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Optimizing drug delivery systems using systematic "design of experiments." Part I: fundamental aspects.

Design of an impeccable drug delivery product normally encompasses multiple objectives. For decades, this task has been attempted through trial and error, supplemented with the previous experience, knowledge, and wisdom of the formulator. Optimization of a pharmaceutical formulation or process using this traditional approach involves changing one variable at a time. Using this methodology, the solution of a specific problematic formulation characteristic can certainly be achieved, but attainment of the true optimal composition is never guaranteed. And for improvement in one characteristic, one has to trade off for degeneration in another. This customary approach of developing a drug product or process has been proved to be not only uneconomical in terms of time, money, and effort, but also unfavorable to fix errors, unpredictable, and at times even unsuccessful. On the other hand, the modern formulation optimization approaches, employing systematic Design of Experiments (DoE), are extensively practiced in the development of diverse kinds of drug delivery devices to improve such irregularities. Such systematic approaches are far more advantageous, because they require fewer experiments to achieve an optimum formulation, make problem tracing and rectification quite easier, reveal drug/polymer interactions, simulate the product performance, and comprehend the process to assist in better formulation development and subsequent scale-up. Optimization techniques using DoE represent effective and cost-effective analytical tools to yield the "best solution" to a particular "problem." Through quantification of drug delivery systems, these approaches provide a depth of understanding as well as an ability to explore and defend ranges for formulation factors, where experimentation is completed before optimization is attempted. The key elements of a DoE optimization methodology encompass planning the study objectives, screening of influential variables, experimental designs, postulation of mathematical models for various chosen response characteristics, fitting experimental data into these model(s), mapping and generating graphic outcomes, and design validation using model-based response surface methodology. The broad topic of DoE optimization methodology is covered in two parts. Part I of the review attempts to provide thought-through and thorough information on diverse DoE aspects organized in a seven-step sequence. Besides dealing with basic DoE terminology for the novice, the article covers the niceties of several important experimental designs, mathematical models, and optimum search techniques using numeric and graphical methods, with special emphasis on computer-based approaches, artificial neural networks, and judicious selection of designs and models.

Drug Delivery Systems↗

Unique optimal foldings of proteins on a triangular lattice.

BACKGROUND: A problem for unique protein folding was raised in 1998: are there proteins having unique optimal foldings for all lengths in the hydrophobic-hydrophilic (hydrophobic-polar; HP) model? To such a question, it was proved that on a square lattice there are (i) closed chains of monomers having unique optimal foldings for all even lengths and (ii) open monomer chains having unique optimal foldings for all lengths divisible by four. In this article, we aim to extend the previous work on a square lattice to the optimal foldings of proteins on a triangular lattice by examining the uniqueness property or stability of HP chain folding. METHOD: We consider this protein folding problem on a triangular lattice using graph theory. For an HP chain with length n > 13, generally it is very time-consuming to enumerate all of its possible folding conformations. Hence, one can hardly know whether or not it has a unique optimal folding. A natural problem is to determine for what value of n there is an n-node HP chain that has a unique optimal folding on a triangular lattice. RESULTS AND CONCLUSION: Using graph theory, this article proves that there are both closed and open chains having unique optimal foldings for all lengths >19 in a triangular lattice. This result is not only general from the theoretical viewpoint, but also can be expected to apply to areas of protein structure prediction and protein design because of their close relationship with the concept of energy state and designability.

Algorithms↗

Determination of optimal immobilizing doses of a medetomidine hydrochloride and ketamine hydrochloride combination in captive reindeer.

OBJECTIVE: To establish optimal immobilizing doses of medetomidine hydrochloride (MED) with ketamine hydrochloride (KET) for hand- and dart-administered injections in captive reindeer. ANIMALS: 12 healthy 6- to 9-month-old reindeer (Rangifer tarandus tarandus). Procedure An optimal dose was defined as a dose resulting in an induction time of 150 to 210 seconds, measured from the time of IM injection until recumbency. Initially, each stalled reindeer was immobilized by hand-administered injection. If the induction time was > 210 seconds, the dose was doubled for the next immobilization procedure. If it was < 150 seconds, the dose was halved for the next immobilization procedure. This iteration procedure was continued for each reindeer until an optimal dose was found. Later the reindeer was placed in a paddock and darted with its optimal dose as determined by hand-administered injection. Adjusting to a linear relationship between dose and induction time, optimal darting doses for each reindeer were predicted and later verified. RESULTS: The established mean optimal hand- and dart-administered doses were 0.10 mg of MED/kg of body mass with 0.50 mg of KET/kg, and 0.15 mg of MED/kg with 0.75 mg of KET/kg, producing mean induction times of 171 seconds and 215 seconds, respectively. The mean induction time after darting was 5 seconds greater than the upper limit of the predefined time interval. CONCLUSIONS AND CLINICAL RELEVANCE: The higher dose requirement of MED-KET administration outdoors, compared with indoors, was explained by factors inherent in the darting technique and the different confinements. The iteration and the prediction methods seem applicable for determination of optimal doses of MED-KET in reindeer. The iteration and the prediction procedures may be used to reduce the number of experimental animals in dose-response studies in other species.

Analgesics↗

The moderating effect of optimism on the relation between hassles and somatic complaints.

The relations between hassles, dispositional optimism, and prospective reports of physical symptoms were examined in a group of 90 Hong Kong undergraduates. Given that most hassle scales are confounded by physical and psychological symptomatology, a decontaminated scale specifically tailored to the experiences of college students was used. Multiple regression analyses indicated that hassle scores and the interaction of hassles and optimism uniquely and reliably predicted symptom reporting. Optimism, however, did not reliably predict symptom reports when effects of hassles and the interaction of hassles and optimism were controlled. Inspection of the interaction showed that optimism predicted symptom scores only at high levels of hassles. The underlying mechanisms were discussed in the light of previous data linking optimism and adaptational outcomes via coping. It was suggested that further pursuit of the connection between optimism and coping in relation to measures of life stress would be worthwhile.

Adaptation, Psychological↗

Choice of optimality criteria for the design of crossbreeding experiments.

Crossbreeding experiments carried out over several generations and analyzed using genetic models including additive, dominance, and epistatic effects deserve careful planning. Designs should be optimized with respect to the specific aim of the experiment. Using an experiment with guinea pigs as an example, designs were optimized for three different criteria: D-optimality, where the determinant of the variance-covariance matrix of all parameters in the genetic model is minimized, DS-optimality, where a specific subset of parameters is of special interest and the respective determinant is minimized, and DA-optimality, where a linear function or a set of linear functions of the parameters in the model is of interest. The linear function used in this particular case relates to the comparison of a composite line of two breeds and a rotational crossbreeding system at equilibrium. The designs produced by a sequential design algorithm depend very much on the optimality criterion. Designs that are optimal for the comparison of composites and rotations are very inefficient for the estimation of the whole set of parameters in the model or the specific subset of special interest in this case. Assuming that the underlying genetic model is correct, composites and rotations at equilibrium may be compared extremely efficiently using only crosses arising in the first three generations of crossbreeding.

Algorithms↗

Optima: a windows-based program for computer-aided optimization of controlled-release dosage forms.

The purpose of this work was to develop a computer program that assists optimization of controlled-release devices, both visually and mathematically, using response surface methodology (RSM). A Windows-based computer program, Optima, which interactively implemented a number of subroutines for the optimization procedure, was developed. Optima is an integrated, user-friendly, and graphically oriented program for pharmaceutical dosage form optimization. Central composite design is implemented in the program. First- and second-order models containing up to five variables can be fitted to the data. The user can also choose between linear and exponential individual desirability functions, and use them to construct an overall desirability function that combines all the response variables in a single response. The program can predict the optimum levels of experimental variables, with respect to individual responses and/or the overall desirability. Optima has been successfully used in the development of sustained-release AZT-loaded microspheres. During the optimization process, three experimental variables were investigated and four responses were measured. The experimental design was a central composite design that was generated by the program. The response values were used by the program to calculate the individual desirability functions, which were then combined into an overall desirability function. The individual responses as well as the overall desirability function were optimized by fitting to a second-order polynomial equation. The response surfaces were generated and optimum levels of the experimental variables were predicted. The observed responses of the optimized formulation were very close to those predicted by Optima. The program proved to be a very useful, integrated tool for optimization of the controlled-release microspheres.

Computer Graphics↗

An "optimal" k-needle placement strategy and its application to guiding transbronchial needle aspirations.

This article addresses the problem of finding an "optimal" strategy for placing k biopsy needles, given a large number of possible initial needle positions. We consider two variations of the problem: (1) Calculate the smallest set of needles necessary to guarantee a successful biopsy; and (2) Given a number k, calculate k needles such that the probability of a successful biopsy is maximized. Note that "needle" is used as shorthand for the parameter vector that specifies the needle placement. Both problems are formulated in terms of two general, NP-hard optimization problems. Our k-needle placement strategy can be considered as "optimal" in the sense that we are able to formulate it as a known NP-hard problem for which it is believed (NP not equal P conjecture) that no efficient algorithm exists that computes the optimal solution. In other words, our strategy is "optimal" with respect to the best approximative algorithm known for the respective NP-hard problem. For the second variation we have implemented an approximative algorithm that is guaranteed to be within a factor of approximately 0.63 of the exact solution. Given a number k, the algorithm calculates k sets of parameters, each set specifying the placement of a needle and the corresponding probability of success. The resulting probabilities show that our approach can provide valuable decision support for the physician in choosing how many needles to place and how to place them.A typical example of a biopsy where the initial needle position is known approximately is a transbronchial needle aspiration (TBNA). We demonstrate how our "optimal" needle placement strategy can be used to achieve sensor-less guidance of TBNA. The basic idea is to use a patient-specific model of the tracheobronchial tree (from CT/MR) and our model for flexible endoscopes to preoperatively estimate the unknown position of the bronchoscope. The result is a set of candidate shapes for the unknown shape of the bronchoscope before needle placement or, in other words, a (large) number of possible initial needle positions. By parameterizing the handling of the bronchoscope, including the insertion of the biopsy needle, we are able to apply our "optimal" strategy. The result is a TBNA protocol that, if executed during the procedure, prescribes how to handle the bronchoscope to maneuver the needle into the target. With the aforementioned endoscope model, we present a new way of modeling long, flexible instruments. The algorithm requires no initialization or preprocessing and calculates the workspace of an instrument based on its insertion depth and a set of internal and external constraints.

Algorithms↗

MetMAP: an integrated Matlab package for analysis and optimization of metabolic systems.

In previous works we have presented and applied a method to predict the parameter profile that optimizes biochemical systems regarding either a single or a set of metabolic responses within physiological constraints [Vera et al., 2003a]. This optimization technique requires a previous model definition and a translation to S-system form and the use of widely available linear programming packages. However, in dealing with these issues the interested researcher has to confront additional difficulties because of a lack of connectivity among available software packages or routines specifically designed to perform different tasks. In addition to this difficulty is the unavailability of any automated package which is capable of performing such optimizations and the previous required analysis. This situation prompted us to develop an integrated software package able to deal with these tasks in a single program environment. In this paper we present a software package for the model definition, analysis and optimization of a biochemical system. It starts with a given model definition that is directly translated to its equivalent S-system form. Once the model quality assessment is performed (stability and sensitivity analysis) the program determines the parameter profile that yields the optimized response compatible with a predefined set of constraints. Moreover the package finds the set of solutions obtained when more than one system's responses are to be optimized (multiobjective optimization).

Algorithms↗

Optimism and coping with a breast cancer symptom.

This study was conducted to assess whether optimism was associated with less delay and anxiety in seeking care for breast cancer symptoms, expectations about such care seeking, and the likelihood of having breast cancer. The influence of optimism on delay and anxiety through expectations about care seeking or likelihood of breast cancer was also examined. Participants (N = 135) with breast cancer symptoms and no history of cancer were interviewed at a surgery clinic. Optimism was associated with less delay and anxiety in care seeking and with expectations of desirable outcomes of care seeking. After controlling for expectations about care seeking, the relationship of optimism and anxiety became nonsignificant. Adjusting for differences in occupational status, the relationship of optimism and delay was nonsignificant. Thus, optimism may influence anxiety in care seeking for breast cancer symptoms through situation-specific expectations. The influence of optimism on delay may be confounded with socioeconomic factors.

Adaptation, Psychological↗

Serum thyrotropin in primary hypothyroidism. A possible predictor of optimal daily levothyroxine dose in primary hypothyroidism.

BACKGROUND: Pretreatment thyrotropin levels may be a reliable predictor of the optimal daily dose of levothyroxine sodium in patients with primary hypothyroidism. However, the older method of serum thyrotropin determination, with the reference range of less than 1 to 8 mU/L, has given way to a newer, supersensitive thyrotropin assay, with a reference range of 0.5 to 5.0 mU/L. Thus, at present, the previously established relationship between the levothyroxine dose and the pretreatment serum thyrotropin concentration may not be reliable in predicting the optimal daily dose of levothyroxine. METHODS: We reassessed the relationship between the optimal daily levothyroxine dose and the pretreatment serum thyrotropin concentration as determined by the newer assay in 192 consecutive patients with primary hypothyroidism referred to an endocrinology clinic over a period of 4 years. RESULTS: The optimal daily dose of levothyroxine sodium ranged from 25 to 225 micrograms, with most patients (65%) requiring 100 to 150 micrograms/d and a median dose of 125 micrograms. Multiple regression analysis documented a significant curvilinear correlation between the mean pretreatment serum thryrotropin concentration and the optimal daily levothyroxine dose for individual groups divided according to available tablet strengths (r = .994, P < .001). A simple linear regression was also significant (r = .92, P < .001), although with an intercept much higher than the minimum levothyroxine sodium dose of 25 micrograms/d. However, the relationships markedly improved when the linear regressions were determined separately for two further subgroups at the median daily dose of 125 micrograms, providing equations to predict even the smallest optimal daily dose of levothyroxine. CONCLUSION: Pretreatment thyrotropin levels determined by new assays may also provide a useful guideline in determining the optimal daily maintenance dose of levothyroxine in patients with primary hypothyroidism.

Adult↗

Concepts of optimality and efficiency in biology and medicine from the viewpoint of philosophy of science.

If everything happens strictly according to the natural laws, which meet extremum principles, in what way can the possibility for life be characterised, so that the optimization processes of evolution can take place? Is it legitimate to "enlarge" the natural laws by certain laws of conservation? The question then arises of which are the new conservation quantities that are introduced by life itself? The concept of genidentity, which must not be confused with the biological concept of genes, is introduced and used to characterise the interface between animate and inanimate systems by the principle of conservation of genidentity. It thus becomes clear that animate systems can differ in the way and in how reliably they achieve their goal of self-preservation. The abundance of possibilities to be or not to be able to reach this goal offers the necessary scope in which the notion of a postulated assumed optimization in the theory of evolution is conceivable. The conservation principle of genidentical systems creates the possibility of evolutionary optimization by ranking these systems. An optimal lifespan of an individual genidentical system refers to the conservation principle of genidentical systems on a second supra-individual level (species). The optimization of the growth of a species needs the conservation of a genidentical system on a third level (symbiotic systems). The ranking of genidentical systems onto ever higher levels--so that the higher conservation principles always impose restrictions on the ones below--would come to an end when the minimization of raw materials and energy consumption limits all possible and available resources. Since the spectrum extending between opposite goals lies within the range of possible means of optimization, supposedly evolutionary goals of optimization are always attributed to nature by the observer.

Biological Evolution↗

The "less than optimal" cytology: importance in obstetric patients and in a routine gynecologic population.

OBJECTIVE: To determine whether patients with less than optimal Papanicolaou tests constitute a low-risk group for developing subsequent abnormalities and thus do not need early repeat screening. METHODS: For the 10-month period October 1989 to August 1990, all screening Papanicolaou tests were classified by the 1988 Bethesda System. Tests designated as less than optimal solely on the basis of lack of an endocervical component were the subject of the study. Prenatal patients with less than optimal tests had repeat tests at the postpartum visit (delayed-repeat group), whereas gynecologic less than optimal tests were repeated within 4 weeks (early-repeat group). The frequency of cytologic abnormalities in our routine gynecologic population was compared with that for both the delayed- and early-repeat testing groups. RESULTS: The less than optimal rate in obstetric patients was 10.2% (153 of 1492), which was significantly higher than the 5.6% rate (473 of 8411) in the routine gynecologic population (P < .0001). The rates of dysplasia or combined abnormalities (dysplasia, human papillomavirus, or atypia) in the delayed-repeat group did not differ significantly from those in the routine gynecologic population (P = .69 and P = .33, respectively). However, the rates of dysplasia or combined abnormalities were significantly lower in the early-repeat group than in the routine gynecologic population (P = .02 and P = .003, respectively). CONCLUSIONS: Less than optimal cervical cytologies occurred almost twice as often in obstetric as in gynecologic patients. Prenatal less than optimal test results were not associated with important cervical pathology, and repeat testing may safely be deferred until postpartum. In addition, early repeat testing in gynecologic patients is a low-yield procedure.

Adult↗

Dispositional optimism and open-label placebo responses in hair cortisol concentrations and psychological distress-A randomized controlled trial.

Open-label placebo (OLP) treatments show beneficial effects on various health-related outcomes, but studies investigating OLP effects on physiological measures remain scarce. This randomized controlled trial examined the effect of a 4-week OLP intervention on psychological distress and hair cortisol concentrations (HCC) in 202 healthy university students preparing for mandatory oral exams and whether dispositional optimism moderates the OLP effects. Participants were randomly assigned to an OLP or control group. Psychological distress was repeatedly assessed via negative affect, test anxiety, and subjective stress. HCC was measured before and within the intervention. Treatment expectations were additionally examined in interaction with optimism. Results show that OLPs significantly reduced psychological distress and HCC compared to the controls. Optimism moderated the OLP effect on HCC, with less optimistic individuals demonstrating the strongest reduction, independent of expectation. Optimism did not moderate OLP effects in psychological distress. However, the OLP effect on psychological distress depended on the three-way interaction of group, optimism, and expectation. The results suggest that OLPs alleviate the psychophysiological impact of a real-life stressor and indicate that optimism and expectation differently shape psychological and physiological OLP responses. These findings are discussed within the framework of the interactionist perspective.

Humans↗

A reinforcement learning-enhanced fuzzy multi-objective equilibrium optimization framework for multiple sequence alignment.

Multiple sequence alignment (MSA) is a fundamental task in bioinformatics, underpinning comparative genomics, structural analysis, and evolutionary inference. However, MSA remains a challenging multi-objective optimization problem due to the need to simultaneously maximize alignment accuracy, preserve conserved regions, and control gap proliferation, particularly in large and heterogeneous sequence collections. In this work, we propose MOFSACEO-MSA, a novel hybrid optimization framework for multiple sequence alignment that integrates a fuzzy multi-objective evaluation scheme with the Equilibrium Optimizer (EO) and a Soft Actor-Critic (SAC)-based adaptive control mechanism. The proposed framework formulates MSA as a dynamic multi-objective optimization problem, in which alignment quality is assessed using complementary residue-level and column-level criteria, including Sum-of-Pairs score, column conservation, entropy, and gap statistics. Fuzzy membership functions are employed to harmonize competing objectives into a unified optimization landscape, while EO provides robust global exploration. To further enhance adaptability, SAC dynamically regulates key EO parameters during the search process, enabling an effective balance between exploration and exploitation across datasets of varying size and heterogeneity. Extensive experiments werew conducted on diverse biological sequence datasets, with a primary focus on RNA benchmarks, including structured families from Rfam, large-scale repositories from RNAcentral and GenBank, and organism-specific tRNA datasets from GtRNAdb. Comparative evaluations against classical alignment tools (ClustalW, MAFFT, MUSCLE, PRANK, KAlign, and T-Coffee), metaheuristic methods (SAGA, Sequoya and EAFSA), and a reinforcement learning-based approach (RLALIGN) demonstrate that MOFSACEO-MSA consistently achieves competitive or superior Sum-of-Pairs scores while significantly reducing gap proportions and maintaining compact alignment lengths. Notably, the proposed framework exhibits improved robustness on large and highly heterogeneous datasets, where existing methods often suffer from excessive gap insertion or unstable convergence. Overall, MOFSACEO-MSA provides a flexible and extensible optimization paradigm that effectively bridges evolutionary search and reinforcement learning for high-quality multiple sequence alignment, with demonstrated effectiveness on challenging RNA alignment tasks.

Sequence Alignment↗

Dispositional optimism and the risk of cardiovascular death: the Zutphen Elderly Study.

BACKGROUND: Dispositional optimism, defined in terms of life engagement and generalized positive outcome expectancies for one's future, may be related to lower cardiovascular mortality. We aimed to determine whether dispositional optimism is a stable trait over time and whether it is independently related to lower cardiovascular mortality in elderly men. METHODS: In a cohort study with a follow-up of 15 years, we included 545 (61.4%) of 887 men, aged 64 to 84 years, who were free of preexisting cardiovascular disease and cancer and who had complete data on cardiovascular risk factors and sociodemographic characteristics. Dispositional optimism was assessed using a 4-item questionnaire in 1985, 1990, 1995, and 2000. In Cox proportional hazards models, the first 2 years of observation were excluded. RESULTS: Optimism scores significantly decreased over 15 years, but showed temporal stability (reliability coefficients, 0.72 over 5 years and 0.78 over 15 years; P < .001). Optimists in 1985 had a hazard ratio for cardiovascular mortality of 0.45 (top tertile vs lowest tertile; 95% confidence interval, 0.29-0.68), adjusted for classic cardiovascular risk factors. The risk of cardiovascular death was inversely associated with increased tertiles of dispositional optimism (P < .001 for trend). Similar results were obtained using 1990 data after additional adjustment for depression (assessed by the Zung Self-rating Depression Scale). CONCLUSION: Dispositional optimism is a relatively stable trait over 15 years and shows a graded and inverse association with the risk of cardiovascular death.

Affect↗

Kidney paired donation and optimizing the use of live donor organs.

CONTEXT: Blood type and crossmatch incompatibility will exclude at least one third of patients in need from receiving a live donor kidney transplant. Kidney paired donation (KPD) offers incompatible donor/recipient pairs the opportunity to match for compatible transplants. Despite its increasing popularity, very few transplants have resulted from KPD. OBJECTIVE: To determine the potential impact of improved matching schemes on the number and quality of transplants achievable with KPD. DESIGN, SETTING, AND POPULATION: We developed a model that simulates pools of incompatible donor/recipient pairs. We designed a mathematically verifiable optimized matching algorithm and compared it with the scheme currently used in some centers and regions. Simulated patients from the general community with characteristics drawn from distributions describing end-stage renal disease patients eligible for renal transplantation and their willing and eligible live donors. MAIN OUTCOME MEASURES: Number of kidneys matched, HLA mismatch of matched kidneys, and number of grafts surviving 5 years after transplantation. RESULTS: A national optimized matching algorithm would result in more transplants (47.7% vs 42.0%, P<.001), better HLA concordance (3.0 vs 4.5 mismatched antigens; P<.001), more grafts surviving at 5 years (34.9% vs 28.7%; P<.001), and a reduction in the number of pairs required to travel (2.9% vs 18.4%; P<.001) when compared with an extension of the currently used first-accept scheme to a national level. Furthermore, highly sensitized patients would benefit 6-fold from a national optimized scheme (2.3% vs 14.1% successfully matched; P<.001). Even if only 7% of patients awaiting kidney transplantation participated in an optimized national KPD program, the health care system could save as much as $750 million. CONCLUSIONS: The combination of a national KPD program and a mathematically optimized matching algorithm yields more matches with lower HLA disparity. Optimized matching affords patients the flexibility of customizing their matching priorities and the security of knowing that the greatest number of high-quality matches will be found and distributed equitably.

Algorithms↗

The hope construct, will, and ways: their relations with self-efficacy, optimism, and general well-being.

This investigation (N = 204) examined (a) the relations between the hope construct (Snyder, Harris et al., 1991; Snyder, Irving, & Anderson, 1991) and its two essential components, "will" and "ways," and the related constructs of self-efficacy and optimism; and (b) the ability of hope, self-efficacy, and optimism to predict general well-being. Maximum-likelihood factor analysis recovered will, ways, self-efficacy, and optimism as generally distinct and independent entities. Results of multiple regression analyses predicting well-being indicated that (a) hope taken as a whole predicts unique variance independent of self-efficacy and optimism, (b) will predicts unique variance independent of self-efficacy, and (c) ways predicts unique variance independent of optimism. Overall, findings suggest that will, ways, self-efficacy, and optimism are related but not identical constructs.

Adolescent↗

The association between treatment-specific optimism and depressive symptomatology in patients enrolled in a Phase I cancer clinical trial.

BACKGROUND: Previous research has found that cancer patients often overestimate the likelihood that they will achieve a positive response in Phase I trials. However, maintaining optimistic expectations may help patients cope with a poor prognosis and uncertain outcome. The authors prospectively examined the association between treatment-specific optimism and mental health among patients participating in a Phase I/b trial. METHODS: Twenty-four patients with metastatic renal cell carcinoma and 22 patients with metastatic melanoma completed an assessment battery at the beginning of treatment and 3 weeks later, on the final day of treatment. Patients completed measures of treatment-specific optimism (e.g., beliefs regarding the treatment working), depressive symptomatology, mood disturbance, and overall distress. RESULTS: The majority of patients believed that the treatment would either cure them (87%) or stop cancer progression (85%). Regression analyses revealed that the level of treatment-specific optimism (e.g., "The treatment I am receiving may cure me") was associated negatively with baseline measures of depressive symptoms (P < 0.006), mood disturbance (P < 0.001), and symptoms of distress (P < 0.0001) after controlling for age, number of metastases, and time since diagnosis. Patients with symptoms of clinical depression at baseline reported significantly lower levels of treatment-specific optimism than patients without symptoms (P < 0.03). Treatment-specific optimism also was associated negatively with symptoms of depression at the end of treatment (P < 0.003), controlling for symptoms of depression at the beginning of treatment. CONCLUSIONS: The results of the current study suggest that high levels of treatment-specific optimism are associated with better mental health outcomes at both the beginning and end of treatment.

Adult↗