Spatial Analysis of Cirques from Three Regions of Iceland: Implications for Cirque Formation and Palaeoclimate

This study is a quantitative analysis of cirques in three regions of Iceland: Tröllaskagi, the East Fjords and Vestfirðir. Using Google Earth and the National Land Survey of Iceland Map Viewer, we identified 347 new cirques on Tröllaskagi and the East Fjords region, and combined these data with 100 cirques previously identified on Vestfirðir. We used ArcGIS to measure length, width, aspect, latitude and distance to coastline of each cirque. Palaeo‐equilibrium‐line altitudes (palaeo‐ELAs) of palaeo‐cirque glaciers were calculated using the altitude‐ratio method, cirque‐floor method and minimum‐point method. The mean palaeo‐ELA values in Tröllaskagi, the East Fjords and Vestfirðir are 788, 643 and 408 m a.s.l, respectively. Interpolation maps of palaeo‐ELAs demonstrate a positive relationship between palaeo‐ELA and distance to coastline. A positive relationship between palaeo‐ELA and latitude is observed on Vestfirðir, a negative relationship is observed on Tröllaskagi and no statistically significant relationship is present on the East Fjords. The modal orientation of cirques on Tröllaskagi and Vestfirðir is northeast, while orientation of cirques in the East Fjords is north. Palaeo‐wind reconstructions for the LGM show that modal aspect is aligned with the prevailing north‐northeast wind directions, although aspect measurements demonstrate wide dispersion. Cirque length is similar on Tröllaskagi and the East Fjords, but cirques are approximately 200 m shorter in Vestfirðir. Cirque widths are similar in all three regions. Comparisons with a global data set show that cirques in Iceland are smaller and more circular than cirques in other regions of the world. Similar to glaciers in Norway and Kamchatka, our results demonstrate that access to a moisture source is a key parameter in determining palaeo‐ELAs in Iceland. Temperatures interpreted from palaeo‐ELA depressions suggest that these cirques may have been glaciated as recently as the Little Ice Age

Preventing gambling-related harm among adolescents (PRoGRAM-A): an embedded multi-modal process evaluation in a pilot cluster random control trial

Background and Aims: Young people’s engagement in gambling can be linked to gambling-related harm. This can cause stress, anxiety, relationship issues, debt, and lost opportunities. There is a lack of independently funded, and evidence-based school-based interventions that seek to prevent and reduce the harms associated with gambling. PRoGRAM-A is one of the first independently research funded interventions to prevent gambling related harm in adolescents. This paper presents findings from an embedded process evaluation of the pilot cluster randomised control trial of PRoGRAM-A, with a specific focus on intervention fidelity, feasibility and acceptability. Method: Multi-modal study design comprised of qualitative focus groups with students (N = 42); and individual interviews with teachers (N = 7), PRoGRAM-A trainers (N = 5), student friends and family (N = 2) and stakeholders (N = 8). Structured Observations of the full cycle of PRoGRAM-A across two intervention schools were also undertaken. Results: PRoGRAM-A was delivered with a high degree of fidelity (95%) to the training manual. It was also found to be both feasible and acceptable to students, staff and parents. It was appealing to schools as it allowed teachers to address the topic of gambling, which had already been flagged as an issue for some of the schools, but they lacked the skill and capacity to take action. Peer Supporters enjoyed the interactive nature of the training workshop. Parents and carers were supportive of the intervention and stakeholders recognised the growing need for a non-industry funded school-based intervention to raise awareness among students of gambling and gambling-related harm (GRH). Suggested intervention refinements include embedding examples of lived experience to aid students’ engagement with the topic of gambling and GRH. Increasing social skills activities to ensure students are comfortable and confident when initiating conversations and making follow-up sessions more interactive (in-line with the two-day workshop). Conclusions: This study demonstrated that it is feasible and acceptable to deliver the PRoGRAM-A gambling harm reduction intervention within secondary schools with a high degree of fidelity. Addressing the topic of gambling and GRH within the school curriculum was deemed to be acceptable by all sample groups, including students. Trial registration: Research Registry researchregistry8699

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society