Studies suggest that written emotional disclosure can improve health. Unknown, however, is whether the presence or absence of an audience for one's disclosure matters, and whether time management control writing has any effects. Undergraduates (N = 165) with unresolved stress were randomized to 1 of 3 groups that wrote for 4 sessions: shared written disclosure (submitted to researchers), private written disclosure (not submitted), or time management control writing; or to a fourth group (no-writing control). At 3-month follow-up, the two control groups were equivalent on outcomes. Both shared and private disclosure resulted in less cognitive intrusion and avoidance than the combined control groups. Yet, shared disclosure reduced depression and interpersonal sensitivity more than either private disclosure or the control groups, and only shared disclosure reduced physical symptoms. Although truly private writing improves cognitive stress effects, shared writing has broader benefits, suggesting that social disclosure for one's writing matters.
The all-oral combination of ixazomib, cyclophosphamide, and dexamethasone (ICD) is well tolerated and effective in newly diagnosed and relapsed multiple myeloma (MM). We carried out MUKeight, a randomised, controlled, open, parallel group, multi-centre phase II trial in patients with relapsed MM after prior treatment with thalidomide, lenalidomide, and a proteasome inhibitor (ISRCTN58227268), with the primary objective to test whether ICD has improved clinical activity compared to cyclophosphamide and dexamethasone (CD) in terms of progression-free survival (PFS). Between January 2016 and December 2018, 112 participants were randomised between ICD (n = 58) and CD (n = 54) in 33 UK centres. Patients had a median age of 70 years and had received a median of four prior lines of therapy. 74% were classed as frail. Median PFS in the ICD arm was 5.6 months, compared to 6.7 months with CD (hazard ratio (HR) = 1.21, 80% CI 0.9–1.6, p = 0.3634). Response rates and overall survival were not significantly different between ICD and CD. Dose modifications or omissions, and serious adverse events (SAEs), occurred more often in the ICD arm. In summary, the addition of ixazomib to cyclophosphamide and dexamethasone did not improve outcomes in the comparatively frail patients enroled in the MUKeight trial.
Background: A substantial proportion of breast cancer patients develop metastatic disease, with over 450,000 deaths globally per year. Bone is the most common first site of metastatic disease accounting for 40% of all first recurrence and 70% of patients with advanced disease develop skeletal involvement. Treatment of bone metastases currently focusses on symptom relief and prevention and treatment of skeletal complications. However, there remains a need for further treatment options for patients with bone metastases. Combining systemic therapy with a bone-targeted agent, such as radium-223, may provide an effective treatment with minimal additional side effects. Methods/design: CARBON is a UK-based, open-label, multi-centre study which comprises an initial safety phase to establish the feasibility and safety of combining radium-223 given on a 6-weekly schedule in combination with orally administered capecitabine followed by a randomised extension phase to further characterise the safety profile and provide preliminary estimation of efficacy. Discussion: The CARBON study is important as the results will be the first to assess radium-223 with chemotherapy in advanced breast cancer. If the results find acceptable rates of toxicity with a decrease in bone turnover markers, further work will be necessary in a phase II/III setting to assess the efficacy and clinical benefit.
Families struggling with a breakdown in communication, trying to control the behavior of an unruly child, or experiencing a crisis often look for outside help. Many families, particularly those without resources to pay for private support, turn to their local status offense system. Status offenders are young people charged with behavior unique to their status as juveniles such as running away, truancy, or disobedience. In 2007, Congress will begin to consider reauthorization of the Juvenile Justice Delinquency Prevention Act (JJDPA), the federal act related to status-offender policy. By providing an overview of recent state status-offense legislation and case law, this article identifies issues to be addressed by Congress in reauthorizing the JJDPA.
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