Long-Term Effectiveness of a Decision Support App (Pink Journey) for Women Considering Breast Reconstruction Surgery: Pilot Randomized Controlled Trial.

BACKGROUND: Various kinds of breast reconstruction (BR) options, including implants and autologous, and surgery techniques, including traditional and endoscope assisted, can be used to perform surgery. All options have their own advantages and disadvantages. Women decide on an option depending on the values and preferences they emphasize. Lacking knowledge about BR or having decision difficulties during the treatment decision process makes women experience more decision regret, psychological distress, and poor body image. Delivering decision support with a values clarification exercise using eHealth approaches would be beneficial for patient outcomes. OBJECTIVE: This study aims to examine the effects of a decision support app on decision-making quality and psychological morbidity for women considering BR surgery. METHODS: This randomized controlled trial included women who were over 20 years of age and were newly diagnosed with breast cancer and candidates for mastectomy. Women having an option for breast conservation were excluded. After being referred from the outpatient physician, the women provided consent and completed the baseline assessment. Women allocated to the control group (CG) received usual care and were provided with a pamphlet with information about types of surgery and the advantages and disadvantages of different surgery types. Women allocated to the intervention group (IG) were given the same pamphlet and guided to use the Pink Journey app to support their decision. Then they were also prompted to discuss the opinions with their significant others. Finally, the decision-making process of using the app was printed out for women that they could take home. Decision conflict, anxiety, and depression were measured at baseline. At 1 week after the intervention (T1) and at 1 month (T2), 8 months (T3), and 12 months (T4) after surgery, the women completed decision conflict, decision regret, anxiety, depression, and body image scales. An intention-to-treat analysis was performed. RESULTS: From February 2018 to July 2019, 96 women were randomly assigned to the CG (n=48) or the IG (n=48). Results revealed that body image distress declined significantly for the IG but increased for the CG. The interaction of time and group also reached significance, indicating a significant decrease in body image distress from baseline in the IG compared with the CG after the 12th month (T4) follow-up (ß=-2.25, standard error=1.01, P=.027). However, there was no significant difference in decision conflict (P=.21-.87), decision regret (P=.44-.55), anxiety (P=.26-.33), and depression (P=.20-.75), indicating that the decrease in these outcomes in the IG was not greater than those in the CG. CONCLUSIONS: Although we found no effect on decision conflict, decision regret, anxiety, and depression, a decision aid that combines surgery information and values clarification can help women reduce their body image distress. TRIAL REGISTRATION: ClinicalTrials.gov NCT04190992; https://clinicaltrials.gov/ct2/show/NCT04190992.

Theoretical insight into hydroxyl production via H2O2 decomposition over the Fe3O4(311) surface.

Fenton's reagent provides a method to produce active hydroxyl radicals (˙OH) for chemical oxidation by mixing iron oxide and hydrogen peroxide, which divides into homogeneous and heterogeneous Fenton's reagent. Heterogeneous Fenton's reagent is fabricated from H2O2 and various iron oxide solid materials, such as α-FeOOH, α-Fe2O3, and Fe3O4. Fe3O4 possesses the Fe2+/Fe3+ mixed valence oxidational state and has been reported to have good catalytic activity. However, the reaction mechanism of H2O2 decomposition on Fe3O4 surfaces is still unclear. In this work, we performed DFT calculations to investigate the H2O2 decomposition mechanisms over the Fe3O4(311) surface. There are two iron environments for H2O2 adsorption and decomposition on the Fe3O4(311) surface, a Fe2+/Fe3+ environment and a Fe3+/Fe3+ environment. We found that the H2O2 can adsorb on the Fe2+/Fe3+ environment by molecular adsorption but by dissociative adsorption on the Fe3+/Fe3+ environment. Our results show that both adsorption structures can produce two OH groups on the Fe3O4(311) surface thermodynamically. In addition, based on the electronic property analysis, H2O2 on the Fe2+/Fe3+ environment follows the Haber-Weiss mechanism to form one OH anion and one OH radical. On the other hand, H2O2 on the Fe3+/Fe3+ environment follows the radical mechanism to form two OH radicals. In particular, the OH radical formed on Fe2+/Fe3+ has energy levels on both sides of the Fermi energy level. It can be expected that this OH radical has good redox activity.

Development and Usability Testing of a Decision Support App for Women Considering Breast Reconstruction Surgery.

Women with breast cancer have difficulty deciding whether to undergo breast reconstruction when mastectomy is necessary. A computer-based decision aid that can be individualized to provide both surgery information and value clarification may be helpful for women considering breast reconstruction surgery. The objectives of this study are to program a prototype of an application (app) with a value clarification exercise and to evaluate the pilot usability, feasibility, and efficacy of the app. In phase 1, a prototype app called Pink Journey for use on the iPhone OS (IOS) platform was created following the framework of shared decision making. In phase 2, 11 women who were given the option of reconstruction by a breast surgeon were recruited from July 2017 to December 2017. A pretest-posttest design was adopted to test the usability and feasibility of the app. The results showed that the women who used the app reported significantly less decisional conflict after intervention on each subscale of the Decision Conflict scale, i.e., "being informed", "uncertainty", "social support", "effective decision", and "value clarification". This research provides preliminary data indicating that Pink Journey holds promise for decreasing decision conflict. Most women felt that the app was both helpful and user-friendly. The app increased their participation in decision making, helped them obtain more accurate risk perceptions, and clarified their values. It also helped the women make decisions regarding breast reconstruction more confidently.

B, N-co-doped graphene-supported Ir and Pt clusters for methane activation and C─C coupling: A density functional theory study.

Methane conversion by using transition metal catalysts plays in an important role in various usages of the industrial process. The mechanism of methane conversion on B, N-co-doped graphene supported Ir and Pt clusters, BNG-Ir4 and BNG-Pt4, have been investigated using density functional theory calculations. Methane was found to adsorb on BNG-Ir4 and BNG-Pt4 clusters via strong agostic interactions. The first step of methane dehydrogenation on BNG-Ir4 has a lower energy barrier, indicating a facile methane dissociation on BNG-Ir4. In addition, it shows that hydrogen molecule can form on the BNG-Ir4 and hydrogen can desorb from the surface. Besides, the C-C coupling reaction of CH3 to form ethane is a more thermodynamically favorable process than CH3 dehydrogenation on BNG-Ir4. Further, ethane is easier to desorb from the surface due to its low desorption energy. Therefore, the BNG-Ir4 cluster is a potential catalyst for activating methane to form ethane and to produce hydrogen. © 2019 Wiley Periodicals, Inc.