning, lærerstudenter, det digitale rom, samspillsarena, fagspråkAbstractThe background for this article is an intervention project in teacher education for primary school. The project addresses a worldwide call for meeting places for the triadic collabo­ration in teacher education. The meeting place is an asynchronous LMS-based discussion forum where second year student teachers write and receive daily response from fellow student teachers, mentors and professors in Norwegian (Mother Tongue) and in Pedagogy and Pupil-related Skills during field practice. The study presented in this article is based on a qualitative analysis of written log discussions and interviews from the second year of the project. The study shows that the student teachers have a subject-oriented focus in their writing. It also shows that it is possible to establish an arena for interplay. The written dialog in the digital room turned out to be a driving force regarding theoretical studies and the develop­ment of a professional language. At the same time, the mentor’s experience based knowledge is highlighted and put into dialog with the theory based knowledge. In the discussion, the characteristics of the triad’s dialog are interpreted in the light of theory on learning as a double process, focusing both on the particular situation and contextualizing the situation. The findings are discussed in the light of previous research on the lack of a sufficient pro­fessional language and lack of orientation towards established knowledge amongst student teachers and teachers.Keywords: teacher education, student teachers, the digital room, arena for interplay, professional language

Lessons Learned Developing the Response Action Record for the Deepwater Horizon Endangered Species Act Biological Assessment

ABSTRACT In an oil spill response environment, urgency looms, and virtually every action is geared toward immediate needs. Clean-up, safety, and listed species protection are at the forefront of the collaborative efforts carried out by an incident management team. However, these needs do not complete the obligation of the Federal Action Agency responsible for the event. This agency must also complete an Endangered Species Act (ESA) Biological Assessment (BA). To do that for a spill of national significance, it is paramount that response personnel track certain details about their daily operations. Unfortunately, in the BA for the Deepwater Incident Response, the action record had to be reconstructed forensically. Although operational permits to work, otherwise known as Shoreline Treatment Recommendations, used standard geographic references and response action terms, they are merely prescriptions for activity and provide only maximum default assumptions. To gain vital insight into more specific temporal elements such as frequency, intensity, and duration, daily response reports were required. These reports were not gathered into a central geodatabase along the way. They were printed to paper, boxed, shipped to a documentation unit, and scanned into image files. These files were organized into approximately 30,000 document sets of up to 4,000 pages each. Qualitative document content analysis was used to distill the needed details from these image sets into a database. This technique for generating the needed data for an effects analysis is arduous. However, the process of its development has produced valuable lessons learned. Here we present the needed schema design and architecture to promote a seamless transition on future responses from the urgency of immediate need to inevitability of post-spill ESA obligation.

Treatment of Advanced Hormone-Sensitive Breast Cancer in Postmenopausal Women With Exemestane Alone or in Combination With Celecoxib

Purpose Preclinical data showed that the combination of exemestane and celecoxib has synergistic effects. Therefore, a study was undertaken to explore the efficacy and tolerability of this combination in postmenopausal patients with advanced, hormone-sensitive breast cancer. Patients and Methods A randomized phase II study was conducted in postmenopausal patients with hormone-sensitive breast cancer and measurable disease who had progressive disease after treatment with tamoxifen. Patients were randomly assigned to either exemestane 25 mg daily or the combination of exemestane 25 mg daily with celecoxib 400 mg twice daily. Response Evaluation Criteria in Solid Tumors Group criteria were used to determine antitumor efficacy. Primary end point was the rate of clinical benefit. Secondary end points were tolerability, objective response rate, time to progression (TTP), and duration of clinical benefit. A pharmacodynamic and a pharmacokinetic study were conducted in parallel. Results One hundred eleven patients (exemestane, n = 55; combination, n = 56) were enrolled in 2002. The demographic characteristics and prognostic factors were similar in both arms. In the assessable population, 24 of 51 patients in the combination arm and 24 of 49 patients in the exemestane arm achieved clinical benefit. TTP was similar in both groups. Duration of clinical benefit was longer in the combination group (median, 96.6 v 49.1 weeks). The addition of celecoxib did not change the tolerability profile of exemestane alone. Conclusion Similar rates of clinical benefit were achieved in both groups.