The impact of Clinical Nurse Specialists on the decision making process in cancer multidisciplinary team meetings: A qualitative study

PURPOSE: There are well-documented barriers to nurse participation in cancer multidisciplinary team (MDT) meetings. This paper aims to identify the approaches used by Clinical Nurse Specialists (CNSs) in this setting to contribute during discussion, and to consider the impact of these approaches on the decision making process. In doing so it aims to highlight ways that CNSs can increase their influence, and enhance multidisciplinary engagement. METHODS: This study is based on analysis of observation data from 122 MDT meetings in gynaecology, haematology and skin cancer MDTs. Field notes were reviewed, identifying 58 cases where CNSs contributed to MDT discussion. Audio recordings of the relevant sections were then transcribed and analysed thematically. RESULTS: Five approaches were used by CNSs to contribute in MDT meetings: sharing information, asking questions, providing practical suggestions, framing and using humour. These approaches influenced three key intermediary processes identified during the analysis ('successful contributions'): prompting discussion, influencing a treatment plan and facilitating teamwork. CNSs contributed successfully in cases where medical factors (such as relapsed disease or complex comorbidities) or non-medical factors (such as strong patient preference), had the potential to impact on the ability of teams to deliver treatment. CONCLUSIONS: CNSs have an important role in cancer MDT meetings. By focusing on a subset of cases where CNSs contributed during MDT discussion, this study has provided an insight into approaches that can be adopted by CNSs to increase their influence on the decision making process, enabling teams to capitalise on their knowledge and expertise in MDT meetings

Airborne Particles in Museums

Presents one in a series of research activities aimed at a better understanding of the origin and fate of air pollution within the built environment

Entropy of Thermally Excited Black Rings

A string theory description of near extremal black rings is proposed. The entropy is computed and the thermodynamic properties are derived for a large family of black rings that have not yet been constructed in supergravity. It is also argued that the most general black ring in N=8 supergravity has 21 parameters up to duality.Comment: 17 pages; v2: minor edits and refs adde

The intensity dependent mass shift: existence, universality and detection

The electron mass shift in a laser field has long remained an elusive concept. We show that the mass shift can exist in pulses but that it is neither unique nor universal: it can be reduced by pulse shaping. We show also that the detection of mass shift effects in laser-particle scattering experiments is feasible with current technology, even allowing for the transverse structure of realistic beams.Comment: 5 pages, 4 figures. V2: references added, introduction expande

Composition algebras and the two faces of G2G_{2}

We consider composition and division algebras over the real numbers: We note two r\^oles for the group $G_{2}$: as automorphism group of the octonions and as the isotropy group of a generic 3-form in 7 dimensions. We show why they are equivalent, by means of a regular metric. We express in some diagrams the relation between some pertinent groups, most of them related to the octonions. Some applications to physics are also discussed.Comment: 11 pages, 3 figure

Peculiar properties of the cluster-cluster interaction induced by the Pauli exclusion principle

Role of the Pauli principle in the formation of both the discrete spectrum and multi-channel states of the binary nuclear systems composed of clusters is studied in the Algebraic Version of the resonating-group method. Solutions of the Hill-Wheeler equations in the discrete representation of a complete basis of the Pauli-allowed states are discussed for 4He+n, 3H+3H, and 4He+4He binary systems. An exact treatment of the antisymmetrization effects are shown to result in either an effective repulsion of the clusters, or their effective attraction. It also yields a change in the intensity of the centrifugal potential. Both factors significantly affect the scattering phase behavior. Special attention is paid to the multi-channel cluster structure 6He+6He as well as to the difficulties arising in the case when the two clustering configurations, 6He+6He and 4He+8He, are taken into account simultaneously. In the latter case the Pauli principle, even in the absence of a potential energy of the cluster-cluster interaction, leads to the inelastic processes and secures an existence of both the bound state and resonance in the 12Be compound nucleus.Comment: 17 pages, 14 figures, 1 table; submitted to Phys.Rev.C Keywords: light neutron-rich nuclei, cluster model

eHealth interventions for the prevention of depression and anxiety in the general population: a systematic review and meta-analysis.

BACKGROUND: Anxiety and depression are associated with a range of adverse outcomes and represent a large global burden to individuals and health care systems. Prevention programs are an important way to avert a proportion of the burden associated with such conditions both at a clinical and subclinical level. eHealth interventions provide an opportunity to offer accessible, acceptable, easily disseminated globally low-cost interventions on a wide scale. However, the efficacy of these programs remains unclear. The aim of this study is to review and evaluate the effects of eHealth prevention interventions for anxiety and depression. METHOD: A systematic search was conducted on four relevant databases to identify randomized controlled trials of eHealth interventions aimed at the prevention of anxiety and depression in the general population published between 2000 and January 2016. The quality of studies was assessed and a meta-analysis was performed using pooled effect size estimates obtained from a random effects model. RESULTS: Ten trials were included in the systematic review and meta-analysis. All studies were of sufficient quality and utilized cognitive behavioural techniques. At post-treatment, the overall mean difference between the intervention and control groups was 0.25 (95% confidence internal: 0.09, 0.41; p = 0.003) for depression outcome studies and 0.31 (95% CI: 0.10, 0.52; p = 0.004) for anxiety outcome studies, indicating a small but positive effect of the eHealth interventions. The effect sizes for universal and indicated/selective interventions were similar (0.29 and 0.25 respectively). However, there was inadequate evidence to suggest that such interventions have an effect on long-term disorder incidence rates. CONCLUSIONS: Evidence suggests that eHealth prevention interventions for anxiety and depression are associated with small but positive effects on symptom reduction. However, there is inadequate evidence on the medium to long-term effect of such interventions, and importantly, on the reduction of incidence of disorders. Further work to explore the impact of eHealth psychological interventions on long-term incidence rates

Knowledge-based vision and simple visual machines

The vast majority of work in machine vision emphasizes the representation of perceived objects and events: it is these internal representations that incorporate the 'knowledge' in knowledge-based vision or form the 'models' in model-based vision. In this paper, we discuss simple machine vision systems developed by artificial evolution rather than traditional engineering design techniques, and note that the task of identifying internal representations within such systems is made difficult by the lack of an operational definition of representation at the causal mechanistic level. Consequently, we question the nature and indeed the existence of representations posited to be used within natural vision systems (i.e. animals). We conclude that representations argued for on a priori grounds by external observers of a particular vision system may well be illusory, and are at best place-holders for yet-to-be-identified causal mechanistic interactions. That is, applying the knowledge-based vision approach in the understanding of evolved systems (machines or animals) may well lead to theories and models that are internally consistent, computationally plausible, and entirely wrong

How hairy can a black ring be?

It has been shown recently that there is a large class of supersymmetric solutions of five-dimensional supergravity which generalize the supersymmetric black ring solution of Elvang et al. This class involves arbitrary functions. We show that most of these solutions do not have smooth event horizons, so they do not provide examples of black objects with infinite amounts of "hair".Comment: 19 pages. v2: minor change

Holographic Description of Gravitational Anomalies

The holographic duality can be extended to include quantum theories with broken coordinate invariance leading to the appearance of the gravitational anomalies. On the gravity side one adds the gravitational Chern-Simons term to the bulk action which gauge invariance is only up to the boundary terms. We analyze in detail how the gravitational anomalies originate from the modified Einstein equations in the bulk. As a side observation we find that the gravitational Chern-Simons functional has interesting conformal properties. It is invariant under conformal transformations. Moreover, its metric variation produces conformal tensor which is a generalization of the Cotton tensor to dimension $d+1=4k-1, k\in Z$. We calculate the modification of the holographic stress-energy tensor that is due to the Chern-Simons term and use the bulk Einstein equations to find its divergence and thus reproduce the gravitational anomaly. Explicit calculation of the anomaly is carried out in dimensions $d=2$ and $d=6$. The result of the holographic calculation is compared with that of the descent method and agreement is found. The gravitational Chern-Simons term originates by Kaluza-Klein mechanism from a one-loop modification of M-theory action. This modification is discussed in the context of the gravitational anomaly in six-dimensional $(2,0)$ theory. The agreement with earlier conjectured anomaly is found.Comment: 24 pages, Latex; presentation re-structured, new references adde