Are women's breast cancer risk appraisals in line with updated clinical risk estimates communicated? Results from a UK Family History Risk and Prevention Clinic.

BACKGROUND: The incorporation of breast density and a polygenic risk score (PRS) into breast cancer risk prediction models can alter previously communicated risk estimates. Previous research finds that risk communication does not usually change personal risk appraisals. This study aimed to examine how women from the Family History Risk (FH-Risk) study appraise their breast cancer risk following communication of an updated risk estimate. METHODS: In the FH-Risk study 323 women attended a consultation to receive an updated breast cancer risk estimate. A subset (n=190) completed a questionnaire, assessing their subjective breast cancer risk appraisals, satisfaction with the information provided and cancer related worry. One hundred and three were notified of a decrease risk, 34 an increase and 53 an unchanged risk. RESULTS: Women's subjective risk appraisals were in line with the updated risk estimates provided, with age, a PRS and breast density explaining most of the variance in these appraisals. Those notified of an increased risk demonstrated higher subjective risk perceptions compared to those whose risk remained unchanged or decreased. CONCLUSIONS: Women's subjective breast cancer risk appraisals are amenable to change following updated risk feedback, with new information breast density and a PRS accepted and integrated into existing risk appraisals. Trust in the service, the analogies and visual communication strategies used may have positively influenced the integration of this new information. IMPACT: Further research is warranted to assess whether similar patterns emerge for other illnesses and in different clinical contexts to determine the best strategies for communicating updated risk estimates.

Understanding the experiences of older adult participants and individuals involved in the delivery of a physical activity programme based on participatory approaches: A qualitative analysis.

BACKGROUND: The present study aimed to understand the experiences of older adult participants and service deliverers involved in a UK-based physical activity programme, developed using participatory approaches. METHODS: Focus groups and one-to-one interviews were conducted with 34 older adults (aged 55+ years) and 13 service providers. Inductive thematic analysis was conducted, structured using the framework approach. FINDINGS: Four themes were identified: (1) Co-designed activities met needs and encouraged attendance; (2) engagement and access of programme activities; (3) enjoyment and perceived benefits of sessions; and (4) support needs of individuals delivering activities. Co-designed activities appeared to meet participant needs and instil a sense of ownership of the programme. Feeling able to relate to other participants seemed important and of potential relevance to attracting older adults to the programme. Peer support may help to increase confidence in attending sessions; place-based approaches (using resources in local communities) and a flexible approach to involvement also seemed to facilitate engagement. Enjoyment of the programme appeared to be enhanced through activity variety and opportunity for socializing, with a sense of community being created through the support and encouragement of fellow participants. It was considered important that volunteers had appropriate recognition and ongoing support. CONCLUSIONS: These findings suggest that using participatory approaches may facilitate enjoyment and sustained engagement of older adults. Provision based on local community assets may contribute to sustainability of services. However, providing ongoing support is imperative, requiring further costs and resources over the longer-term.

Women's experiences of risk-stratified breast cancer screening in the MyPeBS trial: a qualitative comparative study across two European countries.

OBJECTIVE: Risk-stratification should improve the benefits-to-harms ratio for breast screening, whereby higher-risk women receive additional screening and low-risk women are screened less. This study investigated the effects of healthcare context by comparing how women in England and France experienced risk-based breast screening. METHODS AND MEASURES: Fifty-two women were purposively sampled from participants who underwent risk-based screening in the MyPeBS trial. Women received objectively-derived 5-year breast cancer risk estimates (low = < 1%, average = 1-1.66%, high = ≥ 1.67 to <6%, very-high-risk = ≥ 6%). This determined future trial-related screening schedules and prevention options. Semi-structured interviews were transcribed for thematic framework analysis. RESULTS: Two overarching themes were produced: the importance of supported risk communication and accessibility of risk management. Overall, risk-based breast screening was viewed positively. However, trial procedures, especially in risk estimate provision, differed across sites. Women at increased risk were more reassured when appointments were with specialist healthcare professionals (HCP). When absent, this resulted in reduced satisfaction with risk communication and greater uncertainty about its personal relevance. Low-risk women's views on extended mammogram schedules seemed linked to how health services are organised differently. CONCLUSIONS: Context is an important consideration regarding acceptability of healthcare innovations such as risk-stratified screening: it should not be assumed that findings from one country apply universally.

Development of a breast cancer risk assessment and primary prevention pathway for women aged 30-39 years: Views of UK primary care providers on the role of primary care.

BACKGROUND: Identifying women aged 30-39 years at increased risk of developing breast cancer would allow them to receive screening and prevention offers. For this to be feasible, the practicalities of organising risk assessment and primary prevention must be acceptable to the healthcare professionals who would be responsible for delivery. It has been proposed that primary care providers are best placed to deliver a breast cancer risk assessment and primary prevention pathway. The present study aimed to investigate a range of primary care provider's views on the development and implementation of a breast cancer risk assessment and primary prevention pathway within primary care for women aged 30-39 years. METHODS: Twenty-five primary care providers working at general practices in either Greater Manchester or Cambridgeshire and Peterborough participated in five focus groups (n = 18) and seven individual interviews. Data were analysed thematically and organised using a framework approach. RESULTS: Three themes were developed. Challenges with delivering a breast cancer risk assessment and primary prevention pathway within primary care highlights that primary care are willing to facilitate but not lead delivery of such a pathway given the challenges with existing workload pressures and concerns about ensuring effective clinical governance. Primary care's preferred level of involvement describes the aspects of the pathway participants thought primary care could be involved in, namely co-ordinating data collection for risk assessment and calculating and communicating risk. Requirements for primary care involvement captures the need to provide a training and education package to address deficits in knowledge prior to involvement. Additionally, the reservations primary care have about being involved in the management of women identified as being at increased risk are discussed and suggestions are provided for facilitating primary care to take on this role. CONCLUSIONS: Despite optimism that primary care might lead a breast cancer risk assessment and primary prevention pathway, participants had a range of concerns that should be considered when developing such a pathway.

Revisiting sustainable resources in the combustion products of alumina-rich coal: Critical metal (Li, Ga, Nb, and REY) potential of ash from the Togtoh Power Plant, Inner Mongolia, China.

Coal fly ash has gained much attention as a potential alternative source for extracting critical metals such as Li, Ga, Nb, and lanthanides and yttrium (REY). This study investigates their distribution characteristics and modes of occurrence in alumina-rich fly ashes from the Togtoh Power Plant in Inner Mongolia, using various analytical methods. The objective was to provide a reference for the pre-enrichment of critical metals in fly ash. Lithium is primarily present in the glass phase, and its concentration is extremely low in the crystalline phases. Lithium is mainly concentrated in "pure" aluminosilicate glass, and is present but at a low level in Ca-rich aluminosilicate glass. Gallium is primarily present in the glass phase and in corundum, while Nb mainly exists in submicron zircon particles surrounded by Si-Al-Ca glass. Lanthanides and yttrium primarily occur in the glass phase and in crystalline phases, including an intermediate phase composed of the three end-member minerals of the gorceixite-crandallite-florencite series, as well as in monazite, crystalline forms of iron oxides and REY oxides. The Li concentrations in the alumina-rich fly ashes range from 562 to 894 µg/g for Li2O, from 43.9 to 81.9 µg/g for Ga, from 58.7 to 70.6 µg/g for Nb2O5, and from 258 to 450 µg/g for REY oxides, respectively, indicating their substantial potential for resource recovery. Especially, the 2nd row fly ash has the highest contents of these metals, allowing for direct extraction without the necessity for complex pre-processing. Physical separation can further enrich Li, Ga, Nb, and REY in the fly ash. In particular, particle size separation enriches these elements in the < 20 µm size range and magnetic separation enriches Li, Ga, Nb, and REY (except Ce) in the non-magnetic fraction. However, Ce is significantly enriched in the magnetic fraction compared to the original fly ash.

An app promoting weight gain prevention via healthy behaviours amongst young women with a family history of breast cancer: Acceptability and usability assessment.

BACKGROUND: Breast cancer is the most frequent female malignancy in the UK. Around 20% of cases are linked to weight gain, excess weight and health behaviours. We designed a weight gain prevention, health behaviour intervention for young women at increased risk. METHODS: The study comprised a single arm observational study over 2 months testing acceptability and usability of the intervention: online group welcome event, app and private Facebook group. Females aged 18-35 years at moderate or high risk of breast cancer (>17% lifetime risk) were recruited via invite letters and social media posts. The app included behaviour change techniques and education content. Online questionnaires were completed at baseline, as well as at 1 and 2 months. We also assessed feasibility of study procedures. RESULTS: Both recruitment methods were successful. Thirty-five women were recruited, 26% via social media posts. Median age was 33 (interquartile range = 28.2-34.5) years, the majority (94.1%) were of White ethnicity. Thirty-four participants were included in the analyses, of which 94% downloaded the app. Median self-monitoring logs per participant during the study period was 10.0 (interquartile range = 4.8-28.8). App quality mean (SD) score was 3.7 (0.6) at 1 and 2 months (scale: 1-5). Eighty-nine per cent rated the app at average or above at 1 month and 75.0% at 2 months. Nineteen women (55.9%) joined the Facebook group and there were 61 comments and 83 reactions and votes from participants during the study period. CONCLUSIONS: This first iteration of the app and intervention was well received and is suitable to progress to the next stage of refining and further testing.

Service Users' Experiences of a Nationwide Digital Type 2 Diabetes Self-Management Intervention (Healthy Living): Qualitative Interview Study.

BACKGROUND: Diabetes Self-Management Education and Support programs for people living with type 2 diabetes mellitus (T2DM) can increase glycemic control and reduce the risk of developing T2DM-related complications. However, the recorded uptake of these programs is low. Digital self-management interventions have the potential to overcome barriers associated with attendance at face-to-face sessions. Healthy Living is an evidence-based digital self-management intervention for people living with T2DM, based on the Healthy Living for People with Type 2 Diabetes (HeLP-Diabetes) intervention, which demonstrated effectiveness in a randomized controlled trial. NHS England has commissioned Healthy Living for national rollout into routine care. Healthy Living consists of web-based structured education and Tools components to help service users self-manage their condition, including setting goals. However, key changes were implemented during the national rollout that contrasted with the trial, including a lack of facilitated access from a health care professional and the omission of a moderated online support forum. OBJECTIVE: This qualitative study aims to explore service users' experiences of using Healthy Living early in the national rollout. METHODS: A total of 19 participants were interviewed via telephone or a videoconferencing platform. Topics included users' experiences and views of website components, their understanding of the intervention content, and the overall acceptability of Healthy Living. Transcripts were analyzed thematically using a framework approach. RESULTS: Participants valued having trustworthy information that was easily accessible. The emotional management content resonated with the participants, prompting some to book an appointment with their general practitioners to discuss low mood. After completing the structured education, participants might have been encouraged to continue using the website if there was more interactivity (1) between the website and other resources and devices they were using for self-management, (2) with health professionals and services, and (3) with other people living with T2DM. There was consensus that the website was particularly useful for people who had been newly diagnosed with T2DM. CONCLUSIONS: Digital Diabetes Self-Management Education and Support programs offering emotional aspects of self-management are addressing an unmet need. Primary care practices could consider offering Healthy Living to people as soon as they are diagnosed with T2DM. Participants suggested ways in which Healthy Living could increase interaction with the website to promote continued long-term use.

Acceptability of Four Intervention Components Supporting Medication Adherence in Women with Breast Cancer: a Process Evaluation of a Fractional Factorial Pilot Optimization Trial.

Adjuvant endocrine therapy (AET) reduces mortality in early-stage breast cancer, but adherence is low. We developed a multicomponent intervention to support AET adherence comprising: text messages, information leaflet, acceptance and commitment therapy (ACT), and side-effect website. Guided by the multiphase optimization strategy, the intervention components were tested in the ROSETA pilot optimization trial. Our mixed-methods process evaluation investigated component acceptability. The pilot optimization trial used a 24-1 fractional factorial design. Fifty-two women prescribed AET were randomized to one of eight experimental conditions, containing unique component combinations. An acceptability questionnaire was administered 4 months post-randomization, and semi-structured interviews with 20 participants further explored acceptability. Assessments were guided by four constructs of the theoretical framework of acceptability: affective attitude, burden, perceived effectiveness, and coherence. Quantitative and qualitative findings were triangulated to identify agreements/disagreements. There were high overall acceptability scores (median = 14-15/20, range = 11-20). There was agreement between the qualitative and quantitative findings when triangulated. Most participants "liked" or "strongly liked" all components and reported they required low effort to engage in. Between 50% (leaflet) and 65% (SMS) "agreed" or "strongly agreed," it was clear how each component would help adherence. Perceived effectiveness was mixed, with 35.0% (text messages) to 55.6% (ACT) of participants "agreeing" or "strongly agreeing" that each component would improve their adherence. Interview data provided suggestions for improvements. The four components were acceptable to women with breast cancer and will be refined. Mixed-methods and triangulation were useful methodological approaches and could be applied in other optimization trial process evaluations.

Watershed features shape spatial patterns of fish tissue mercury in a boreal river network.

Freshwater mercury (Hg) contamination is a widespread environmental concern but how proximate sources and downstream transport shape Hg spatial patterns in riverine food webs is poorly understood. We measured total Hg (THg) in slimy sculpin (Cottus cognatus) across the Kuskokwim River, a large boreal river in western Alaska and home to subsistence fishing communities which rely on fish for primary nutrition. We used spatial stream network models (SSNMs) to quantify watershed and instream conditions influencing sculpin THg. Spatial covariates for local watershed geology and slope accounted for 55 % of observed variation in sculpin THg and evidence for downstream transport of Hg in sculpins was weak. Empirical semivariograms indicated these spatial covariates accounted for most spatial autocorrelation in observed THg. Watershed geology and slope explained up to 70 % of sculpin THg variation when SSNMs accounted for instream spatial dependence. Our results provide network-wide predictions for fish tissue THg based largely on publicly available geospatial data and open-source software for SSNMs, and demonstrate how these emerging models can be used to understand contaminant behavior in spatially complex aquatic ecosystems.