A mixed methods process evaluation of a print-based intervention supported by internet tools to improve physical activity in UK cancer survivors.

OBJECTIVE: A waiting list randomised control trial has shown the Move More Pack, a print-based intervention supported by Internet tools, to improve physical activity levels in cancer survivors; however, one-third of them do not improve from the intervention. The objective of this process evaluation is to understand intervention use, the mechanisms of impact, the perceived benefits and the contextual factors influencing these, identifying for whom it is a useful resource. METHODS: The process evaluation used mixed methods, based on guidance from the UK Medical Research Council, including 181 questionnaire responses on intervention use and physical activity improvement over 12 weeks, 56 open-text responses and 17 semistructured interviews. RESULTS: The Move More Pack was suggested to be most useful when delivered towards the start of the cancer journey to those with a positive attitude to fight cancer but with a low level of physical activity, capitalising on a teachable moment. It was suggested that healthcare professionals could support the effective distribution of the Move More Pack. The intervention's printed components were more popular and well used than the Internet tools. Use of the printed intervention components was positively correlated with physical activity improvement but use of the Internet tools was not. Women were more likely to use the intervention's printed components than men. Cancer survivors using the intervention reflected that they had increased confidence and motivation for physical activity and other lifestyle behaviours. CONCLUSION: The Move More Pack should be offered by healthcare professionals, during cancer treatment, when health is salient, to those with a positive attitude to fight cancer but with low levels of physical activity. Use of the intervention's printed components is more likely to improve physical activity than the Internet tools, and the components are more likely to be used by women. The use of Internet tools to support physical activity improvement in cancer survivors requires further investigation.

A randomised control trial and cost-consequence analysis to examine the effects of a print-based intervention supported by internet tools on the physical activity of UK cancer survivors.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of a print-based intervention supported by Internet tools at improving physical activity in cancer survivors compared with a standard letter recommendation. Prediagnosis physical activity and self-efficacy were hypothesised to predict physical activity improvement. STUDY DESIGN: Waiting list randomised control trial and cost-consequence analysis. METHODS: Adult cancer survivors who could become physically active without prior medical approval were randomised to receive either a print-based intervention supported by Internet tools (intervention, n = 104) or a standard letter recommendation (control, n = 103). Physical activity was assessed at 12 weeks with maintenance assessed at 24 weeks in the intervention arm. The number needed to treat was calculated, and a cost-consequence analysis completed. RESULTS: Participants in receipt of a print-based intervention supported by Internet tools improved their physical activity by 36.9% over 12 weeks compared with 9.1% in the control arm. Physical activity was maintained at 24 weeks in the intervention arm. A total of 6.29 cancer survivors needed to receive the intervention for one cancer survivor to improve their physical activity over a standard letter recommendation. Intervention delivery cost £8.19 per person. Prediagnosis physical activity and self-efficacy did not predict physical activity improvement. CONCLUSION: A print-based intervention supported by Internet tools offers a promising low-cost means to intervene to improve physical activity in cancer survivors. The study was registered with the International Standard Randomised Controlled Trials Number registry (registration number: 66418871), and ethical approval was received from the University of Surrey (reference: UEC/2017/023/FHMS).

PD-L1 and immune infiltrates are differentially expressed in distinct subgroups of gastric cancer.

This study investigates the association of PD-L1 expression and immune cell infiltrates and their impact on clinical outcome, in addition to their overlap with microsatellite instability (MSI), HER2 and ATM molecular subgroups of gastric cancer (GC). PD-L1 membrane expression on tumour cells (TC) and infiltrating immune cells (IC), CD3 + T-lymphocytes, CD8+ cytotoxic T-cells, ATM and HER2 were assessed by immunohistochemistry (IHC) in the ACRG (Asian Cancer Research Group) GC cohort (N = 380). EBV status was determined using in situ hybridization and MSI status was performed using PCR and MLH1 IHC. The PD-L1 segment was associated with increased T-cell infiltrates, while the MSI-high segment was enriched for PD-L1, CD3, and CD8. Multivariate analysis confirmed PD-L1 positivity, high CD3 and high CD8 as independent prognostic factors for both disease-free survival and overall survival (all p < 0.05). Patients with MSI-high tumours had better overall survival by both univariate and multivariate analysis. The ATM-low and HER2-high subgroups differed markedly in their immune profile; the ATM-low subgroups enriched for MSI, PD-L1 positivity and CD8 + T-cells, while the HER2 segment was enriched for MSS, with no enrichment for immune markers. Hence, we demonstrate a molecular profiling approach that can divide GC into four molecular subgroups, namely ATM-low, HER2-high, PD-L1 positive and MSI-high with differing levels of immune infiltrates and prognostic significance which may help to stratify patients for response to targeted therapies.

Effects of preoperative cisapride on postoperative aspiration pneumonia in dogs with laryngeal paralysis.

OBJECTIVES: Retrospective evaluation of a preoperative prokinetic protocol using a constant-rate infusion of a serotonin 5-HT4 receptor agonist, cisapride, and its association with frequency of postoperative aspiration pneumonia in dogs undergoing unilateral arytenoid lateralisation as compared to a historical population at the same institution. MATERIALS AND METHODS: Medical records of dogs undergoing unilateral arytenoid lateralisation for laryngeal paralysis were reviewed for historical findings, imaging findings, anaesthesia and surgery durations, perioperative medications and if surgery was performed as an emergency. Aspiration pneumonia events in the first 72 hours after surgery were recorded. The study group received a preoperative cisapride constant-rate infusion; historical 'controls' did not receive the cisapride protocol. RESULTS: One of 50 dogs in the cisapride group and six of 52 dogs in the historical group developed aspiration pneumonia within the immediate postoperative period. The cisapride protocol was largely well tolerated. A markedly lower rate of aspiration pneumonia in patients administered butorphanol with acepromazine preoperatively and buprenorphine postoperatively was noted, but the overall low frequency of aspiration pneumonia and variation in case management protocols precluded definitive conclusions with respect to optimal perioperative drug choices. CLINICAL SIGNIFICANCE: Laryngeal paralysis is commonly treated by unilateral arytenoid lateralisation, and aspiration pneumonia is one of the most serious potential complications of this procedure. This study suggests that further investigation of a cisapride constant-rate infusion to prevent this complication is warranted.

Contracting for care - the construction of the farrier role in supporting horse owners to prevent laminitis.

BACKGROUND: Emerging research highlights how, due to demographic changes in horse owner populations in Western societies, complex owner-horse relationships are leading to inappropriate horse care, including overnutrition, which in turn can lead to laminitis. Farriers, due to their regular visits, may be in a position to support owners in dealing with this problem. OBJECTIVES: This study explored whether UK farriers have a role in working with horse owners to support horse welfare and prevent laminitis. STUDY DESIGN: Grounded theory analysis, a qualitative methodology. METHODS: Semi-structured interviews were conducted with 12 farriers and 11 horse owners. The interviews were transcribed verbatim and systematically analysed, using an inductive coding approach. RESULTS: The analysis of the farrier and horse owner interview data revealed farriers and horse owners undertake a contracting process leading to either a task-focussed or holistic care-focussed approach. Either approach can be satisfactory, but the evidence from this study suggests that when horses are at risk of laminitis, a task-focussed approach misses important opportunities to prevent it. MAIN LIMITATIONS: This analysis, based on a small sample of participants, was not able to identify the frequency of farriers or horse owners orientating towards different approaches in a way that can be generalised to a wider population. However, the power of grounded theory lies in its inductive design to develop new theory, which can be subsequently tested. CONCLUSIONS: Farriers are in a perfect position to support horse owners to prevent laminitis through providing feedback, guidance and advice. However, not all farriers adopt this role and it is not necessary in all contexts. The evidence presented in this study has implications for equine veterinarians and welfare officers in educating horse owners about the value of holistic care-focussed farriery.

Morphological determinants of signal carrier frequency in katydids (Orthoptera): a comparative analysis using biophysical evidence of wing vibration.

Male katydids produce mating calls by stridulation using specialized structures on the forewings. The right wing (RW) bears a scraper connected to a drum-like cell known as the mirror and a left wing (LW) that overlaps the RW and bears a serrated vein on the ventral side, the stridulatory file. Sound is generated with the scraper sweeping across the file, producing vibrations that are amplified by the mirror. Using this sound generator, katydids exploit a range of song carrier frequencies (CF) unsurpassed by any other insect group, with species singing as low as 600 Hz and others as high as 150 kHz. Sound generator size has been shown to scale negatively with CF, but such observations derive from studies based on few species, without phylogenetic control, and/or using only the RW mirror length. We carried out a phylogenetic comparative analysis involving 94 species of katydids to study the relationship between LW and RW components of the sound generator and the CF of the male's mating call, while taking into account body size and phylogenetic relationships. The results showed that CF negatively scaled with all morphological measures, but was most strongly related to components of the sound generation system (file, LW and RW mirrors). Interestingly, the LW mirror (reduced and nonfunctional) predicted CF more accurately than the RW mirror, and body size is not a reliable CF predictor. Mathematical models were verified on known species for predicting CF in species for which sound is unknown (e.g. fossils or museum specimens).

Randomized controlled trial to compare the effect of simple distraction interventions on pain and anxiety experienced during conscious surgery.

BACKGROUND: High levels of anxiety during surgery are associated with poorer post-surgical outcomes. This prospective, non-blinded randomized controlled trial aimed to compare the effectiveness of four intraoperative distraction interventions for anxiety and pain management during minimally invasive venous surgery under local anaesthetic. METHODS: 407 patients presenting with varicose veins at a private clinic, were randomized to one of four intraoperative distraction interventions or treatment as usual. All participants received endovenous thermoablation and/or phlebectomies of varicose veins. After losses to follow-up, 398 participants were entered into the analysis. Participants were randomly allocated to one of the following intraoperative distraction techniques: patient selected music (n = 85), patient selected DVD (n = 85), interaction with nurses (n = 81), touch (stress balls) (n = 80) or treatment as usual (TAU, n = 76). The state scale of the STAI, the Short-form McGill pain questionnaire and numeric rating scales were used to assess intraoperative pain and anxiety. RESULTS: Intraoperative anxiety ratings were significantly lower when participants interacted with nurses, used stress balls or watched a DVD during surgery compared to treatment as usual. Intraoperative pain ratings were significantly lower than treatment as usual when participants interacted with nurses or used stress balls during surgery. Patients' satisfaction was not significantly impacted by intraoperative distractions. CONCLUSIONS: The use of simple intraoperative distraction techniques, particularly interacting with nurses, using stress balls or watching a DVD during surgery conducted under local anaesthetic can significantly improve patients' experiences.

An assessment of electric vehicles: technology, infrastructure requirements, greenhouse-gas emissions, petroleum use, material use, lifetime cost, consumer acceptance and policy initiatives.

Concerns about climate change, urban air pollution and dependence on unstable and expensive supplies of foreign oil have led policy-makers and researchers to investigate alternatives to conventional petroleum-fuelled internal-combustion-engine vehicles in transportation. Because vehicles that get some or all of their power from an electric drivetrain can have low or even zero emissions of greenhouse gases (GHGs) and urban air pollutants, and can consume little or no petroleum, there is considerable interest in developing and evaluating advanced electric vehicles (EVs), including pure battery-electric vehicles, plug-in hybrid electric vehicles and hydrogen fuel-cell electric vehicles. To help researchers and policy-makers assess the potential of EVs to mitigate climate change and reduce petroleum use, this paper discusses the technology of EVs, the infrastructure needed for their development, impacts on emissions of GHGs, petroleum use, materials use, lifetime costs, consumer acceptance and policy considerations.

The impact of varying post-operative dressing size on recovery from laparoscopic cholecystectomy.

This study aimed to explore the impact of the size of a post-operative dressing and the subsequent visibility of the wound on recovery from laparoscopic cholecystectomy (LC). A randomised controlled trial was conducted. Fourty-one patients (8 men and 33 women, mean age = 44 years) scheduled for LC were included. Participants were randomly assigned to receive either small gauze dressings (n = 19) or large gauze dressings (n = 22) which were directly applied on post-operative incisions. Patients' mood, psychological well-being, illness cognitions, and pain and recovery were assessed at three time points: baseline, immediately after the procedure and then two weeks later. The findings suggest that the management of post-surgical incisions influences patients' interpretation of their illness which in turn has an impact upon the process of recovery from LC. This implies that visual information available to patients after the procedure through the cognitive and emotional mechanisms involved in their processing can alter the process of convalescence from LC.

A study of the atmospherically important reactions of dimethylsulfide (DMS) with I2 and ICl using infrared matrix isolation spectroscopy and electronic structure calculations.

The reactions of dimethylsulfide (DMS) with molecular iodine (I(2)) and iodine monochloride (ICl) have been studied by infrared matrix isolation spectroscopy by co-condensation of the reagents in an inert gas matrix. Molecular adducts of DMS + I(2) and DMS + ICl have also been prepared using standard synthetic methods. The vapour above each of these adducts trapped in an inert gas matrix gave the same infrared spectrum as that recorded for the corresponding co-condensation reaction. In each case, the infrared spectrum has been interpreted in terms of a van der Waals adduct, DMS : I(2) and DMS : ICl, with the aid of infrared spectra computed for their minimum energy structures at the MP2 level. Computed relative energies of minima and transition states on the potential energy surfaces of these reactions were used to understand why they do not proceed further than the reactant complexes DMS : I(2) and DMS : ICl. The main findings of this research are compared with results obtained earlier for the DMS + Cl(2) and DMS + Br(2) reactions, and the atmospheric implications of the conclusions are also considered.

Thermal decomposition of methyl 2-azidopropionate studied by UV photoelectron spectroscopy and matrix isolation IR spectroscopy: heterocyclic intermediate vs imine formation.

Methyl 2-azidopropionate (N(3)CH(3)CHCOOCH(3), M2AP) has been synthesized and characterized by different spectroscopic methods, and the thermal decomposition of this molecule has been investigated by matrix isolation infrared (IR) spectroscopy and ultraviolet photoelectron spectroscopy (UVPES). Computational methods have been employed in the spectral simulation of both UVPES and matrix IR spectra and in the rationalization of the thermal decomposition results. M2AP presents a HOMO vertical ionization energy (VIE) of 9.60 ± 0.03 eV and contributions from all four lowest-energy conformations of this molecule are detected in the gas phase. Its thermal decomposition starts at ca. 400 °C and is complete at ca. 650 °C, yielding N(2), CO, CO(2), CH(3)CN, and CH(3)OH as the final decomposition products. Methyl formate (MF) and CH(4) are also found during the pyrolysis process. Analysis of the potential energy surface of the decomposition of M2AP indicates that M2AP decomposes preferentially into the corresponding imine (M2IP), through a 1,2-H shift synchronous with the N(2) elimination (Type 1 mechanism), requiring an activation energy of 160.8 kJ/mol. The imine further decomposes via two competitive routes: one accounting for CO, CH(3)OH, and CH(3)CN (ΔE(G3) = 260.2 kJ/mol) and another leading to CO(2), CH(4), and CH(3)CN (ΔE(G3) = 268.6 kJ/mol). A heterocyclic intermediate (Type 2 mechanism)-4-Me-5-oxazolidone-can also be formed from M2AP via H transfer from the remote O-CH(3) group, together with the N(2) elimination (ΔE(G3) = 260.2 kJ/mol). Finally, a third pathway which accounts for the formation of MF through an M2AP isomer is envisioned.

Matrix isolation studies on the co-condensation reactions of molecular SiO and GeO: the characterisation of the novel cyclic species SiGeO(2), Si(2)GeO(3) and SiGe(2)O(3).

Matrix isolation IR studies, together with DFT calculations, have established that the co-condensation of molecular SiO and GeO in low temperature (12 K) nitrogen matrices leads to the formation of the novel silicon germanium oxide species SiGeO(2), Si(2)GeO(3) and SiGe(2)O(3) analogous to the known dimer and trimer species M(2)O(2) and M(3)O(3) (M = Si, Ge). Controlled diffusion studies in the temperature range 20-34 K result in a significant increase in trimer formation, which implies a very low activation energy for this oligomerisation step. Characteristic IR modes are assigned for all three novel mixed oxide molecules, and the DFT calculations establish that these species have cyclic C(2v) structures and provide estimates for their geometrical parameters. The significance of these results is noted in the light of current interest in the properties of mixed Si/Ge oxide systems.

Spectroscopic study of the reaction between Br2 and dimethyl sulfide (DMS), and comparison with a parallel study made on Cl2 + DMS: possible atmospheric implications.

The reaction between molecular bromine and dimethyl sulfide (DMS) has been studied both as a co-condensation reaction in low temperature matrices by infrared (IR) matrix isolation spectroscopy and in the gas-phase at low pressures by UV photoelectron spectroscopy (PES). The co-condensation reaction leads to the formation of the molecular van der Waals adduct DMS-Br(2). This was identified by IR spectroscopy supported by results of electronic structure calculations. Calculation of the minimum energy structures in important regions of the reaction surface and computed IR spectra of these structures, which could be compared with the experimental spectra, allowed the structure of the adduct (C(s)) to be determined. The low pressure (ca. 10(-5) mbar) gas-phase reaction was studied by UV-PES, but did not yield any observable products, indicating that a third body is necessary for the adduct to be stabilised. These results are compared with parallel co-condensation and gas-phase reactions between DMS and Cl(2). For this reaction, a similar van der Waals adduct DMS-Cl(2) is observed by IR spectroscopy in the co-condensation reactions, but in the gas-phase, this adduct converts to a covalently bound structure Me(2)SCl(2), observed in PES studies, which ultimately decomposes to monochlorodimethylsulfide and HCl. For these DMS + X(2) reactions, computed relative energies of minima and transition states on the potential energy surfaces are presented which provide an interpretation for the products observed from the two reactions studied. The implications of the results obtained to atmospheric chemistry are discussed.

A mechanistic study of the low pressure pyrolysis of linear siloxanes.

Matrix isolation IR spectroscopy has been used to study the vacuum pyrolysis of 1,1,3,3-tetramethyldisiloxane (L1), 1,1,3,3,5,5-hexamethyltrisiloxane (L2) and 3H,5H-octamethyltetrasiloxane (L3) at ca. 1000 K in a flow reactor at low pressures. The hydrocarbons CH3, CH4, C2H2, C2H4, and C2H6 were observed as prominent pyrolysis products in all three systems, and amongst the weaker features are bands arising from the methylsilanes Me2SiH2 (for L1 and L2) and Me3SiH (for L3). The fundamental of SiO was also observed very weakly. By use of quantum chemical calculations combined with earlier kinetic models, mechanisms have been proposed involving the intermediacy of silanones Me2Si=O and MeSiH=O. Model calculations on the decomposition pathways of H3SiOSiH3 and H3SiOSiH2OSiH3 show that silanone elimination is favoured over silylene extrusion.

Matrix isolation studies and DFT calculations on molecular alkali metal bromates.

DFT and MP2 calculations have been carried out on a series of molecular alkali metal bromates MBrO3 (M = Na, K, Rb, Cs), and the results compared with matrix isolation IR studies on the vaporisation of the solid salts. For M = Na, K or Rb, no ternary molecular species were detected in the low temperature matrix, but vaporisation of solid caesium bromate at 730 K resulted in the formation of molecular CsBrO3, which was identified as having a C3v structure involving tridentate coordination. Additionally, the DFT and MP2 calculations provide estimates of the molecular parameters for all four MBrO3 species, and for the related MXO3 species CsClO3 and CsIO3. The proven stability of MBrO3 molecules may have a bearing on the atmospheric chemistry of bromine oxo-species.

Possibility of predicting separations in supercritical fluid chromatography with the solvation parameter model.

In order to obtain a selection of optimal chromatographic columns for the separation of chlorotriazine pesticides in packed column supercritical fluid chromatography (pSFC), a multi-criteria approach is applied. For this purpose, prediction of the separations is carried out, based on quantitative structure-retention relationships, then Derringer's desirability function is proposed to determine the stationary phase that will result in the most desirable separation. The best SFC separation obtained was then optimized using a mobile phase gradient. Besides, the accuracy of the solvation parameter model as SFC retention predictive model is assessed.

The impact of viewing a hysteroscopy on a screen on the patient's experience: a randomised trial.

BACKGROUND: The introduction of patient screens for outpatient procedures is becoming increasingly common. To date, the impact on the patient of viewing the screen remains unknown. OBJECTIVES: To explore how viewing the screen during a hysteroscopy procedure affects the patient's experience. SETTING: The outpatient clinics at the Royal Surrey Hospital in Guildford and the Royal Infirmary in Bradford. DESIGN: A randomised control trial. SAMPLE: Women undergoing a hysteroscopy procedure were randomly allocated to see the screen (n=81) or not to see the screen (n=76). METHODS: A quantitative study with measures taken before and after the intervention. MAIN OUTCOME MEASURES: Pain perception, mood, illness cognitions, communication. RESULTS: Seeing the screen or not had no impact on several measures of pain perception, mood, illness cognitions or communication. However, women who did not see the screen were more optimistic about the effectiveness of their treatment and felt that the health professional was more receptive to them during the consultation compared with those who saw the screen. After controlling for the use of a local anaesthetic, those who did not see the screen also reported a greater decrease in anxiety after the procedure. However, those who saw the screen described pain more positively (i.e. in terms of comfort, reassurance or encouragement) compared with those who did not see the screen. CONCLUSION: Viewing the screen does not benefit the patient and may interfere with the patient-physician interaction.

A mechanistic study of cyclic siloxane pyrolyses at low pressures.

Matrix isolation IR spectroscopy has been used to study the vacuum pyrolysis of hexamethylcyclotrisiloxane (D3), octamethylcyclotetrasiloxane (D4) and decamethyl cyclopentasiloxane (D5), and the results interpreted in the context of various kinetic models. In particular, it is shown that the significant pyrolysis products--which include CH3, CH4, C2H2, C2H4, C2H6 and SiO--may be satisfactorily accounted for by radical reactions involving dimethylsiloxane (D1), and estimates are made of the various chain lengths for the proposed reactions based on a range of ambient conditions.