IntroductionNew classes of drugs for metastatic or unresectable melanoma (MM) have shown improved survival in randomized trials (e.g., anti-CTLA-4, anti-PD-1, BRAF/MEK inhibitors). We sought to describe uptake of these new drugs and their impact on population-based survival outcomes of MM.
Objectives and ApproachWe sought to describe uptake of these new drugs and their impact on population-based survival outcomes of MM. This was a retrospective, population-based cohort study of all treated MM in Ontario 2007-2015. Administrative data sources from the Institute for Clinical Evaluative Sciences (ICES) were utilized. Within ICES, cutaneous and non-cutaneous primaries were identified in the Ontario Cancer Registry. Administrative sources from Cancer Care Ontario, Ministry of Health and Long-Term Care, and Canadian Institute for Health Information identified patients treated with palliative systemic therapy, radiotherapy and metastatectomy. Temporal trends in utilization and survival were investigated. Survival by drug class was described.
ResultsWe identified 2,793 MM patients. First treatment was systemic therapy (46%), radiotherapy (41%) or metastatectomy (14%). MM patient number increased from 270 in 2007 to 418 in 2015. Systemic treatment rose from 125 MM first treated in 2007 to 343 in 2015. New drug treatments increased from <6% of reported first-line regimens in 2007 to 82\% in 2015. 1-year and 2-year overall survival (OS) was 28% and 15% respectively for all MM in 2007-2009, rising to 46% and 35% for 2014-2015 (logrank p<0.001; adjusted hazard ratio (AHR) 0.56, 95% confidence interval (CI): (0.49,0.63)). Survival gains were largely in the subset treated primarily systemically, where new drugs were increasingly utilized (2-year OS 16% 2007-2009 vs. 44% 2014-2015 logrank p<0.001; AHR 0.46, 95% CI: (0.38,0.56)).
Conclusion/ImplicationsUtilization of systemic therapy for MM has increased considerably in routine practice during 2007-2015; at least some of this increase relates to use of novel agents since 2011. In line with randomized trial findings, new drug adoption was associated with substantial increases in population-based MM survival.


This paper analyses inflation forecasting power of artificial neural networks with alternative univariate time series models for Turkey. The forecasting accuracy of the models is compared in terms of both static and dynamic forecasts for the period between 1982:1 and 2009:12. We find that at earlier forecast horizons conventional models, especially ARFIMA and ARIMA, provide better one-step ahead forecasting performance. However, unobserved components model turns out to be the best performer in terms of dynamic forecasts. The superiority of the unobserved components model suggests that inflation in Turkey has time varying pattern and conventional models are not able to track underlying trend of inflation in the long run.


Intimate partner violence (IPV) against women is a significant public health problem with negative physical and mental health consequences. Pregnant women are not immune to IPV, and as many as 4% to 8% of all pregnant women are victims of partner violence. Among pregnant women, IPV has been associated with poor physical health outcomes such as increased sexually transmitted diseases, preterm labor, and low-birth-weight infants. This article focuses on the physical health consequences of IPV for mothers and their infants. The purpose of this review is therefore to examine timely research ranging from 2001 to 2006 on IPV during pregnancy, the morbidity and mortality risks for mothers and their infants, and the association between IPV and perinatal health disparities. It will also identify gaps in the published empirical literature and make recommendations for practice, policy, and research.


Climatic fluctuations have severe effects on water and soil resources and economy as a whole. It is hence important to study the fluctuations of climatic parameters in different regions in order to recognize the source and type of parameter that have led to fluctuating climatic parameters. To achieve this goal, the current study attempts to address the following issues: what are the different sources of fluctuations in climate parameters? Do different regions have the same degree of vulnerability and what is the most fluctuating parameter in each region? To answer these questions, the study suggests climate vulnerability index fluctuation. Calculating the index requires data provided by weather stations, so weather stations (115 stations) were divided into 12 climatic zones based on the availability of data. This index considered permanent and frequent temperature, precipitation, storm and aridity shocks. The results indicated that the maximum rank of index has occurred in hot semi-mountainous and very hot desert. Also, temperature fluctuation was the major factor in five regions, whereas wind fluctuation was the major factor in three regions. Generally, the northern and western parts of the country experienced minimum climatic changes. Moving towards southern regions of the country, more climatic changes were observed.


Background Evidence shows that after anterior cruciate ligament (ACL) reconstruction, patients may have varied access to physical therapy. In particular, physical therapy input may end many months before patients reach full recovery. Telerehabilitation may provide an opportunity to address this rehabilitation gap and improve access to evidence-based rehabilitation alongside physical therapy at all stages of care. Objective This study aims to understand the opinions of patients who have undergone ACL surgery and rehabilitation on the use of telerehabilitation as part of ACL care and define the population and explore their experiences and views on the acceptability of telerehabilitation after ACL reconstruction. Methods This study was a cross-sectional, voluntary, web-based survey combining both closed and open questions. Ethical approval was obtained from the Yale School of Medicine Institutional Review Board. Participants were aged 16 years or older at the time of recruitment and had undergone ACL reconstruction within the past 5 years. A 26-item survey was developed using the Qualtrics survey platform. No items were mandatory. Responses were multiple choice, binary, and qualitative. The CHERRIES (Checklist for Reporting Results of Internet E-Surveys) was used to ensure the quality of reporting of surveys in the medical literature. Data were analyzed using Stata version 15. Qualitative data were analyzed using NVivo 11. The theoretical framework for this analysis is based on the Capability, Opportunity, and Motivation-Behavior model of behavior change. Results A total of 100 participants opened the survey. All completers were unique. The participation and completion rates were each 96% (96/100). Patients reported their physical therapy care ended at an average of 6.4 months and that they felt fully recovered at an average of 13.2 months. Only 26% (25/96) of patients felt fully recovered at the end of physical therapy. Of these 96 patients, 54 (60%) were younger than 30 years, 71 (74%) were recreational athletes, 24 (24%) were competitive athletes, 72 (75%) had private insurance, 74 (77%) were not familiar at all with telerehabilitation, and 89% (85/96) felt capable. They preferred to use telerehabilitation at different stages of care. Reported benefits included resource saving, improved access to care, improved learning, and greater engagement. Concerns included incorrect performance of exercises or unmanaged pain being missed and less access to manual therapy, motivation, and opportunities to ask questions. Participants' priorities for a future telerehabilitation intervention included its use as an adjunct to physical therapy rather than a replacement, with content available for each stage of care, especially return to sports. Participants stressed that the intervention should be personalized to them and include measures of progress. Conclusions These findings helped understand and define the ACL reconstruction population. Participants found telerehabilitation acceptable in principle and highlighted the key user requirements and scope of future interventions.