General Matter Coupled N=4 Gauged Supergravity in Five Dimensions

We construct the general form of matter coupled N=4 gauged supergravity in five dimensions. Depending on the structure of the gauge group, these theories are found to involve vector and/or tensor multiplets. When self-dual tensor fields are present, they must be charged under a one-dimensional Abelian group and cannot transform non-trivially under any other part of the gauge group. A short analysis of the possible ground states of the different types of theories is given. It is found that AdS ground states are only possible when the gauge group is a direct product of a one-dimensional Abelian group and a semi-simple group. In the purely Abelian, as well as in the purely semi-simple gauging, at most Minkowski ground states are possible. The existence of such Minkowski ground states could be proven in the compact Abelian case.Comment: 30 pages, Latex, some references modified, typos in eq. (4.18) and (5.3) corrected. Version to appear in Nuclear Physics

Simple Supergravity

We present a short overview of the structure and couplings of supergravity theories at the component level. We do so with as little technical machinery as possible, working directly with the physical on-shell fields and using explicit computations and geometrical reasoning to arrive at the result, highlighting the new properties of supersymmetry in the context of a gravitational theory.Comment: 48 pages. Chapter for the "Handbook of Quantum Gravity" (Eds. C. Bambi, L. Modesto and I.L. Shapiro, Springer Singapore, expected in 2023

Warm dark energy

Motivated by some of the recent swampland conjectures, we study the implementation for the late time acceleration of the Universe of a mechanism developed by Anber and Sorbo in the context of primordial inflation, in which an axion field can slowly roll in a steep potential due to additional friction provided by its coupling to some U(1) gauge field. We first study the realization of this mechanism in N = 2 supergravity models resulting from string compactifications on Calabi--Yau manifolds. We then study the transition between matter domination and the axion domination, and show that indeed the backreaction of the produced gauge field can sufficiently slow the motion of the axion, so to produce the present accelerated era. We finally study the transition from a pre-inflationary matter or radiation domination to primordial inflation. In the regime that we could explore numerically, the evolution is characterized by stages of faster axion roll (and consequent bursts of gauge field amplification) intermitted by stages of slower roll, with a pattern that "oscillates'' about the steady state Anber and Sorbo solution, but that does not appear to relax to it.Comment: 35 page

Unified Maxwell-Einstein and Yang-Mills-Einstein Supergravity Theories in Five Dimensions

Unified N=2 Maxwell-Einstein supergravity theories (MESGTs) are supergravity theories in which all the vector fields, including the graviphoton, transform in an irreducible representation of a simple global symmetry group of the Lagrangian. As was established long time ago, in five dimensions there exist only four unified Maxwell-Einstein supergravity theories whose target manifolds are symmetric spaces. These theories are defined by the four simple Euclidean Jordan algebras of degree three. In this paper, we show that, in addition to these four unified MESGTs with symmetric target spaces, there exist three infinite families of unified MESGTs as well as another exceptional one. These novel unified MESGTs are defined by non-compact (Minkowskian) Jordan algebras, and their target spaces are in general neither symmetric nor homogeneous. The members of one of these three infinite families can be gauged in such a way as to obtain an infinite family of unified N=2 Yang-Mills-Einstein supergravity theories, in which all vector fields transform in the adjoint representation of a simple gauge group of the type SU(N,1). The corresponding gaugings in the other two infinite families lead to Yang-Mills-Einstein supergravity theories coupled to tensor multiplets.Comment: Latex 2e, 28 pages. v2: reference added, footnote 14 enlarge

Nurse-led telephone follow-up for early palliative care patients with advanced cancer

Aim and objectives To present our experience of a nursing telephone consultation service, describing patient and caregiver requests, and outlining ensuing nursing or medical interventions. Background Recently, there has been an increase in the use of telephone consultation for cancer patients. However, there is still limited data on the characteristics of this type of service and on the nature of the interventions carried out. Design and methods In this observational retrospective study, we evaluated the phone calls made over a 6-month period by patients or caregivers to the early palliative care team of a cancer institute. Information regarding telephone calls (frequency, reason and management) was systematically collected by a nursing case manager. The study complies with the STROBE checklist File S1. Results 171 patients used the service, for a total of 323 phone calls. The majority (80.8%) were from patients followed at the outpatient clinic and the most common requests were for pain management (38.4%) and for updates on the clinical situation (23.8%). Other frequent requests were for medication management (18.9%) and scheduling (18.3%). 210 of the 323 phone calls were handled by the nurse, while 22 were managed in collaboration with a physician. An 87.6% effectiveness in telephone management was observed. Conclusion The overall use of the phone service was higher for early palliative care patients. The majority of phone calls were effectively handled by the nursing case manager. Relevance to clinical practice An effective and feasible nurse-led telephone follow-up of early palliative care patients with advanced cancer could improve their care experience. Specifically, it could impact on patients and families improving quality of life and symptom control securing access to timely care without travel or additional cost.It can also improve continuity of care, adherence to oncological treatments and minimise acute care visits

Development of a predictive model for patients with bone metastases referred to palliative radiotherapy: Secondary analysis of a multicenter study (the PRAIS trial)

Background: The decision to administer palliative radiotherapy (RT) to patients with bone metastases (BMs), as well as the selection of treatment protocols (dose, fractionation), requires an accurate assessment of survival expectancy. In this study, we aimed to develop three predictive models (PMs) to estimate short-, intermediate-, and long-term overall survival (OS) for patients in this clinical setting. Materials and Methods: This study constitutes a sub-analysis of the PRAIS trial, a longitudinal observational study collecting data from patients referred to participating centers to receive palliative RT for cancer-induced bone pain. Our analysis encompassed 567 patients from the PRAIS trial database. The primary objectives were to ascertain the correlation between clinical and laboratory parameters with the OS rates at three distinct time points (short: 3 weeks; intermediate: 24 weeks; prolonged: 52 weeks) and to construct PMs for prognosis. We employed machine learning techniques, comprising the following steps: (i) identification of reliable prognostic variables and training; (ii) validation and testing of the model using the selected variables. The selection of variables was accomplished using the LASSO method (Least Absolute Shrinkage and Selection Operator). The model performance was assessed using receiver operator characteristic curves (ROC) and the area under the curve (AUC). Results: Our analysis demonstrated a significant impact of clinical parameters (primary tumor site, presence of non-bone metastases, steroids and opioid intake, food intake, and body mass index) and laboratory parameters (interleukin 8 [IL-8], chloride levels, C-reactive protein, white blood cell count, and lymphocyte count) on OS. Notably, different factors were associated with the different times for OS with only IL-8 included both in the PMs for short- and long-term OS. The AUC values for ROC curves for 3-week, 24-week, and 52-week OS were 0.901, 0.767, and 0.806, respectively. Conclusions: We successfully developed three PMs for OS based on easily accessible clinical and laboratory parameters for patients referred to palliative RT for painful BMs. While our findings are promising, it is important to recognize that this was an exploratory trial. The implementation of these tools into clinical practice warrants further investigation and confirmation through subsequent studies with separate databases

Pain Management Adequacy in Patients With Bone Metastases: A Secondary Analysis From the Palliative Radiotherapy and Inflammation Study Trial

Background: Bone metastases (BMs) are a common complication in patients with cancer, often leading to significant pain that adversely affects quality of life, necessitating effective pain management strategies. This study aims to evaluate the effectiveness of pain management in patients with BMs undergoing palliative radiotherapy and to identify determinants of pain management adequacy. Methods: We conducted an observational analysis of 560 patients from the Palliative Radiotherapy and Inflammation Study (PRAIS) trial across several European centers, focusing on the Pain Management Index (PMI) for assessing pain management adequacy. Key predictors examined included Karnofsky Performance Status (KPS), treatment setting, primary tumor type, and site of BMs. Results: Our findings indicate that 19.0% of patients experienced inadequate pain management (PMI < 0). Specifically, patients with KPS ⩾ 90 had a notably lower rate of adequate analgesic therapy (59.3%) compared with those with a KPS < 90 (85.0%). Among outpatients, 23.7% reported inadequate pain management, contrasted with a significantly lower inadequacy rate (3.8%) in palliative care or hospice settings. In addition, in outpatients, pain management adequacy varied with the primary tumor type, showing improved outcomes for patients with lung cancer (89.2%) versus other primary tumors (79.1%). Moreover, in non-outpatients, pain management was less effective for patients receiving radiotherapy on pelvic BMs (89.5%) compared with other sites (95.7%). Conclusion: Although overall rates of inadequate pain management were lower than seen in previous studies, significant variability exists based on patient health status, care setting, primary tumor type, and site of BMs. These results underscore the need for personalized pain management approaches and highlight specific areas for improvement in outpatient settings and among patients with generally good health but significant pain from BMs

Prognostication in palliative radiotherapy-ProPaRT: Accuracy of prognostic scores

BackgroundPrognostication can be used within a tailored decision-making process to achieve a more personalized approach to the care of patients with cancer. This prospective observational study evaluated the accuracy of the Palliative Prognostic score (PaP score) to predict survival in patients identified by oncologists as candidates for palliative radiotherapy (PRT). We also studied interrater variability for the clinical prediction of survival and PaP scores and assessed the accuracy of the Survival Prediction Score (SPS) and TEACHH score. Materials and methodsConsecutive patients were enrolled at first access to our Radiotherapy and Palliative Care Outpatient Clinic. The discriminating ability of the prognostic models was assessed using Harrell's C index, and the corresponding 95% confidence intervals (95% CI) were obtained by bootstrapping. ResultsIn total, 255 patients with metastatic cancer were evaluated, and 123 (48.2%) were selected for PRT, all of whom completed treatment without interruption. Then, 10.6% of the irradiated patients who died underwent treatment within the last 30 days of life. The PaP score showed an accuracy of 74.8 (95% CI, 69.5-80.1) for radiation oncologist (RO) and 80.7 (95% CI, 75.9-85.5) for palliative care physician (PCP) in predicting 30-day survival. The accuracy of TEACHH was 76.1 (95% CI, 70.9-81.3) and 64.7 (95% CI, 58.8-70.6) for RO and PCP, respectively, and the accuracy of SPS was 70 (95% CI, 64.4-75.6) and 72.8 (95% CI, 67.3-78.3). ConclusionAccurate prognostication can identify candidates for low-fraction PRT during the last days of life who are more likely to complete the planned treatment without interruption.All the scores showed good discriminating capacity; the PaP had the higher accuracy, especially when used in a multidisciplinary way

Systematic versus on-demand early palliative care: results from a multicentre, randomised clinical trial

Background Early palliative care (EPC) in oncology has been shown to have a positive impact on clinical outcome, quality-of-care outcomes, and costs. However, the optimal way for activating EPC has yet to be defined. Methods This prospective, multicentre, randomised study was conducted on 207 outpatients with metastatic or locally advanced inoperable pancreatic cancer. Patients were randomised to receive ‘standard cancer care plus on-demand EPC’ (n = 100) or ‘standard cancer care plus systematic EPC’ (n = 107). Primary outcome was change in quality of life (QoL) evaluated through the Functional Assessment of Cancer Therapy – Hepatobiliary questionnaire between baseline (T0) and after 12 weeks (T1), in particular the integration of physical, functional, and Hepatic Cancer Subscale (HCS) combined in the Trial Outcome Index (TOI). Patient mood, survival, relatives' satisfaction with care, and indicators of aggressiveness of care were also evaluated. Findings The mean changes in TOI score and HCS score between T0 and T1 were −4.47 and −0.63, with a difference between groups of 3.83 (95% confidence interval [CI] 0.10–7.57) (p = 0.041), and −2.23 and 0.28 (difference between groups of 2.51, 95% CI 0.40–4.61, p = 0.013), in favour of interventional group. QoL scores at T1 of TOI scale and HCS were 84.4 versus 78.1 (p = 0.022) and 52.0 versus 48.2 (p = 0.008), respectively, for interventional and standard arm. Until February 2016, 143 (76.9%) of the 186 evaluable patients had died. There was no difference in overall survival between treatment arms. Interpretations Systematic EPC in advanced pancreatic cancer patients significantly improved QoL with respect to on-demand EPC