Pest population dynamics are related to a continental overwintering gradient.

Overwintering success is an important determinant of arthropod populations that must be considered as climate change continues to influence the spatiotemporal population dynamics of agricultural pests. Using a long-term monitoring database and biologically relevant overwintering zones, we modeled the annual and seasonal population dynamics of a common pest, Helicoverpa zea (Boddie), based on three overwintering suitability zones throughout North America using four decades of soil temperatures: the southern range (able to persist through winter), transitional zone (uncertain overwintering survivorship), and northern limits (unable to survive winter). Our model indicates H. zea population dynamics are hierarchically structured with continental-level effects that are partitioned into three geographic zones. Seasonal populations were initially detected in the southern range, where they experienced multiple large population peaks. All three zones experienced a final peak between late July (southern range) and mid-August to mid-September (transitional zone and northern limits). The southern range expanded by 3% since 1981 and is projected to increase by twofold by 2099 but the areas of other zones are expected to decrease in the future. These changes suggest larger populations may persist at higher latitudes in the future due to reduced low-temperature lethal events during winter. Because H. zea is a highly migratory pest, predicting when populations accumulate in one region can inform synchronous or lagged population development in other regions. We show the value of combining long-term datasets, remotely sensed data, and laboratory findings to inform forecasting of insect pests.

Development and validation of a patient reported experience measure for experimental cancer medicines (PREM-ECM) and their carers (PREM-ECM-Carer).

BACKGROUND: Our aim was to develop a validated Patient Reported Experience Measure (PREM) to capture patient and carer experience during participation in experimental cancer medicine trials (ECM): called PREM-ECM. METHODS: Mixed method design, consisting of four stages. Questionnaire items were produced for both patients and carers using interviews, focus groups, and cognitive interviews with patients and carers separately. For both patient and carer PREMs, a cross-sectional questionnaire study was conducted to identify final items for inclusion using hierarchical item reduction and Rasch analysis. Questionnaire validity and reliability were assessed, including administration feasibility. RESULTS: Initial interview participants suggested the need for three PREMs, two specific to patients: (i) a 'prior' questionnaire that captured experiences of trial introduction, screening, consenting, and early trial experience (< 6 weeks post consent); and (ii) 'on-trial' that captured experiences of ongoing consent and trial participation; and (iii) a PREM specific for carers. The draft 25-item 'prior' questionnaire was completed by 162 patients and 162 patients completed the draft 35-item 'on-trial' questionnaire. Hierarchical and Rasch analysis produced a 14-item 'prior' list and a 15-item list for 'on-trial'. Both patient PREM's demonstrated a good fit to the Rasch model following Bonferroni correction (X2p = 0.008). The carer 34-draft item questionnaire was completed by 102 participants. Hierarchical and Rasch analysis produced a 13-item list for PREM-ECM-Carer, with good fit to the Rasch model ( X2p = 0.62). The pilot testing demonstrated the feasibility of all the PREMs in capturing patient and caregiver experiences in routine clinical settings. CONCLUSIONS: The three PREM-ECM questionnaires will be the first validated experience measures for ECM trial patients and their carers. These questionnaires may be used to assess patients' and their carers' experiences of ECM and enable robust comparisons across cancer trial units highlighting areas for service improvement.

Understanding the experiences of lung cancer patients during the COVID-19 pandemic: a qualitative interview study.

PURPOSE: The study explores experiences of lung cancer patients during COVID-19 and considers how changes to care delivery and personal lives affected patient needs. METHODS: Semi-structured telephone interviews were conducted to explore experiences of lung cancer patients during COVID-19. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Interview participants were purposively selected based on age, gender, treatment status, timing of diagnosis (pre/post first COVID-19 lockdown) from a sample of lung cancer patients (any histological subtype/any cancer stage/any point in treatment) who had completed a questionnaire exploring how participants' lives were impacted by the pandemic and their thoughts on clinical care and remote communication. RESULTS: Thirty lung cancer patients who participated in the questionnaire study were approached and participated in an interview. Three themes were identified: (1) Adapting to new modes of communication (focusing on experiences of remote communication); (2) Experience of care delivery during the pandemic (describing how all aspects of care delivery had been affected); (3) Impact of the COVID-19 pandemic on quality of life (QOL) (focus on the psychological impact and feeling of reduced support). Themes 1 and 2 are heavily interlinked and both had bearing on patients' QOL experience. CONCLUSION: Lung cancer patients were impacted psychologically by changes to care delivery and changes in their personal life. The findings highlight some benefits to remote consultations but the stage of the treatment pathway and illness trajectory should be considered when determining if this is appropriate. Participants felt support from peers, family and friends was limited during the pandemic.

A Mobility Measure for Inpatient Rehabilitation Using Multigroup, Multidimensional Methods.

BACKGROUND AND PURPOSE: Inpatient rehabilitation facilities (IRFs) report patient functional status to Medicare and other payers using Quality Indicators (QI). While the QI is useful for payment purposes, its measurement properties are limited for monitoring patient progress. A mobility measure based on QI items and additional standardized assessments may enhance clinicians' ability to track patient improvement. Thus, we developed the Mobility Ability Quotient (Mobility AQ) to assess mobility during inpatient rehabilitation. METHODS: For 10 036 IRF inpatients, we extracted assessments from electronic health records, used confirmatory factor analysis to define subdimensions of mobility, and then applied multidimensional item response theory (MIRT) methods to develop a unidimensional construct. Assessments included the QI items and standardized measures of mobility, motor performance, and wheelchair and transfer skills. RESULTS: Confirmatory factor analysis resulted in good-fitting models (root-mean-square errors of approximation ≤0.08, comparative fit indices, and nonnormed fit indices ≥0.95) for 3 groups defined by anticipated primary mode of locomotion at discharge-walking, wheelchair propulsion, or both. Reestimation as a multigroup, MIRT model yielded scores more sensitive to change compared with QI mobility items (dlast-first = 1.08 vs 0.60 for the QI; dmax-min = 1.16 vs 1.05 for the QI). True score equating analysis demonstrated a higher ceiling and lower floor for the Mobility AQ than the QI. DISCUSSION AND CONCLUSIONS: The Mobility AQ demonstrates improved sensitivity over the QI mobility items. This MIRT-based mobility measure describes patient function and progress for patients served by IRFs and has the potential to reduce assessment burden and improve communication regarding patient functional status.Video Abstract available for more insights from authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A341).

Development of a Multidimensional, Multigroup Measure of Self-Care for Inpatient Rehabilitation.

OBJECTIVE: To develop and evaluate a measure of clinician-observed and patient-performed self-care function for use during inpatient rehabilitation. DESIGN: Retrospective analysis of self-care assessments collected by therapists using confirmatory factor analysis (CFA) followed by multidimensional item response theory (MIRT). SETTING: Freestanding inpatient rehabilitation hospital in the Midwestern United States. PARTICIPANTS: Inpatients (N=7719) with stroke, traumatic brain injury, spinal cord injury, neurologic disorders, and musculoskeletal conditions. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: A total of 19 clinician-selected self-care measures including the FIM and patient-performed, clinician-rated measures of balance, upper extremity function, strength, changing body position, and swallowing. Clinicians completed assessments on admission and at least 1 interim assessment. RESULTS: CFA was completed for 3 patient groups defined by their highest level of balance (sitting, standing, walking). We reduced the number of items by 47.5% while maintaining acceptable internal consistency; unidimensionality within each item set required development of testlets. A recursive analysis defined a self-care measure with sensitivity (Cohen dmax-min =1.13; Cohen dlast-first.=0.91) greater than the FIM self-care items (dmax-min.=0.94; dlast-first .=0.83). The CFA models provided good to acceptable fit (root mean square error of approximations 0.03-0.06). Most patients with admission FIM self-care ratings of total assistance (88%, 297 of 338) made improvements on the MIRT self-care measure that were undetected by the FIM; the FIM detected no change for 26% of these patients (78 of 297). The remaining 74% (219 of 297) improved on the MIRT-based measure an average of 14 days earlier than was detected by the FIM. CONCLUSIONS: This MIRT self-care measure possesses measurement properties that are superior to the FIM, particularly for patients near its floor or ceiling. Methods assure accommodation for multidimensionality and high levels of sensitivity. This self-care measure has the potential to improve monitoring of self-care and manage therapy effectively during inpatient rehabilitation.

Evaluation of the safety and effectiveness of prostate-specific antigen (PSA) monitoring in primary care after discharge from hospital-based follow-up following prostate cancer treatment.

OBJECTIVE: To examine follow-up procedures after men are discharged into primary care following prostate cancer and highlight any areas for service improvement. METHODS: Patient record data from two Greater Manchester boroughs were retrieved retrospectively to investigate discharge instructions and monitoring adherence. Questionnaires were sent to patients exploring their understanding of the follow-up process. RESULTS: A total of 300 records were accessed. Prostate-specific antigen (PSA) re-referral level was provided to GPs in 39% of cases. Forty- six percent of men were not tested frequently enough, and 6% had no PSA testing recorded post-discharge. A total of 222 patient questionnaires were returned. Sixty-seven percent felt GPs should be responsible for PSA monitoring, and 60% felt confident that their GP was doing so effectively. Conversely, 12% felt their PSA monitoring had been neglected. CONCLUSION: The findings highlight the complex nature of the follow-up and monitoring processes for prostate cancer patients. There is an urgent need for consensus in terms of monitoring frequency and referral pathways. Many patients do not engage in accurate monitoring post-treatment which has implications for early diagnosis of recurrence. Findings will be used to create an evidence-based, uniform Greater Manchester PSA monitoring service which is safe, acceptable and effective for all.

Patient and professional experiences of palliative care referral discussions from cancer services: A qualitative interview study.

OBJECTIVES: The aim of this paper was to identify current barriers, facilitators and experiences of raising and discussing palliative care with people with advanced cancer. METHODS: Semi-structured interviews were conducted with patients with advanced cancer and healthcare professionals (HCPs). Patients were included who had and had not been referred to palliative care. Transcripts were analysed using framework analysis. RESULTS: Twenty-four patients and eight HCPs participated. Two overarching themes and five sub-themes emerged: Theme one-referral process: timing and triggers, responsibility. Theme two-engagement: perception of treatment, prognosis and palliative care, psychological and emotional preparedness for discussion, and understanding how palliative care could benefit present and future care. CONCLUSION: There is a need to identify suitable patients earlier in their cancer trajectory, address misconceptions about palliative care, treatment and prognosis, and better prepare patients and HCPs to have meaningful conversations about palliative care. Patients and HCPs need to establish and communicate the relevance of palliative care to the patient's current and future care, and be clear about the referral process.

Fusarium Hardlock Associated With Lygus lineolaris (Hemiptera: Miridae) Injury in Southeastern Cotton.

The tarnished plant bug, Lygus lineolaris (Palisot de Beauvois), is an important insect pest in cotton that feeds on reproductive fruit, contributing to yield loss. Economically damaging infestations of L. lineolaris have doubled in Virginia since 2013. Escalation of L. lineolaris abundance may increase Fusarium hardlock disease observed in this region, compounding economic losses. Research has linked Fusarium hardlock with fungal species Fusarium verticillioides and F. proliferatum. Field and greenhouse experiments were performed to investigate (i) Fusarium hardlock occurrence in field plots managed and unmanaged for L. lineolaris, (ii) severity of F. verticillioides infection of cotton bolls with and without the presence of L. lineolaris feeding in a greenhouse setting, and (iii) Fusarium species composition and prevalence within field-collected L. lineolaris and cotton lint with and without insect feeding injury and hardlock symptoms present. Nearly twice the amount of hardlock (i.e., proportion of hardlocked locules) occurred in field-collected bolls with L. lineolaris feeding symptoms (0.40 ± 0.02) compared with bolls without (0.21 ± 0.01). Based on real-time quantitative PCR, cotton bolls exposed to F. verticillioides inoculum and caged with L. lineolaris adults had greater levels of F. verticillioides DNA compared with untreated bolls. F. proliferatum, F. verticillioides, and F. fujikuroi were isolated from field-collected L. lineolaris and hardlocked cotton lint at harvest. These findings suggest that the presence of L. lineolaris is associated with an increased risk of Fusarium hardlock in Southeastern cotton, and both should be carefully managed using timely insecticide applications and cultural control practices to minimize yield loss.

The Role of e-Health in the Delivery of Care for Patients with Hematological Cancers: A Systematic Literature Review.

Background: Hematological cancer survivors have significant unmet needs. The use of e-health interventions has been shown to be effective in improving patient experiences and outcomes in other diseases. The aim of this review is to explore the role of e-health interventions in the delivery of care for patients with hematological cancers across the illness trajectory. Methods: A systematic narrative review approach using thematic analysis was used to identify the key issues and themes in the literature. Medical subject headings and keywords were used in several databases: Medline, Embase, PsycInfo, CINAHL, and The Cochrane Collaboration Cochrane Review Database. This review focuses on the use of e-health interventions for patients with hematological cancers within any study design. Results: Twenty-three (n = 23) studies were identified in this review. The studies were of varying designs: randomized controlled trials (n = 6); pre- and postdesign (n = 1); feasibility and acceptability (n = 11) and varying methodological quality. Seven studies included patients with any cancer diagnosis rather than focusing specifically on hematology patients. Our thematic analysis identified four main categories of intervention: information provision (n = 4); self-help (n = 6); communication facilitation (n = 5); and patient-reported outcome recording or monitoring (n = 8). Conclusion: The clinical management of patients with hematological cancers, particularly those in survivorship, presents opportunities to explore e-health approaches to improve patient care. This review highlights that e-health tools may be acceptable and feasible to use with a hematology patient population, but more robust and well-designed trials that engage patients and health professionals are required to determine which and how interventions can be used most effectively.

Identifying professionals' needs in integrating electronic pain monitoring in community palliative care services: An interview study.

BACKGROUND: Poor pain assessment is a barrier to effective pain control. There is growing interest internationally in the development and implementation of remote monitoring technologies to enhance assessment in cancer and chronic disease contexts. Findings describe the development and testing of pain monitoring systems, but research identifying the needs of health professionals to implement routine monitoring systems within clinical practice is limited. AIM: To inform the development and implementation strategy of an electronic pain monitoring system, PainCheck, by understanding palliative care professionals' needs when integrating PainCheck into routine clinical practice. DESIGN: Qualitative study using face-to-face interviews. Data were analysed using framework analysis Setting/participants: Purposive sample of health professionals managing the palliative care of patients living in the community Results: A total of 15 interviews with health professionals took place. Three meta-themes emerged from the data: (1) uncertainties about integration of PainCheck and changes to current practice, (2) appraisal of current practice and (3) pain management is everybody's responsibility Conclusion: Even the most sceptical of health professionals could see the potential benefits of implementing an electronic patient-reported pain monitoring system. Health professionals have reservations about how PainCheck would work in practice. For optimal use, PainCheck needs embedding within existing electronic health records. Electronic pain monitoring systems have the potential to enable professionals to support patients' pain management more effectively but only when barriers to implementation are appropriately identified and addressed.

Patterns in Wheeled Mobility Skills Training, Equipment Evaluation, and Utilization: Findings from the SCIRehab Project.

Patients with traumatic spinal cord injury (SCI) participate in manual and power wheelchair (WC) skills training during inpatient rehabilitation; wheeled mobility evaluations aim to optimize use, fit, and function of equipment following discharge. Occupational and physical therapists documented treatment sessions during inpatient rehabilitation to describe types and quantity of WC skills training and adaptive equipment (AE) provided by neurological level of injury. Most patients participated in WC skills training; variation in type and frequency exists. Propulsion/driving skills were practiced most frequently. A majority of patients participated in equipment evaluations; assessment/prescription and fitting were performed frequently; mat evaluations were done infrequently. Most patients received mobility equipment in a timely manner; they continued to use their WC and were satisfied with its fit and function at the one-year injury anniversary. High levels of respondent satisfaction with fit and function of WCs suggest clinicians are prescribing mobility devices adequately and accurately supplementing information obtained during equipment assessment and fitting sessions with information from general treatment sessions. Variation in type and frequency of WC training provided by level of SCI and in types of WC prescribed use provides a foundation for future research to relate treatment modalities with functional and participation outcomes.

A novel insecticide, isocycloseram, shows promise as an alternative to chlorpyrifos against a direct pest of peanut, Diabrotica undecimpunctata howardi (Coleoptera: Chrysomelidae).

Larvae of the southern corn rootworm (SCR) Diabrotica undecimpunctata howardi Barber (Coleoptera: Chrysomelidae) are primary pests of peanut in the Virginia-Carolina region of the United States, and are relatively sporadic pests in southern states such as Georgia, Alabama, and Florida. Peanuts have strict quality standards which, when they are not met, can diminish crop value by more than 65%. Management of direct pests like SCR is therefore crucial to maintaining the economic viability of the crop. The soil-dwelling nature of SCR larvae complicates management due to difficulties associated with monitoring and predicting infestations. Nonchemical management options are limited in this system; preventative insecticide applications are the most reliable management strategy for at-risk fields. Chlorpyrifos was the standard product for larval SCR management in peanut until its registration was revoked in 2022, leaving no effective chemical management option for larvae. We tested a novel insecticide, isocycloseram, for its ability to reduce pod scarring, pod penetration, and non-SCR pod damage in field studies conducted in Suffolk, Virginia in 2020-2022. Overall injury was low in 2020 and 2022, and in 2022 there was not a significant effect of treatment. In 2021, 2 simulated chemigation applications of isocycloseram in July significantly reduced pod scarring and overall pod injury relative to chlorpyrifos and the untreated control. Our results suggest that isocycloseram may become an effective option for managing SCR in peanut, although more work is needed to understand the mechanisms by which it is effective as a soil-applied insecticide.

Advanced Ovarian Cancer Patients' Experiences of Surgical Treatment: A Qualitative Analysis.

OBJECTIVES: Recommended treatment for advanced ovarian cancer involves a combination of debulking surgery and chemotherapy. Surgery places a significant burden on a patient's physical, social, sexual, and emotional wellbeing. Existing research exploring the impact of surgery is often limited to questionnaire administration with large gaps between data collection time points, missing key aspects of the perioperative period. Little is known of the experience of ovarian cancer surgical treatment from a patient perspective. This research aims to qualitatively explore advanced ovarian cancer patients' experience of surgery and identify areas in which quality of life may be impacted. METHODS: Semi-structured telephone or face-to-face interviews were conducted with patients who had undergone combined surgical and chemotherapy treatment. Interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using an inductive approach to thematic analysis. RESULTS: Twenty ovarian cancer patients who had undergone debulking surgery participated in interviews lasting between 33 and 68 minutes. Qualitative analysis generated five key themes: (1) care services; (2) experiences of a stoma; (3) preoperative experience; (4) impact of surgery; and (5) coping mechanisms. CONCLUSIONS: Understanding the patient experience of surgical treatment for advanced ovarian cancer can help inform and improve future care. This research explored the ways in which a patient's quality of life is impacted by surgery and highlights areas in which further support may be needed. Knowledge of the patient experience may also aid decision-making for both clinicians and patients when considering different treatment pathways. IMPLICATIONS FOR NURSING PRACTICE: Results highlighted two crucial points in the surgical pathway where patients' need for emotional support was significant: during pre-op and recovering from surgery as an inpatient. Nursing staff are key to providing reassurance during this time. Specialized stoma nurses were also essential for supporting patients to adapt to their stomas both physically and psychologically.

Enhanced supportive care: prospective cohort study of oncology patients and caregivers.

OBJECTIVES: A prospective cohort study to evaluate clinical effectiveness of the enhanced supportive care (ESC) service at a comprehensive cancer centre and to explore the impact of the service on patient and caregiver outcomes and experience. METHODS: Patients who received care under the ESC service and their caregivers were eligible. Consented patients (n=184) and caregivers (n=67) completed questionnaires at baseline, 4 weeks and 8 weeks post-ESC. Patient questionnaires assessed quality of life (QOL), symptoms, experience of ESC and health service use. Caregiver questionnaires included QOL and needs assessment. Selected patients (n=13) participated in qualitative interviews. Quantitative analysis explored differences in questionnaire responses over time (p<0.05). Qualitative data were analysed thematically. RESULTS: Patient quantitative data showed improvements in QOL (p=0.004 for European Quality of Life Questionnaire 5 dimensions (EQ5D) health index scores) and anxiety (p=0.006) at 4 weeks, reduction in some symptoms (pain p=0.02 at 4 weeks), improvement in self-efficacy, an increase in problems being addressed and a decrease in health service use (reduction in outpatient appointments). Qualitative findings suggested patients were generally satisfied with the ESC service but identified areas for improvement such as increased awareness of ESC and earlier referral. Fewer improvements were noted for caregivers; however, they did report a decrease in unmet needs. CONCLUSION: The ESC service had a positive impact on various patient-reported and caregiver-reported outcomes. There were also positive impacts on health service use. Increasing awareness of ESC and engaging patients at an earlier stage in the disease trajectory may further improve patient satisfaction and outcomes.

Geographic and sociodemographic access to systemic anticancer therapies for secondary breast cancer: a systematic review.

BACKGROUND: The review aimed to investigate geographic and sociodemographic factors associated with receipt of systemic anticancer therapies (SACT) for women with secondary (metastatic) breast cancer (SBC). METHODS: Included studies reported geographic and sociodemographic factors associated with receipt of treatment with SACT for women > 18 years with an SBC diagnosis. Information sources searched were Ovid CINAHL, Ovid MEDLINE, Ovid Embase and Ovid PsychINFO. Assessment of methodological quality was undertaken using the Joanna Briggs Institute method. Findings were synthesised using a narrative synthesis approach. RESULTS: Nineteen studies published between 2009 and 2023 were included in the review. Overall methodological quality was assessed as low to moderate. Outcomes were reported for treatment receipt and time to treatment. Overall treatment receipt ranged from 4% for immunotherapy treatment in one study to 83% for systemic anticancer therapies (unspecified). Time to treatment ranged from median 54 days to 95 days with 81% of patients who received treatment < 60 days. Younger women, women of White origin, and those women with a higher socioeconomic status had an increased likelihood of timely treatment receipt. Treatment receipt varied by geographical region, and place of care was associated with variation in timely receipt of treatment with women treated at teaching, research and private institutions being more likely to receive treatment in a timely manner. CONCLUSIONS: Treatment receipt varied depending upon type of SACT. A number of factors were associated with treatment receipt. Barriers included older age, non-White race, lower socioeconomic status, significant comorbidities, hospital setting and geographical location. Findings should however be interpreted with caution given the limitations in overall methodological quality of included studies and significant heterogeneity in measures of exposure and outcome. Generalisability was limited due to included study populations. Findings have practical implications for the development and piloting of targeted interventions to address specific barriers in a socioculturally sensitive manner. Addressing geographical variation and place of care may require intervention at a commissioning policy level. Further qualitative research is required to understand the experience and of women and clinicians. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020196490.

A pragmatic qualitative study to explore women's and clinicians' experience of access to systemic anti-cancer therapies for the treatment of secondary breast cancer.

PURPOSE: An estimated 57,000 women are currently living with secondary (metastatic) breast cancer across the UK. Equitable access to treatment has been associated with improved clinical outcomes, however geographical disparities have been reported which remain poorly understood. The purpose of our study was to explore women and clinicians' experience of geographic access to systemic anti-cancer therapies for the treatment of secondary breast cancer. METHOD: The study setting was the integrated cancer system across the northwest region of Greater Manchester UK. A pragmatic qualitative study design was used. Women aged >18 years with a confirmed SBC diagnosis and clinicians responsible for the care and treatment of women with a secondary breast cancer diagnosis were interviewed using semi structured interviews to elicit their experience and perspectives on geographic access to treatment. Data were analysed using thematic analysis to identify emergent themes. RESULTS: Eighteen interviews with women and 12 interviews with clinicians were completed. Four meta-themes were identified for geographic access, the influence of the health care system, person centred factors and the impact of Covid-19 on treatment access and receipt. CONCLUSION: Our study was the first of its kind to explore women and clinicians experience of geographic access to systemic anti-cancer therapies for the treatment of secondary breast cancer. Findings provided a greater understanding of distance decay and the influence of the health care system on treatment access. This included the importance and availability of clinical trials as a potential treatment option. This provided important insights and contributed to ongoing debate.

Assessing the Acceptability of Home Blood Monitoring for Patients With Cancer Who Are Receiving Systemic Anticancer Therapy From a Patient, Caregiver, and Clinician Perspective: Focus Group and Interview Study.

BACKGROUND: Regular blood testing is an integral part of systemic anticancer therapy delivery. Blood tests are required before every administration of treatment to ensure that a patient is sufficiently well to receive it. Blood testing is burdensome for patients as they require either an extra visit within 48 hours of planned administration of treatment or a significantly long visit if performed on the day of treatment. The additional time for appointments can have a significant impact on the quality of life of someone who is living with cancer. In the United Kingdom, the COVID-19 pandemic created unprecedented disruption to the delivery of cancer care. Face-to-face hospital visits were reduced, resulting in the need to develop more innovative ways of working to minimize treatment interruptions. This led to significant uptake of digital technologies, with new models of care rapidly deployed across the UK health service to meet these challenges. OBJECTIVE: This study aimed to explore the acceptability of a point-of-care home blood monitoring device for people with cancer who are receiving systemic anticancer therapy, which is being developed in response to the increased need for remote care for patients with cancer. METHODS: Qualitative focus groups and semistructured interviews were conducted with patients (23/47, 49%), caregivers (6/47, 13%), and health care professionals (18/47, 38%) over a 19-month time frame from May 2019 to December 2020. Data were analyzed using framework analysis guided by the Unified Theory of Acceptance and Use of Technology model. RESULTS: Analysis identified 4 overarching themes: performance expectancy, effort expectancy, social influence, and facilitating conditions. CONCLUSIONS: This study found that patients with cancer, their caregivers, and health care professionals had positive perceptions about home blood monitoring. Although they are often considered synonymously, self-testing and self-management are not mutually exclusive, and this study illustrated some disparity in opinions regarding patient self-management. Home blood monitoring has the potential to provide patients with cancer with a convenient option for blood monitoring. It would minimize hospital attendances, decrease late treatment deferrals, and provide prompt recognition of cancer treatment toxicities, thus enhancing the existing nurse-led protocols and clinical pathways. Home blood monitoring would create a long-term sustainable transformation for the delivery of cancer care, using digital health to act as a facilitator to address a pertinent issue regarding improving the efficiency of hospital resources and increasing the delivery of personalized patient care. Further studies are needed to determine how and where home blood monitoring would fit within clinical pathways, in a way that is robust and equitable.

Understanding the impact of radiotherapy related insufficiency fractures and exploring satisfaction with two existing patient reported outcome measures: A qualitative interview study.

Introduction: Radiotherapy related insufficiency fractures (RRIFs) occur in approximately 10-15% of cancer survivors who underwent pelvic radiotherapy. Little research has been conducted to explore the impact of RRIFs on quality of life (QOL). Patient reported outcome measures (PROMs) are often used in oncology to measure side effects and QOL. The study aims to understand the influence of RRIF on QOL and to discover whether available PROMs address their needs. Materials and methods: Twenty-five patients randomly selected from a Tertiary Oncology Centre bone health clinic database of patients referred with RRIFs were approached. Interested patients were sent two existing PROMs and a patient information sheet. Eleven patients agreed to take part in a semi-structured interview to explore their experiences and their opinion on the existing PROMs. Telephone interviews were conducted. Interviews were audio recorded, transcribed, and analysed using thematic analysis. Results: Four themes were identified: 1) Route to diagnosis, 2) management of RRIFs and 3) resilience all had an impact on 4) QOL. Additionally, participants discussed PROMs and how they might be integrated into clinical practice. The data highlights the wide ranging QOL impacts experienced and highlights potential areas for improvement in terms of diagnosis and management pathways. Discussion: The impact of RRIFs on QOL is considerable. Participants highlighted key areas for improvement including the provision of more information, more access to support and improved management pathways. Participants also highlighted the potential benefits of PROMs but suggested existing measures could be improved.

Inpatient rehabilitation wheelchair management quality improvement project: Implications for patients with spinal cord injury.

Context/Objective: Evaluate hospital fleet wheelchair (WC) requests submitted by physical therapists (PT) for patients with spinal cord injury (SCI) to trial and use during inpatient rehabilitation.Design: Quality improvement project secondary analysis of delivery process and WC trials.Setting: Urban inpatient rehabilitation hospital.Participants: Internal review of 4,371 WC requests narrowed to 750 patients with SCI.Interventions: PTs submitted WC requests between March 25, 2017, and September 30, 2019.Outcome Measures: WC delivery timeframe, level of SCI, type of WC.Results: PTs requested power (28%), and manual WC bases: standard (19.1%), tilt (18.9%), ultralight rigid (18.9%), ultralight folding (13.5%), and recliner (1.6%) respectively. Patients received fleet WCs 49.9% of the time within specified urgency timeframes. A Chi-Square test showed a significant association between WC request urgency and fulfillment within established timeframes (χ2 = 19.68, P < 0.001, n = 750). Broken down by urgency level: 60.0% low (n = 12), 56.2% medium (n = 244), and 39.9% high (n = 118) received their WC within established timeframes. Patients with cervical level SCI (n = 162) had the highest mean wait time of 8.28 days for power WCs. The second highest wait time was 6.29 days (SD 6.6) for manual ultralight rigid WCs (n = 34).Conclusion: Inpatient fleet WC delivery is critical to patients with SCI. Variation occurs by WC type requested and by the level of injury. Gaps exist in providing appropriate WCs in facility timeframe guidelines by the level of urgency that is within 24 h for high, 3-5 days for medium, and 5-7 days for low.

Removing neonicotinoid seed treatments has negligible effects on refuge function and crop protection in transgenic maize targeting western corn rootworm (Coleoptera: Chrysomelidae).

Nearly all maize seed sold in the United States includes a neonicotinoid seed treatment (NST), meant to protect seedlings against early-season insect pests. For key pests, including western corn rootworm (Diabrotica virgifera virgifera LeConte) (D.v.v), insecticidal proteins derived from Bacillus thuringiensis (Bt) are expressed in plant tissues as alternatives to soil-applied insecticides. Insect resistance management (IRM) plans use non-Bt "refuges" to encourage survival of Bt-susceptible D.v.v., which maintains susceptible alleles in the population. In non-cotton producing regions, IRM guidelines require a minimum 5% blended refuge for maize expressing more than 1 trait targeting D.v.v. Prior work has shown that 5% blends yield insufficient proportions of refuge beetles to contribute reliably to IRM. Whether NSTs interfere with survivorship of refuge beetles is unknown. Our objective was to determine whether NSTs affect proportions of refuge beetles, and secondarily, to determine whether NSTs provide agronomic advantages over Bt seed alone. To reveal host plant type (i.e., Bt or refuge), we used a stable isotope (15N) to mark refuge plants in plots with 5% seed blends. To assess refuge performance between treatments, we compared proportions of beetles from respective natal hosts. In all site-years, NSTs showed inconsistent effects on proportions of refuge beetles. Treatment comparisons showed inconsistent agronomic benefits of NSTs when combined with Bt traits. Our results demonstrate that NSTs have a negligible impact on refuge performance and reinforces the assertion that 5% blends are serving little benefit for IRM. Plant stand and yield were not improved by NSTs.