What are the current challenges of managing cancer pain and could digital technologies help?

OBJECTIVES: Pain remains a problem for people with cancer despite effective treatments being available. We aimed to explore current pain management strategies used by patients, caregivers and professionals and to investigate opportunities for digital technologies to enhance cancer pain management. METHODS: A qualitative study comprising semistructured interviews and focus groups. Patients with cancer pain, their caregivers and health professionals from Northeast Scotland were recruited from a purposive sample of general practices. Professionals were recruited from regional networks. RESULTS: Fifty one participants took part in 33 interviews (eight patients alone, six patient/caregiver dyads and 19 professionals) and two focus groups (12 professionals). Living with cancer was hard work for patients and caregivers and comparable to a 'full-time job'. Patients had personal goals which involved controlling pain intensity and balancing this with analgesic use, side effects, overall symptom burden and social/physical activities.Digital technologies were embraced by most patients, and made living life with advanced cancer easier and richer (eg, video calls with family). Technology was underutilised for pain and symptom management. There were suggestions that technology could support self-monitoring and communicating problems to professionals, but patients and professionals were concerned about technological monitoring adding to the work of managing illness. CONCLUSIONS: Cancer pain management takes place in the context of multiple, sometimes competing personal goals. It is possible that technology could be used to help patients share individual symptom experiences and goals, thus enhancing tailored care. The challenge is for digital solutions to add value without adding undue burden

Observations of Faint Eclipsing Cataclysmic Variables

We present time-resolved photometry of six faint (V>17mag) cataclysmic variables (CVs); one of them is V849 Oph and the others are identified from the Sloan Digital Sky Survey (SDSS J0920+0042, SDSS J1327+6528, SDSS J1227+5139, SDSS J1607.02+3623, SDSS J1457+5148). The optical CCD photometric observations of these objects were performed at the T\"UB\.ITAK National Observatory (Turkey) between February 2006 and March 2009. We aimed to detect short time scale orbital variability arisen from hot-spot modulation, flickering structures which occur from rapid fluctuations of material transferring from red star to white dwarf and orbital period changes for selected short-period (P<4h) CVs at quiescence. Results obtained from eclipse timings and light curves morphology related to white dwarf stars, accretion disks and hot-spots are discussed for each system. Analysis of the short time coverage of data, obtained for SDSS J1227+5139 indicates a cyclical period change arisen from magnetic activity on the secondary star. Photometric period of SDSS J1607+3623 is derived firstly in this study, while for the other five systems light elements are corrected using the previous and new photometric observations. The nature of SDSS J1457+5148 is not precisely revealed that its light curve shows any periodicity that could be related to the orbital period

The use, quality and effectiveness of pelvic examination in primary care for the detection of gynaecological cancer : a systematic review

Background Urgent suspected cancer referral guidelines recommend that women with gynaecological cancer symptoms should have a pelvic examination (PE) prior to referral. We do not know to what extent GPs comply, their competency at PE, or if PE shortens the diagnostic interval. Objectives We conducted a systematic review of the use, quality and effectiveness of PE in primary care for women with suspected gynaecological cancer. Method PRISMA guidelines were followed. Three databases were searched using four terms: PE, primary care, competency and gynaecological cancer. Citation lists of all identified papers were screened independently for eligibility by two reviewers. Data extraction was performed in duplicate and independently. Paper quality was assessed using the relevant Critical Appraisal Skills Programme checklist. Emergent themes and contrasting issues were explored in a narrative ecological synthesis. Main Findings Twenty papers met the inclusion criteria. 52% or less of women with suspicious symptoms had a PE. No papers directly explored GPs’ competence at performing PE. Pre-referral PE was associated with reduced diagnostic delay and earlier stage diagnosis. Ecological synthesis demonstrated a complex interplay between patient and practitioner factors and the environment in which examination is performed. Presenting symptoms are commonly misattributed by patients and practitioners resulting in misdiagnosis and lack of PE. Conclusion We do not know if pre-referral PE leads to better outcomes for patients. PE is often not performed for women with gynaecological cancer symptoms, and evidence that it may result in earlier stage of diagnosis is weak. More research is needed

Modified gravity without dark matter

On an empirical level, the most successful alternative to dark matter in bound gravitational systems is the modified Newtonian dynamics, or MOND, proposed by Milgrom. Here I discuss the attempts to formulate MOND as a modification of General Relativity. I begin with a summary of the phenomenological successes of MOND and then discuss the various covariant theories that have been proposed as a basis for the idea. I show why these proposals have led inevitably to a multi-field theory. I describe in some detail TeVeS, the tensor-vector-scalar theory proposed by Bekenstein, and discuss its successes and shortcomings. This lecture is primarily pedagogical and directed to those with some, but not a deep, background in General RelativityComment: 28 pages, 10 figures, lecture given at Third Aegean Summer School, The Invisible Universe: Dark Matter and Dark Energy, minor errors corrected, references update

Progression from external pilot to definitive randomised controlled trial : a methodological review of progression criteria reporting

Objectives: Prespecified progression criteria can inform the decision to progress from an external randomised pilot trial to a definitive randomised controlled trial. We assessed the characteristics of progression criteria reported in external randomised pilot trial protocols and results publications, including whether progression criteria were specified a priori and mentioned in prepublication peer reviewer reports. Study design: Methodological review. Methods: We searched four journals through PubMed: British Medical Journal Open, Pilot and Feasibility Studies, Trials and Public Library of Science One. Eligible publications reported external randomised pilot trial protocols or results, were published between January 2018 and December 2019 and reported progression criteria. We double data extracted 25% of the included publications. Here we report the progression criteria characteristics. Results: We included 160 publications (123 protocols and 37 completed trials). Recruitment and retention were the most frequent indicators contributing to progression criteria. Progression criteria were mostly reported as distinct thresholds (eg, achieving a specific target; 133/160, 83%). Less than a third of the planned and completed pilot trials that included qualitative research reported how these findings would contribute towards progression criteria (34/108, 31%). The publications seldom stated who established the progression criteria (12/160, 7.5%) or provided rationale or justification for progression criteria (44/160, 28%). Most completed pilot trials reported the intention to proceed to a definitive trial (30/37, 81%), but less than half strictly met all of their progression criteria (17/37, 46%). Prepublication peer reviewer reports were available for 153/160 publications (96%). Peer reviewer reports for 86/153 (56%) publications mentioned progression criteria, with peer reviewers of 35 publications commenting that progression criteria appeared not to be specified. Conclusions: Many external randomised pilot trial publications did not adequately report or propose prespecified progression criteria to inform whether to proceed to a future definitive randomised controlled trial

Constraints from Inflation on Scalar-Tensor Gravity Theories

We show how observations of the perturbation spectra produced during inflation may be used to constrain the parameters of general scalar-tensor theories of gravity, which include both an inflaton and dilaton field. An interesting feature of these models is the possibility that the curvature perturbations on super-horizon scales may not be constant due to non-adiabatic perturbations of the two fields. Within a given model, the tilt and relative amplitude of the scalar and tensor perturbation spectra gives constraints on the parameters of the gravity theory, which may be comparable with those from primordial nucleosynthesis and post-Newtonian experiments.Comment: LaTeX (with RevTex) 19 pages, 8 uuencoded figures appended, also available on WWW via http://star.maps.susx.ac.uk/index.htm

Insights into the function of silver as an oxidation catalyst by ab initio, atomistic thermodynamics

To help understand the high activity of silver as an oxidation catalyst, e.g., for the oxidation of ethylene to epoxide and the dehydrogenation of methanol to formaldehyde, the interaction and stability of oxygen species at the Ag(111) surface has been studied for a wide range of coverages. Through calculation of the free energy, as obtained from density-functional theory and taking into account the temperature and pressure via the oxygen chemical potential, we obtain the phase diagram of O/Ag(111). Our results reveal that a thin surface-oxide structure is most stable for the temperature and pressure range of ethylene epoxidation and we propose it (and possibly other similar structures) contains the species actuating the catalysis. For higher temperatures, low coverages of chemisorbed oxygen are most stable, which could also play a role in oxidation reactions. For temperatures greater than about 775 K there are no stable oxygen species, except for the possibility of O atoms adsorbed at under-coordinated surface sites Our calculations rule out thicker oxide-like structures, as well as bulk dissolved oxygen and molecular ozone-like species, as playing a role in the oxidation reactions.Comment: 15 pages including 9 figures, Related publications can be found at http://www.fhi-berlin.mpg.de/th/paper.htm

Understanding Galaxy Formation and Evolution

The old dream of integrating into one the study of micro and macrocosmos is now a reality. Cosmology, astrophysics, and particle physics intersect in a scenario (but still not a theory) of cosmic structure formation and evolution called Lambda Cold Dark Matter (LCDM) model. This scenario emerged mainly to explain the origin of galaxies. In these lecture notes, I first present a review of the main galaxy properties, highlighting the questions that any theory of galaxy formation should explain. Then, the cosmological framework and the main aspects of primordial perturbation generation and evolution are pedagogically detached. Next, I focus on the ``dark side'' of galaxy formation, presenting a review on LCDM halo assembling and properties, and on the main candidates for non-baryonic dark matter. It is shown how the nature of elemental particles can influence on the features of galaxies and their systems. Finally, the complex processes of baryon dissipation inside the non-linearly evolving CDM halos, formation of disks and spheroids, and transformation of gas into stars are briefly described, remarking on the possibility of a few driving factors and parameters able to explain the main body of galaxy properties. A summary and a discussion of some of the issues and open problems of the LCDM paradigm are given in the final part of these notes.Comment: 50 pages, 10 low-resolution figures (for normal-resolution, DOWNLOAD THE PAPER (PDF, 1.9 Mb) FROM http://www.astroscu.unam.mx/~avila/avila.pdf). Lectures given at the IV Mexican School of Astrophysics, July 18-25, 2005 (submitted to the Editors on March 15, 2006

Signatures of Relativistic Neutrinos in CMB Anisotropy and Matter Clustering

We present a detailed analytical study of ultra-relativistic neutrinos in cosmological perturbation theory and of the observable signatures of inhomogeneities in the cosmic neutrino background. We note that a modification of perturbation variables that removes all the time derivatives of scalar gravitational potentials from the dynamical equations simplifies their solution notably. The used perturbations of particle number per coordinate, not proper, volume are generally constant on superhorizon scales. In real space an analytical analysis can be extended beyond fluids to neutrinos. The faster cosmological expansion due to the neutrino background changes the acoustic and damping angular scales of the cosmic microwave background (CMB). But we find that equivalent changes can be produced by varying other standard parameters, including the primordial helium abundance. The low-l integrated Sachs-Wolfe effect is also not sensitive to neutrinos. However, the gravity of neutrino perturbations suppresses the CMB acoustic peaks for the multipoles with l>~200 while it enhances the amplitude of matter fluctuations on these scales. In addition, the perturbations of relativistic neutrinos generate a *unique phase shift* of the CMB acoustic oscillations that for adiabatic initial conditions cannot be caused by any other standard physics. The origin of the shift is traced to neutrino free-streaming velocity exceeding the sound speed of the photon-baryon plasma. We find that from a high resolution, low noise instrument such as CMBPOL the effective number of light neutrino species can be determined with an accuracy of sigma(N_nu) = 0.05 to 0.09, depending on the constraints on the helium abundance.Comment: 38 pages, 7 figures. Version accepted for publication in PR