Most high school baseball pitchers are using weighted ball throwing programs to increase ball velocity: crosssectional analysis of US high school pitchers.

Background: Weighted-ball velocity training programs are popular but may be associated with increased injury risk. The purpose of this study was to determine the current frequency of these programs, as well as their association with range of motion, strength, velocity, injury, and utilization in high school baseball pitchers. Methods: This was a multicenter, prospective, community-based study including high schools from the Northeastern, Southeastern, Midwestern, and Western regions of the United States. Preseason pitchers were surveyed about their use of weighted ball velocity programs and history of injury. Preseason pitchers underwent standardized physical examinations and pitch velocity was measured. During a single high school season, pitch counts and injury incidence were prospectively collected. Results: In total, 115 pitchers were recruited, of whom 63% had participated in a weighted ball program. There were no differences in range of motion or strength between groups who used weighted balls and those who did not. Pitchers that utilized weighted ball programs demonstrated a higher average fastball velocity (114.26 vs. 106.22 km/h [71 vs. 66 mph]; P < .001) as well as peak fastball velocity (115.87 vs. 109.44 km/h [72 vs. 68 mph]; P = .001) compared to those that did not use weighted ball programs. Pitchers that utilized weighted ball programs were no more likely to be single-sport athletes (44%) than those who were multisport athletes (49%, P = .667). Within the group who had used a weighted ball program 29% (13/45) reported a history of injury and within the group who had not used a weighted ball program 25% (10/40) reported a history of injury (P = .687). As only a single injury occurred in the entire cohort, comparison of injury rates could not be completed. Conclusion: In this prospective study, the majority of high school pitchers reported using weighted ball programs to increase velocity, and these programs were associated with increased average and peak velocity compared to pitchers who did not use weighted ball programs. There were no significant differences in injury history between the 2 groups. Further study is necessary to understand the injury risk associated with weighted ball programs.

Identifying ways to improve diabetes management during cancer treatments (INDICATE): protocol for a qualitative interview study with patients and clinicians.

INTRODUCTION: A large and growing number of patients with cancer have comorbid diabetes. Cancer and its treatment can adversely impact glycaemic management and control, and there is accumulating evidence that suboptimal glycaemic control during cancer treatment is a contributory driver of worse cancer-related outcomes in patients with comorbid diabetes. Little research has sought to understand, from the perspective of patients and clinicians, how and why different aspects of cancer care and diabetes care can complicate or facilitate each other, which is key to informing interventions to improve diabetes management during cancer treatments. This study aims to identify and elucidate barriers and enablers to effective diabetes management and control during cancer treatments, and potential intervention targets and strategies to address and harness these, respectively. METHODS AND ANALYSIS: Qualitative interviews will be conducted with people with diabetes and comorbid cancer (n=30-40) and a range of clinicians (n=30-40) involved in caring for this patient group (eg, oncologists, diabetologists, specialist nurses, general practitioners). Semistructured interviews will examine participants' experiences of and perspectives on diabetes management and control during cancer treatments. Data will be analysed using framework analysis. Data collection and analysis will be informed by the Theoretical Domains Framework, and related Theory and Techniques Tool and Behaviour Change Wheel, to facilitate examination of a comprehensive range of barriers and enablers and support identification of pertinent and feasible intervention approaches. Study dates: January 2021-January 2023. ETHICS AND DISSEMINATION: The study has approval from National Health Service (NHS) West Midlands-Edgbaston Research Ethics Committee. Findings will be presented to lay, clinical, academic and NHS and charity service-provider audiences via dissemination of written summaries and presentations, and published in peer-reviewed journals. Findings will be used to inform development and implementation of clinical, health services and patient-management intervention strategies to optimise diabetes management and control during cancer treatments.

Low-Voltage Electron-Probe Microanalysis of Uranium.

Electron-probe microanalysis of uranium and uranium alloys poses several problems, such as rapid oxidation, large poorly constrained correction factors, and a large number of characteristic x-ray lines. We show that U-metal can grow 10 nm of oxide within ~20 s of air exposure, increasing to 15­20 nm within a few minutes, which can produce a 30% quantification error at 5 kV. A 15 nm carbon coating on the UO2 reference material also produces an ~30% quantification error of the uncoated but surface oxidized U sample at 5 kV. Correcting for both the coating and oxide improved the analysis accuracy to better than ±1% down to 7 kV and ~2% at 5 kV, but the error increases strongly below this. The measurement of C in U identified a previously unreported U N6­O4 line interference on the C Kα peak, which can produce over 1% error in the analysis total. Oxide stoichiometry was demonstrated to have only a small impact on quantification. The measurement of the O Kα and U Mα mass absorption coefficients in U as 9,528 and 798 cm2/g, respectively, shows good agreement with recently published values and also produces small differences in a quantification error.

Electron Probe Microanalysis Through Coated Oxidized Surfaces.

Low voltage electron probe microanalysis (EPMA) of metals can be complicated by the presence of a surface oxide. If a conductive coating is applied, analysis becomes one of a three-layer structure. A method is presented which allows for the coating and oxide thicknesses and the substrate intensities to be determined. By restricting the range of coating and oxide thicknesses, tc and to respectively, x-ray intensities can be parameterized using a combination of linear functions of tc and to. tc can be determined from the coating element k-ratio independently of the oxide thickness. to can then be derived from the O k-ratio and tc. From tc and to the intensity components of the k-ratios from the oxide layer and substrate can each be derived. Modeled results are presented for an Ag on Bi2O3 on Bi system, with tc and to each ranging from 5 to 20 nm, for voltages of 5-20 kV. The method is tested against experimental measurements of Ag- or C-coated samples of polished Bi samples which have been allowed to naturally oxidize. Oxide thicknesses determined both before and after coating with Ag or C are consistent. Predicted Bi Mα k-ratios also show good agreement with EPMA-measured values.

Electron Beam-Induced Carbon Erosion and the Impact on Electron Probe Microanalysis.

Electron beam-induced carbon contamination is a balance between simultaneous deposition and erosion processes. Net erosion rates for a 25 nA 3 kV beam can reduce a 5 nm C coating by 20% in 60 s. Measurements were made on C-coated Bi substrates, with coating thicknesses of 5-20 nm, over a range of analysis conditions. Erosion showed a step-like increase with increasing electron flux density. Both the erosion rate and its rate of change increase with decreasing accelerating voltage. As the flux density decreases the rate of change increases more rapidly with decreasing voltage. Time-dependent intensity (TDI) measurements can be used to correct for errors, in both coating and substrate quantifications, resulting from carbon erosion. Uncorrected analyses showed increasing errors in coating thickness with decreasing accelerating voltage. Although the erosion rate was found to be independent of coating thickness this produces an increasing absolute error with decreasing starting thickness, ranging from 1.5% for a 20 nm C coating on Bi at 15 kV to 14% for a 5 nm coating at 3 kV. Errors in Bi Mα measurement are <1% at 5 kV or above but increase rapidly below this, both with decreasing voltage and increasing coating thickness to 20% for a 20 nm coated sample at 3 kV.

The Accuracy of Al and Cu Film Thickness Determinations and the Implications for Electron Probe Microanalysis.

The accuracy to which Cu and Al coatings can be determined, and the effect this has on the quantification of the substrate, is investigated. Cu and Al coatings of nominally 5, 10, 15, and 20 nm were sputter coated onto polished Bi using two configurations of coater: One with the film thickness monitor (FTM) sensor colocated with the samples, and one where the sensor is located to one side. The FTM thicknesses are compared against those calculated from measured Cu Lα and Al Kα k-ratios using PENEPMA, GMRFilm, and DTSA-II. Selected samples were also cross-sectioned using focused ion beam. Both systems produced repeatable coatings, the thickest coating being approximately four times the thinnest coating. The side-located FTM sensor indicated thicknesses less than half those of the software modeled results, propagating on to 70% errors in substrate quantification at 5 kV. The colocated FTM sensor produced errors in film thickness and substrate quantification of 10-20%. Over the range of film thicknesses and accelerating voltages modeled both the substrate and coating k-ratios can be approximated by linear trends as functions of film thickness. The Al films were found to have a reduced density of ~2 g/cm2.

Supporting prostate cancer survivors in primary care: Findings from a pilot trial of a nurse-led psycho-educational intervention (PROSPECTIV).

PURPOSE: This study sought to test the acceptability and feasibility of a nurse-led psycho-educational intervention (NLPI) delivered in primary care to prostate cancer survivors, and to provide preliminary estimates of the effectiveness of the intervention. METHODS: Men who reported an ongoing problem with urinary, bowel, sexual or hormone-related functioning/vitality on a self-completion questionnaire were invited to participate. Participants were randomly assigned to the NLPI plus usual care, or to usual care alone. Recruitment and retention rates were assessed. Prostate-related quality of life, self-efficacy, unmet needs, and psychological morbidity were measured at baseline and 9 months. Health-care resource use data was also collected. An integrated qualitative study assessed experiences of the intervention. RESULTS: 61% eligible men (83/136) participated in the trial, with an 87% (72/83) completion rate. Interviews indicated that the intervention filled an important gap in care following treatment completion, helping men to self-manage, and improving their sense of well-being. However, only a small reduction in unmet needs and small improvement in self-efficacy was observed, and no difference in prostate-related quality of life or psychological morbidity. Patients receiving the NLPI recorded more primary care visits, while the usual care group recorded more secondary care visits. Most men (70%; (21/30)) felt the optimal time for the intervention was around the time of diagnosis/before the end of treatment. CONCLUSIONS: Findings suggest a nurse-led psycho-educational intervention in primary care is feasible, acceptable and potentially useful to prostate cancer survivors.

New approaches to enhance pollutant removal in artificially aerated wastewater treatment systems.

Freshwater ecosystems sustain human society through the provision of a range of services. However, the status of these ecosystems is threatened by a multitude of pressures, including point sources of wastewater. Future treatment of wastewater will increasingly require new forms of decentralised infrastructure. The research reported here sought to enhance pollutant removal within a novel wastewater treatment technology, based on un-planted, artificially aerated, horizontal subsurface flow constructed wetlands. The potential for these systems to treat de-icer contaminated runoff from airports, a source of wastewater that is likely to grow in importance alongside the expansion of air travel and under future climate scenarios, was evaluated. A new configuration for the delivery of air to aerated treatment systems was developed and tested, based on a phased-aeration approach. This new aeration approach significantly improved pollutant removal efficiency compared to alternative aeration configurations, achieving >90% removal of influent load for COD, BOD5 and TOC. Optimised operating conditions under phased aeration were also determined. Based on a hydraulic retention time of 1.5 d and a pollutant mass loading rate of 0.10 kg d-1 m-2 BOD5, >95% BOD5 removal, alongside final effluent BOD5 concentrations <21 mg L-1, could be achieved from an influent characterised by a BOD5 concentration > 800 mg L-1. Key controls on oxygen transfer efficiency within the aerated treatment system were also determined, revealing that standard oxygen transfer efficiency was inversely related to aeration rate between 1 L and 3 L min-1 and positively related to bed media depth between 1500 mm and 3000 mm. The research reported here highlights the potential for optimisation and subsequent widespread application of the aerated wetland technology, in order to protect and restore freshwater ecosystems and the services that they provide to human society.

Symptoms, unmet needs, psychological well-being and health status in survivors of prostate cancer: implications for redesigning follow-up.

OBJECTIVE: To explore ongoing symptoms, unmet needs, psychological wellbeing, self-efficacy and overall health status in survivors of prostate cancer. PATIENTS AND METHODS: An invitation to participate in a postal questionnaire survey was sent to 546 men, diagnosed with prostate cancer 9-24 months previously at two UK cancer centres. The study group comprised men who had been subject to a range of treatments: surgery, radiotherapy, hormone therapy and active surveillance. The questionnaire included measures of prostate-related quality of life (Expanded Prostate cancer Index Composite 26-item version, EPIC-26); unmet needs (Supportive Care Needs Survey 34-item version, SCNS-SF34); anxiety and depression (Hospital Anxiety and Depression Scale, HADS), self-efficacy (modified Self-efficacy Scale), health status (EuroQol 5D, EQ-5D) and satisfaction with care (questions developed for this study). A single reminder was sent to non-responders after 3 weeks. Data were analysed by age, co-morbidities, and treatment group. RESULTS: In all, 316 men completed questionnaires (64.1% response rate). Overall satisfaction with follow-up care was high, but was lower for psychosocial than physical aspects of care. Urinary, bowel, and sexual functioning was reported as a moderate/big problem in the last month for 15.2% (n = 48), 5.1% (n = 16), and 36.5% (n = 105) men, respectively. The most commonly reported moderate/high unmet needs related to changes in sexual feelings/relationships, managing fear of recurrence/uncertainty, and concerns about the worries of significant others. It was found that 17% of men (51/307) reported potentially moderate-to-severe levels of anxiety and 10.2% (32/308) reported moderate-to-severe levels of depression. The presence of problematic side-effects was associated with higher psychological morbidity, poorer self-efficacy, greater unmet needs, and poorer overall health status. CONCLUSION: While some men report relatively few problems after prostate cancer treatment, this study highlights important physical and psycho-social issues for a significant minority of survivors of prostate cancer. Strategies for identifying those men with on-going problems, alongside new interventions and models of care, tailored to individual needs, are needed to improve quality of life.

PROSPECTIV-a pilot trial of a nurse-led psychoeducational intervention delivered in primary care to prostate cancer survivors: study protocol for a randomised controlled trial.

BACKGROUND: Prostate cancer survivors can experience physical, sexual, psychological and emotional problems, and there is evidence that current follow-up practices fail to meet these men's needs. Studies show that secondary and primary care physicians see a greater role for primary care in delivering follow-up, and that primary care-led follow-up is acceptable to men with prostate cancer. METHODS AND ANALYSIS: A two-phase study with target population being men who are 9-24 months from diagnosis. Phase 1 questionnaire aims to recruit 300 men and measure prostate-related quality of life and unmet needs. Men experiencing problems with urinary, bowel, sexual or hormonal function will be eligible for phase 2, a pilot trial of a primary care nurse-led psychoeducational intervention. Consenting eligible participants will be randomised either to intervention plus usual care, or usual care alone (40 men in each arm). The intervention, based on a self-management approach, underpinned by Bandura's Social Cognitive Theory, will provide advice and support tailored to these men's needs and address any problems they are experiencing. Telephone follow-up will take place at 6 months. Study outcomes will be measured by a questionnaire at 7 months. Phase 1 will allow us to estimate the prevalence of urinary, sexual, bowel and hormone-related problems in prostate cancer survivors and the level of unmet needs. 'Usual care' will also be documented. Phase 2 will provide information on recruitment and retention, acceptability of the intervention/outcome measures, effect sizes of the intervention and cost-effectiveness data, which is required to inform development of a larger, phase 3 randomised controlled trial. The main outcome of interest is change in prostate-cancer-related quality of life. Methodological issues will also be addressed. ETHICS AND DISSEMINATION: Ethics approval has been gained (Oxford REC A 12/SC/0500). Findings will be disseminated in peer-reviewed journals, at conferences, through user networks and relevant clinical groups. TRIAL REGISTRATION NUMBER: ISRCTN 97242511.