Cancer survivors' experiences of discharge from hospital follow-up.

Discharge from hospital follow-up is a key time point in the cancer journey. With recommendations for earlier discharge of cancer survivors, attention to the discharge process is likely to become increasingly important. This study explored cancer survivors' experiences of discharge from hospital follow-up. Survivors of breast, colorectal and prostate cancer (n= 1275), 5-16 years post diagnosis were approached to take part in a questionnaire survey. The questionnaire included questions about discharge status, provision of time/information prior to discharge, feelings at discharge and satisfaction with how discharge was managed. Completed questionnaires were returned by 659 survivors (51.7%). Approximately one-third of respondents were not discharged from follow-up 5-16 years post diagnosis. Of those discharged, a substantial minority reported insufficient time (27.9%), information (24.5-45.0%) or adverse emotions (30.9%) at the time of discharge. However, 90.6% of respondents reported satisfaction with how discharge from hospital follow-up was managed. Despite high levels of satisfaction, discharge of cancer survivors from hospital follow-up could be improved with the provision of additional time, information and support. Better structuring of the final hospital appointment or a review appointment in primary care at this time could help to ensure that discharge from hospital follow-up is managed optimally for cancer survivors.

Prevalence and factors associated with postpartum posttraumatic stress in a population-based maternity survey in England.

BACKGROUND: Studies on prevalence and factors associated with postpartum posttraumatic stress (PTS) typically do not distinguish between PTS related to childbirth (PTS-C) and PTS related to other stressors (PTS-O). This study aimed to describe the prevalence, clinical characteristics, and factors associated with PTS-C and PTS-O in postpartum women. METHODS: The study was a cross-sectional population-based survey of 16,000 postpartum women, selected at random from birth registrations in England to receive a postal questionnaire, including the Primary Care Posttraumatic Stress Disorder Screen. RESULTS: Questionnaires were returned by 4,509 women. The median age was 32 years (IQR=29-36), 64% were married, 77% were UK-born, and 76% were White-British. Prevalence of PTS-C was 2.5% (95%CI:2.0-3.0) and prevalence of PTS-O was 6.8% (95%CI:6.0-7.8). Women with PTS-C were significantly more likely to report re-experiencing symptoms (Chi-Square=7.69,p<0.01). Factors associated with PTS-C were: higher level of deprivation, not having a health professional to talk to about sensitive issues during pregnancy, and the baby being admitted for neonatal intensive care. Factors associated with PTS-O were: age ≤24 years, depression during pregnancy, and having a pregnancy affected by long-term health problems. Factors associated with both were: living without a partner, anxiety during pregnancy, pregnancy-specific health problems, and lower birth satisfaction. CONCLUSIONS: PTS during the postpartum period is relatively common and, for many women, unrelated to childbirth. Increased awareness among health professionals of prevalence, clinical characteristics and factors associated with postpartum PTS-C and PTS-O will aid the development of appropriate management protocols to identify and support women during the perinatal period. Posttraumatic stress, posttraumatic stress disorder, postpartum PTSD/PTS, birth-related PTSD/PTS, birth trauma, perinatal mental health.

Application and validation of the lattice Boltzmann method for modelling flow-related clotting.

The purpose of this paper is to present a simple clotting model, based on residence time and shear stress distribution, that can simulate the deposition over time of enzyme-activated milk in an in vitro system. Results for the model are compared with experiments exhibiting clot deposition in the region of a sharp-edged stenosis. The milk experiments have been shown to be a valuable analogue for the experimental representation of flow-induced blood clotting, particularly in the context of separation of hydrodynamic from biochemical factors. The facility to predict the flow-induced clotting of the blood analogue, in which the chemistry reduces to what is effectively a zeroth order reaction, gives confidence in this physics-based approach to simulation of the final part of the coagulation cascade. This type of study is a necessary precursor to the development of a complex, multi-factorial, biochemical model of the process of thrombosis. In addition to the clotting simulations, comparisons are reported between the computed flow patterns prior to clot deposition and flow visualisation studies. Excellent agreement of hydrodynamic parameters is reported for a Reynolds number of 100, and qualitative agreement is seen for the complex, disturbed flow occurring at a physiologically relevant Reynolds number of 550. The explicit, time-stepping lattice Boltzmann approach may have particular merit for the transitional flow at this higher Reynolds number.

Primary blast injuries to the eye: a review of the evidence.

OBJECTIVES: Eye injuries are relatively common following detonations. The majority of these are caused by secondary fragments. Primary blast injury to the eye (from the air-blast alone) has been described historically, but the differentiation of air-blast and fragment aetiologies in the reports is not clear. The aim of this review is to consider the evidence in the literature for true primary blast injury to the eye. METHODS: A literature review using Medline, Pub-med and Web of Knowledge databases. CONCLUSIONS: Overall, there is little conclusive evidence that primary ocular blast injury occurs in survivors of explosions. However, some case reports do surmise its occurrence and it cannot be unequivocally ruled out. If it does occur, it is more likely to be at high overpressures that will produce life-threatening injuries. The development of enhanced blast weapons may result in an increased incidence. At present however, the most severe and damaging threat to the eyes from blast remains the impact of fragments and debris.

Oxidation Effects in Rare Earth Doped Topological Insulator Thin Films.

The breaking of time-reversal symmetry (TRS) in topological insulators is a prerequisite for unlocking their exotic properties and for observing the quantum anomalous Hall effect (QAHE). The incorporation of dopants which exhibit magnetic long-range order is the most promising approach for TRS-breaking. REBiTe3, wherein 50% of the Bi is substitutionally replaced by a RE atom (RE = Gd, Dy, and Ho), is a predicted QAHE system. Despite the low solubility of REs in bulk crystals of a few %, highly doped thin films have been demonstrated, which are free of secondary phases and of high crystalline quality. Here we study the effects of exposure to atmosphere of rare earth-doped Bi2(Se, Te)3 thin films using x-ray absorption spectroscopy. We demonstrate that these RE dopants are all trivalent and effectively substitute for Bi(3+) in the Bi2(Se, Te)3 matrix. We find an unexpected high degree of sample oxidation for the most highly doped samples, which is not restricted to the surface of the films. In the low-doping limit, the RE-doped films mostly show surface oxidation, which can be prevented by surface passivation, encapsulation, or in-situ cleaving to recover the topological surface state.

Study of Dy-doped Bi2Te3: thin film growth and magnetic properties.

Breaking the time-reversal symmetry (TRS) in topological insulators (TIs) through ferromagnetic doping is an essential prerequisite for unlocking novel physical phenomena and exploring potential device applications. Here, we report the successful growth of high-quality (Dy(x)Bi(1-x))2Te3 thin films with Dy concentrations up to x = 0.355 by molecular beam epitaxy. Bulk-sensitive magnetisation studies using superconducting quantum interference device magnetometry find paramagnetic behaviour down to 2 K for the entire doping series. The effective magnetic moment, µeff, is strongly doping concentration-dependent and reduces from ∼12.6 µ(B) Dy(-1) for x = 0.023 to ∼4.3 µ(B) Dy(-1) for x = 0.355. X-ray absorption spectra and x-ray magnetic circular dichroism (XMCD) at the Dy M4,5 edge are employed to provide a deeper insight into the magnetic nature of the Dy(3+)-doped films. XMCD, measured in surface-sensitive total-electron-yield detection, gives µ(eff )= 4.2 µ(B) Dy(-1). The large measured moments make Dy-doped films interesting TI systems in which the TRS may be broken via the proximity effect due to an adjacent ferromagnetic insulator.

Massive Dirac Fermion Observed in Lanthanide-Doped Topological Insulator Thin Films.

The breaking of time reversal symmetry (TRS) in three-dimensional (3D) topological insulators (TIs), and thus the opening of a 'Dirac-mass gap' in the linearly dispersed Dirac surface state, is a prerequisite for unlocking exotic physical states. Introducing ferromagnetic long-range order by transition metal doping has been shown to break TRS. Here, we present the study of lanthanide (Ln) doped Bi2Te3, where the magnetic doping with high-moment lanthanides promises large energy gaps. Using molecular beam epitaxy, single-crystalline, rhombohedral thin films with Ln concentrations of up to ~35%, substituting on Bi sites, were achieved for Dy, Gd, and Ho doping. Angle-resolved photoemission spectroscopy shows the characteristic Dirac cone for Gd and Ho doping. In contrast, for Dy doping above a critical doping concentration, a gap opening is observed via the decreased spectral intensity at the Dirac point, indicating a topological quantum phase transition persisting up to room-temperature.

The influence of calcium on glucose metabolism in the rabbit lens.

Results were obtained which demonstrate that calcium accumulation in the rabbit lens may suppress glycolysis, not only by its inhibitory effect on cation transport but by its direct effect on glycolytic enzymes. In lenses cultured in calcium-enriched medium, lactate production declined in proportion to the increase in free and bound levels of calcium. In lens homogenates to which varying amounts of calcium were added, lactate production also decreased. To insure that excess calcium was not simply chelating ATP, homogenates were exposed to calcium and then dialyzed against a calcium-free buffer prior to addition of ATP. Under these conditions, lactate production diminished maximally by approximately 50% as bound calcium increased five-fold.

Intracellular calcium concentration and calcium transport in the rabbit lens.

Calcium-sensitive microelectrodes have been employed to determine that the free, intracellular concentration of calcium in the lens is approximately 30 microM. Additionally, active extrusion of intracellular calcium has been demonstrated.

Enzyme polymorphism in Trichinella.

The isoenzyme profiles of five isolates of the supposed 'species' of Trichinella, T. nativa, T. spiralis and T. nelsoni were compared. Four enzymes (AK, PGM, MPI and GPI) gave good resolution and clearly differentiated T. Spiralis from the other two species. T. nativa and T. nelsoni had similar isoenzyme patterns; the two separate isolates of T. nativa and T. spiralis used gave similar results, thus indicating the validity and the reproducibility of the technique. The value of enzyme electrophoresis for specific and subspecific classification of Trichinella is discussed and compared with the more traditional methods of taxonomy which have failed to resolve the controversy surrounding speciation.

Exogenous control of diel locomotor activity in the whitefish Coregonus clupeaformis: effects of light and temperature.

Data on factors determining activity cycles of nearctic fishes are scarce overall, and nonexistent for Coregoniae (family Salmonidae), a group with closely related and somewhat better known palaearctic species. We studied effects of photoperiodicity, light intensity and temperature on diel locomotor activity of lake whitefish Coregonus clupeaformis (Mitchill). Under LD 12:12, a day-active pattern was evident. Under continuous light (LL) and continuous dark (DD), rhythmicity was greatly suppressed or absent, respectively. Day-time activity levels were positively correlated with illuminance over the range tested (0.005 to 500 lux). At the three temperatures tested, activity was lowest at 7° C, highest at 12° C (a reported temperature optimum), and intermediate at 17° C. Our results suggest that level and diel pattern of lake whitefish activity are under overriding external control, and we find similarities with published data on the European species Coregonus lavaretus.

Effects of intracellular calcium on lens membrane permeability.

The present investigation was designed to assess whether lens membrane permeability is affected by changes in levels of intracellular calcium. Lanthanum, an inhibitor of Ca-ATPase, affected an increase in the concentration of intracellular calcium (Cai) measured in cortical fiber cells. Preculture of lenses in lanthanum (1.0mM) caused an accumulation of 36Cl during subsequent culture at a rate three-fold higher than control lenses. Changes in calcium levels, however, were not responsible for the observed flux changes because a 40mV depolarization was observed to occur prior to a significant increase in calcium levels. The non-specific effects of lanthanum and other potential inhibitors of calcium transport were avoided by preculturing lenses in an ion-HEPES medium containing 20mM calcium chloride. In lenses with a six-fold increase in calcium levels there resulted only a 10% increase in 36Cl uptake over a 3 hr period. 86Rb efflux was also measured and the rate constant was unchanged compared to control lenses. Calcium accumulation did lead to a small (8mV) depolarization which may account for the small increase in chloride accumulation. By light microscopy, morphology of cortical lens fibers and the epithelium appeared unchanged in the calcium-loaded lens. The results provide little evidence that an increase in Cai leads to acute changes in lens membrane permeability.

Fates of metal radiotracers added to a whole lake: accumulation in slimy sculpin (Cottus cognatus) and white sucker (Catostomus commersoni).

Six gamma-emitting isotopes, iron-59, cobalt-60, zinc-65, selenium-75, cesium-134 and mercury-203, were added in mid-summer to Lake 224 of the Experimental Lakes Area in northwestern Ontario, Canada. Isotope activities in whole bodies of slimy sculpins and in blood, gills, gut contents, kidney, liver and spleen of white suckers were determined for periods up to 247 days after isotope addition. Results demonstrate delay between contamination of a lake and transfer of contaminant to these fish species. General relationships between movement and distribution of isotopes in water and their accumulation in these fish indicate that direct accumulation from water is not a major route of uptake.

The modified Lothrop procedure: indications, results, and complications.

The modified Lothrop procedure or frontal sinus drill-out is a completely intranasal technique that creates a common frontonasal communication to allow drainage and ventilation of the chronically infected frontal sinus. It is an effective alternative to the classic frontal sinus obliteration. The modified Lothrop is usually performed on an outpatient basis, leaves no external scars, provides excellent visualization of the frontal sinus in the postoperative setting, and yields a high cure rate in chronically infected patients.

Health service computing: putting the patient on line.

The potential of computers for speeding up communications and routine decision-making in hospitals is still not being fully exploited. S. E. Harrison, formerly regional management services officer, SW Thames RHA, considers what hospitals need from a patient administration system and how it might be achieved.

Basic concepts and an overview of cryosurgery in ophthalmic plastic surgery.

In cryosurgery, a rapid double freeze using liquid nitrogen spray coupled with a slow thaw generates optimum cell destruction. Important factors in using the cryosurgical technique include temperature monitoring of the lesion, the type of instrumentation, the type of cryogen, and the nonhomogeneity of human tissue. Physiological processes occurring subsequent to cryogen application cause tissue necrosis. Cryosurgery is indicated for treatment of some basal cell carcinomas and occasional squamous cell carcinomas; most other lesions should be treated by surgical excision at the present time. The authors are involved in research to determine means of observing tissue destruction, temperature monitoring and control methods, and evaluation of post-thawing processes.

Real-time monitoring of intracellular Staphylococcus aureus replication.

A high-throughput system to rapidly assess the intracellular replication of Staphylococcus aureus has been developed utilizing S. aureus transformed with a dual gfp-luxABCDE reporter operon under the control of a growth-dependent promoter. Replication of tagged bacteria internalized into bovine mammary epithelial cells (MAC-T) could be measured by monitoring fluorescence and bioluminescence from the reporter operon following removal of extracellular bacteria from the plates. Bacterial replication inside cells was confirmed by a novel ex vivo time-lapse confocal microscopic method. This assay of bacterial replication was used to evaluate the efficacy of antibiotics which are commonly used to treat staphylococcal infections. Not all antibiotics tested were able to prevent intracellular replication of S. aureus and some were ineffective at preventing replication of intracellular bacteria at concentrations above the MIC determined for bacteria in broth culture. Comparison of the fluorescence and bioluminescence signals from the bacteria enabled effects on protein synthesis and metabolism to be discriminated and gave information on the entry of compounds into the eukaryotic cell, even if bacterial replication was not prevented. Elevated resistance of S. aureus to antibiotics inside host cells increases the likelihood of selecting S. aureus strains which are resistant to commonly used antimicrobial agents within the intracellular niche. The approach presented directly assesses intracellular efficacy of antibiotics and provides an evidence-based approach to antibiotic selection for prescribing physicians and medical microbiologists.

Exocrine secretions of bees V. Terpenoid esters in the Dufour's secretions ofPanurginus bees (Hymenoptera: Andrenidae).

The volatile components of Dufour's gland extracts were analyzed in two species of HolarcticPanurginus bees:Panurginus pontentillae andP. atramontensis. Two terpenoid esters, citronellyl citronellate and citronellyl geranate, were identified inP. pontentillae, whereas only the latter was inP. atramontensis. Citronellyl citronellate was identified in pollen ball extracts ofP. pontentillae. Mandibular gland extracts from male and femaleP. pontentillae contained neral and geranial. The significance of the Dufour's gland secretion in andrenid systematics and its function in the Andrenidae are discussed.