Surrogate Respondents Research Articles

Social support and reputational defense strategies of Chinese social networking site users in Sun Yang’s controversy

This study examines the online expression of Chinese social networking site (SNS) users in a human brand crisis. Using the case of Sun Yang’s doping allegations controversy, the research employed content analysis to examine how Chinese users rendered social support and acted as surrogate crisis responders for Sun in a collectivist Chinese culture. The results indicate that (1) Sun’s supporters were most likely to display emotional support, and this pattern continued over time, (2) Chinese SNS users were inclined to implement the reputational defense strategies of attacking the accuser, denial, and reminding in response to their hero’s case, and (3) the prevalence of the three defense strategies varied over time. Theoretical and managerial implications are provided regarding how parasocial relationship with the accused human brand and in-group/out-group differentiation affect SNS users’ online expressions of social support and reputational defense in the Chinese culture.

Alternative Tobacco Product Use in Critically Ill Patients.

Background: Alternative tobacco product (ATP) use has bee linked to critical illness, however, few studies have examined the use of these substances in critically ill populations. We sought to examine ATP use within critically ill patients and to define barriers in accurately assessing use within this population. Methods: We prospectively studied 533 consecutive patients from the Early Assessment of Renal and Lung Injury study, enrolled between 2013 and 2016 at a tertiary referral center and a safety-net hospital. ATP use information (electronic cigarettes, cigars, pipes, hookahs/waterpipes, and snus/chewing tobacco) was obtained from the patient or surrogate using a detailed survey. Reasons for non-completion of the survey were recorded, and differences between survey responders vs. non-responders, self- vs. surrogate responders, and ATP users vs. non-users were explored. Results: Overall, 80% (n = 425) of subjects (56% male) completed a tobacco product use survey. Of these, 12.2% (n = 52) reported current ATP use, while 5.6% reported using multiple ATP products. When restricted to subjects who were self-responders, 17% reported ATP use, while 10% reported current cigarette smoking alone. The mean age of ATP users was 57 ± 17 years. Those who did not complete a survey were sicker and more likely to have died during admission. Subjects who completed the survey as self-responders reported higher levels of ATP use than ones with surrogate responders (p < 0.0001). Conclusion: ATP use is common among critically ill patients despite them being generally older than traditional users. Survey self-responders were more likely than surrogate responders to report use. These findings highlight the importance of improving our current methods of surveillance of ATP use in older adults in the outpatient setting.

Pediatric perioperative outcomes: Protocol for a systematic literature review and identification of a core outcome set for infants, children, and young people requiring anesthesia and surgery.

Clinical outcomes are measurable changes in health, function, or quality of life that are important for evaluating the quality of care and comparing the efficacy of interventions. However, clinical outcomes and related measurement tools need to be well-defined, relevant, and valid. In adults, Core Outcome Measures in Effectiveness Trials (COMET) methodology has been used to develop core outcome sets for perioperative care. Systematic literature reviews identified standardized endpoints (StEP) and valid measurement tools, and consensus across a broader range of relevant stakeholders was achieved via a Delphi process to establish Core Outcome Measures in Perioperative and Anaesthetic Care (COMPAC). Core outcome sets for pediatric perioperative care cannot be directly extrapolated from adult data. The type and weighting of endpoints within particular domains can be influenced by age-dependent differences in the indications for and/or nature of surgery and medical comorbidities, and the validity and utility of many measurement tools vary significantly with developmental stage and age. The involvement of parents/carers is essential as they frequently act as surrogate responders for preverbal and developmentally delayed children, parental response may influence child outcome, and parental and/or child ranking of outcomes may differ from those of health professionals. Here, we describe the formation of the international Pediatric Perioperative Outcomes Group, which aims to identify and create validated, broadly applicable, patient-centered outcome measures for infants, children, and young people. Methodologies parallel that of the StEP and COMPAC projects, and systematic literature searches have been performed within agreed age-dependent subpopulations to identify reported outcomes and measurement tools. This represents the first steps for developing core outcome sets for pediatric perioperative care.

Anti-PDL1/IL-15 fusion protein increases rare effector cells in cynomolgus monkeys and mice

Abstract Background Kadmon has generated an anti-PDL1/IL-15 fusion protein (KD033) by combining a proprietary, fully human, high affinity anti-human/mouse PD-L1 antibody with human IL-15. Initial assessment of KD033 showed enhanced tolerability relative to a non-targeted IL-15 fusion protein, in addition to its potent anti-tumor activity and immune memory generation. KD033 increased CD8+ T and NK cells in peripheral blood of humans, cynomolgus monkeys and mice as expected from on target engagement of IL-15. In this study, we evaluated additional immune cell population changes in mice and cynomolgus monkeys treated with KD033. Methods Tumor size, measured at day 7 in syngeneic subcutaneous CT26 colorectal cancer mouse model after a single KD033 surrogate treatment, was used to define mice as either KD033 responders (decreasing tumor volumes) or non-responders (no change or increasing tumor volumes). Peripheral blood from KD033 responders and non-responders as well as from cynomolgus monkeys treated with KD033 at predose, 24 and 168 hours after dosing was analyzed by flow cytometry for various immune cell populations. Results Granzyme B+ CD8+ T and gamma delta T cells in peripheral blood were specifically increased in KD033 surrogate responder mice. These increases were not observed in non-responder mice. Greater increases in NKT-like cells were also observed in KD033 surrogate best responders. This is in contrast to other immune populations, such as CD8+ T and B cells, which were similarly impacted, in both KD033 surrogate responder and non-responder mice. In cynomolgus monkeys, CD3+CD4-CD8- cells, which includes gamma delta T cells, were one of the immune populations with the highest increases at 168 hours post dose. Conclusion KD033 administration increases CD8+ T and NK cells, consistent with IL-15 pharmacodynamics. In addition, analysis of peripheral blood from KD033 surrogate best and non-responder mice demonstrated increases in different immune populations, which can facilitate their use as in-treatment biomarkers of KD033 activity in tumors. Importantly, KD033 administration resulted in increases in rare cytotoxic cells such as NKT and gamma delta T cells in peripheral blood which may contribute to its anti-tumor activity and immunity. Legal entity responsible for the study Kadmon Corporation LLC. Funding Kadmon Corporation LLC. Disclosure S. Martomo: Full / Part-time employment: Kadmon Corporation. D. Lu: Full / Part-time employment: Kadmon Corporation. Z. Polonskaya: Full / Part-time employment: Kadmon Corporation. X. Luna: Full / Part-time employment: Kadmon Corporation. F. Miyara: Full / Part-time employment: Kadmon Corporation. J. Patel: Full / Part-time employment: Kadmon Corporation.

Labor of Love: Gestational Surrogacy and the Work of Making Babies. By Heather Jacobson. New Brunswick, N.J.: Rutgers University Press, 2016. Pp. x+203. $90.00 (cloth); $28.95 (paper).

<i>Labor of Love: Gestational Surrogacy and the Work of Making Babies</i>. By Heather Jacobson. New Brunswick, N.J.: Rutgers University Press, 2016. Pp. x+203. $90.00 (cloth); $28.95 (paper).

Feasibility of screening for preinjury frailty in hospitalized injured older adults.

Frailty assessment of injured older adults (IOAs) is important for clinical management; however, the feasibility of screening for preinjury frailty has not been established in a Level I trauma center. The aims of our study were to assess enrollment rates of IOAs and their surrogates as well as completion rates of selected brief frailty screening instruments. We conducted a prospective cohort study on patients, age 65 years and older with a primary injury diagnosis. Patients and/or surrogates were interviewed within 48 hours of admission using the Vulnerable Elders Survey (VES-13), Barthel Index (BI), and the Life Space Assessment (LSA). Data analysis included frequency distributions, χ statistics, Mann-Whitney and Kruskal-Wallis tests, and general linear modeling (analysis of variance). Of 395 admitted patients, 188 were enrolled with subsequent surrogate screening. Corresponding patient interviews were conducted for 77 patients (41%). Screening time was less than 5 minutes for each instrument, and item completion was 100%. Forty-two enrolled patients (22%) had nurse-reported delirium, and 69 (37%) patients either did not feel like answering questions or were unable to be interviewed secondary to their medical condition. The median score of surrogate responses for the VES-13 was 3.5 (interquartile range, 2-7), with 64% of the sample having a score of 3 or greater, indicating vulnerability or frailty. Median scores for the BI (19.0) and LSA (56.0) indicated high numbers with limitations in activities of daily living and limitations in mobilization. Screening for preinjury frailty in IOAs is feasible yet highly dependent on the presence of a surrogate respondent. A clinically significant percentage of patients have functional deficits consistent with frailty, dependence in activities of daily living, and limitations in mobilization. Implementation of validated brief screening instruments to identify frailty in clinical settings is warranted for targeting timely, efficient, and effective care interventions. Epidemiologic study, level II.

Five-year reliability of key demographic and life history data collected from self-respondents and next-of-kin.

The ability of study participants or their next-of-kin to provide basic demographic and life history data is of critical importance in epidemiologic studies and government surveys. Most interview studies to date have focused on the reliability of these variables either as self-reported over short periods of time (<2 years) or as reported by the next-of-kin concurrently with the study participant. In a unique reinterview study, the authors examine the concordance of responses 5 years after the initial interview among 196 surviving study participants and 107 next-of-kin respondents of participants who died after the first interview. The reliability of demographic, anthropometric, reproductive, and residential history questions was high overall, with most κ and Spearman rank-correlation coefficients being above 0.80 for both self-respondents and next-of-kin at reinterview in 1985. In particular, almost perfect agreement was observed for year of birth, religion raised, number of children, and age at first birth, whereas agreement was lowest for childhood residential history. Contrary to expectation, the next-of-kin responses were generally as reliable as those of the original participants themselves 5 years after the initial study, providing further support for the usefulness of surrogate respondents in collecting demographic and life history information in epidemiologic investigations when no other source is available.

Alcohol consumption in Mozambique: Results from a national survey including primary and surrogate respondents

Background: Data on the correspondence between information on alcohol consumption obtained from household members directly interviewed and those evaluated through surrogate respondents are scarce in developing countries.Aim: To estimate alcohol consumption in Mozambique and to compare the information self-reported by subjects directly interviewed with data provided by surrogate respondents referring to household members that were absent during interview.Subjects and methods: A representative sample of 20 033 Mozambicans aged 25–64 years was evaluated in 2003 as part of a national household survey. Face-to-face interviews were conducted using a structured questionnaire assessing socio-demographic and behavioural factors (12 902 participants were directly interviewed and for 7238 data were provided by surrogate respondents).Results: Nearly a quarter of women and half the men were current drinkers, of which about 60% drank 1–2 days/week and more than 75% reported traditional beverages as the most frequently consumed. No meaningful differences were observed between the estimates obtained using only data reported directly by the participants and when surrogate reports were also considered.Conclusion: Alcohol consumption was frequent in Mozambique, especially consumption of traditional beverages. Proxy respondents provided valid information on alcohol intake, which may be used to improve the efficiency of household surveys in this setting.

Self- and surrogate-reported communication functioning in aphasia

To evaluate the dimensionality and measurement invariance of the aphasia communication outcome measure (ACOM), a self- and surrogate-reported measure of communicative functioning in aphasia. Responses to a large pool of items describing communication activities were collected from 133 community-dwelling persons with aphasia of ≥ 1 month post-onset and their associated surrogate respondents. These responses were evaluated using confirmatory and exploratory factor analysis. Chi-square difference tests of nested factor models were used to evaluate patient-surrogate measurement invariance and the equality of factor score means and variances. Association and agreement between self- and surrogate reports were examined using correlation and scatterplots of pairwise patient-surrogate differences. Three single-factor scales (Talking, Comprehension, and Writing) approximating patient-surrogate measurement invariance were identified. The variance of patient-reported scores on the Talking and Writing scales was higher than surrogate-reported variances on these scales. Correlations between self- and surrogate reports were moderate-to-strong, but there were significant disagreements in a substantial number of individual cases. Despite minimal bias and relatively strong association, surrogate reports of communicative functioning in aphasia are not reliable substitutes for self-reports by persons with aphasia. Furthermore, although measurement invariance is necessary for direct comparison of self- and surrogate reports, the costs of obtaining invariance in terms of scale reliability and content validity may be substantial. Development of non-invariant self- and surrogate report scales may be preferable for some applications.

Is the association found between faecaliths and right iliac fossa pain reliable?

The article on appendiceal faecaliths by Grimes et al. has proposed a very interesting finding; however, a few points need to be discussed before acceptance of the conclusion from this study. The selection of the cases and controls is merely on the basis of presence or absence of appendiceal faecaliths but the comparability of the groups with regards to age, gender and other demographic details has not been mentioned. This makes the control selection doubtful. A better way of ascertaining the pre-operative and postoperative pain and other symptoms in this case would have been medical records. This would have addressed recall bias introduced through telephone interview and would have made the two groups comparable. The authors have not mentioned anything about the responders of the questionnaires. A few patients might have been too young to remember anything at all introducing limitation to recall. Were surrogate responders used to address this issue? Many potential confounders were not addressed, for example, is there another cause of right iliac fossa pain in normal appendix? Mesenteric adenitis in children1 has not been addressed in this patient population. Evaluation of the operative notes and detailed histological reports would have provided information about other potential causes. The sample size is too small and such a finding could merely result from chance rather than having a clinical implication. Moreover, measure of association in a case control study is done by computing the odds ratio.2 Most of the referenced studies in the discussion are of the paediatric age group again creating bias about the comparison; moreover, these referenced studies had a small sample size making acceptance of their results difficult. Unconditional logistic regression would have been a better model to look for association between right iliac fossa pain and faecaliths which will adjust for confounders. The conclusion by the authors that removing normal-looking appendices would reduce re-admission cannot be accepted because of the lack of proper evidence which can only be obtained by a randomised controlled trial.

The Quality of Dying and Death Questionnaire (QODD): Empirical Domains and Theoretical Perspectives

We used exploratory factor analysis within the confirmatory analysis framework, and data provided by family members and friends of 205 decedents in Missoula, Montana, to construct a model of latent-variable domains underlying the Quality of Dying and Death questionnaire (QODD). We then used data from 182 surrogate respondents, who were survivors of Seattle decedents, to verify the latent-variable structure. Results from the two samples suggested that survivors' retrospective ratings of 13 specific aspects of decedents' end-of-life experience served as indicators of four correlated, but distinct, latent-variable domains: Symptom Control, Preparation, Connectedness, and Transcendence. A model testing a unidimensional domain structure exhibited unsatisfactory fit to the data, implying that a single global quality measure of dying and death may provide insufficient evidence for guiding clinical practice, evaluating interventions to improve quality of care or assessing the status or trajectory of individual patients. In anticipation of possible future research tying the quality of dying and death to theoretical constructs, we linked the inferred domains to concepts from identity theory and existential psychology. We conclude that research based on the current version of the QODD might benefit from the use of composite measures representing the four identified domains, but that future expansion and modification of the questionnaire are in order.

Validity of Maternal Recall of Preschool Diet After 43 Years

Validation of early childhood diet recalls by surrogate responders decades later has not been possible because of a lack of diet records from the distant past. Between 1948 and 1970, parents of children participating in the Fels Longitudinal Study (Kettering, Ohio) completed a 7-day diet record for their children every year from birth to age 18 years. In 2005-2006, all surviving women (n = 59) with a child aged 3-5 years when diet records had been collected were asked to complete a 42-item food frequency questionnaire (FFQ) pertaining to 1 of their children's diets at age 3-5 years. One or more diet records were available for 48 children. The authors calculated Spearman correlation coefficients for correlations between food, food-group, and nutrient intakes from the diet records and the FFQ and deattenuated them to account for the effects of within-person variation in the diet records on the association. For foods, the median deattenuated correlation coefficient was 0.19 (range, -0.31 to 0.85); moderate-to-high correlations were found for some specific foods. Correlations for food groups were slightly higher (median, 0.27; range, -0.14 to 0.85). Correlations for nutrient intakes were consistently low (median, 0.06; range, -0.35 to 0.27). Overall, the FFQ did not validly reflect overall preschool diet when completed by mothers 4 decades later.

Measuring the Quality of Dying in Long‐Term Care

To describe two versions of a new measure, The Quality of Dying in Long-Term Care, for postdeath administration to surrogate respondents (staff and family caregivers) of all decedents (QOD-LTC) and of cognitively intact decedents (QOD-LTC-C) who die in nursing homes (NHs) and residential care or assisted living (RC/AL) facilities. Using two levels of exploratory factor analysis, 15 candidate items for the QOD-LTC and 36 candidate items for the QOD-LTC-C were tested using multiple criteria to determine factor structure and interpretability of the quality of dying in long-term care (LTC). One hundred seventeen RC/AL facilities and 31 NHs in FL, MD, NC, and NJ. Family (n=439) and staff (n=332) caregivers of 633 decedents from a stratified random sample from RC/AL facilities and NHs in four states. Trained interviewers asked respondents to rate statements describing potentially important aspects of the quality of dying using a 5-point Likert scale. The scale items were analyzed using exploratory factor analysis with communalities set to unity using a Promax rotation. The 11-item QOD-LTC (alpha=0.66), appropriate for surrogate respondents for all decedents, consists of three domains (personhood, closure, preparatory tasks). The 23-item instrument for surrogate respondents of cognitively intact decedents, the QOD-LTC-C (alpha=0.85), consists of five domains (sense of purpose, closure, control, social connection, preparatory tasks). The QOD-LTC and QOD-LTC-C are psychometrically acceptable measures of the quality of the dying experience, developed for and tested in LTC settings. Use of these measures can increase understanding of the dying experience in LTC.

Link between Epilepsy and Malnutrition in a Rural Area of Benin

Epilepsy and malnutrition are both important public health problems in sub-Saharan Africa. A relationship between epilepsy and malnutrition has been suspected for many years. Our objective was to investigate the association between epilepsy and malnutrition in Djidja, Benin. A matched population-based cross-sectional case-control survey was performed: cases (patients with epilepsy) were matched to controls according to sex, age +/- 5 years, and village of residence. The World Health Organization's criteria for malnutrition was used. Anthropometric measurements (weight, height, mid arm upper circumference, triceps skinfold thickness) were taken. Bioelectrical impedance analysis, a standardized food and social questionnaire and a clinical examination were done. Statistical analysis (conditional logistic regression) was performed using SAS 8.0. A total of 131 cases and 262 controls were included. The prevalence of malnutrition was higher in cases than in controls (22.1% vs. 9.2%, p = 0.0006). Social factors were significantly different between cases and controls. Feeding difficulties were more frequent and health status was worse in cases. Seven variables were associated with epilepsy: (i) nutritional factors: mid arm upper circumference (prevalence odds ratio (pOR) = 0.7, CI: 0.6-0.9), cereal consumption <3 times during the 3 days before the study (pOR = 4.2, CI: 1.8-10.0), <3 meals/day (pOR = 4.2, CI: 1.6-10.9), tooth decay (pOR = 2.9, CI: 1.1-7.4), food taboos (pOR = 25.0, CI: 8.3-100.0), (ii) social factors: surrogate respondent (pOR = 16.8, CI: 3.1-90.3) and no second job (pOR = 7.1, CI: 2.3-22.3). Epilepsy and nutritional status are linked in sub-Saharan Africa. Programs to improve the nutritional status of people with epilepsy are needed.

Are Family Proxies a Valid Source of Information About Cancer Patients' Quality of Life at the End-of-Life? A Literature Review

AbstractIn patients with advanced cancer, the achievement of a peaceful death through palliative care is highly desired. The preservation of quality of life (QOL) is a primary goal of palliative treatments; measures of QOL thus serve as important indicators of the treatment efficacy. Patient ratings have traditionally been viewed as the gold standard for QOL measures because the physical and emotional symptoms that influence QOL are subjective phenomena. However, the palliative patient group may experience difficulties with symptom self-report. This raises serious issues in clinical trials concerning non-response bias and generalizability of the data. To address the non-response issue, proxy informants are often elicited to act as surrogate respondents for patients with advanced disease. However, satisfactory levels of agreement between patient and proxy QOL appraisals must be demonstrated before caregivers (i.e., family members and close friends) can be deemed reliable sources of QOL assessments. This re...

Emergency Medicine Research Directors and Research Programs: Characteristics and Factors Associated with Productivity

Background: Periodic surveys of research directors (RDs) in emergency medicine (EM) are useful to assess the specialty's development and evolution of the RD role. Objectives: To assess associations between characteristics and research productivity of RDs and EM programs. Methods: A survey of EM RDs was developed using the nominal group technique and pilot tested. RDs or surrogate respondents at programs certified by the Accreditation Council for Graduate Medical Education were contacted by e-mail in early 2005. The survey assessed programs' research infrastructure and productivity, as well as RD characteristics, responsibilities, and career satisfaction. Three measures of research productivity were empirically defined: research publications, grant awards, and grant revenue. Results: Responses were received from 86% of 123 EM programs. Productivity was associated with the presence of nonclinical faculty, dedicated research coordinators, and reduced clinical hours for research faculty. Programs with an RD did not have greater research productivity, using any measure, than those without an RD. The majority of RDs cited pursuing their own studies, obtaining funding, research mentoring, and research administration to be major responsibilities. The majority characterized internal research funding, grant development support, and support from other faculty as inadequate. Most RDs are satisfied with their careers and expect to remain in the position for three or more years. Conclusions: Research productivity of EM residency programs is associated with the presence of dedicated research faculty and staff and with reduced clinical demands for research faculty. Despite perceiving deficiencies in important resources, most RDs are professionally satisfied.

Emergency Medicine Research Directors and Research Programs: Characteristics and Factors Associated with Productivity

Periodic surveys of research directors (RDs) in emergency medicine (EM) are useful to assess the specialty's development and evolution of the RD role. To assess associations between characteristics and research productivity of RDs and EM programs. A survey of EM RDs was developed using the nominal group technique and pilot tested. RDs or surrogate respondents at programs certified by the Accreditation Council for Graduate Medical Education were contacted by e-mail in early 2005. The survey assessed programs' research infrastructure and productivity, as well as RD characteristics, responsibilities, and career satisfaction. Three measures of research productivity were empirically defined: research publications, grant awards, and grant revenue. Responses were received from 86% of 123 EM programs. Productivity was associated with the presence of nonclinical faculty, dedicated research coordinators, and reduced clinical hours for research faculty. Programs with an RD did not have greater research productivity, using any measure, than those without an RD. The majority of RDs cited pursuing their own studies, obtaining funding, research mentoring, and research administration to be major responsibilities. The majority characterized internal research funding, grant development support, and support from other faculty as inadequate. Most RDs are satisfied with their careers and expect to remain in the position for three or more years. Research productivity of EM residency programs is associated with the presence of dedicated research faculty and staff and with reduced clinical demands for research faculty. Despite perceiving deficiencies in important resources, most RDs are professionally satisfied.

Palliative Care Research: Issues and Opportunities

Palliative Care Research: Issues and Opportunities

Reliability of data from next‐of‐kin: Results from a case‐control study of occupational and lifestyle risk factors for cancer

Use of surrogate responders often needs to be considered in case-control studies with a high case fatality. Agreement between 98 colon cancer patients and their closest relative was expressed as a percentage of the exact agreement and by Kappa coefficients and intra-class correlation coefficients. The percentage of "don't know" answers was higher for surrogates than for index cases and the highest percentage was seen for questions on early events like childhood diseases. Agreement was best for responses to dichotomous questions on smoking and for prevalent or chronic diseases like diabetes or psoriasis, and lower (54-64%) when a quantitative response of, e.g., smoking was requested. The next-of-kin reported fewer job periods than the study person, 4.5 and 2.8, respectively, and there was a higher agreement for the latest job held than for the longest held job. We found an overall agreement between 91% and 100% for responses to ever having worked in a specific type of industry or occupation. Use of next-of-kin data will often be a better alternative than excluding severely ill or deceased cases, if the exposure under study correlates with disease progression.

Use of surrogate respondents in a case control study of dietary risk factors for Alzheimer's disease

Use of surrogate respondents in a case control study of dietary risk factors for Alzheimer's disease