The relationship between distress tolerance and symptoms of depression: Validation of the Distress Tolerance Scale (DTS) and short-form (DTS-SF).

OBJECTIVE: Distress tolerance (DT) has been found to be implicated in the development and maintenance of depressive symptomatology and various other significant psychological conditions. As such, it is critical to have measures of DT that are effective and easy to administer. This study aimed to examine the factor structure, psychometric properties, and clinical utility of the Distress Tolerance Scale (DTS) and the short-form version, the Distress Tolerance Scale Short-form (DTS-SF), in a large population of individuals with varying levels of self-reported depressive symptoms. METHOD: A total of 959 participants completed an online battery of questionnaires which included an assessment of depressive symptoms as well as the DTS and related measures. Results: Confirmatory factor analyses validated the four-factor structure of the DTS and the one-factor structure of the DTS-SF. Good construct validity and good internal consistency were observed across both the DTS and DTS-SF. CONCLUSION: Overall, this paper provides new evidence for the validity, reliability and discriminative ability of the DTS and the brief version of the questionnaire, the DTS-SF.

Correlative Imaging of Trace Elements and Intact Molecular Species in a Single-Tissue Sample at the 50 µm Scale.

Elemental and molecular imaging play a crucial role in understanding disease pathogenesis. To accurately correlate elemental and molecular markers, it is desirable to perform sequential elemental and molecular imaging on a single-tissue section. However, very little is known about the impact of performing these measurements in sequence. In this work, we highlight some of the challenges and successes associated with performing elemental mapping in sequence with mass spectrometry imaging. Specifically, the feasibility of molecular mapping using the mass spectrometry imaging (MSI) techniques matrix-assisted laser desorption ionization (MALDI) and desorption electrospray ionization (DESI) in sequence with the elemental mapping technique particle-induced X-ray emission (PIXE) is explored. Challenges for integration include substrate compatibility, as well as delocalization and spectral changes. We demonstrate that while sequential imaging comes with some compromises, sequential DESI-PIXE imaging is sufficient to correlate sulfur, iron, and lipid markers in a single tissue section at the 50 µm scale.

Preventing depression in older people with multimorbidity: 24-month follow-up of a trial of internet-delivered cognitive behaviour therapy.

BACKGROUND: older people coping with the impacts of living with multimorbidity are at increased risk of developing a depressive disorder. OBJECTIVE: this article reports the 24-month results of a randomised controlled trial of an internet-delivered cognitive behaviour therapy, which aimed to test whether depressive disorders could be prevented in this population. PARTICIPANTS: community-based participants aged 65 years and over, who had two or more chronic physical health conditions and were assessed as having no current depressive disorder. METHODS: in total, 302 participants were randomised to an 8-week, five-lesson, internet-delivered intervention program (n = 150) or treatment as usual (TAU, n = 152). The primary outcomes were cases of depressive disorder, assessed post-intervention and at 3-month intervals throughout the trial, and depressive symptoms, assessed at pre-intervention, post-intervention, 6, 12 and 24 months following the intervention. RESULTS: there were significantly fewer cases of depressive disorder in the intervention group (n = 23, 15%) compared with the TAU group (n = 41, 27%) during the 24 months after the intervention (χ2(1, N = 302) = 6.13, P = 0.013, odds ratio = 0.490 [95% confidence interval: 0.277, 0.867]), representing a 44% reduction in cases of depressive disorder. No differences were found on depressive symptoms at 24-month follow-up. Internet-delivered cognitive behaviour therapy had high engagement and acceptability. CONCLUSIONS: the results provide support that depressive disorders can be prevented in older people with multimorbidity through participation in internet-delivered cognitive behaviour therapy. With access to internet-delivered interventions in clinical care settings increasing, this has implications for older patient care where multimorbidity is extremely common.

Children's understanding of habitual behaviour.

Research into the development of Theory of Mind (ToM) has shown how children from a very early age infer other people's goals. However, human behaviour is sometimes driven not by plans to achieve goals, but by habits, which are formed over long periods of reinforcement. Habitual and goal-directed behaviours are often aligned with one another but can diverge when the optimal behavioural policy changes without being directly reinforced (thus specifically hobbling the habitual learning strategy). Unlike the flexibility of goal-directed behaviour, rigid habits can cause agents to persist in behaviour that is no longer adaptive. In the current study, all children predict agents will tend to behave consistently with their goals, but between the ages of 5 and 10, children showed an increasing understanding of how habits can cause agents to persistently take suboptimal actions. These findings stand out from the typical way the development of social reasoning is examined, which instead focuses on children's increasing appreciation of how others' beliefs or expectations affect how they will act in service of their goals. The current findings show that children also learn that under certain circumstances, people's actions are suboptimal despite potentially 'knowing better.'

Exploring the Facilitators and Barriers to Physical Activity in Older People With Sight Loss.

This study aimed to explore facilitators and barriers to physical activity in older people with sight loss. Focus groups were conducted with 13 community-dwelling older adults with sight loss ranging from poor to completely blind. Transcripts were analyzed using an inductive thematic analysis. Facilitators and barriers are experienced in three ways: psychologically; through opportunity and access; and at a societal and policy level. Campaigns are needed to challenge unhelpful age-related stereotypes at both psychological and societal levels. Additionally, interventions grounded in evidence and theory should be trialled and evaluated for increasing physical activity in this population.

Quantitative trait loci associated with soybean seed weight and composition under different phosphorus levels.

Seed size and composition are important traits in food crops and can be affected by nutrient availability in the soil. Phosphorus (P) is a non-renewable, essential macronutrient, and P deficiency limits soybean (Glycine max) yield and quality. To investigate the associations of seed traits in low- and high-P environments, soybean recombinant inbred lines (RILs) from a cross of cultivars Fiskeby III and Mandarin (Ottawa) were grown under contrasting P availability environments. Traits including individual seed weight, seed number, and intact mature pod weight were significantly affected by soil P levels and showed transgressive segregation among the RILs. Surprisingly, P treatments did not affect seed composition or weight, suggesting that soybean maintains sufficient P in seeds even in low-P soil. Quantitative trait loci (QTLs) were detected for seed weight, intact pods, seed volume, and seed protein, with five significant QTLs identified in low-P environments and one significant QTL found in the optimal-P environment. Broad-sense heritability estimates were 0.78 (individual seed weight), 0.90 (seed protein), 0.34 (seed oil), and 0.98 (seed number). The QTLs identified under low P point to genetic regions that may be useful to improve soybean performance under limiting P conditions.

Confirmatory factor analysis and examination of the psychometric properties of the eating beliefs questionnaire.

BACKGROUND: The Eating Beliefs Questionnaire (EBQ) is a 27-item self-report measure that assesses positive and negative beliefs about binge eating. It has been validated and its factor structure explored in a non-clinical sample. This study tested the psychometric properties of the EBQ in a clinical and a non-clinical sample. METHOD: A sample of 769 participants (573 participants recruited from the university and general community, 76 seeking treatment for an eating disorder and 120 participating in obesity research) completed a battery of questionnaires. A subset of clinical participants with a diagnosis of Bulimia Nervosa or Binge Eating Disorder completed the test-battery before and after receiving a psychological treatment (n = 27) or after allocation to a wait-list period (n = 28), and a subset of 35 community participants completed the test battery again after an interval of two-weeks. Confirmatory Factor Analysis (CFA) was performed. RESULTS: CFA found a two-factor structure that provided a good fit to the data, supporting the solution presented in the development paper. Items with poor psychometric properties were removed, resulting in a 16 item measure. EBQ scores were found to correlate with binge eating episode frequency, increases in body mass index (BMI), and measures of eating disorder behaviours and related psychopathology. The EBQ was found to have excellent internal consistency (α = .94), good test-retest reliability (r = .91) and sensitivity to treatment. CONCLUSION: These findings indicate that the EBQ is a psychometrically sound and clinically useful measure.

How behavioural science can contribute to health partnerships: the case of The Change Exchange.

BACKGROUND: Health partnerships often use health professional training to change practice with the aim of improving quality of care. Interventions to change practice can learn from behavioural science and focus not only on improving the competence and capability of health professionals but also their opportunity and motivation to make changes in practice. We describe a project that used behavioural scientist volunteers to enable health partnerships to understand and use the theories, techniques and assessments of behavioural science. CASE STUDIES: This paper outlines how The Change Exchange, a collective of volunteer behavioural scientists, worked with health partnerships to strengthen their projects by translating behavioural science in situ. We describe three case studies in which behavioural scientists, embedded in health partnerships in Uganda, Sierra Leone and Mozambique, explored the behaviour change techniques used by educators, supported knowledge and skill development in behaviour change, monitored the impact of projects on psychological determinants of behaviour and made recommendations for future project developments. DISCUSSION: Challenges in the work included having time and space for behavioural science in already very busy health partnership schedules and the difficulties in using certain methods in other cultures. Future work could explore other modes of translation and further develop methods to make them more culturally applicable. CONCLUSION: Behavioural scientists could translate behavioural science which was understood and used by the health partnerships to strengthen their project work.

Graves' disease in children: long-term outcomes of medical therapy.

BACKGROUND AND OBJECTIVES: Management options are limited for the treatment of Graves' disease, and there is controversy regarding optimal treatment. We describe the demographic and biochemical characteristics of children with Graves' disease and the outcomes of its management. METHODS: This is a retrospective study reviewing medical records from 2001 to 2011 at a tertiary-care paediatric hospital. Diagnostic criteria included elevated free T4 and total T3, suppressed TSH, and either positive thyroid-stimulating immunoglobulin or thyroid receptor antibodies or clinical signs suggestive of Graves' disease, for example exophthalmos. Patients were treated with antithyroid drugs (ATD), radioactive iodine, or thyroidectomy. The main outcome measures were remission after medical therapy for at least 6 months and subsequent relapse. RESULTS: A total of 291 children met diagnostic criteria. A total of 62 were male (21%); 117 (40%) were Hispanic, 90 (31%) Caucasian, and 59 (20%) African American. Mean age (±standard deviation) at diagnosis was 12·3 ± 3·8 (range 3-18·5) years. At diagnosis, 268 patients were started on an antithyroid drug and 23 underwent thyroid ablation or thyroidectomy. Fifty-seven (21%) children achieved remission and 16 (28%) of these patients relapsed, almost all within 16 months. Gender and ethnicity did not affect rates of remission or relapse. Of 251 patients treated with methimazole, 53 (21%) had an adverse reaction, including rash, arthralgias, elevated transaminases, or neutropenia. CONCLUSIONS: Most children with Graves' disease treated with ATD do not experience remission, but most remissions do not end in relapse. Adverse reactions to methimazole are common but generally mild.

Phenotypic variation and identification of quantitative trait loci for ozone tolerance in a Fiskeby III × Mandarin (Ottawa) soybean population.

KEY MESSAGE: Soybean quantitative trait loci for ozone response. Ground-level ozone reduces yield in crops such as soybean (Glycine max (L.) Merr.). Phenotypic variation has been observed for this trait in multiple species; however, breeding for ozone tolerance has been limited. A recombinant inbred population was developed from soybean genotypes differing in tolerance to ozone: tolerant Fiskeby III and sensitive Mandarin (Ottawa). Plants were exposed to ozone treatment for 5 days in greenhouse chambers followed by visual scoring for foliar injury. Mean injury score in the mid-canopy was 16 % for Fiskeby III, and 81 % for Mandarin (Ottawa). Injury scores were lower in younger leaves for both parents and progeny, compared to scores in the older leaves. Segregation was consistent with multigenic inheritance. Correlation coefficients for injury between leaf positions ranged from 0.34 to 0.81, with the closer leaf positions showing the greater correlation. Narrow sense heritability within an ozone treatment chamber was 0.59, 0.40, 0.29, 0.30, 0.19, and 0.35 for the 2nd, 3rd, 4th, 5th, 6th, and combined 3rd-5th main stem leaf positions (numbered acropetally), respectively, based on genotypic means over three independent replications. Quantitative trait loci (QTL) analysis showed that loci were associated with distinct leaf developmental stages. QTL were identified on Chromosome 17 for the 2nd and 3rd leaf positions, and on Chromosome 4 for the 5th and 6th leaf positions. Additional loci were identified on Chromosomes 6, 18, 19, and 20. Interacting loci were identified on Chromosomes 5 and 15 for injury on trifoliate 4. The ozone sensitive parent contributed one favorable allele for ozone response.

Psychometric evaluation of self-report measures of binge-eating symptoms and related psychopathology: A systematic review of the literature.

OBJECTIVE: Binge eating is a symptom common to bulimia nervosa, anorexia nervosa (binge/purge subtype), and binge eating disorder. There are many self-report measures available to aid the assessment of eating disorders symptoms, but there has not yet been a systematic review of the literature to identify the most valid and reliable measures for use in assessment and treatment of binge eating. METHOD: A systematic review of the psychometric properties of self-report measures that assess binge eating symptoms and psychopathology was conducted. Two independent raters assessed the psychometric properties of each measure using a standardized quality analysis tool. RESULTS: Of the 2,927 studies identified, 72 studies met the inclusion criteria and described the psychometric properties of 29 different self-report measures, and nine specific subscales within these. Results from the quality analysis tool utilized in this study indicated that none of the included measures currently meet all nine criteria of adequate psychometric properties. DISCUSSION: Most of the included measures had evidence for some adequate psychometric properties. Two measures received six out of nine positive ratings for the assessed psychometric properties, the BITE and the BULIT-R, and thus appear to be the measures with the most evidence of their validity and reliability. Overall, our findings implicate a need for further investigation of the psychometric properties of the available self-report questionnaires in this field.

Evaluation of a workshop to improve residents' patient-centred obesity counselling skills.

BACKGROUND: Primary care physicians are being asked to counsel their patients on obesity and weight management. Few physicians conduct weight loss counselling citing barriers, among them a lack of training and confidence. Our objective was to pilot test the effectiveness of a 3-h interactive obesity-counselling workshop for resident physicians based on motivational interviewing (MI) techniques. DESIGN: This study used a pretest/post-test cross-sectional design. A convenience sample of resident physicians was invited to participate. Participating resident physicians completed a preintervention and postintervention questionnaire to assess their knowledge, beliefs and confidence in obesity counselling. MI techniques taught in the intervention were evaluated by audio recording interviews with a standardised patient (SP) pre intervention and post intervention. Audio recordings were transcribed and coded by two independent coders using a validated assessment tool. Paired t tests were used to assess preintervention and postintervention differences. RESULTS: Eight-six residents attended the workshop. At baseline, the majority (71%) felt that there is not enough time to counsel patients about obesity and only 24% felt that residency trained them to counsel. After the intervention, knowledge and confidence in counselling increased (p<0.001). Among the 55 residents with complete pre-post SP interview data, MI adherent statements increased from a mean of 2.88 to 5.42 while the MI non-adherent statements decreased from 6.73 to 2.33 (p<0.001). CONCLUSIONS: After a brief workshop to train physicians to counsel on obesity-related behaviours, residents improved their counselling skills and felt more confident on counselling patients. Future studies are needed to assess whether these gains are sustained over time.

RNA-seq analysis reveals genetic response and tolerance mechanisms to ozone exposure in soybean.

BACKGROUND: Oxidative stress caused by ground level ozone is a contributor to yield loss in a number of important crop plants. Soybean (Glycine max) is considered to be ozone sensitive, and current research into its response to oxidative stress is limited. To better understand the genetic response in soybean to oxidative stress, an RNA-seq analysis of two soybean cultivars was performed comparing an ozone intolerant cultivar (Mandarin-Ottawa) and an ozone resistant cultivar (Fiskeby III) following exposure to ozone. RESULTS: Analysis of the transcriptome data revealed cultivar-specific expression level differences of genes previously implicated in oxidative stress responses, indicating unique cultivar-specific responses. Both Fiskeby III and Mandarin (Ottawa) exhibit an increased expression of oxidative response genes as well as glutathiones, phenylpropanoids, and phenylalanine ammonia-lyases. Mandarin (Ottawa) exhibited more general stress response genes whereas Fiskeby III had heightened expression of metabolic process genes. An examination of the timing of gene responses over the course of ozone exposure identified significantly more differentially expressed genes across all time points in Mandarin (Ottawa) than in Fiskeby III. The timing of expression was also considered to identify genes that may be indicative of a delayed response to ozone stress in Fiskeby III, We found that Mandarin (Ottawa) exhibits an higher level of expression in early time points for oxidative and general stress response genes while Fiskeby III seems to maintain expression of defense and stress response genes. Of particular interest was the expression of wax and cutin biosynthetic genes that we found to be expressed in Mandarin (Ottawa) in all sampled time points, whereas the expression of this pathway is only in the first time point for Fiskeby III. CONCLUSIONS: We were able to identify differentially expressed genes that correspond to each of the known or expected categories of genes previously implicated in other species for ozone stress. Our study shows evidence that at least part of the observed ozone tolerance of Fiskeby III may be due to its thicker, denser leaves providing passive resistance thereby limiting the degree of ozone exposure. The observed diminished genetic response is then likely a consequence of this reduced exposure.

QTL mapping and phenotypic variation of root anatomical traits in maize (Zea mays L.).

KEY MESSAGE: Root anatomical trait variation is described for three maize RIL populations. Six quantitative trait loci (QTL) are presented for anatomical traits: root cross-sectional area, % living cortical area, aerenchyma area, and stele area. Root anatomy is directly related to plant performance, influencing resource acquisition and transport, the metabolic cost of growth, and the mechanical strength of the root system. Ten root anatomical traits were measured in greenhouse-grown plants from three recombinant inbred populations of maize [intermated B73 × Mo17 (IBM), Oh43 × W64a (OhW), and Ny821 × H99 (NyH)]. Traits included areas of cross section, stele, cortex, aerenchyma, and cortical cells, percentages of the cortex occupied by aerenchyma, and cortical cell file number. Significant phenotypic variation was observed for each of the traits, with maximum values typically seven to ten times greater than minimum values. Means and ranges were similar for the OhW and NyH populations for all traits, while the IBM population had lower mean values for the majority of traits, but a 50% greater range of variation for aerenchyma area. A principal component analysis showed a similar trait structure for the three families, with clustering of area and count traits. Strong correlations were observed among area traits in the cortex, stele, and cross-section. The aerenchyma and percent living cortical area traits were independent of other traits. Six QTL were identified for four of the traits. The phenotypic variation explained by the QTL ranged from 4.7% (root cross-sectional area, OhW population) to 12.0% (percent living cortical area, IBM population). Genetic variation for root anatomical traits can be harnessed to increase abiotic stress tolerance and provide insights into mechanisms controlling phenotypic variation for root anatomy.

QTL mapping and phenotypic variation for root architectural traits in maize (Zea mays L.).

KEY MESSAGE: QTL were identified for root architectural traits in maize. Root architectural traits, including the number, length, orientation, and branching of the principal root classes, influence plant function by determining the spatial and temporal domains of soil exploration. To characterize phenotypic patterns and their genetic control, three recombinant inbred populations of maize were grown for 28 days in solid media in a greenhouse and evaluated for 21 root architectural traits, including length, number, diameter, and branching of seminal, primary and nodal roots, dry weight of embryonic and nodal systems, and diameter of the nodal root system. Significant phenotypic variation was observed for all traits. Strong correlations were observed among traits in the same root class, particularly for the length of the main root axis and the length of lateral roots. In a principal component analysis, relationships among traits differed slightly for the three families, though vectors grouped together for traits within a given root class, indicating opportunities for more efficient phenotyping. Allometric analysis showed that trajectories of growth for specific traits differ in the three populations. In total, 15 quantitative trait loci (QTL) were identified. QTL are reported for length in multiple root classes, diameter and number of seminal roots, and dry weight of the embryonic and nodal root systems. Phenotypic variation explained by individual QTL ranged from 0.44% (number of seminal roots, NyH population) to 13.5% (shoot dry weight, OhW population). Identification of QTL for root architectural traits may be useful for developing genotypes that are better suited to specific soil environments.

Development and validation of the Pain-Induced Comfort Eating Scale in a chronic pain sample.

Background: Chronic pain and higher body weight frequently co-occur. This common comorbidity is thought to be mediated by the use of comfort eating as a strategy for managing both the physical and psychological pain and discomfort associated with flare-ups of chronic pain. Valid and reliable assessment tools are needed to inform the development of effective treatments. Aims: This study aimed to assess the psychometric properties of a new brief measure of pain-induced comfort eating in chronic pain, the Pain-Induced Comfort Eating Scale (PICES). Methods: A sample of 166 patients with chronic pain completed an online test battery including the PICES along with measures of chronic pain and pain-related symptoms, disordered eating, and related psychological factors. Results: Results of exploratory factor analysis revealed a single-factor model for the four-item PICES. Further, the PICES demonstrated evidence of good internal consistency as well as convergent validity with demonstrated correlations with related measures. The results of this study also revealed that comfort eating in chronic pain appears to be related to psychological distress; the PICES correlated more strongly with measures assessing mood and psychological distress compared to interference/intensity of physical pain itself. Scores on the PICES also correlated strongly with measures of uncontrolled and emotional eating. Conclusions: Overall, our results indicate that the PICES provides a valid and useful brief measure of comfort eating in chronic pain that might be useful to inform treatments targeting the comorbid disordered eating practices that can lead to higher body weights in patients with chronic pain.

Contexte : La douleur chronique et un poids corporel élevé coexistent fréquemment.On pense que cette comorbidité commune est médiée par la consommation d'aliments de réconfort comme stratégie de gestion de la douleur physique et psychologique, ainsi que de l'inconfort associé aux poussées de douleur chronique. Des outils d'évaluation valides et fiables sont nécessaires pour informer le développement de traitements efficaces.Objectifs : Cette étude visait à évaluer les propriétés psychométriques d'une nouvelle mesure brève de la consommation d'aliments de réconfort induite par la douleur chronique, l'Échelle de consommation d'aliments de réconfort induite par la douleur (PICES).Méthodes : Un échantillon de 166 patients souffrant de douleur chronique se sont soumis à une batterie de tests en ligne comprenant le PICES, de même que des mesures de la douleur chronique et des symptômes liés à la douleur, des troubles alimentaires et des facteurs psychologiques associés.Résultats : Les résultats de l'analyse factorielle exploratoire ont révélé un modèle à un seul facteur pour le PICES à quatre éléments. De plus, le PICES a démontré une bonne cohérence interne ainsi qu'une validité convergente avec des corrélations démontrées avec des mesures connexes. Les résultats de cette étude ont également révélé que la consommation d'aliments de réconfort dans les cas de douleur chronique semble être liée à la détresse psychologique; le PICES était plus fortement corrélé aux mesures évaluant l'humeur et la détresse psychologique que l'interférence/l'intensité de la douleur physique elle-même. Les scores obtenus pour le PICES étaient également fortement corrélés avec des mesures de la consommation alimentaire incontrôlée et émotionnelle.Conclusions : Dans l'ensemble, nos résultats indiquent que l'échelle PICES constitue une mesure brève, valide et utile de la consommation d'aliments de réconfort par les patients souffrant de douleur chronique qui pourrait être utile pour informer les traitements ciblant les pratiques alimentaires comorbides qui peuvent conduire à la douleur. Les traitements ciblant les troubles alimentaires comorbides qui peuvent conduire à un poids corporel plus élevé chez les patients souffrant de douleur chronique pourraient s'en inspirer.

Evaluation of Inlet Temperature with Three Sprayer Designs for Desorption Electrospray Ionization Mass Spectrometry Tissue Analysis.

Mass spectrometry imaging (MSI) allows for the spatially resolved detection of endogenous and exogenous molecules and atoms in biological samples, typically prepared as thin tissue sections. Desorption electrospray ionization (DESI) is one of the most commonly utilized MSI modalities in preclinical research. DESI ion source technology is still rapidly evolving, with new sprayer designs and heated inlet capillaries having recently been incorporated in commercially available systems. In this study, three iterations of DESI sprayer designs are evaluated: (1) the first, and until recently only, commercially available Waters sprayer; (2) a developmental desorption electro-flow focusing ionization (DEFFI)-type sprayer; and (3) a prototype of the newly released Waters commercial sprayer. A heated inlet capillary is also employed, allowing for controlled inlet temperatures up to 500 °C. These three sprayers are evaluated by comparative tissue imaging analyses of murine testes across this temperature range. Single ion intensity versus temperature trends are evaluated as exemplar cases for putatively identified species of interest, such as lactate and glutamine. A range of trends are observed, where intensities follow either increasing, decreasing, bell-shaped, or other trends with temperature. Data for all sprayers show approximately similar trends for the ions studied, with the commercial prototype sprayer (sprayer version 3) matching or outperforming the other sprayers for the ions investigated. Finally, the mass spectra acquired using sprayer version 3 are evaluated by uniform manifold approximation and projection (UMAP) and k-means clustering. This approach is shown to provide valuable insight that is complementary to the presented univariate evaluation for reviewing the parameter space in this study. Full spectral temperature optimization data are provided as supporting data to enable other researchers to design experiments that are optimal for specific ions.

Is a nurse-led telephone intervention a viable alternative to nurse-led home care and standard care for patients receiving oral capecitabine? Results from a large prospective audit in patients with colorectal cancer.

Home care nursing has been shown to be a valuable service for patients receiving oral chemotherapy; however, associated costs can be high and telephone-based services may be more cost-effective options. This prospective audit explored the usefulness of a nurse-led telephone intervention for supporting cancer patients treated with Capecitabine, comparing historical findings from a randomised trial evaluating a home-based intervention over standard care with a modified nurse-led telephone follow-up intervention. Self-reported toxicity and service use were assessed in 298 patients who received nurse-led telephone follow-up, compared with historical data from 164 patients (81 receiving standard care and 83 home care intervention). Findings suggested that nurse-led telephone follow-up can potentially lead to reduced toxicity (chest pain, vomiting, oral mucositis, nausea, insomnia) when compared with standard care, and that it has a similar impact on the management of some symptoms when compared with home care (i.e. vomiting, oral mucositis), although it was not as effective as the home care intervention for other toxicities (diarrhoea and insomnia). These encouraging findings need to be explored further using a randomised trial design before we reach any conclusions. Further research should also include a health economics study to assess the cost-effectiveness of the telephone-based services for patients receiving oral chemotherapy.

Exploring Vegan Mothers' Experiences of Making Food Choices for Infants and Young Children.

OBJECTIVE: Our study aimed to explore vegan mothers' experiences and decision-making processes when feeding their children (up to 3 years old). METHODS: We conducted a qualitative photo-elicitation interview study in the United Kingdom. Eight vegan mothers provided 5 photographs of food choices they had made for their children and completed online photo-elicitation interviews to discuss these images. Data were transcribed verbatim and analyzed using reflexive thematic analysis. RESULTS: Five themes were developed: role modeling eating behavior, shared decision-making, nutritional guidance for vegan parents, fear of judgment for being vegan, and desire for convenience. CONCLUSIONS AND IMPLICATIONS: Findings illustrate the complexity of the decision-making process and highlight the need for targeted resources for vegan parents. There is a need for awareness raising and training for health care professionals and the development of vegan-specific child-feeding resources to facilitate the provision of evidence-based nutritional guidance for vegan parents.

"I don't know if I understood the whole process from the beginning": A photo-elicitation exploration of the experience of mastectomy and breast reconstruction decision making.

Objectives: Policy and guidance assume that reconstruction following mastectomy will have physical and psychological benefits, however research has disputed whether this is always the case. This study aimed to explore mastectomy experiences and reconstruction decision making. Methods: Semi-structured interviews about self-curated participant photographs of the breast cancer experience were analysed using interpretative phenomenological analysis (IPA). Results: Three themes were developed: 'Life before mastectomy'; 'I don't know if I understood the whole process from the beginning'; and getting back to 'normal'. Conclusions: Decisions regarding reconstruction were influenced by needs of others, and surgeons' communication and behaviour and negative experiences were prominent. Over time participants came to terms with physical and psychological impacts of mastectomy reporting re-finding themselves alongside acceptance of their post mastectomy bodies. However, many participants were living with the fear that their cancer may one day return. Communication skills training for healthcare professionals should be a priority to ensure decisions made result in the best possible outcomes for patients. Innovation: Photo-elicitation is a novel research method enabling rich investigation of mastectomy experiences. Self-curation of images enables patient-led discussions about mastectomy experience and illustrates the importance of life context. Photographs may have value within clinical training to facilitate understanding of patient experiences.