Feasibility of Delivering an Avatar-Facilitated Life Review Intervention for Patients with Cancer.

Background: Life review, a narrative-based intervention, helps individuals organize memories into a meaningful whole, providing a balanced view of the past, present, and future. Examining how the content of memories contributes to life's meaning improves some clinical outcomes for oncology patients. Combining life review with other modalities may enhance therapeutic efficacy. We hypothesized a life review intervention might be enhanced when combined with a kinetic, digital representation (avatar) chosen by the patient. Our goal was to determine the feasibility of an avatar-based intervention for facilitating life review in patients with advanced cancer. Methods: We conducted an observational, feasibility trial in a supportive care clinic. Motion capture technology was used to synchronize voice and movements of the patient onto an avatar in a virtual environment. Semistructured life review questions were adapted to the stages of child, teenager, adult, and elder. Outcome measures included adherence, recruitment, comfort of study procedure, patients' perceived benefits, and ability to complete questionnaires, including the Edmonton Symptom Assessment System (ESAS) and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Results: Seventeen patients were approached, with 11/12 completing the intervention. The total visit time of a single intervention averaged 67 minutes. The post-intervention survey found all patients agreed or strongly agreed (Likert Scale 1-5) they would participate again, would recommend it to others, and found the experience beneficial. After one month, ESAS scores were either unchanged or improved in 80% of patients. Conclusion: An avatar-facilitated life review was feasible with a high rate of adherence, completion, and acceptability by patients. The findings support the need for a clinical trial to test the efficacy of this novel intervention. Clinical Trial Number NCT03996642.

Nanoscale viscoelastic properties of an aligned collagen scaffold.

Localised mechanical properties for aligned collagen scaffolds derived from Type 1 collagen were determined by application of nanoindentation based techniques. It was possible to measure the modulus and hardness with nanometre control over the depth of penetration and quasi-static testing under displacement control yielded average modulus values ranging from 1.71 GPa to 3.31 GPa; a narrower range of values than obtained by other methods. Hardness values of 222 MPa to 256 MPa were recorded and showed little scatter, highlighting the potential of nanoindentation hardness values as a reproducible and accurate measure of soft material properties. Open loop Load-displacement curves for the collagen exhibited the expected shapes for a viscoelastic material and it was thus possible to apply dynamic stiffness measurement at the nano scale. As well as determining the storage modulus (0.71 GPa) and the loss modulus (0.40 GPa) at the sub-micron length and nano depth resolution it was also possible to discriminate between surface and bulk readings allowing surface effects to be discarded if necessary. In addition to being a more accurate indentation method than atomic force microscopy, the localised dynamic mechanical properties of collagen were measured for the first time. These results demonstrate that this nanoindentation technique can serve as a powerful tool for the characterisation of collagen based biomaterials that are used as scaffolds for a variety of engineered tissues, such as artificial skin, skeletal muscle, heart valves and neuroregeneration guides.