Patients' views and experiences on the supported self-management/patient-initiated follow up pathway for breast cancer.

PURPOSE: To explore patients' expectations and experience of Supportive Self-Management (SSM)/ Patient Initiated Follow Up (PIFU) following breast cancer treatments over a 12-month period. METHODS: In total, 32/110 (29%) patient participants in the PRAGMATIC (Patients' experiences of a suppoRted self-manAGeMent pAThway In breast Cancer) study were interviewed at baseline, 3, 6, 9 and 12 months. Interviews in this sub-study used a mix-methods approach to explore understanding of the pathway, confidence in self-management, triggers to seek help and/or re-engage with the clinical breast team and impact of the COVID-19 pandemic. Responses to pre-assigned categories were summarised as counts/ percentages and collated in tabular or graphic format. Free responses were recorded verbatim and reviewed using framework analysis. RESULTS: Participants regarded the SSM/PIFU pathway as a way to save time and money for them and the National Health Service (NHS) (14/32; 44%) and as a means of assuming responsibility for their own follow-up (18/32; 56%). Most maintained (very/somewhat) confidence in managing their BC follow-up care (baseline 31/32, 97%; 12 months 29/31, 93%). During the year, 19% (5/26) stopped endocrine therapy altogether because of side effects. Qualitative analysis revealed general satisfaction with SSM/PIFU and described the breast care nurses as reassuring and empathic. However, there was a lingering anxiety about identifying signs and symptoms correctly, particularly for those with screen-detected cancers. There was also uncertainty about who to contact for psychological support. The COVID-19 pandemic discouraged some participants from contacting the helpline as they did not want to overburden the NHS. CONCLUSIONS: The results show that during the first year on the SSM/PIFU pathway, most patients felt confident managing their own care. Clinical teams should benefit from understanding patients' expectations and experiences and potentially modify the service for men with BC and/or those with screen-detected breast cancers.

Volumetric-modulated arc therapy (RapidArc) vs. conventional fixed-field intensity-modulated radiotherapy for ¹8F-FDG-PET-guided dose escalation in oropharyngeal cancer: a planning study.

UNLABELLED: Fluorine-18-fluorodeoxyglucose-positron emission tomography (¹8F-FDG-PET)-guided focal dose escalation in oropharyngeal cancer may potentially improve local control. We evaluated the feasibility of this approach using volumetric-modulated arc therapy (RapidArc) and compared these plans with fixed-field intensity-modulated radiotherapy (IMRT) focal dose escalation plans. MATERIALS AND METHODS: An initial study of 20 patients compared RapidArc with fixed-field IMRT using standard dose prescriptions. From this cohort, 10 were included in a dose escalation planning study. Dose escalation was applied to ¹8F-FDG-PET-positive regions in the primary tumor at dose levels of 5% (DL1), 10% (DL2), and 15% (DL3) above standard radical dose (65 Gy in 30 fractions). Fixed-field IMRT and double-arc RapidArc plans were generated for each dataset. Dose-volume histograms were used for plan evaluation and comparison. The Paddick conformity index (CI(Paddick)) and monitor units (MU) for each plan were recorded and compared. Both IMRT and RapidArc produced clinically acceptable plans and achieved planning objectives for target volumes. Dose conformity was significantly better in the RapidArc plans, with lower CI(Paddick) scores in both primary (PTV1) and elective (PTV2) planning target volumes (largest difference in PTV1 at DL3; 0.81 ± 0.03 [RapidArc] vs. 0.77 ± 0.07 [IMRT], p = 0.04). Maximum dose constraints for spinal cord and brainstem were not exceeded in both RapidArc and IMRT plans, but mean doses were higher with RapidArc (by 2.7 ± 1 Gy for spinal cord and 1.9 ± 1 Gy for brainstem). Contralateral parotid mean dose was lower with RapidArc, which was statistically significant at DL1 (29.0 vs. 29.9 Gy, p = 0.01) and DL2 (29.3 vs. 30.3 Gy, p = 0.03). MU were reduced by 39.8-49.2% with RapidArc (largest difference at DL3, 641 ± 94 vs. 1261 ± 118, p < 0.01). ¹8F-FDG-PET-guided focal dose escalation in oropharyngeal cancer is feasible with RapidArc. Compared with conventional fixed-field IMRT, RapidArc can achieve better dose conformity, improve contralateral parotid sparing, and uses fewer MU.

Morphological architecture of dual-layer hollow fiber for membrane distillation with higher desalination performance.

A new strategy to enhance the desalination performance of polyvinylidene fluoride (PVDF) hollow fiber membrane for membrane distillation (MD) via architecture of morphological characteristics is explored in this study. It is proposed that a dual-layer hollow fiber consisting of a fully finger-like macrovoid inner-layer and a sponge-like outer-layer may effectively enhance the permeation flux while maintaining the wetting resistance. Dual-layer fibers with the proposed morphology have been fabricated by the dry-jet wet spinning process via careful choice of dopes composition and coagulation conditions. In addition to high energy efficiency (EE) of 94%, a superior flux of 98.6 L m(-2) h(-1) is obtained during the direct contact membrane distillation (DCMD) desalination experiments. Moreover, the liquid entry pressure (LEP) and long-term DCMD performance test show high wetting resistance and long-term stability. Mathematical modeling has been conducted to investigate the membrane mass transfer properties in terms of temperature profile and apparent diffusivity of the membranes. It is concluded that the enhancement in permeation flux arises from the coupling effect of two mechanisms; namely, a higher driving force and a lower mass transfer resistance, while the later is the major contribution. This work provides an insight on MD fundamentals and strategy to tailor making ideal membranes for DCMD application in desalination industry.

Surface microcracks decoration and disclination defects of wholly aromatic liquid crystalline copolyesters.

An intensive study has been conducted to map the director fields of disclination of nematic liquid crystalline copolyesters. In this study, films of two wholly aromatic main-chain polyesters containing para- (ABA/MH/TFTA) and meta-linkages (ABA/MH/TFIA) (ABA, p-acetoxybenzoic acid; MH, maleic hydrazine; TFTA, tetrafluoroterephthalic acid; TFIA, tetrafluoroisophthalic acid) were synthesized to investigate the effects of kinks on liquid crystallinity, disclination strength (S), and surface microcracks decoration. These two copolyesters were prepared by in-situ thin film polymerization and characterized by polarizing light microscope, wide-angle X-ray diffraction, as well as "rotational isomeric states" (RIS) Metropolis Monte Carlo (RMMC) simulation. An optical microscope shows that the surface microcracks forms in the nematic-mosaic texture during a rapid quenching. The ABA/MH/TFTA film exhibits disclination strength with S = +1 and S = -(1)/(2); however, disclination strengths with S = +/-1 have been observed in the ABA/MH/TFIA system. To our best knowledge, this is the first paper reporting the effects and evidence of kink (meta and para moieties) on topological defect of disclination. In addition, the RMMC analysis supports the liquid crystal formation in both polyester films with a persistence ratio greater than 6.42.