Protocol for a longitudinal qualitative interview study: maintaining psychological well-being in advanced cancer - what can we learn from patients' and carers' own coping strategies?

IntroductionPeople with advanced cancer and their carers experience stress and uncertainty which affects the quality of life and physical and mental health. This study aims to understand how patients and carers recover or maintain psychological well-being by exploring the strategies employed to self-manage stress and uncertainty.Methods and analysisA longitudinal qualitative interview approach with 30 patients with advanced cancer and 30 associated family or informal carers allows the exploration of contexts, mechanisms and outcomes at an individual level. Two interviews, 4–12?weeks apart, will not only enable the exploration of individuals’ evolving coping strategies in response to changing contexts but also how patients’ and carers’ strategies inter-relate. Patient and Carer focus groups will then consider how the findings may be used in developing an intervention. Recruiting through two major tertiary cancer centres in the North West and using deliberately broad and inclusive criteria will enable the sample to capture demographic and experiential breadth.Ethics and disseminationThe research team will draw on their considerable experience to ensure that the study is sensitive to a patient and carer group, which may be considered vulnerable but still values being able to contribute its views. Public and patient involvement (PPI) is integral to the design and is evidenced by: a research advisory group incorporating patient and carers, prestudy consultations with the PPI group at one of the study sites and a user as the named applicant. The study team will use multiple methods to disseminate the findings to clinical, policy and academic audiences. A key element will be engaging health professionals in patient and carer ideas for promoting self-management of psychological well-being. The study has ethical approval from the North West Research Ethics Committee and the appropriate NHS governance clearance.RegistrationNational Institute for Health Research (NIHR) Clinical Studies Portfolio, UK Clinical Research Network (UKCRN) Study number 11725

Radio emission models of Colliding-Wind Binary Systems

We present calculations of the spatial and spectral distribution of the radio emission from a wide WR+OB colliding-wind binary system based on high-resolution hydrodynamical simulations and solutions to the radiative transfer equation. We account for both thermal and synchrotron radio emission, free-free absorption in both the unshocked stellar wind envelopes and the shocked gas, synchrotron self-absorption, and the Razin effect. The applicability of these calculations to modelling radio images and spectra of colliding-wind systems is demonstrated with models of the radio emission from the wide WR+OB binary WR147. Its synchrotron spectrum follows a power-law between 5 and 15 GHz but turns down to below this at lower and higher frequencies. We find that while free-free opacity from the circum-binary stellar winds can potentially account for the low-frequency turnover, models that also include a combination of synchrotron self-absorption and Razin effect are favoured. We argue that the high-frequency turn down is a consequence of inverse-Compton cooling. We present our resulting spectra and intensity distributions, along with simulated MERLIN observations of these intensity distributions. From these we argue that the inclination of the WR147 system to the plane of the sky is low. We summarise by considering extensions of the current model that are important for models of the emission from closer colliding wind binaries, in particular the dramatically varying radio emission of WR140.Comment: 18 pages, 18 figures; Accepted by Astronomy and Astrophysics, July 8, 200

Evidence for ablated flows in the shell of nova DQ Her

High-resolution longslit Halpha spectra of the shell of the old nova DQ Her have been obtained with the William Herschel Telescope using the ISIS spectrograph. An equatorial expansion velocity of 370+/-14 km/s is derived from the spectra which, in conjunction with a narrowband Halpha image of the remnant, allows a distance estimate of 525+/-28 pc. An equatorial ring which exhibits enhanced [NII] emission has also been detected and the inclination angle of the shell is found to be 86.8+/-0.2 degrees with respect to the line of sight. The spectra also reveal tails extending from the clumps in the shell, which have a radial velocity increasing along their length. This suggests the presence of a stellar wind, collimated in the polar direction, which ablates fragments of material from the clumps and accelerates them into its stream up to a terminal velocity of order 800-900 km/s.Comment: 7 pages, 6 figure

Prevalence of non-functional overreaching in elite male and female youth academy football players

Purpose: The purpose of this study was to examine the prevalence of non-functional overreaching (NFOR) and overtraining (OT) in elite male and female youth football players. Methods: Two-hundred and forty-two youth football players (n = 138 boys and n = 104 girls) aged between 12 - 17 y completed a questionnaire to identify the occurrence of NFOR/OT and associated symptoms. Results: No players experienced OT. Significant sex differences for NFOR were found between girls 9% compared to boys 27% (p <0.05). For players that experienced NFOR, 33% of girls and 60% of boys experienced multiple bouts. Compared to girls, boys completed higher volumes of football training (16.3 ± 4.5 versus 12.7 ± 5.7 hours per week, p <0.05), but training load was not a significant predictor of NFOR for either sex. In both sexes NFOR was associated with tiredness, a lack of appetite, sore or heavy muscles, feeling in a bad mood, and feeling apathetic. Conclusion: Male and female elite youth football players engaged in high training volumes and experienced similar NFOR symptoms. However, there is a much higher prevalence of NFOR in boys and in those who have suffered previous bouts of NFOR

Development of the Carers’ Alert Thermometer (CAT) to identify family carers struggling with caring for someone dying at home: a mixed method consensus study

Background: There is an increasing international policy direction to promote home death for dying patients which will impact on the demands placed on family carers. The early identification of carer needs and appropriate intervention can help avoid crisis situations for the carer and avoidable hospital admissions which are reported to be a global concern. The aim of the study was to explore what professionals and carers of patients with cancer and advanced progressive illness, in their last year of life, find burdensome and to develop an alert system for use by non-specialist staff. Methods: A mixed-method, multi-phased, consensus study sequentially utilising qualitative and quantitative data to develop and pilot the Carers’ Alert Thermometer (CAT). 245 people (117 carers and 128 professionals) participated in the study across a range of health and social care settings in the North West of England (2011–2014). Results: A number of key domains were identified and prioritised by consensus for inclusion in the CAT. The 8 domains fit within two overarching themes of the reported carer experience; the support needed by the carer to provide care and the support needed for the carer’s own health and well-being. The resultant CAT is an evidence-based alert thermometer consisting of 10 questions, guidance on the possible actions for each alert and space for an action plan to be jointly agreed by the assessor and carer. Preliminary piloting of the CAT has shown it to be valued, fit for purpose and it can be administered by a range of personnel. Conclusions: The CAT enables the identification of current and potential future needs so a proactive approach can be taken to supporting the carer as their role develops over time, with a view to enhancing their well-being and preventing avoidable hospital admissions; ultimately supporting patient choice to remain in their own home

Sunshine, Sea, and Season of Birth: MS Incidence in Wales

Maternal sun exposure in gestation and throughout the lifetime is necessary for vitamin D synthesis, and living near the sea is a population level index of seafood consumption. The aim of this study was to estimate the incidence rate of multiple sclerosis (MS) in Wales and examine its association with sun exposure, coastal living, and latitude. The study used a database of MS hospital visits and admissions in Wales between 2002 and 2013. For the 1,909 lower layer super output areas (LSOAs) in Wales, coastal status, population, longitude/latitude, and average sunshine hours per day were obtained. Age-specific and age-standardised MS incidence were calculated and modelled using Poisson regression. The distribution of births by month was compared between MS cases and the combined England and Wales population. There were 3,557 new MS cases between 2002 and 2013, with an average annual incidence of 8.14 (95% CI: 7.69-8.59) among males and 12.97 (95% CI: 12.44-13.50) among females per 100,000 population. The female-to-male ratio was 1.86:1. For both sexes combined, the average annual incidence rate was 9.10 (95% CI: 8.80-9.40). All figures are age-standardized to the 1976 European standard population. Compared to the combined England and Wales population, more people with MS were born in April, observed-to-expected ratio: 1.21 (95% CI: 1.08-1.36). MS incidence varied directly with latitude and inversely with sunshine hours. Proximity to the coast was associated with lower MS incidence only in easterly areas. This study shows that MS incidence rate in Wales is comparable to the rate in Scotland and is associated with environmental factors that probably represent levels of vitamin D

The separated electric and magnetic field responses of luminescent bacteria exposed to pulsed microwave irradiation

Electromagnetic fields (EMFs) are ubiquitous in the digital world we inhabit, with microwave and millimetre wave sources of non-ionizing radiation employed extensively in electronics and communications, e.g., in mobile phones and Wi-Fi. Indeed, the advent of 5G systems and the “internet of things” is likely to lead to massive densification of wireless networks. Whilst the thermal effects of EMFs on biological systems are well characterised, their putative non-thermal effects remain a controversial subject. Here, we use the bioluminescent marine bacterium, Vibrio fischeri, to monitor the effects of pulsed microwave electromagnetic fields, of nominal frequency 2.5 GHz, on light emission. Separated electric and magnetic field effects were investigated using a resonant microwave cavity, within which the maxima of each field are separated. For pulsed electric field exposure, the bacteria gave reproducible responses and recovery in light emission. At the lowest pulsed duty cycle (1.25%) and after short durations (100 ms) of exposure to the electric field at power levels of 4.5 W rms, we observed an initial stimulation of bioluminescence, whereas successive microwave pulses became inhibitory. Much of this behaviour is due to thermal effects, as the bacterial light output is very sensitive to the local temperature. Conversely, magnetic field exposure gave no measurable short-term responses even at the highest power levels of 32 W rms. Thus, we were able to detect, de-convolute, and evaluate independently the effects of separated electric and magnetic fields on exposure of a luminescent biological system to microwave irradiation

Lattice dynamics and electron-phonon coupling calculations using nondiagonal supercells

We study the direct calculation of total energy derivatives for lattice dynamics and electronphonon coupling calculations using supercell matrices with non-zero off-diagonal elements. We show that it is possible to determine the response of a periodic system to a perturbation characterized by a wave vector with reduced fractional coordinates (m₁/n₁, m₂/n₂, m₃/n₃) using a supercell containing a number of primitive cells equal to the least common multiple of n₁, n₂, and n₃. If only diagonal supercell matrices are used, a supercell containing n₁n₂n₃ primitive cells is required. We demonstrate that the use of non-diagonal supercells significantly reduces the computational cost of obtaining converged zero-point energies and phonon dispersions for diamond and graphite. We also perform electron-phonon coupling calculations using the direct method to sample the vibrational Brillouin zone with grids of unprecedented size, which enables us to investigate the convergence of the zero-point renormalization to the thermal and optical band gaps of diamond.J. H. L.-W. thanks the Engineering and Physical Sciences Research Council (UK) for a PhD studentship. B. M. thanks Robinson College, Cambridge, and the Cambridge Philosophical Society for a Henslow Research Fellowship. This work used the Cambridge High Performance Computing Service, for which access was funded by the EPSRC [EP/J017639/1], and the ARCHER UK National Supercomputing Service, for which access was obtained via the UKCP consortium and funded by the EPSRC [EP/K013564/1].This is the author accepted manuscript. The final version is available from APS via http://dx.doi.org/10.1103/PhysRevB.92.184301 All relevant data present in this article can be accessed at: https://www.repository.cam.ac.uk/ handle/1810/25142

Neo-Aristotelian Naturalism and the Evolutionary Objection: Rethinking the Relevance of Empirical Science

Neo-Aristotelian metaethical naturalism is a modern attempt at naturalizing ethics using ideas from Aristotle’s teleological metaphysics. Proponents of this view argue that moral virtue in human beings is an instance of natural goodness, a kind of goodness supposedly also found in the realm of non-human living things. Many critics question whether neo-Aristotelian naturalism is tenable in light of modern evolutionary biology. Two influential lines of objection have appealed to an evolutionary understanding of human nature and natural teleology to argue against this view. In this paper, I offer a reconstruction of these two seemingly different lines of objection as raising instances of the same dilemma, giving neo-Aristotelians a choice between contradicting our considered moral judgment and abandoning metaethical naturalism. I argue that resolving the dilemma requires showing a particular kind of continuity between the norms of moral virtue and norms that are necessary for understanding non-human living things. I also argue that in order to show such a continuity, neo-Aristotelians need to revise the relationship they adopt with empirical science and acknowledge that the latter is relevant to assessing their central commitments regarding living things. Finally, I argue that to move this debate forward, both neo-Aristotelians and their critics should pay attention to recent work on the concept of organism in evolutionary and developmental biology