An Exploratory Study into the Traumatic Impact of Advanced Cancer among Patients and Partners

People living with cancer may experience both psychological distress and a sense of personal development. These two responses can be conceptualised using theories of post-traumatic stress (PTS) and post-traumatic growth (PTG), respectively. This hospice-based study investigated the range of experiences of people living with advanced cancer and of their partners, with consideration of how theories of PTS and PTG resonated with their accounts. Strategic sampling (n=11) was used to gather data from eight individuals living with advanced cancer and from three individuals caring for someone with the diagnosis. Q methodology was used to investigate the participants’ subjective experiences. A set of 62 statements, informed by theories of trauma, were sorted by the participants according to the extent to which the individual statements were consistent with their personal experiences of living with cancer. The participants were then interviewed about their Q sorts, to consider the personal meanings that had informed their statement rankings. The Q sort data were factor analysed, and theories of PTS and PTG were used to aid the interpretation of four differing viewpoints: “Accepting and Growing,†“Fearful yet Adapting,†“Resigned and Grieving†and “Traumatised.†These different expressions of the positive and negative feelings associated with living with advanced cancer are considered in relation to professional healthcare provision. The study recommends that future research involve a broader sample of individuals, including patients not accessing hospice care, the partners of this population and cancer healthcare professionals

Estimating the number of green and loggerhead turtles nesting annually in the Mediterranean

Most species of marine turtle breed every two or more years and it is the norm for females to lay more than one clutch of eggs within a nesting season. Knowing the interval between breeding seasons and the clutch frequency (number of clutches laid by an individual in a breeding season) of females allows us to assess the status of a nesting population. At Alagadi Beach, Northern Cyprus, over a period of 6 years (1995–2000), we attributed 96% of green Chelonia mydas and 80% of loggerhead Caretta caretta turtle clutches to known individual females. This intensive level of monitoring enabled us to estimate the clutch frequency for both species. Using four different methods we estimated clutch frequency to be 2.9–3.1 clutches per female for green turtles and 1.8–2.2 clutches per female for loggerhead turtles. The median interval between nesting seasons for green turtles was 3 years, and for loggerhead turtles it was 2 years. Utilizing these parameters and available data from other beaches that are monitored regularly, we estimate that there are 2,280–2,787 logger-head and 339–360 green turtles nesting annually at these sites in the Mediterranean. This highlights the Critically Endangered status of this population of green turtles. Furthermore, as conventional beach patrols underestimate clutch frequency, these population estimates are likely to be optimistic

An exploratory study into the traumatic impact of advanced cancer among patients and partners.

People living with cancer may experience both psychological distress and a sense of personal development. These two responses can be conceptualised using theories of post-traumatic stress (PTS) and post-traumatic growth (PTG), respectively. This hospice-based study investigated the range of experiences of people living with advanced cancer and of their partners, with consideration of how theories of PTS and PTG resonated with their accounts. Strategic sampling (n=11) was used to gather data from eight individuals living with advanced cancer and from three individuals caring for someone with the diagnosis. Q methodology was used to investigate the participants’ subjective experiences. A set of 62 statements, informed by theories of trauma, were sorted by the participants according to the extent to which the individual statements were consistent with their personal experiences of living with cancer. The participants were then interviewed about their Q sorts, to consider the personal meanings that had informed their statement rankings. The Q sort data were factor analysed, and theories of PTS and PTG were used to aid the interpretation of four differing viewpoints: “Accepting and Growing,” “Fearful yet Adapting,” “Resigned and Grieving” and “Traumatised.” These different expressions of the positive and negative feelings associated with living with advanced cancer are considered in relation to professional healthcare provision. The study recommends that future research involve a broader sample of individuals, including patients not accessing hospice care, the partners of this population and cancer healthcare professionals

Children as vulnerable consumers: a first conceptualisation

© 2015 Westburn Publishers Ltd. Understandings of consumer vulnerability remain contentious and despite recent developments, models remain unsuitable when applied to children. Taxonomic models, and those favouring a ‘state’- or ‘class’-based approach have been replaced by those attempting to tackle both individual and structural antecedents. However, these are still overly individualistic and fail to progress from an artificial view that these dimensions work separately and independently. In contrast, the new sociology of childhood conceptualises childhood as a hybridised, fluid combination of structure and agency. This paper introduces this approach, new to the consumer vulnerability field, and proposes that it has considerable implications for the way that children’s consumer vulnerability is theorised and researched, and for the formulation of policy

Significant climate benefits from near-term climate forcer mitigation in spite of aerosol reductions

Near-term climate forcers (NTCFs), including aerosols and chemically reactive gases such as tropospheric ozone and methane, offer a potential way to mitigate climate change and improve air quality-so called "win-win" mitigation policies. Prior studies support improved air quality under NTCF mitigation, but with conflicting climate impacts that range from a significant reduction in the rate of global warming to only a modest impact. Here, we use state-of-the-art chemistry-climate model simulations conducted as part of the Aerosol and Chemistry Model Intercomparison project (AerChemMIP) to quantify the 21st-century impact of NTCF reductions, using a realistic future emission scenario with a consistent air quality policy. Non-methane NTCF (NMNTCF; aerosols and ozone precursors) mitigation improves air quality, but leads to significant increases in global mean precipitation of 1.3% by mid-century and 1.4% by end-of-the-century, and corresponding surface warming of 0.23 and 0.21 K. NTCF (all-NTCF; including methane) mitigation further improves air quality, with larger reductions of up to 45% for ozone pollution, while offsetting half of the wetting by mid-century (0.7% increase) and all the wetting by end-of-the-century (non-significant 0.1% increase) and leading to surface cooling of -0.15 K by mid-century and -0.50 K by end-of-the-century. This suggests that methane mitigation offsets warming induced from reductions in NMNTCFs, while also leading to net improvements in air quality

Identification of multiple risk loci and regulatory mechanisms influencing susceptibility to multiple myeloma

Genome-wide association studies (GWAS) have transformed our understanding of susceptibility to multiple myeloma (MM), but much of the heritability remains unexplained. We report a new GWAS, a meta-analysis with previous GWAS and a replication series, totalling 9974 MM cases and 247,556 controls of European ancestry. Collectively, these data provide evidence for six new MM risk loci, bringing the total number to 23. Integration of information from gene expression, epigenetic profiling and in situ Hi-C data for the 23 risk loci implicate disruption of developmental transcriptional regulators as a basis of MM susceptibility, compatible with altered B-cell differentiation as a key mechanism. Dysregulation of autophagy/apoptosis and cell cycle signalling feature as recurrently perturbed pathways. Our findings provide further insight into the biological basis of MM.</p

Is the relationship between increased knee muscle strength and improved physical function following exercise dependent on baseline physical function status?

BACKGROUND: Clinical guidelines recommend knee muscle strengthening exercises to improve physical function. However, the amount of knee muscle strength increase needed for clinically relevant improvements in physical function is unclear. Understanding how much increase in knee muscle strength is associated with improved physical function could assist clinicians in providing appropriate strength gain targets for their patients in order to optimise outcomes from exercise. The aim of this study was to investigate whether an increase in knee muscle strength is associated with improved self-reported physical function following exercise; and whether the relationship differs according to physical function status at baseline. METHODS: Data from 100 participants with medial knee osteoarthritis enrolled in a 12-week randomised controlled trial comparing neuromuscular exercise to quadriceps strengthening exercise were pooled. Participants were categorised as having mild, moderate or severe physical dysfunction at baseline using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Associations between 12-week changes in physical function (dependent variable) and peak isometric knee extensor and flexor strength (independent variables) were evaluated with and without accounting for baseline physical function status and covariates using linear regression models. RESULTS: In covariate-adjusted models without accounting for baseline physical function, every 1-unit (Nm/kg) increase in knee extensor strength was associated with physical function improvement of 17 WOMAC units (95% confidence interval (CI) -29 to -5). When accounting for baseline severity of physical function, every 1-unit increase in knee extensor strength was associated with physical function improvement of 24 WOMAC units (95% CI -42 to -7) in participants with severe physical dysfunction. There were no associations between change in strength and change in physical function in participants with mild or moderate physical dysfunction at baseline. The association between change in knee flexor strength and change in physical function was not significant, irrespective of baseline function status. CONCLUSIONS: In patients with severe physical dysfunction, an increase in knee extensor strength and improved physical function were associated. TRIAL REGISTRATION: ANZCTR 12610000660088 . Registered 12 August 2010

Identification of multiple risk loci and regulatory mechanisms influencing susceptibility to multiple myeloma

Genome-wide association studies (GWAS) have transformed our understanding of susceptibility to multiple myeloma (MM), but much of the heritability remains unexplained. We report a new GWAS, a meta-analysis with previous GWAS and a replication series, totalling 9974 MM cases and 247,556 controls of European ancestry. Collectively, these data provide evidence for six new MM risk loci, bringing the total number to 23. Integration of information from gene expression, epigenetic profiling and in situ Hi-C data for the 23 risk loci implicate disruption of developmental transcriptional regulators as a basis of MM susceptibility, compatible with altered B-cell differentiation as a key mechanism. Dysregulation of autophagy/apoptosis and cell cycle signalling feature as recurrently perturbed pathways. Our findings provide further insight

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication