Fear, worry and sadness: an exploratory study of psychological wellbeing in men caring for their partner with ovarian cancer.

PURPOSE: Ovarian cancer is the leading cause of death from female cancers in Australia with the majority of women presenting with advanced disease. The burden of caregiving is largely borne by male carers; however, little research has examined the challenges male ovarian cancer caregivers (MOCC) experience. This study aimed to explore the psychosocial wellbeing and cancer-related challenges experienced by MOCC. METHODS: A cross-sectional small-scale exploratory online survey study recruited 36 MOCC. The study questionnaire was comprised of the Generalised Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire Depression Module (PHQ-9), Functional Assessment of Cancer Therapy Scale (FACT-G) Family Member, Fear of Cancer Recurrence Scale, Insomnia Severity Index (ISI), Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACTIT-F) and Cancer-Related Challenges Scale (CRCS). RESULTS: The most common challenges ever experienced were worry about the future (91%), fear of metastasis (90%) and feeling worried or uncertain (88%). The most common current challenges were fear of cancer recurrence (75%), fear of metastasis (68%) and changes in sexual relationships (64%). Depression and anxiety were significantly correlated with all psychosocial variables highlighting the relationships between elements of wellbeing for MOCC. Clinical levels of fear of cancer recurrence were reported by 89% of MOCC. CONCLUSIONS: The challenges faced by MOCC are psychosocial in nature. There is a high correlation between anxiety and depression, and this coupled with the fear of disease recurrence indicates a greater need for screening of these issues, appropriate referral and development of support resources for this high-risk group of cancer carers.

Interstitial pneumonia with autoimmune features: from research classification to diagnosis.

PURPOSE OF REVIEW: The term interstitial pneumonia with autoimmune features (IPAF) was first proposed by an international task force in 2015 as a research classification to standardise nomenclature regarding patients with idiopathic interstitial pneumonia and features of connective tissue disease. However, how the use of this term and its proposed definition translates to clinical practice remains uncertain. This review will provide a comprehensive overview of studies of IPAF cohorts to date, discuss the consideration of IPAF as a distinct diagnostic entity and outline a suggested approach to patient management. RECENT FINDINGS: Considerable heterogeneity exists between published IPAF cohorts, with some cohorts exhibiting similarities to those with connective tissue disease-associated interstitial lung disease (CTD-ILD), and others more similar to idiopathic interstitial pneumonias including idiopathic pulmonary fibrosis (IPF). Little data exist to inform the management of patients who fulfil the IPAF criteria. Preliminary data supports pragmatic management of these patients as having a working clinical diagnosis of either idiopathic interstitial pneumonia or CTD-ILD. Future research studies into this approach are required. SUMMARY: The term IPAF, and its definition, have been of fundamental benefit to facilitating research in this diverse patient group. However, to date, there remain many unanswered questions regarding their natural histories and response to treatment.

The male perspective: A mixed methods study of the impact, unmet needs and challenges of caring for women with breast cancer.

OBJECTIVES: As a formative investigation toward the development of a supportive care intervention for male caregivers, this study explored the emotional impact, unmet needs and challenges experienced by men when caring for a woman with breast cancer. DESIGN: A cross-sectional mixed methods study, with an online survey and interviews. SAMPLE: A total of 89 participants completed the survey, of whom 13 completed interviews. The majority (93%) of participants were husbands of care recipients; of the care recipients, 75% had early stage breast cancer and 45% were diagnosed over 5 years ago. METHOD: Participants completed questionnaires assessing their emotional wellbeing, unmet needs and biopsychosocial challenges, with a sub-sample participating in subsequent interviews to elaborate on survey responses. FINDINGS: Emotional difficulty was reported by <25% of the sample, and 83% reported experiencing at least one unmet need (M = 81.5, SD = 33.2). Of the 39 biopsychosocial challenges presented, 100%, 86% and 73% reported "ever experiencing," "currently experiencing," and "ever needing help," respectively. Interviewed participants echoed the most reported needs and challenges as changes to sex life, fear of recurrence and lack of practical information. CONCLUSIONS: Male cancer caregivers experience diverse challenges and require psychological support and practical information using both online and offline approaches to support their caregiving responsibilities. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: Healthcare professionals can support male caregivers by: being aware of their information and psycho-social needs; directing caregivers to online interventions for additional information; and facilitating the provision of online psycho-sexual and FCR support.

Functional characterization of a chr13q22.1 pancreatic cancer risk locus reveals long-range interaction and allele-specific effects on DIS3 expression.

Genome-wide association studies (GWAS) have identified multiple common susceptibility loci for pancreatic cancer. Here we report fine-mapping and functional analysis of one such locus residing in a 610 kb gene desert on chr13q22.1 (marked by rs9543325). The closest candidate genes, KLF5, KLF12, PIBF1, DIS3 and BORA, range in distance from 265-586 kb. Sequencing three sub-regions containing the top ranked SNPs by imputation P-value revealed a 30 bp insertion/deletion (indel) variant that was significantly associated with pancreatic cancer risk (rs386772267, P = 2.30 × 10-11, OR = 1.22, 95% CI 1.15-1.28) and highly correlated to rs9543325 (r2 = 0.97 in the 1000 Genomes EUR population). This indel was the most significant cis-eQTL variant in a set of 222 histologically normal pancreatic tissue samples (ß = 0.26, P = 0.004), with the insertion (risk-increasing) allele associated with reduced DIS3 expression. DIS3 encodes a catalytic subunit of the nuclear RNA exosome complex that mediates RNA processing and decay, and is mutated in several cancers. Chromosome conformation capture revealed a long range (570 kb) physical interaction between a sub-region of the risk locus, containing rs386772267, and a region ∼6 kb upstream of DIS3 Finally, repressor regulatory activity and allele-specific protein binding by transcription factors of the TCF/LEF family were observed for the risk-increasing allele of rs386772267, indicating that expression regulation at this risk locus may be influenced by the Wnt signaling pathway. In conclusion, we have identified a putative functional indel variant at chr13q22.1 that associates with decreased DIS3 expression in carriers of pancreatic cancer risk-increasing alleles, and could therefore affect nuclear RNA processing and/or decay.

A systematic review of psychotherapeutic interventions for women with metastatic breast cancer: Context matters.

OBJECTIVES: To summarise the evidence-base of psychological interventions for women with metastatic breast cancer, by mode of delivery (group, individual, or low-intensity interventions). To synthesise data regarding core intervention-elements (eg, intervention duration) and context factors (trial setting, uptake and adherence, and demographic characteristics). METHODS: Four databases were searched (inception-May 2016): MEDLINE (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCO), and SCOPUS; reference lists were examined for additional publications. Grey literature was excluded. Outcome data were extracted for survival, distress, quality of life, coping, sleep, fatigue, and/or pain and summarised through narrative synthesis. RESULTS: Fifteen randomised clinical trials (RCTs), reported across 23 articles, met inclusion criteria: 7 groups, 4 individuals, and 4 low-intensity interventions. Overall, interventions improved distress (8/13 RCTs), coping (4/5 RCTs), and pain (4/5 RCTs). No evidence of survival benefit was found. For remaining outcomes, evidence was either insufficient, or too mixed to draw conclusions. Group programs had the strongest evidence-base for efficacy; individual and low-intensity therapy had insufficient evidence to form conclusions. Group interventions had longest intervention durations and lowest uptake and adherence; low-intensity interventions had shortest durations and highest uptake and adherence. Disparities in uptake, adherence, and reach were evident, with the demographic profile of participants polarised to young, Caucasian, English-speaking, partnered women. CONCLUSIONS: There remains a paucity of psychological interventions for women with metastatic breast cancer. Those that exist have an inconsistent evidence-base across the range of patient-reported outcomes. Further research is needed to evaluate accessible delivery formats that ensure efficacy as well as uptake.

eHealth System for Collecting and Utilizing Patient Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care) Among Cancer Patients: Mixed Methods Approach to Evaluate Feasibility and Acceptability.

BACKGROUND: Despite accumulating evidence indicating that collecting patient-reported outcomes (PROs) and transferring results to the treating health professional in real time has the potential to improve patient well-being and cancer outcomes, this practice is not widespread. OBJECTIVE: The aim of this study was to test the feasibility and acceptability of PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care), a newly developed electronic health (eHealth) system that facilitates PRO data capture from cancer patients, data linkage and retrieval to support clinical decisions and patient self-management, and data retrieval to support ongoing evaluation and innovative research. METHODS: We developed an eHealth system in consultation with content-specific expert advisory groups and tested it with patients receiving treatment or follow-up care in two hospitals in New South Wales, Australia, over a 3-month period. Participants were recruited in clinic and completed self-report Web-based assessments either just before their upcoming clinical consultation or every 4 weeks if in follow-up care. A mixed methods approach was used to evaluate feasibility and acceptability of PROMPT-Care; data collected throughout the study informed the accuracy and completeness of data transfer procedures, and extent of missing data was determined from participants' assessments. Patients participated in cognitive interviews while completing their first assessment and completed evaluation surveys and interviews at study-end to assess system acceptability and usefulness of patient self-management resources, and oncology staff were interviewed at study-end to determine the acceptability and perceived usefulness of real-time PRO reporting. RESULTS: A total of 42 patients consented to the study; 7 patients were withdrawn before starting the intervention primarily because of changes in eligibility. Overall, 35 patients (13 on treatment and 22 in follow-up) completed 67 assessments during the study period. Mean completeness of patient-reported data was 93%, with 100% accuracy of data transfer. Ten patients completed cognitive interviews, 28 completed evaluation surveys, and 14 completed evaluation interviews at study-end. PROMPT-Care patient acceptability was high-100% (28/28) reported the time to complete the Web-based assessments (average 15 min) as about right, most willing to answer more questions (79%, 22/28 yes), 96% (27/28) found the Web-based assessment easier or same as completing a paper copy, and they valued the self-management resources . Oncology staff (n=5) also reported high acceptability and potential feasibility of the system. CONCLUSIONS: Patients and oncology staff found the PROMPT-Care system to be highly acceptable, and the results suggest that it would be feasible to implement it into an oncology setting. Suggested modifications to the patient assessment survey, clinician access to the reports, and system requirements will be made as part of the next stage of large-scale testing and future implementation of the system as part of routine care. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN1261500135294; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369299&isReview=true (Archived by WebCite at http://www.webcitation.org/6lzylG5A0).

A pilot, multisite, randomized controlled trial of a self-directed coping skills training intervention for couples facing prostate cancer: accrual, retention, and data collection issues.

PURPOSE: To examine the acceptability of the methods used to evaluate Coping-Together, one of the first self-directed coping skill intervention for couples facing cancer, and to collect preliminary efficacy data. METHODS: Forty-two couples, randomized to a minimal ethical care (MEC) condition or to Coping-Together, completed a survey at baseline and 2 months after, a cost diary, and a process evaluation phone interview. RESULTS: One hundred seventy patients were referred to the study. However, 57 couples did not meet all eligibility criteria, and 51 refused study participation. On average, two to three couples were randomized per month, and on average it took 26 days to enrol a couple in the study. Two couples withdrew from MEC, none from Coping-Together. Only 44 % of the cost diaries were completed, and 55 % of patients and 60 % of partners found the surveys too long, and this despite the follow-up survey being five pages shorter than the baseline one. Trends in favor of Coping-Together were noted for both patients and their partners. CONCLUSIONS: This study identified the challenges of conducting dyadic research, and a number of suggestions were put forward for future studies, including to question whether distress screening was necessary and what kind of control group might be more appropriate in future studies.

Couples coping with cancer: exploration of theoretical frameworks from dyadic studies.

OBJECTIVE: A diagnosis of cancer and subsequent treatment are distressing not only for the person directly affected, but also for their intimate partner. The aim of this review is to (a) identify the main theoretical frameworks underpinning research addressing dyadic coping among couples affected by cancer, (b) summarise the evidence supporting the concepts described in these theoretical frameworks, and (c) examine the similarities and differences between these theoretical perspectives. METHODS: A literature search was undertaken to identify descriptive studies published between 1990 and 2013 (English and French) that examined the interdependence of patients' and partners' coping, and the impact of coping on psychosocial outcomes. Data were extracted using a standardised form and reviewed by three of the authors. RESULTS: Twenty-three peer-reviewed manuscripts were identified, from which seven theoretical perspectives were derived: Relationship-Focused Coping, Transactional Model of Stress and Coping, Systemic-Transactional Model (STM) of dyadic coping, Collaborative Coping, Relationship Intimacy model, Communication models, and Coping Congruence. Although these theoretical perspectives emphasised different aspects of coping, a number of conceptual commonalities were noted. CONCLUSION: This review identified key theoretical frameworks of dyadic coping used in cancer. Evidence indicates that responses within the couple that inhibit open communication between partner and patient are likely to have an adverse impact on psychosocial outcomes. Models that incorporate the interdependence of emotional responses and coping behaviours within couples have an emerging evidence base in psycho-oncology and may have greatest validity and clinical utility in this setting.

The Parental Cancer Questionnaire: scale structure, reliability, and validity.

PURPOSE: This study aims to determine the principal component structure of the Parental Cancer Questionnaire (PCQ) in a sample of adult children whose parents had cancer and to illustrate the validity and reliability of subscales. METHOD: The PCQ was administered to 311 adult children of parents with cancer along with the Posttraumatic Growth Inventory, Carer's Assessment of Difficulties Scale, Carer's Assessment of Satisfactions Scale, Reaction to Diagnosis of Cancer Questionnaire, and the Grief Diagnostic Instrument. RESULTS: Exploratory Principal Components Analysis identified three dimensions of the parental cancer experience (explaining 51 % of the variance amongst scale items). The components were parental cancer benefits (e.g. 'I became closer to my sick parent during his/her cancer.'), emotional experiences (e.g. 'I was devastated by my parent's cancer.'), and caregiver strain (e.g. 'I feel/felt there was nobody to assist or support me in caring for my parent.'). Convergent and discriminant validity were demonstrated by meaningful correlations with other related measures (ranging from 0.14 to 0.68), and strong internal reliability was shown with Cronbach α between 0.87 and 0.91. CONCLUSIONS: The PCQ has a clear three-component structure and demonstrates good reliability. The measure has excellent face, content, convergent, and discriminant validity, indicating a structure suitable for use in future research. The measure appears to be a useful measure of the experience of parental cancer for adult children.

Predictors of benefit finding in the adult children of patients with cancer.

This study aimed to investigate the predictors of benefit finding in 311 adult children of patients with cancer. Participants completed a comprehensive online/pen-and-paper survey measuring benefit finding, gender of parent, outcome and duration of illness, caregiving experience, and emotional experiences including reaction to diagnosis and grief and loss. Greater benefit finding was positively associated with stronger emotional experiences, satisfaction with the caregiving role, and outcome of parental cancer, explaining 15.3% of the variance in benefit finding. Higher emotional reactions and outcome of parental cancer as significant predictors of parental cancer provide some support for the applicability of theories of post-traumatic growth to this cohort.

Parental cancer: catalyst for positive growth and change.

Cancer is a disease that affects the entire family, with each member having unique psychological needs. To date, there has been limited research into the effect of parental cancer on adult children. Furthermore, existing research has largely overlooked the possibility of positive psychological growth in the adult offspring of cancer patients. To investigate the perceived benefits arising from parental cancer, 11 interviews were undertaken with adults whose parents had been diagnosed with cancer, to discuss their experiences of their parent's illness, and their evaluation of both the positive and negative changes that had arisen. All participants were able to identify positive outcomes in direct response to their parent's cancer. Frequently suggested changes included improved relationships with their sick parent, an increased emphasis on family, revised life priorities, and personal development. The implications of these findings, their link to posttraumatic growth theory, and avenues for future research are discussed.

System design and production practices of aquaponic stakeholders.

Aquaponics is an agricultural practice incorporating aquaculture and hydroponic principles. This study assesses the current system design and production practices of the aquaponic industry, compares these metrics by stakeholder group, identifies trends, and provides recommendations for future development. An electronic survey of aquaponic stakeholders was conducted from December 2019 to June 2020 targeting hobbyists, producers, and educators from various aquaponic-focused professional associations, email and social media groups. Of 378 total responses, 84% came from the United States and were clustered in plant hardiness zones five to nine. Aquaponic systems were commonly homemade/do-it-yourself (DIY), many of which incorporated commercially available (turn-key) technology. Most growers used coupled systems that integrated recirculating aquaculture systems and either deep-water culture (DWC) or media bed hydroponic units. Common plant lighting sources were sunlight and light emitting diode (LED). Water sources were typically municipal or wells. Personal labor input was typically less than 20 hrs/wk. Funding sources were primarily personal funds, followed by government grants, and private investor funds. System sizes varied greatly, but the median area was 50 to 500 ft2 for hobbyists and educators and 500 to 3,000 ft2 for producers. Respondents commonly sold vegetable produce, training and education, food fish, and microgreens. Tilapia and ornamental fish were commonly grown, with 16 other species reported. Common crops were lettuce, leafy greens, basil, tomatoes, peppers, and herbs with many additional lesser-grown crops reported, including cannabis. Overall, the industry still growing, with a large portion of stakeholders having less than two years of experience. However, veteran growers have remained in operation, particularly in the producer and educator groups. The survey results suggest a shift away from outdoor systems, media beds, tomatoes, ornamental fish, and perch production, and a shift toward decoupled systems, DWC, drip irrigation, and wicking beds, larger system area, leafy greens, and trout/salmon production compared to previous industry surveys. The reduced diversity of plant species grown suggest some level of crop standardization. Commercial producers tended to sell more types of products than other stakeholders, suggesting that diversification of offerings may be key to profitability. The combined production area specified by respondents indicates the industry has grown substantially in recent years. Finally, the presence of bank loan-funded operations suggests increased knowledge and comfort with aquaponics among lenders.

The pharmacotherapeutic options in patients with catecholamine-resistant vasodilatory shock.

INTRODUCTION: Septic and vasoplegic shock are common types of vasodilatory shock (VS) with high mortality. After fluid resuscitation and the use of catecholamine-mediated vasopressors (CMV), vasopressin, angiotensin II, methylene blue (MB), and hydroxocobalamin can be added to maintain blood pressure. AREAS COVERED: VS treatment utilizes a phased approach with secondary vasopressors added to vasopressor agents to maintain an acceptable mean arterial pressure (MAP). This review covers additional vasopressors and adjunctive therapies used when fluid and catecholamine-mediated vasopressors fail to maintain target MAP. EXPERT OPINION: Evidence supporting additional vasopressor agents in catecholamine-resistant VS is limited to case reports, series, and a few randomized control trials (RCTs) to guide recommendations. Vasopressin is the most common agent added next when MAPs are not adequately supported with CMV. VS patients failing fluids and vasopressors with cardiomyopathy may have cardiotonic agents such as dobutamine or milrinone added before or after vasopressin. Angiotensin II, another class of vasopressor, is used in VS to maintain adequate MAP. MB and/or hydroxocobalamin, vitamin C, thiamine, and corticosteroids are adjunctive therapies used in refractory VS. More RCTs are needed to confirm the utility of these drugs, at what doses, which combinations and in what order they should be given.

ATS Core Curriculum 2021. Adult Pulmonary Medicine: Thoracic Oncology.

The American Thoracic Society Core Curriculum updates clinicians annually in adult and pediatric pulmonary disease, medical critical care, and sleep medicine at the annual international conference. The 2021 Pulmonary Core Curriculum focuses on lung cancer and include risks and prevention, screening, nodules, therapeutics and associated pulmonary toxicities, and malignant pleural effusions. Although tobacco smoking remains the primary risk factor for developing lung cancer, exposure to other environmental and occupational substances, including asbestos, radon, and burned biomass, contribute to the global burden of disease. Randomized studies have demonstrated that routine screening of high-risk smokers with low-dose chest computed tomography results in detection at an earlier stage and reduction in lung cancer mortality. On the basis of these trials and other lung cancer risk tools, screening recommendations have been developed. When evaluating lung nodules, clinical and radiographic features are used to estimate the probability of cancer. Management guidelines take into account the nodule size and cancer risk estimates to provide recommendations at evaluation. Newer lung cancer therapies, including immune checkpoint inhibitors and molecular therapies, cause pulmonary toxicity more frequently than conventional chemotherapy. Treatment-related toxicity should be suspected in patients receiving these medications who present with respiratory symptoms. Evaluation is aimed at excluding other etiologies, and treatment is based on the severity of symptoms. Malignant pleural effusions can be debilitating. The diagnosis is made by using simple pleural drainage and/or pleural biopsies. Management depends on the clinical scenario and the patient's preferences and includes the use of serial thoracentesis, a tunneled pleural catheter, or pleurodesis.

Psychosocial Experiences, Challenges, and Coping Strategies of Chinese-Australian Women with Breast Cancer.

OBJECTIVE: Chinese migrant women with breast cancer are at risk of poorer psychosocial outcomes. However, little is known about the cancer-related challenges experienced by these women, or how they self-manage their concerns. This qualitative study aims to explore the experience of breast cancer for Chinese-Australian women and gain insight into their coping behaviors. METHODS: Twenty-four Chinese-Australian women, previously diagnosed with breast cancer, participated in a semi-structured interview or focus group session, conducted in the participant's preferred language. Qualitative data were subjected to thematic analysis. RESULTS: Three main themes emerged, reflecting the psychological impact of the diagnosis, the challenges experienced, and the use of social support and other coping behaviors. The theme of psychological impact highlighted the emotional toll of diagnosis and the ongoing anxiety surrounding the fear of cancer recurrence. The theme of challenges identified stressors relating to treatment side effects and the need for psychological support. The social support and coping theme identified the various levels of social support participants received and how Chinese-Australian women may limit their use of social support to protect others. Participants used several behavioral (e.g., diet and exercise) and cognitive (e.g., reframing) strategies to cope with their cancer experience. CONCLUSIONS: Chinese-Australian women with breast cancer face significant challenges that impact on their psychological well-being. Varying levels of social support, and the desire to protect others through self-sacrifice, may reflect the cultural expectations of women. The results highlight the need for cultural understanding when developing strategies that optimally support Chinese migrant women with breast cancer.

What Male Caregivers of Women With Breast Cancer Want in an Online Intervention: A Qualitative Study.

The diversity in cancer caregiver responsibilities often leaves caregivers feeling ill-prepared for their role. To inform the development of an online caregiver training intervention, we examined the views of men caring for a woman with breast cancer on intervention mode, timing, and content preferences. Thirteen men participated in a qualitative interview. The findings reveal that an online intervention should include educational content and psychological support, be interactive and personalized, and be available from the point of diagnosis. There is encouraging support for an online caregiver training intervention that covers numerous topics and is available for men to tailor how they use the content based on their individual needs.

Chinese-Australian women with breast cancer call for culturally appropriate information and improved communication with health professionals.

BACKGROUND: For culturally and linguistically diverse patients, breast cancer presents complex physical, psychosocial, and health care challenges, often exacerbated by a lack of culturally appropriate information and communication barriers with the treating team (even with the help of interpreters). AIM: This qualitative study aims to broadly explore the experience of breast cancer and coping strategies utilized by Chinese-Australian women. METHODS AND RESULTS: Twenty-four Chinese-Australian women with breast cancer participated in either a semi-structured interview or a focus group conducted in participants' preferred language, audio-recorded, transcribed, and subjected to thematic analysis. Two prominent themes emerged, related to information seeking, and communication with health care professionals. The theme of information needs and seeking highlighted unmet information needs and the multiple sources that are consulted for information. The second theme, communication with health care professionals, language barriers, and preferences, identified varying degrees of involvement in treatment decision-making, preference for information and interactions in Cantonese or Mandarin, and problems with interpreter services. CONCLUSION: Chinese women with breast cancer face significant challenges in obtaining adequate information and can feel excluded from treatment decision-making. Women in this study expressed their eagerness for obtaining accurate information and engaging in open communication with their doctors. There is a need for culturally sensitive information resources and decision aids to enhance communication between Chinese migrant patients with cancer and health care professionals. Clinician participation in cultural awareness training is also recommended.

Pharmacotherapeutic management of asthma in the elderly patient.

INTRODUCTION: Asthma is a heterogeneous syndrome with variable phenotypes. Reversible airway obstruction and airway hyper-responsiveness often with an atopic or eosinophilic component is common in the elderly asthmatic. Asthma chronic obstructive pulmonary disease overlap syndrome (ACOS), a combination of atopy-mediated airway hyper-responsiveness and a history of smoking or other environmental noxious exposures, can lead to some fixed airway obstruction and is also common in elderly patients. Little specific data exist for the treating the elderly asthmatic, thus requiring the clinician to extrapolate from general adult data and asthma treatment guidelines. AREAS COVERED: A stepwise approach to pharmacotherapy of the elderly patient with asthma and ACOS is offered and the literature supporting the use of each class of drugs reviewed. EXPERT OPINION: Inhaled, long-acting bronchodilators in combination with inhaled corticosteroids represent the backbone of treatment for the elderly patient with asthma or ACOS . Beyond these medications used as direct bronchodilators and topical anti-inflammatory agents, a stepwise approach to escalation of therapy includes multiple options such as oral leukotriene receptor antagonist or 5-lipoxygense inhibitor therapy, oral phosphodiesterase inhibitors, systemic corticosteroids, oral macrolide antibiotics and if evidence of eosinophilic/atopic component disease exists then modifying monoclonal antibody therapies.

Reduced sensitivity to devaluation for instrumental but not consummatory behaviors in binge eating prone rats.

Binge eating is characterized by the consumption of a large amount of palatable food in a short period of time and is a core feature of many eating disorders. Patients with eating disorders are also known to display impairments in inhibitory control, cognition and decision-making, which may promote and maintain binge eating symptomology. In the current study, we examined whether rats that were subsequently characterized as displaying a higher propensity to binge eat would show pre-existing deficits in reinforcer devaluation-a paradigm used to examine decision-making following reductions in the value of a food reinforcer. Female rats were first trained to respond on two levers for the delivery of two food reinforcers (sucrose and maltodextrin solutions). At the test stage, rats were provided 1 h access to one of the two reinforcers to allow for devaluation via sensory specific satiety, immediately followed by an extinction test with both levers. Normal rats typically show reductions in responding on the lever associated with the devalued reinforcer (i.e., intact goal-directed responding). Subsequently, we used intermittent access to palatable food to identify high (BE prone [BEP]; n = 14), intermediate (BE neutral [BEN]; n = 48), and low (BE resistant [BER]; n = 13) phenotypes of binge eating. Prior reinforcer devaluation performance showed BEN and BER rats suppressed responding on the lever associated with the devalued reinforcer while BEP rats did not. This insensitivity to instrumental reinforcer devaluation in BEP rats did not reflect impaired sensory-specific satiety as during a food choice test, BEP rats showed a more robust alteration in food preferences following devaluation. Additionally, across all rats sensory specific satiety was correlated with subsequent intake of palatable food. Collectively, these findings suggest dissociable effects of devaluation procedures on instrumental actions and consummatory behaviors in BEP rats, and may indicate that pre-existing differences in goal-directed behavior and sensory-specific satiety contribute to the propensity to overeat palatable food.

The Unmet Supportive Care Needs of Arab Australian and Arab Jordanian Cancer Survivors: An International Comparative Survey.

BACKGROUND: Research exploring the unmet supportive care needs of Arab cancer survivors is limited, with most conducted with immigrant groups. No study has compared the unmet supportive care needs of immigrant Arab cancer survivors with Arab cancer survivors living in their native country. OBJECTIVE: To explore the unmet supportive care needs of both Arab Australian and Arab Jordanian cancer survivors. METHODS: Arab people living in Sydney, Australia, and Amman, Jordan, and diagnosed with cancer within the last 5 years were invited to complete a questionnaire that measured unmet supportive care needs, depression, and language acculturation. Multiple regression analysis was performed to identify predictors of unmet supportive care needs. RESULTS: Seventy-seven Arab Jordanian and 66 Arab Australian cancer survivors were recruited. Australian participants were older than their Jordanian counterparts (61.5 vs 52.3 years; P < .001) and reported higher levels of overall unmet needs (44.9 vs 36.1; P = .012). Controlling for age and stage of cancer diagnosis, higher levels of depression (ß = .34) and living in Australia (ß = .26) were significant predictors of unmet needs and explained almost 17% of the variance. CONCLUSIONS: These findings have extended our understanding of the unmet supportive care needs of Arab cancer survivors and confirm disparities in unmet needs in immigrant populations. IMPLICATIONS FOR PRACTICE: Greater attention is needed to ensure the supportive care needs are met for immigrant patients with cancer. Additional strategies to address physical and psychological needs are particularly needed in this group.