Search

Purpose: Recent guidelines for prognostic evaluation recommend clinicians’ prediction of survival (CPS) for survival prediction in patients with advanced cancer. However, CPS is often inaccurate and optimistic. Studies on factors associated with overestimation or underestimation of CPS are limited. We aimed to investigate the factors associated with the overestimation and underestimation of CPS in patients with far-advanced cancer. Methods: The current study was a secondary analysis of an international multicenter prospective cohort study, which enrolled newly admitted patients with advanced cancer in palliative care units (PCUs) in Japan, Korea, and Taiwan from 2017 to 2018. We obtained the temporal CPS at enrollment and performed multivariate logistic regression analysis to identify the factors associated with “underestimation (less than 33% of actual survival)” and “overestimation (more than 33% of actual survival).” Results: A total of 2571 patients were assessed and admitted in 37 PCUs between January 2017 and September 2018. Older age (adjusted odds ratio [aOR] 1.01; 95% confidence interval [CI] 1.01–1.02; P < 0.01) and reduced oral intake (aOR 0.68; 95% CI 0.51–0.89; P < 0.01) were identified as significant factors associated with underestimation. Dyspnea (aOR 1.28; 95% CI 1.06–1.54; P = 0.01) and hyperactive delirium (aOR 1.34; 95% CI 1.05–1.72; P = 0.02) were identified as significant factors associated with overestimation. Conclusion: Older age was related to underestimation, while dyspnea and hyperactive delirium were related to overestimation of CPS for patients with weeks of survival. However, reduced oral intake was less likely to lead to underestimation. [ABSTRACT FROM AUTHOR]

For the global-scale multimedia live streaming services, both of the cost-efficiency at the service provider side and the Quality of Experience (QoE) satisfaction at the viewer side need to be achieved. This is a difficult challenge because the request patterns of global live-streaming services are highly dynamic. In this paper, we solve this issue by cloud-based adaptive resource allocation. We first present a cloud-based multi-tier architecture, called MaaS (Media as a Service), which consists of four types of modules. The main issue that we focus on is the deployment of properly dimensioned MaaS modules in proper geographical regions. We take the QoE of the Dynamic Adaptive Streaming over HTTP viewers into account for this decision. We propose a combination of deep-learning based demand prediction scheme and a dynamic-programming based heuristic to make a good tradeoff between viewers' QoE and the cloud resource cost. Extensive evaluation shows that the proposed scheme clearly outperforms the existing schemes. [ABSTRACT FROM AUTHOR]

Purpose: Few large-scale studies have focused on the prevalence of symptoms and signs during the last days of patients diagnosed with advanced cancer. Identifying the patterns of specific symptoms according to cancer type is helpful to provide end-of-life care for patients with advanced cancer. We investigated the prevalence and severity of symptoms and signs associated with impending death in patients with advanced cancer.Methods: In this secondary analysis of an international multicenter cohort study conducted in three East Asian countries, we compared the severity of symptoms and signs among dying patients in the last 3 days of life according to the type of primary cancer using one-way analysis of variance (ANOVA). Post hoc analysis was conducted for multiple comparisons of each symptom according to the type of primary cancer.Results: We analyzed 2131 patients from Japan, Korea, and Taiwan. The prevalence of most symptoms and signs were relatively stable from 1 week after admission to the last 3 days of life. According to cancer type, edema of the lower extremities was the most common symptom and fatigue/ ascites were the most severe symptoms in digestive tract cancer. For lung cancer, respiratory secretion was the most prevalent and dyspnea/respiratory secretion were the most severe symptoms.Conclusion: We demonstrated the prevalence and severity of symptoms and signs associated with the impending death of patients with advanced cancer in East Asia. Our study can enable clinicians to recognize the specific symptoms and signs at the very end of life. [ABSTRACT FROM AUTHOR]

Purpose: No study has been conducted to compare the clinicians' prediction of survival (CPS) with Palliative Prognostic Scores (PaP) across countries. We aimed to compare the performance of the CPS in PaP (PaP-CPS), the PaP without the CPS, and the PaP total scores in patients with advanced cancer in three East Asian countries.Methods: We compared the discriminative accuracy of the three predictive models (the PaP-CPS [the score of the categorical CPS of PaP], the PaP without the CPS [sum of the scores of only the objective variables of PaP], and the PaP total score) in patients admitted to palliative care units (PCUs) in Japan, Korea, and Taiwan. We calculated the area under the receiver operating characteristic curve (AUROC) for 30-day survival to compare the discriminative accuracy of these three models.Results: We analyzed 2,072 patients from three countries. The AUROC for the PaP total scores was 0.84 in patients in Japan, 0.76 in Korea, and 0.79 in Taiwan. The AUROC of the PaP-CPS was 0.82 in patients in Japan, 0.75 in Korea, and 0.78 in Taiwan. The AUROC of the PaP without the CPS was 0.75 in patients in Japan, 0.66 in Korea, and 0.67 in Taiwan.Conclusion: The PaP total scores and the PaP-CPS consistently showed similar discriminative accuracy in predicting 30-day survival in patients admitted to PCUs in Japan, Korea, and Taiwan. It may be sufficient for experienced clinicians to use the CPS alone for estimating the short-term survival (less than one month) of patients with far-advanced cancer. The PaP may help to improve prognostic confidence and further reduce subjective variations. [ABSTRACT FROM AUTHOR]

Background: Well detection of the symptoms and signs of dying patients is essential for providing proper palliative care. Our goal is to evaluate the predominant symptoms and compare the changes in dying patients with digestive tract cancer in Japan, South Korea, and Taiwan.Methods: A total of 1057 cancer patients aged 18 years or older admitted in palliative care units with locally advanced or metastatic gastroesophageal, colorectal, and pancreaticobiliary cancer were enrolled from January 2017 to March 2019. The severity of physical and psychological symptoms and signs assessed by physicians and/or nurses upon admission, 1 week after admission, and within 3 days of death, was compared according to cancer type and country of origin.Results: Among the 338 gastroesophageal, 358 pancreaticobiliary, and 361 colorectal cancer patients, 894 (93.1%) died during the observation period. Fatigue was the most severe symptom in all cancer groups before dying. Dyspnea, fatigue, drowsiness, and ascites improved after hospitalization albeit they worsened prior to death. In particular, ascites was a marked symptom in patients with pancreaticobiliary cancer. Delirium and hallucination gradually worsened during the period leading to death. Differences in manifestations with respect to the country of origin were not significant.Conclusion: We identified the most prevalent signs and symptoms in patients from East Asia who were dying from digestive tract cancers. Proper management, based on these prevalent signs and symptoms during the dying period, plays a vital role in providing adequate palliative care. [ABSTRACT FROM AUTHOR]

The heterogeneity of the application data size needs to be considered in Delay Tolerant Networks (DTN) routing. Depending on the size of data, certain node contacts may not be long enough for complete data forwarding, i.e., data forwarding may be interrupted if the link is disconnected before the completion of data transfer. In this paper, we present a peer-to-peer DTN routing scheme that considers data size and contact duration. We classify node contacts into social contacts and pass-by contacts. The former corresponds to the case social interaction between users is involved, while the latter corresponds to the case contact occurs only due to physical proximity between nodes. Our scheme is novel in the following aspects. Firstly, we utilize both types of contacts unlike the existing social DTN routing which utilizes only social contacts. Large data is forwarded at social contacts which generally has long contact duration. Pass-by contacts are used for forwarding small data. Secondly, we characterize the strength of social ties by combining heterogeneous properties of contacts. We have evaluated the effectiveness of the proposed scheme by simulating the real world contact traces. It is shown that our scheme substantially higher delivery ratio and lower relaying overhead than the existing schemes when the size of data varies. [ABSTRACT FROM AUTHOR]

Conventional cellular technology is being extended for Internet of Thing(IoT) network, which needs to support relatively small amount of traffic generated by a large number of devices. This so-called Machine-Type Communication(MTC) cellular however is not a universal solution for IoT connectivity. It may be infeasible to equip some IoT devices with MTC cellular due to manufacturing cost, operation fee, limited battery lifetime, etc. For low-power IoT devices, using shorter range radios (e.g., IEEE 802.15.4) is more viable. Sensing data generated by the IoT devices are delivered to the IoT gateway by the forwarding of other nodes without relying on cellular links. Such peer-to-peer data delivery may utilize ’muling’ (i.e., data is stored and carried by mobile nodes) if the forwarding path may not be immediately available. Since muling will extend the delivery delay, it is suitable for the IoT applications that can tolerate relatively large message delivery delay. In this paper, we propose a peer-to-peer DTN (Delay Tolerant Network) routing scheme for IoT network. To enhance routing efficiency, we utilize the location information of the nodes. Our scheme does not rely on expensive location tracking methods like GPS or triangulation. Instead, we use RSSI (Received Signal Strength Indicator) which is readily available in virtually any wireless network at low cost. It is shown that the proposed scheme clearly outperforms the existing schemes via extensive simulations. [ABSTRACT FROM AUTHOR]

Purpose: Commonly used terms such as "supportive care," "best supportive care," "palliative care," and "hospice care" were rarely and inconsistently defined in the palliative oncology literature. We conducted a systematic review of the literature to further identify concepts and definitions for these terms.Methods: We searched MEDLINE, PsycInfo, EMBASE, and CINAHL for published peer-reviewed articles from 1948 to 2011 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. Dictionaries/textbooks were also searched.Results: Nine of 32 "SC/BSC," 25 of 182 "PC," and 12 of 42 "HC" articles focused on providing a conceptual framework/definition. Common concepts for all three terms were symptom control and quality-of-life for patients with life-limiting illness. "SC" focused more on patients on active treatment compared to other categories (9/9 vs. 8/37) and less often involved interdisciplinary care (4/9 vs. 31/37). In contrast, "HC" focused more on volunteers (6/12 vs. 6/34), bereavement care (9/12 vs. 7/34), and community care (9/12 vs. 6/34). Both "PC" and "SC/BSC" were applicable earlier in the disease trajectory (16/34 vs. 0/9). We found 13, 24, and 17 different definitions for "SC/BSC," "PC," and "HC," respectively. "SC/BSC" was the most variably defined, ranging from symptom management during cancer therapy to survivorship care. Dictionaries/textbooks showed similar findings.Conclusion: We identified defining concepts for "SC/BSC," "PC," and "HC" and developed a preliminary conceptual framework unifying these terms along the continuum of care to help build consensus toward standardized definitions. [ABSTRACT FROM AUTHOR]