The TELEhealth Shared decision-making Coaching and Navigation in Primary carE (TELESCOPE) intervention: a study protocol for delivering shared decision-making for lung cancer screening by patient navigators.

Background: Lung cancer screening (LCS) can reduce lung cancer mortality but has potential harms for patients. A shared decision-making (SDM) conversation about LCS is required by the Centers for Medicare & Medicaid Services (CMS) for LCS reimbursement. To overcome barriers to SDM in primary care, this protocol describes a telehealth decision coaching intervention for LCS in primary care clinics delivered by patient navigators. The objective of the study is to evaluate the effectiveness of the intervention and its implementation potential, compared with an enhanced usual care (EUC) arm. Methods: Patients (n = 420) of primary care clinicians (n = 120) are being recruited to a cluster randomized controlled trial. Clinicians are randomly assigned to 1) TELESCOPE intervention: prior to an upcoming non-acute clinic visit, patients participate in a telehealth decision coaching session about LCS delivered by trained patient navigators and nurse navigators place a low-dose CT scan (LDCT) order for each TELESCOPE patient wanting LCS, or 2) EUC: patients receive enhanced usual care from a clinician. Usual care is enhanced by providing clinicians in both arms with access to a Continuing Medical Education (CME) webinar about LCS and an LCS discussion guide. Patients complete surveys at baseline and 1-week after the scheduled clinic visit to assess quality of the SDM process. Re-navigation is attempted with TELESCOPE patients who have not completed the LDCT within 3 months. One month before being due for an annual screening, TELESCOPE patients whose initial LCS showed low-risk findings are randomly assigned to receive a telehealth decision coaching booster session with a navigator or no booster. Electronic health records are abstracted at 6, 12 and 18 months after the initial decision coaching session (TELESCOPE) or clinic visit (EUC) to assess initial and annual LCS uptake, imaging results, follow-up testing for abnormal findings, cancer diagnoses, treatment, and tobacco treatment referrals. This study will evaluate factors that facilitate or interfere with program implementation using mixed methods. Discussion: We will assess whether a decision coaching and patient navigation intervention can feasibly support high-quality SDM for LCS and guideline-concordant LCS uptake for patients in busy primary care practices serving diverse patient populations. Trial Registration: This study was registered at ClinicalTrials.gov (NCT05491213) on August 4, 2022.

Randomized trial promoting cancer genetic risk assessment when genetic counseling cost removed: 1-year follow-up.

PURPOSE: Cancer genetic risk assessment (CGRA) is recommended for women with ovarian and high-risk breast cancer. However, the underutilization of CGRA has long been documented, and cost has been a major barrier. In this randomized controlled trial, a tailored counseling and navigation (TCN) intervention significantly improved CGRA uptake at 6-month follow-up, compared with targeted print (TP) and usual care (UC). We aimed to examine the effect of removing genetic counseling costs on CGRA uptake by 12 months. METHODS: We recruited racially and geographically diverse women with breast and ovarian cancer from cancer registries in Colorado, New Jersey, and New Mexico. Participants assigned to TCN received telephone-based psychoeducation and navigation. After 6 months, the trial provided free genetic counseling to participants in all arms. RESULTS: At 12 months, more women in TCN obtained CGRA (26.6%) than those in TP (11.0%; odds ratio [OR] = 2.77, 95% confidence interval [CI] = 1.56 to 4.89) and UC (12.2%; OR = 2.46, 95% CI = 1.41 to 4.29). There were no significant differences in CGRA uptake between TP and UC. The Kaplan-Meier curve shows that the divergence of cumulative incidence slopes (TCN vs UC, TCN vs TP) appears primarily within the initial 6 months. CONCLUSION: TCN significantly increased CGRA uptake at the 12-month follow-up. Directly removing the costs of genetic counseling attenuated the effects of TCN, highlighting the critical enabling role played by cost coverage. Future policies and interventions should address multilevel cost-related barriers to expand patients' access to CGRA. TRIAL REGISTRATION: This trial was registered with the NIH clinical trial registry, clinicaltrials.gov, NCT03326713. https://clinicaltrials.gov/ct2/show/NCT03326713.

Racial/Ethnic disparities in exposure to neighborhood violence and lung cancer risk in Chicago.

BACKGROUND: Despite the lower prevalence and frequency of smoking, Black adults are disproportionately affected by lung cancer. Exposure to chronic stress generates heightened immune responses, which creates a cell environment conducive to lung cancer development. Residents in poor and segregated neighborhoods are exposed to increased neighborhood violence, and chronic exposure to violence may have downstream physiological stress responses, which may explain racial disparities in lung cancer in predominantly Black urban communities. METHODS: We utilized retrospective electronic medical records of patients who underwent a screening or diagnostic test for lung cancer at an academic medical center in Chicago to examine the associations between lung cancer diagnosis and individual characteristics (age, gender, race/ethnicity, and smoking status) and neighborhood-level homicide rate. We then used a synthetic population to estimate the neighborhood-level lung cancer risk to understand spatial clusters of increased homicide rates and lung cancer risk. RESULTS: Older age and former/current smoking status were associated with increased odds of lung cancer diagnosis. Hispanic patients were more likely than White patients to be diagnosed with lung cancer, but there was no statistical difference between Black and White patients in lung cancer diagnosis. The odds of being diagnosed with lung cancer were significantly higher for patients living in areas with the third and fourth quartiles of homicide rates compared to the second quartile of homicide rates. Furthermore, significant spatial clusters of increased lung cancer risk and homicide rates were observed on Chicago's South and West sides. CONCLUSIONS: Neighborhood violence was associated with an increased risk of lung cancer. Black residents in Chicago are disproportionately exposed to neighborhood violence, which may partially explain the existing racial disparity in lung cancer. Incorporating neighborhood violence exposure into lung cancer risk models may help identify high-risk individuals who could benefit from lung cancer screening.

Promoting informed approaches in precision oncology and clinical trial participation for Black patients with cancer: Community-engaged development and pilot testing of a digital intervention.

BACKGROUND: Black patients with cancer are less likely to receive precision cancer treatments than White patients and are underrepresented in clinical trials. To address these disparities, the study aimed to develop and pilot-test a digital intervention to improve Black patients' knowledge about precision oncology and clinical trials, empower patients to increase relevant discussion, and promote informed decision-making. METHODS: A community-engaged approach, including a Community Advisory Board and two rounds of key informant interviews with Black patients with cancer, their relatives, and providers (n = 48) was used to develop and refine the multimedia digital intervention. Thematic analysis was conducted for qualitative data. The intervention was then pilot-tested with 30 Black patients with cancer to assess feasibility, acceptability, appropriateness, knowledge, decision self-efficacy, and patient empowerment; Wilcoxon matched pairs signed-rank test was used to analyze quantitative data. RESULTS: The digital tool was found to be feasible, acceptable, and culturally appropriate. Key informants shared their preferences and recommendations for the digital intervention and helped improve cultural appropriateness through user and usability testing. In the pilot test, appreciable improvement was found in participants' knowledge about precision oncology (z = -2.04, p = .052), knowledge about clinical trials (z = -3.14, p = .001), and decisional self-efficacy for targeted/immune therapy (z = -1.96, p = .0495). CONCLUSIONS: The digital intervention could be a promising interactive decision-support tool for increasing Black patients' participation in clinical trials and receipt of precision treatments, including immunotherapy. Its use in clinical practice may reduce disparities in oncology care and research. PLAIN LANGUAGE SUMMARY: We developed a digital interactive decision support tool for Black patients with cancer by convening a Community Advisory Board and conducting interviews with Black patients with cancer, their relatives, and providers. We then pilot-tested the intervention with newly diagnosed Black patients with cancer and found appreciable improvement in participants' knowledge about precision oncology, knowledge about clinical trials, and confidence in making decisions for targeted/immune therapy. Our digital tool has great potential to be an affordable and scalable solution for empowering and educating Black patients with cancer to help them make informed decisions about precision oncology and clinical trials and ultimately reducing racial disparities.

Identifying Mediators of Intervention Effects Within a Randomized Controlled Trial to Motivate Cancer Genetic Risk Assessment Among Breast and Ovarian Cancer Survivors.

BACKGROUND: A theory-guided Tailored Counseling and Navigation (TCN) intervention successfully increased cancer genetic risk assessment (CGRA) uptake among cancer survivors at increased risk of hereditary breast and ovarian cancer (HBOC). Understanding the pathways by which interventions motivate behavior change is important for identifying the intervention's active components. PURPOSE: We examined whether the TCN intervention exerted effects on CGRA uptake through hypothesized theoretical mediators. METHODS: Cancer survivors at elevated risk for HBOC were recruited from three statewide cancer registries and were randomly assigned to three arms: TCN (n = 212), Targeted Print (TP, n = 216), and Usual Care (UC, n = 213). Theoretical mediators from the Extended Parallel Process Model, Health Action Planning Approach, and Ottawa Decision Support Framework were assessed at baseline and 1-month follow-up; CGRA uptake was assessed at 6 months. Generalized structural equation modeling was used for mediation analysis. RESULTS: The TCN effects were most strongly mediated by behavioral intention alone (ß = 0.49 and 0.31) and by serial mediation through self-efficacy and intention (ß = 0.041 and 0.10) when compared with UC and TP, respectively. In addition, compared with UC, the TCN also increased CGRA through increased perceived susceptibility, knowledge of HBOC, and response efficacy. CONCLUSIONS: Risk communication and behavioral change interventions for hereditary cancer should stress a person's increased genetic risk and the potential benefits of genetic counseling and testing, as well as bolster efficacy beliefs by helping remove barriers to CGRA. System-level and policy interventions are needed to further expand access.

It is recommended that cancer survivors at increased risk for heredity seek cancer genetic risk assessment (CGRA), which includes cancer genetic counseling and genetic testing. A Tailored Counseling and Navigation (TCN) intervention successfully increased CGRA uptake among women with a history of cancer who enrolled in a randomized controlled trial. Understanding reasons for TCN's effectiveness can guide future interventions that use risk messages and behavior change techniques. We conducted mediation analyses, which enabled identification of the TCN's active components. Eligible breast and ovarian cancer survivors (n = 641) were recruited from three statewide cancer registries and were assigned to three groups: TCN, Targeted Print, and Usual Care. Mediator variables drawn from behavioral and risk communication theories were assessed at baseline and 1-month follow-up; CGRA uptake was assessed at 6 months. The strongest mediator was intention to obtain a CGRA, followed by self-efficacy, perceived risk, knowledge of hereditary breast and ovarian cancer, and perceived CGRA benefits. Risk communication and behavioral change interventions for hereditary cancer should stress a person's increased genetic risk and the potential benefits of genetic counseling and testing, as well as bolster efficacy beliefs by helping remove CGRA barriers. System-level and policy interventions are needed to further expand access.

In situ SERS reveals the route regulation mechanism mediated by bimetallic alloy nanocatalysts for the catalytic hydrogenation reaction.

Synthesizing arylamines with high selectivity via hydrogenation of nitroaromatics is a long-standing challenge because of the complex reaction pathways. Revealing the route regulation mechanism is the key to obtain high selectivity of arylamines. However, the underlying reaction mechanism of route regulation is uncertain owing to a lack of direct in situ spectral evidence of the dynamic transformation of intermediate species during the reaction process. In this work, by using in situ surface-enhanced Raman spectroscopy (SERS), we have employed 13 nm Au100-x Cu x nanoparticles (NPs) deposited on a SERS-active 120 nm Au core to detect and track the dynamic transformation of intermediate species of hydrogenation of para-nitrothiophenol (p-NTP) into para-aminthiophenol (p-ATP). Direct spectroscopic evidence demonstrates that Au100 NPs exhibited a coupling route with the in situ detection of the Raman signal assigned to coupling product p,p'-dimercaptoazobenzene (p,p'-DMAB). However, Au67Cu33 NPs displayed a direct route without the detection of p,p'-DMAB. The combination of X-ray photoelectron spectroscopy (XPS) and density functional theory (DFT) calculations reveals that Cu doping can favor the formation of active Cu-H species owing to the electron transfer from Au to Cu, which can promote the formation of phenylhydroxylamine (PhNHOH*) and favor the occurrence of the direct route on Au67Cu33 NPs. Our study provides direct spectral evidence demonstrating the critical role of Cu in route regulation for the nitroaromatic hydrogenation reaction at a molecular level and clarifies the route regulation mechanism. The results have significant implications for revealing multimetallic alloy nanocatalyst mediated reaction mechanisms and help to guide the rational design of multimetallic alloy catalysts for catalytic hydrogenation reactions.

Delayed Presentation, Diagnosis, and Treatment of Breast Cancer Among Chinese Women: An Integrative Literature Review.

BACKGROUND: Delays before treatment initiation increase the likelihood of later-stage diagnosis of breast cancer and reduce survival. Among Chinese women living in mainland China, Hong Kong, and Taiwan, the amount of time lost in delay and the factors influencing it are unclear. OBJECTIVE: This integrative review aimed to characterize delay intervals among Chinese women, identify factors contributing to delay, and develop a conceptual model of these factors. METHODS: Using Whittemore and Knafl's methodology for integrative reviews, PubMed, CINAHL, Web of Science, SCOPUS, PsycINFO, and China National Knowledge Infrastructure were searched for primary research articles. For 15 selected studies, quality evaluation was performed employing the Crowe Critical Appraisal Tool. A narrative synthesis was developed to summarize and explain the findings. RESULTS: Total delay intervals (from first discovery of breast symptoms to treatment initiation) exceeded 3 months for 50.2% to 52% of breast cancer patients. The greatest delay occurred between symptom discovery and first presentation (patient intervals). Factors affecting delay in presentation, diagnosis, and treatment included symptom appraisal, Chinese cultural factors, knowledge of breast cancer symptoms and screening, health history, personality, social and healthcare factors, and background factors. CONCLUSIONS: Half of Chinese breast cancer patients delayed long enough to lower their chances of survival. Our review sheds light on how the reviewed factors contribute to delay and their unique influences in this population. IMPLICATIONS FOR PRACTICE: Factors identified can inform nursing interventions that raise breast cancer awareness and promote timely diagnosis and treatment in Chinese women.

Perceived needs and health-related quality of life in women with breast cancer undergoing chemotherapy: a cross-sectional study.

OBJECTIVES: Women with breast cancer have different needs that are various in perceived importance and satisfaction. This study aimed to examine the relationship among perceived needs satisfaction, perceived needs importance with health-related quality of life (HRQoL) in women with breast cancer and determine the intermediary role of perceived needs importance in the relationship between perceived needs satisfaction and HRQoL. DESIGN: Cross-sectional design. SETTING: Two tertiary level hospitals in Shaanxi Province, China. PARTICIPANTS: Women newly diagnosed with breast cancer were recruited. OUTCOME MEASURES: The Needs Self-Rating Questionnaire for Breast Cancer and the Medical Outcomes Study 36-item Short-Form Health Survey V. 2.0 were used for data collection regarding perceived needs satisfaction, perceived needs importance and HRQoL. RESULTS: A total of 359 valid questionnaires were collected. The perceived needs importance was negatively associated with physical component summary (PCS) (b=-0.067, p=0.024) and mental component summary (MCS) (b=-0.185, p<0.001). On the contrary, perceived needs satisfaction was positively associated with PCS (c'=0.005, p=0.843), although not statistically significant. Perceived needs satisfaction was positively associated with MCS (c'=0.194, p<0.001) and perceived needs importance (a=0.458, p<0.001). Furthermore, the perceived needs importance suppressed the relationship between perceived needs satisfaction and PCS (a*b=-0.031; 95% CI -0.058 to -0.004) and the relationship between perceived needs satisfaction and MCS (a*b=-0.085; 95% CI -0.138 to -0.043). CONCLUSION: For women with breast cancer, higher perceived needs satisfaction is associated with higher HRQoL. However, higher perceived needs importance would be conversely associated with lower HRQoL by suppressing the positive association of perceived needs satisfaction with HRQoL. Healthcare providers should pay more attention to those who have high perceived needs importance but low perceived needs satisfaction and fulfil the important needs.

Effectiveness of the COVID-19 Community Vulnerability Index in explaining COVID-19 deaths.

Objectives: To explore the effectiveness of a COVID-19 specific social vulnerability index, we examined the relative importance of four COVID-19 specific themes and three general themes of the COVID-19 Community Vulnerability Index (CCVI) in explaining COVID-19 mortality rates in Cook County, Illinois. Methods: We counted COVID-19 death records from the Cook County Medical Examiner's Office, geocoded incident addresses by census tracts, and appended census tracts' CCVI scores. Negative binomial regression and Random Forest were used to examine the relative importance of CCVI themes in explaining COVID-19 mortality rates. Results: COVID-19 specific Themes 6 (High risk environments) and 4 (Epidemiological factors) were the most important in explaining COVID-19 mortality (incidence rate ratio (IRR) = 6.80 and 6.44, respectively), followed by a general Theme 2 (Minority status & language, IRR = 3.26). Conclusion: The addition of disaster-specific indicators may improve the accuracy of social vulnerability indices. However, variance for Theme 6 was entirely from the long-term care resident indicator, as the other two indicators were constant at the census tract level. Thus, CCVI should be further refined to improve its effectiveness in identifying vulnerable communities. Also, building a more robust local data infrastructure is critical to understanding the vulnerabilities of local places.

Single-Molecule Imaging of Reactive Oxygen Species on a Semiconductor Nano-Heterostructure for Understanding Photocatalytic Heterogeneity in Aqueous.

We constructed a single-molecule fluorescence imaging technique to monitor the spatiotemporal distribution of the hydroxyl radical (•OH) on TiO2-attached multiwalled carbon nanotubes (TiO2-MWCNTs) in aqueous. We found the heterogeneous distribution of •OH is closely related to the composition and heterostructure of the catalysts. The dynamic •OH production rate was evaluated by counting the single-molecule fluorescent bursts. We further confirmed the production of •OH on TiO2-MWCNTs mainly occurred via electron reduction during the aqueous photocatalytic process. Our study reveals the mechanism of reactive oxygen species involved photocatalytic reaction and guides the design of advanced semiconductor photocatalysts.

Impact of the COVID-19 pandemic on cardiovascular disease mortality in a major metropolitan area.

Background: The mortality from COVID-19 alone cannot account for the impact of the pandemic. Cardiovascular disease (CVD) mortality has increased disproportionately in specific racial/ethnic populations. Objective: This study aimed to characterize how the COVID-19 pandemic impacted the association between CVD mortality and social and demographic factors as characterized by the Social Vulnerability Index (SVI). Methods: Medical Examiner Case Archive of Cook County, Illinois was utilized to identify CVD deaths in 2019 (pre-pandemic) and 2020 (pandemic). Rate ratios (RRs) were used to compare age-adjusted mortality rates (AAMRs). Addresses of deaths were geocoded to Chicago Community Areas. The Spearman's rank correlation coefficient (ρ) test was used to identify the association between SVI and CVD mortality. Results: AAMRs of CVD deaths significantly increased among non-Hispanic Black individuals (AAMRR, 1.1; 95 % CI, 1.1-1.2) and Hispanic individuals (AAMRR, 1.8; 95 % CI, 1.5-2.1) from 2019 to 2020. Among non-Hispanic White individuals, the AAMR did not significantly increase (AAMRR, 1.0; 95 % CI, 0.9-1.1). A significant positive association was observed between SVI and the percentage of non-Hispanic Black residents (ρ = 0.45; P < 0.05), while the inverse was observed with the percentage of non-Hispanic White residents (ρ = -0.77; P < 0.05). A significant positive association between SVI and CVD mortality rate increased (ρ = 0.24 and 0.28; P < 0.05). Conclusions: Significant association between SVI and CVD mortality was strengthened from 2019 to 2020, and CVD mortality increased among non-Hispanic Black and Hispanic populations. These findings demonstrate that the COVID-19 pandemic has led to an exacerbation of health inequities among different racial/ethnic populations resulting in increased CVD mortality.

A Critique of the Theory of Planned Behavior in the Cancer Screening Domain.

The theory of planned behavior (TPB) has been widely used to guide research in cancer screening-related behavior, but no critique of the TPB's application in this domain has been published. We used Fawcett and DeSanto-Madeya's 2013 framework to analyze and evaluate the theory. The theory was developed on the basis of antecedent knowledge regarding human behavior, and its concepts and propositions are comprehensively delineated. The TPB shows adequate internal consistency and impressive social and theoretical significance. Methodologically sound studies are called for to further test some theory propositions and to evaluate its pragmatic adequacy for promoting cancer screening in nursing practice.

Assessing the relationship between body image and quality of life among rural and urban breast cancer survivors in China.

BACKGROUND: Breast cancer survivors experience altered body image and quality of life (QoL) due to the disease and its treatment. The multidimensional nature of body image and QoL makes their relationships complex. This study aimed to examine the associations between the two concepts in Chinese breast cancer survivors and test whether these associations are moderated by rural-urban residence. METHODS: A cross-sectional design was adopted. Breast cancer survivors were recruited via a convenience sampling method. Two validated questionnaires (the Body Image Self-Rating Questionnaire for Breast Cancer and 36-item Short-Form Health Survey) and questions assessing demographic and clinical covariates were administered. Multiple linear regressions were used to assess the relationship between body image and QoL domains and to examine the moderating effect of rural-urban residence. RESULTS: In our sample of 354 breast cancer survivors, half (50.28%) lived in rural areas. After adjusting for demographic and clinical variables, better perception of body image-related sexual activity change, role change, and psychological change was significantly associated with better physical (ß ranged from - 0.15 to - 0.11, p < 0.05) and mental (ß ranged from - 0.46 to - 0.34, p < 0.001) well-being. Better perception of body image-related social and behavior change was significantly associated only with better mental well-being (ß ranged from - 0.40 to - 0.33, p < 0.001). The association between body image and mental well-being was much stronger in urban subjects (b = - 0.38, p < 0.001) than in rural subjects (b = - 0.20, p < 0.001). CONCLUSIONS: Our findings suggest that multidimensional body image is associated with physical and mental well-being in Chinese breast cancer survivors. Body image appears to play a larger role in urban breast cancer survivors' mental well-being. Our results indicate that incorporating interventions that address body image issues would be advantageous for survivorship care to enhance QoL in breast cancer survivors. Furthermore, rural-urban differences should be considered in the strategic design of survivorship care programs in rural and urban settings.

Body image mediates the relationship between post-surgery needs and health-related quality of life among women with breast cancer: a cross-sectional study.

BACKGROUND: Although body image (BI) disturbance is a common problem that often contributes to poor health-related quality of life (HRQoL) among women with breast cancer following surgery, the mediating role of BI (as a self-perceptive factor) in the relationship between needs and HRQoL after controlling for socio-demographic factors remains unclear. The purpose of this study was to identify the mediating role of BI between post-surgery needs and HRQoL after controlling for socio-demographic factors among women with breast cancer. METHODS: In this cross-sectional study, the primary outcome was HRQoL (as measured with the 36-item Short-Form Health Survey version 2 [SF-36v2] and Functional Assessment of Cancer Therapy-Breast version 4.0 [FACT-Bv4.0]). The secondary outcomes included needs (measured in terms of needs importance [NI] and needs satisfaction [NS]) and BI. Structural equation modeling was used to identify the mediating role of BI between needs and HRQoL while considering socio-demographics. RESULTS: The 406 eligible patients reported poor HRQoL, and approximately half reported important unmet needs and poor BI. NI, NS, and socio-demographics had differing direct effects on BI and HRQoL, and contrasting indirect effects on HRQoL via BI. NI, NS, surgery type, presence of chronic disease, and BI explained 4% of the variance in the SF-36v2 physical component summary score; NI, NS, surgery type, residence, and BI explained 20% of the variance in the mental component summary score; and NI, NS, marital status, employment status, radiotherapy, and BI explained 33% of the variance in the FACT-Bv4.0 total score. CONCLUSIONS: After surgery, women with breast cancer have poor HRQoL and BI, and important unmet needs. BI mediates the relationship between needs and HRQoL after controlling for socio-demographics. The present findings provide information for developing comprehensive BI-based needs interventions and preparing targeted health-management programs for patients with breast cancer.

Benefits of a WeChat-based multimodal nursing program on early rehabilitation in postoperative women with breast cancer: A clinical randomized controlled trial.

BACKGROUND: Primary treatments for early-stage breast cancer can cause adverse effects, such as pain, fatigue, and sleep disturbance, that can markedly affect the patients' health-related quality of life. OBJECTIVE: This study aimed to evaluate the benefits of a WeChat-based multimodal nursing program on early rehabilitation in postoperative women with breast cancer. DESIGN: Clinical randomized controlled trial. SETTING: Surgical breast cancer department of a general hospital in Shaanxi Province, China. PARTICIPANTS: Women with breast cancer were recruited via convenience sampling. The inclusion criteria were (1) age ≥18 years, (2) newly diagnosed with breast cancer, (3) stage I-III disease, and (4) indicated for surgery with adjuvant therapy. Exclusion criteria were (1) comorbidity with other malignant tumors and infections and (2) cognitive or psychiatric disorders. METHODS: We recruited patients with breast cancer and randomly allocated them to the intervention (n = 56) and control (n = 55) groups. The former was subjected to the WeChat-based multimodal nursing program plus routine nursing care for 6 months, whereas the latter received only routine nursing care. The primary endpoint (health-related quality of life) and secondary endpoints (pain, fatigue, and sleep) were measured using the Functional Assessment of Cancer Therapy-Breast version 4.0 (FACT-Bv4.0) and the Numerical Rating Scale at 4 time points (i.e., pre-surgery and 1, 3, and 6 months post-surgery). RESULTS: The intervention group had significantly improved total FACT-Bv4.0 scores owing to the effects of group (F = 16.28, P < 0.001), time (F = 28.82, P < 0.001), and group-time interaction (F = 5.35, P = 0.001). Similar improvements were also found in social/family well-being and functional well-being (P < 0.05). Emotional well-being was improved based on the effects of time (F = 42.12, P < 0.001) and group-time interaction (F = 10.20, P < 0.001). The 'breast cancer-specific subscale for additional concerns' was affected by group (F = 21.55, P < 0.001) and time (F = 28.96, P < 0.001), whereas physical well-being was only affected by time (F = 35.39, P < 0.001). Pain, fatigue, and sleep were not significantly influenced by group effects. CONCLUSIONS: We found a significant improvement in the health-related quality of life of postoperative women with breast cancer who used the WeChat-based multimodal nursing program during early rehabilitation. This demonstrated that the program is an effective intervention for postoperative rehabilitation in such patients. Findings of the study will provide evidence for eHealth services in clinical and transitional nursing care.

Effects of Progressive Upper Limb Exercises and Muscle Relaxation Training on Upper Limb Function and Health-Related Quality of Life Following Surgery in Women with Breast Cancer: A Clinical Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to examine the effects of progressive upper limb exercises and muscle relaxation training (PULE-MRT) on upper limb function and health-related quality of life (HRQoL) following surgery in Chinese mainland women with breast cancer (BC). METHODS: Overall, 102 patients following surgery (i.e. mastectomy or breast-conserving surgery, with sentinel lymph node biopsy or axillary lymph node dissection) were randomly allocated to the intervention (n = 51) or control (n = 51) groups. The former received PULE-MRT plus routine nursing care, whereas the latter received only routine nursing care for 6 months. Upper limb function and HRQoL were measured at baseline and 1, 3, and 6 months using Constant-Murley scores (CMS) and Functional Assessment of Cancer Therapy-Breast version 4.0 (FACT-Bv4.0), respectively. RESULTS: All patients in the intervention group completed the exercises and training, with 100% compliance and no adverse events. The intervention group had significantly higher total CMS and FACT-Bv4.0 scores at 1-, 3-, and 6-month follow-up than the control group. The significant effects in total CMS comparisons were group (F = 25.30, p < 0.001), time (F = 18.02, p < 0.001), and group-by-time interaction (F = 9.95, p < 0.001), and, in FACT-Bv4.0, total score comparisons were group (F = 15.87, p < 0.001), time (F = 17.92, p < 0.001), and group-by-time interaction (F = 7.88, p < 0.001). Similar results were observed for the scale scores of CMS and FACT-Bv4.0. CONCLUSIONS: PULE-MRT had positive effects on improving upper limb function and HRQoL following surgery in women with BC and could be used as an optional rehabilitation management strategy in post-surgery BC patient populations. Trial Registration ChiCTR-IOR-16008253 (Chictr.org.cn; 9 April 2016).

The Needs Self-Rating Questionnaire for Breast Cancer (NSQ-BC): Development of a tool for the needs assessment of women with breast cancer in mainland China.

RATIONALE, AIMS, AND OBJECTIVES: A needs assessment tool considering the cultural background of mainland China has not been reported. This study developed a Needs Self-rating Questionnaire for Breast Cancer (NSQ-BC) based on Maslow's hierarchy of needs for mainland Chinese patients. METHODS: The Delphi technique and pilot cross-sectional surveys (two rounds) were performed for item selection. In the Delphi technique, items were selected according to the experts' perspective on the item's significance (ie, 1-5 Likert-scale ratings of importance; mean > 4.0 and coefficients of variation <0.25). In the pilot cross-sectional surveys, items were selected according to internal consistency reliability (Cronbach's α ≥ 0.70), discriminant validity (stronger correlations of the item with the hypothesized subscale than for other subscales), and convergent validity (hypothesized item-subscale correlations ≥0.40). All decisions were made based on the results of statistical analyses, recommendations of the experts, and in-depth discussion among research team members. RESULTS: Following the two evaluation rounds, the revised NSQ-BC comprised 26 items across five subscales of needs: physical, psychological, respect/self-esteem, information, and rehabilitation. Item ratings from the expert panellists met the aforementioned criteria (ie, Kendall's W = 0.329, P < 0.001). Except for the "respect/self-esteem needs" subscale, Cronbach's α for all subscales exceeded 0.70. All items had acceptable discriminant and convergent validity. Additionally, two new items-good environment/facilities and economic support-were added to the NSQ-BC, as recommended by the experts. CONCLUSIONS: The NSQ-BC was developed fully via the comprehensive use of Delphi technique and pilot cross-sectional surveys. It provides evidence of a proper instrument for needs assessment and evaluation among women with breast cancer in mainland China.

Reliability, validity, and sensitivity of the Chinese Short-Form 36 Health Survey version 2 (SF-36v2) in women with breast cancer.

RATIONALE, AIMS, AND OBJECTIVES: The psychometrics of the Short-Form 36 Health Survey version 2 (SF-36v2) in female breast cancer patients remains unknown. This study aimed to test the reliability, validity, and sensitivity of the Chinese SF-36v2 in women with breast cancer. METHODS: The sample included 326 eligible participants. The reliability and the item convergent and discriminant validity were estimated using Cronbach α (≥0.70) and the multi-trait multi-item matrix analysis, respectively. The structural validity was tested using confirmatory factor analysis. Sensitivity was determined via an analysis of variance and the relative efficiency for initially diagnosed cases (yes vs no) as well as the time since diagnosis (years) before and after stratifying by initially diagnosed cases. RESULTS: The overall Cronbach α was 0.91 (eight scales range: 0.72-0.92). All hypothesized item-scale correlations were greater than the alternatives (r ≥ 0.40). With acceptable model fit indices, the physical functioning, role-physical, bodily pain, and general health subscales had stronger contributions to the physical component summary (goodness-of-fit index [GFI]: 0.92, parsimony goodness-of-fit index [PGFI]: 0.60, comparative fit index [CFI]: 0.91, Tucker-Lewis index [TLI]: 0.93, adjusted goodness-of-fit index [AGFI]: 0.91, root mean square error of approximation [RMSEA]: 0.06, normed chi-squared [NC]: 2.65), while the vitality, social functioning, role-emotional, and mental health subscales contributed more to the mental component summary (GFI: 0.91, PGFI: 0.62, CFI: 0.91, TLI: 0.92, AGFI: 0.91, RMSEA: 0.07, NC: 2.76). The relative efficiencies with significant F-statistics were found for mental health (relative efficiency: 34.28; initially diagnosed cases), physical functioning (12.88; time since diagnosis), and physical functioning (5.80), role-physical (5.15), bodily pain (7.70), social functioning (4.62), role-emotional (4.72), mental health (4.75), and physical component summary (6.96; initially diagnosed cases with time since diagnosis; P < 0.05 for all variables). CONCLUSIONS: Chinese SF-36v2 has acceptable psychometric properties and is suitable for women with breast cancer.

Capping experiments reveal multiple surface active sites in CeO2 and their cooperative catalysis.

Understanding of surface active sites (SAS) of CeO2 is crucial to its catalytic applications. In the present study, we have employed capping experiments, DFT calculations, and spectroscopic characterization to study pristine CeO2 catalyst. We find that multiple SAS coexist on the CeO2 surface: oxygen vacancies as redox sites and the coordinately unsaturated Ce cations near the oxygen vacancies and the neighboring oxygen ions as Lewis acid-base sites. Dimethylsulfoxide (DMSO), pyridine, and benzoic acid are utilized to cap the redox sites, Lewis acid sites, and base sites, respectively. Selective capping on the redox site does not have much effect on the acid-base catalysis, and vice versa, indicating the distinct surface proximity and independent catalysis of these SAS. We draw attention to a relationship between the well-known redox sites and the surface Lewis acid and Lewis base pairs on CeO2 surface, which are responsible for driving various heterogeneous catalytic reactions.

Selective production of phase-separable product from a mixture of biomass-derived aqueous oxygenates.

Selective conversion of an aqueous solution of mixed oxygenates produced by biomass fermentation to a value-added single product is pivotal for commercially viable biomass utilization. However, the efficiency and selectivity of the transformation remains a great challenge. Herein, we present a strategy capable of transforming ~70% of carbon in an aqueous fermentation mixture (ABE: acetone-butanol-ethanol-water) to 4-heptanone (4-HPO), catalyzed by tin-doped ceria (Sn-ceria), with a selectivity as high as 86%. Water (up to 27 wt%), detrimental to the reported catalysts for ABE conversion, was beneficial for producing 4-HPO, highlighting the feasibility of the current reaction system. In a 300 h continuous reaction over 2 wt% Sn-ceria catalyst, the average 4-HPO selectivity is maintained at 85% with 50% conversion and > 90% carbon balance. This strategy offers a route for highly efficient organic-carbon utilization, which can potentially integrate biological and chemical catalysis platforms for the robust and highly selective production of value-added chemicals.