Mechanisms and applications of dioxirane chemistry

Dimethyldioxirane oxidises nitrogen-containing substrates. The sites of oxidation are generally the sp3 nitrogen atoms in the molecules although other reactive groups can be oxidised if present. An indication of the reactivity of different dioxiranes was obtained qualitatively from the polarographic peak reduction potentials and quantitatively by reaction with the model substrate 4-nitro-N,N-dimethylaniline. The polarographic peak potentials were shown to be of a similar order to those of typical acyclic peroxides. The rank order in terms of reactivity was shown to be methyl(trifluoromethyl)dioxirane > dimethyldioxirane > ethylmethyldioxirane. The rate of the reaction was not influenced by pH or ionic strength but was accelerated greatly by the presence of water. An explanation for this observation was proposed through consideration of dielectric constant and hydrogen bonding effects. [Continues.

Whole person integrative cancer care in action - an overview of its implementation and patient related outcomes

Learning Objectives: Explore and understand the implementation and evaluation of an integrative cancer care model based on evidence based care and programming. Goals of care are to improve quality of life for those with cancer and work towards cancer prevention through a combination of approaches including Complementary medicine including nutrition, exercise and lifestyle management.Background and Project Objectives:The Ottawa Integrative Cancer Centre (OICC) provides evidence-informed integrative and preventative cancer care, research, and education across the spectrum of prevention to survivorship. The purpose of this presentation is to describe the population receiving care at the OICC in terms of demographic and disease-related characteristics, in addition to their experience receiving care in terms of therapies received and preliminary outcomes.Methods: All people receiving care at the OICC are invited to complete a registration package that documents demographic and disease-related characteristics in addition to baseline quality of life (EORTC-QLQ C30), cancer-related symptom (ESAS) and patient-identified concerns or problems (MYCaW). Every 3 months, a follow up assessment is completed for continuing patients.Results:The majority of people seek care at the OICC to manage cancer and treatment related side effects. Other people seek supportive care with their prescribed standard care, to control or cure their cancer, or to prevent a recurrence. Approximately one half of people self-identify as under distress for at least one common cancerrelated symptom. Most patients consult a naturopathic doctor, often in combination with a general practitioner, nutritionist, acupuncturist, physiotherapist, or counselor.Results will be presented regarding quality of life, cancer related symptoms and patient-identified concerns, stratified as possible by age, sex, cancer type, stage and types of treatment received.

The head start program for women newly diagnosed with breast cancer

We present the beneficial impact that our Head Start Program for women newly diagnosed with breast cancer has on participants at the Ottawa Integrative Cancer Centre. While beginning a new world of conventional cancer treatments, our program provides support and guidance at a crucial time of flux in a woman’s life, and addresses the spiritual, physical and mental emotional health of women of all ages, from generation Y through to our elders, who are dealing with a cancer diagnosis.This 6 week program is comprised of workshops, support group sessions and experiential mind body techniques, and is led by a group of therapists skilled in cancer’s psychological and physiological effects.Our research outcome measures of the program to date will be touched upon

Mechanisms of Fetal Programming in Hypertension

Events that occur in the early fetal environment have been linked to long-term health and lifespan consequences in the adult. Intrauterine growth restriction (IUGR), which may occur as a result of nutrient insufficiency, exposure to hormones, or disruptions in placental structure or function, may induce the fetus to alter its developmental program in order to adapt to the new conditions. IUGR may result in a decrease in the expression of genes that are responsible for nephrogenesis as nutrients are rerouted to the development of more essential organs. Fetal survival under these conditions often results in low birth weight and a deficit in nephron endowment, which are associated with hypertension in adults. Interestingly, male IUGR offspring appear to be more severely affected than females, suggesting that sex hormones may be involved. The processes of fetal programming of hypertension are complex, and we are only beginning to understand the underlying mechanisms

Protocol update for a multi-centre randomised controlled trial of exercise rehabilitation for people with pulmonary hypertension:the SPHERe trial

Background: The SPHERe (Supervised Pulmonary Hypertension Exercise Rehabilitation) trial is a multi-centre, pragmatic, randomised controlled trial assessing the clinical and cost-effectiveness of supervised exercise rehabilitation with psychosocial and motivational support compared to best-practice usual care for people with pulmonary hypertension (PH). The original protocol was published in BMC Pulmonary Medicine (accessible online). We randomised our first participant in January 2020. In response to the COVID-19 pandemic, the trial was stopped in March 2020. In person delivery of the SPHERe intervention to a vulnerable population was not possible during the COVID-19 pandemic. We describe here how trial procedures and intervention delivery were adapted in response to the COVID-19 pandemic.Methods: Restrictions imposed by the COVID-19 pandemic on the clinically vulnerable PH population meant that trial delivery was changed from a centre-based rehabilitation programme to remotely delivered group online sessions. This led to minor alterations to the eligibility criteria. These changes followed a consultation process with stakeholders and people with PH and were approved by the funder and independent trial committees.Conclusions: We describe the modified SPHERe trial protocol in response to restrictions imposed by the COVID-19 pandemic. SPHERe is the first randomised controlled trial to assess the clinical and cost-effectiveness of an online group rehabilitation programme for people with PH compared to usual care.Trial registration: ISRCTN no. 10608766. Prospectively registered on 18th March 2019, updated 16th August 2023.</p

Personal goals of women recently diagnosed with breast cancer: Protocol for a cohort study

Objectives: This study aims to identify the personal goals of women with breast cancer, to describe the characteristics of partici- pants’ personal goals over four months, and to identify barriers and facilitators to their pursuit. Methods: This protocol outlines plans to conduct a prospective cohort study. We will recruit women participating in the Ottawa In- tegrative Cancer Centre’s Head Start program (an integrative oncology psychoeducational program in Ottawa, Canada), and those on the program’s waiting list if possible. We anticipate a sample size of approximately 18 to 36 women. Prior to the beginning of Head Start, participants will identify their current personal goals and rate them on various dimensions on a questionnaire. At one and three months, participants will re-assess their goals and their goal pursuit. In a one-on-one interview at three months, they will identify barriers and facilitators to the pursuit of their goals. We will analyze quantitative data using descriptive and inferential statistics, and qualitative data using thematic content analysis. Conclusion: Findings from this study will identify important information about the personal goals of women recently diagnosed with breast cancer that can help to support the process of positive goal adjustment and enhance support to these women.  Résumé Objectifs : Cette étude vise à identifier les objectifs personnels des femmes atteintes d’un cancer du sein, à décrire les caractéristiques des objectifs personnels des participantes sur une période de quatre mois, et à identifier les obstacles et les facilitateurs à leur poursuite. Méthodes : Ce protocole décrit les plans pour mener une étude de cohorte prospective. Nous recruterons des femmes qui participeront au programme Head Start du Centre de cancérologie intégrative d’Ottawa (un programme psychopédagogique intégratif en oncologie à Ottawa, au Canada) et celles qui sont sur la liste d’attente du programme, si possible. Nous prévoyons un échantillon d’environ 18 à 36 femmes. Avant le début de Head Start, les participantes identifieront leurs objectifs personnels actuels et les noteront sur différentes dimensions dans un questionnaire. À un et trois mois, les participantes réévalueront leurs objectifs et la poursuite de leur objectif. Dans une entrevue individuelle à trois mois, elles identifieront les obstacles et les facilitateurs à la poursuite de leurs objectifs. Nous analyserons les données quantitatives à l’aide de statistiques descriptives et inférentielles, et les données qualitatives à l’aide d’analyses de contenu thématiques. Conclusion : Les résultats de cette étude permettront d’identifier des informations importantes sur les objectifs personnels des femmes récemment diagnostiquées avec un cancer du sein qui peuvent aider à soutenir le processus d’ajustement positif des objectifs et améliorer le soutien à ces femmes. 

Co-visualise the impact of Sickle Cell: How can we use design thinking to investigate and visualise the impact of Sickle Cell?

Background: This study leverages the principles of design thinking and system thinking to investigate and visualise the impact of Sickle Cell. Sickle cell is a genetic disorder that affects millions of people worldwide and disproportionately affects people of African and Caribbean descent. Patients with this condition face a range of physical, emotional, and social challenges due to the unpredictable nature of the disease. The fundamental principle explored in this study is designing for empathy. Design for Sickle Cell (D4SC) initiative was developed to bridge the gap between art, design and science within the Sickle Cell landscape. Aim: This design research project aims to investigate and visualise the condition's impact from a multi-stakeholder perspective by developing art and design prototypes that can inform an innovative Sickle Cell exhibition. Methods: Techniques from social constructionism, phenomenological qualitative research and user-experience research were utilised to create a novel methodology for this small-scale study. The methodology involved a multi-step process combining the double diamond, system thinking, and action research frameworks to gather insights that guided the development of this design research practice. Semi-structured interviews were conducted with Sickle Cell experts consisting of patients, a healthcare practitioner and support staff. Common themes were generated from their experience of the condition's impact. D4SC collaborated with Imperial's Invisible Warrior Project, RCABlack, a PhD Archivist Researcher and Photographer at the Slade School of Fine Art, to develop visual prototypes for the exhibition. Results: The findings from these interviews informed the development of a range of workshops and prototypes. The prototypes were tested by Sickle Cell experts and healthcare designers, who provided feedback on the concept. The results showed that the design outputs and exhibition were well-received and had the potential to improve education and awareness of the condition and promote empathy. Design research in healthcare has the potential to create innovative solutions. With the use of a multidisciplinary approach, it can yield a positive impact. Conclusions: The project highlights the importance of design thinking, system thinking and collaboration in developing innovative healthcare solutions for this complex health condition. The study demonstrates the value of a multi-stakeholder approach to designing for empathy. It shows the potential of visualising the impact of Sickle Cell to promote understanding and awareness of the condition. To facilitate the further advancement of the concepts developed in this study, securing funding an

Supervised pulmonary hypertension exercise rehabilitation (SPHERe):Study protocol for a multi-centre randomised controlled trial

Background Supervised cardio-pulmonary rehabilitation may be safe and beneficial for people with pulmonary hypertension (PH) in groups 1 (pulmonary arterial hypertension) and 4 (chronic thromboembolic disease), particularly as a hospital in-patient. It has not been tested in the most common PH groups; 2 (left heart disease), 3 (lung disease), or 5 (other disorders). Further it has not been evaluated in the UK National Health Service (NHS) out-patient setting, or with long-term follow-up. The aim of this randomised controlled trial (RCT) is to test the clinical and cost-effectiveness of a supervised exercise rehabilitation intervention with psychosocial support compared to best practice usual care for people with PH in the community/outpatient setting. Methods This multi-centre, pragmatic, two-arm RCT with embedded process evaluation aims to recruit 352 clinically stable adults with PH (groups 1–5) and WHO functional class II-IV. Participants will be randomised to either the Supervised Pulmonary Hypertension Exercise Rehabilitation (SPHERe) intervention or control. The SPHERe intervention consists of 1) individual assessment and familiarisation sessions; 2) 8-week, twice-weekly, supervised out-patient exercise training; 3) psychosocial/motivational support and education; 4) guided home exercise plan. The control intervention consists of best practice usual care with a single one-to-one practitioner appointment, and general advice on physical activity. Outcomes will be measured at baseline, 4 months (post-intervention) and 12 months by researchers blinded to treatment allocation. The primary outcome is the incremental shuttle walk test at 4 months. Secondary outcomes include health-related quality of life (HRQoL), time to clinical worsening and health and social care use. A purposive sample of participants (n = 20 intervention and n = 20 control) and practitioners (n = 20) will be interviewed to explore experiences of the trial, outcomes and interventions. Discussion The SPHERe study is the first multi-centre clinical RCT to assess the clinical and cost effectiveness of a supervised exercise rehabilitation intervention compared to usual care, delivered in the UK NHS, for people in all PH groups. Results will inform clinicians and commissioners as to whether or not supervised exercise rehabilitation is effective and should be routinely provided for people with PH

Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study):multicentre randomised controlled trial

OBJECTIVE: To evaluate whether a structured online supervised group physical and mental health rehabilitation programme can improve health related quality of life compared with usual care in adults with post-covid-19 condition (long covid).DESIGN: Pragmatic, multicentre, parallel group, superiority randomised controlled trial.SETTING: England and Wales, with home based interventions delivered remotely online from a single trial hub.PARTICIPANTS: 585 adults (26-86 years) discharged from NHS hospitals at least three months previously after covid-19 and with ongoing physical and/or mental health sequelae (post-covid-19 condition), randomised (1:1.03) to receive the Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) intervention (n=298) or usual care (n=287).INTERVENTIONS: Best practice usual care was a single online session of advice and support with a trained practitioner. The REGAIN intervention was delivered online over eight weeks and consisted of weekly home based, live, supervised, group exercise and psychological support sessions.MAIN OUTCOME MEASURES: The primary outcome was health related quality of life using the patient reported outcomes measurement information system (PROMIS) preference (PROPr) score at three months. Secondary outcomes, measured at three, six, and 12 months, included PROMIS subscores (depression, fatigue, sleep disturbance, pain interference, physical function, social roles/activities, and cognitive function), severity of post-traumatic stress disorder, general health, and adverse events.RESULTS: Between January 2021 and July 2022, 39 697 people were invited to take part in the study and 725 were contacted and eligible. 585 participants were randomised. Mean age was 56 (standard deviation (SD) 12) years, 52% were female participants, mean health related quality of life PROMIS-PROPr score was 0.20 (SD 0.17), and mean time from hospital discharge was 323 (SD 144) days. Compared with usual care, the REGAIN intervention led to improvements in health related quality of life (adjusted mean difference in PROPr score 0.03 (95% confidence interval 0.01 to 0.05), P=0.02) at three months, driven predominantly by greater improvements in the PROMIS subscores for depression (1.39 (0.06 to 2.71), P=0.04), fatigue (2.50 (1.19 to 3.81), P&lt;0.001), and pain interference (1.80 (0.50 to 3.11), P=0.01). Effects were sustained at 12 months (0.03 (0.01 to 0.06), P=0.02). Of 21 serious adverse events, only one was possibly related to the REGAIN intervention. In the intervention group, 141 (47%) participants fully adhered to the programme, 117 (39%) partially adhered, and 40 (13%) did not receive the intervention.CONCLUSIONS: In adults with post-covid-19 condition, an online, home based, supervised, group physical and mental health rehabilitation programme was clinically effective at improving health related quality of life at three and 12 months compared with usual care.TRIAL REGISTRATION: ISRCTN registry ISRCTN11466448.</p

Development of an online intervention for the Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) trial [version 2; peer review: 2 approved]

Background: Up to half of people hospitalised with COVID-19 report diverse and persistent symptoms affecting quality of life for months and sometimes years after discharge (long-COVID). We describe the development of an online group exercise and behavioural support intervention for people who continue to experience such physical and/or emotional health problems more than three months after hospital discharge.  Methods: Intervention development was informed by the Medical Research Council framework for complex interventions. Our multidisciplinary team of academics, clinicians, and people with long-COVID, had collective expertise in the development and testing of complex interventions. We integrated a bio-psycho-social model of care drawing on rehabilitation literature for long-term health conditions and experiences from our pre-pilot study. Multiple stakeholder meetings were held to refine the intervention which was designed to be deliverable within the UK National Health Service. We adhere to TIDieR guidance for transparent and explicit reporting of telehealth interventions.  Results: The final REGAIN online exercise and behavioural support intervention consisted of an initial 1:1 consultation with a trained practitioner, followed by eight online group exercise, and six group support, sessions delivered over eight weeks. Participants could also access an online library of on-demand exercise and support videos. Conclusions: The final REGAIN intervention, combining exercise and behavioural support, is fully manualised with clear pathways to delivery and implementation. It is currently being tested in a randomised controlled trial. The intervention, developed with extensive patient and stakeholder engagement, could be incorporated into existing NHS rehabilitation programmes, should it prove to be clinically and cost-effective for people with long-COVID. Trial registration: International Standard Randomised Controlled Trial Number (ISRCTN) 11466448: Rehabilitation exercise and psychological support after COVID-19 infection: REGAIN