ABSTRACT
In the field of air analysis, highlights within this review period included: a new in situ method for measuring resuspended road dust arising from vehicular movements;new ink-printed filter reference materials for black- and elemental-carbon measurements;coupling of a scanning mobility particle sizer to a single-particle-ICP-MS instrument for improved nanoparticle characterisation;developments in total-reflection XRF spectrometry for trace analysis and evaluation of vibrational spectroscopic techniques for measuring respirable crystalline silica in the workplace. The increasing availability of ICP-MS/MS instruments is revolutionising the analysis of environmental samples such as waters for trace elements. The advent of the mass shift mode makes some elements such as P and S much easier to quantify and allows the REEs and some radioisotopes to be determined at much lower concentrations than previously possible. Advances in vapour generation methods are mostly limited to photochemical and chemical vapour generation as reflected in the new table listing the main advances. Solid or liquid phase extraction prior to analysis remains of great interest, although a notable trend is the synthesis of new materials rather than optimisation of commercially available chelating agents and columns. The analytical effort presented in a paper is sometimes much less than the effort put into the synthesis of the materials so one wonders about the likelihood of methods actually being used and results replicated. Notable in the analysis of soils and plants was the unusually large number of review articles - possibly because practical research was hampered by the Covid-19 epidemic. Areas of continued growth were research on nanoparticles, the application of high-resolution continuum source AAS for multielement analysis, the development of miniaturised AES instruments that may ultimately be field-portable and application of LIBS to the analysis of plant materials. A concerted effort to characterise natural minerals that are sufficiently homogeneous to act as reference materials in the microanalysis of geological materials has resulted in the availability of new materials for isotope ratio determinations. Tied to this has been research into U-Pb dating of zircon and a variety of other accessory minerals by LA-ICP-MS and SIMS. New chemometric models have been developed to handle the complex LIBS data arising from the analysis of geological matrices in the field and during ore processing. Studies on the use of ICP-MS/MS to reduce polyatomic interferences in geological applications were widespread, reflecting the availability of such instruments. In contrast, the potential offered by integrating LIBS data with those from LA-ICP-MS has only just started to be explored but is likely to increase with the development of commercial instruments. © 2022 The Royal Society of Chemistry.
ABSTRACT
Background: Use of patient-reported outcomes (PRO) to evaluate symptoms improves clinical outcomes. Best practices for implementing PROs into routine care may vary according to clinical scenario, site-specific resources and programmatic goals. Patients with metastatic breast cancer (MBC) often experience a variety of symptoms. Methods: As a quality improvement project, we are pilot testing incorporation of a battery of PRO measures into routine care for patients with MBC at Johns Hopkins in order to gain experience that will guide future broader implementation of PROs across our program. Participants complete the PROs on paper at baseline (BL), 3, and 6 months (mo). Measures include NCCN Distress Thermometer (BL only), Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder-7 (GAD-7), PRO-CTCAE Insomnia questions and a modified version of the revised Edmonton Symptom Assessment System (rESAS) questionnaire with 3 extra symptom domains. Project team members alert clinicians by email of scores that exceed severity thresholds as follows-Distress: ≥4, PHQ-8: ≥8, GAD-7: ≥10, any item on r-ESAS: ≥4 and PROCTCAE Insomnia: Severe/very severe or quite a bit/very much. Results: From May 29, 2020 and April 5, 2021, 67 patients were approached for participation, and 40 (59.7%) completed the BL PROs. Median age was 64 (range 36-85). Most participants were White (70%), non-Hispanic (90%) and had hormone receptor-positive (93%) MBC. At BL, 22 (55%) had visceral disease and most were receiving endocrine-based regimens [21 (53%)] or chemotherapy [16 (40%)]. 27 (68%) participants had ≥1 BL alert. The most common BL alerts were for symptoms on the r-ESAS [23 participants (58%)]. The most frequent items on the r-ESAS for which participants had BL alerts were pain, tiredness, well-being, tingling/numbness and rash. Other BL alerts were: Distress [9 participants (23%)], PROCTCAE Insomnia [5 participants (13%)], PHQ-8 [4 participants (10%)] and GAD-7 [2 participants (5%)]. To date, 24 of 35 (69%) and 15 of 28 (54%) participants who have reached the 3 and 6 mo time points have completed the respective follow-up (FU) PROs. Most common FU alerts to date are on the r-ESAS [3 mo: 14 participants (58%), 6 mo: 9 participants (60%)]. The project team has successfully notified providers of all alerts to date. Clinical actions (phone calls, provider visits and/or referrals) have been taken within 30 days of notification for > 75% of alerts. Conclusions: Implementation of a PRO battery for patients receiving routine care for MBC led to detection of a range of symptoms, the majority of which were clinically actionable. Restrictions on in-person interactions during the COVID-19 pandemic may have contributed to low rates of PRO completion in this pilot project. Prior to broader implementation, we will consider strategies such as an electronic platform and a shorter battery to enhance patient engagement.