Reliable Indicators of Cancer Related Malnutrition for an Outpatient Oncology Nutritional Screening Tool Identified Through a Systematic Review

© 2014 Humphreys et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly citedPeer reviewedFinal Published versio

Medicalised maternity : an investigation into women's experiences of medicalised childbirth

Bibliography: leaves 169-175.This dissertation reports on a qualitative study of the childbearing experiences of 20 women having their first child. The study attempts to examine the dominant discourses surrounding pregnancy, childbirth and motherhood, with specific reference to the medical discourse, and to describe the way in which these impact on the women's experiences. The non-probability, convenience sample used in the study comprised women attending an antenatal class held at a Cape Town private hospital. The sample was relatively socially and medically homogeneous. The size and nature of the sample makes broad generalisations tentative. Individual interviews based on in-depth and open-ended questions were conducted. These were aimed at gathering qualitative data on the women's perceptions of their experiences. The women were interviewed during the last trimester of pregnancy about their experiences of pregnancy and their anticipation of childbirth. A further interview conducted a few weeks after birth focused on their experience of childbirth within the hospital setting and their impressions of early motherhood. It was found that the women's accounts of their experiences of pregnancy, childbirth and early motherhood were shaped to a large extent by the discourses within which the process of childbearing has been constructed. These include the medical, 'natural' birth and feminine discourses. The dominance of the medical discourse of birth was evident in the fact that the medical view was thoroughly incorporated into the women's perceptions of their childbearing experiences. This view of birth, along with the dominance of scientific medical knowledge, was found to limit the perception of acceptable birthing practice. The medical discourse intersected with both the 'natural' birth discourse which, as a social construction, was shown to uphold essentialist and prescriptive notions of motherhood, and the feminine discourse. This discourse, along with its assumptions regarding the mothering role, was fom1d to impact on the women's experiences through the creation of unrealistic expectations and ideals, which contributed to the shock and stress of first-time motherhood

Time from breast cancer diagnosis to therapeutic surgery and breast cancer prognosis : a population-based cohort study

Theoretically, time from breast cancer diagnosis to therapeutic surgery should affect survival. However, it is unclear whether this holds true in a modern healthcare setting in which breast cancer surgery is carried out within weeks to months of diagnosis. This is a population- and register-based study of all women diagnosed with invasive breast cancer in the Stockholm-Gotland healthcare region in Sweden, 2001 - 2008, and who were initially operated. Follow-up of vital status ended 2014. 7017 women were included in analysis. Our main outcome was overall survival. Main analyses were carried out using Cox proportional hazards models. We adjusted for likely confounders and stratified on mode of detection, tumor size and lymph node metastasis. We found that a longer interval between date of morphological diagnosis and therapeutic surgery was associated with a poorer prognosis. Assuming a linear association, the hazard rate of death from all causes increased by 1.011 (95% CI 1.006 to 1.017) per day. Comparing, e.g., surgery 6 weeks after diagnosis to surgery 3 weeks after diagnosis, thereby confers a 1.26-fold increased hazard rate. The increase in hazard rate associated with surgical delay was strongest in women with largest tumors. Whilst there was a clear association between delays and survival in women without lymph node metastasis, the association may be attenuated in subgroups with increasing number of lymph node metastases. We found no evidence of an interaction between time to surgery and mode of detection. In conclusion, unwarranted delays to primary treatment of breast cancer should be avoided.Swedish Research CouncilSwedish Cancer SocietyStockholm County CouncilFORTEAccepte

Longitudinal association between change in the neighbourhood built environment and the wellbeing of local residents in deprived areas: an observational study.

BACKGROUND: Features of the urban neighbourhood influence the physical, social and mental wellbeing of residents and communities. We explored the longitudinal association between change to the neighbourhood built environment and the wellbeing of local residents in deprived areas of Glasgow, Scotland. METHODS: A cohort of residents (n = 365; mean age 50 years; 44% male; 4.1% of the 9000 mailed surveys at baseline) responded to a postal survey in 2005 and 2013. Wellbeing was assessed with the mental (MCS-8) and physical (PCS-8) components of the SF-8 scale. We developed software to aid identification of visible changes in satellite imagery occurring over time. We then used a Geographical Information System to calculate the percentage change in the built environment occurring within an 800 m buffer of each participant's home. RESULTS: The median change in the neighbourhood built environment was 3% (interquartile range 6%). In the whole sample, physical wellbeing declined by 1.5 units on average, and mental wellbeing increased by 0.9 units, over time. In multivariable linear regression analyses, participants living in neighbourhoods with a greater amount of change in the built environment (unit change = 1%) experienced significantly reduced physical (PCS-8: -0.13, 95% CI -0.26 to 0.00) and mental (MCS-8: -0.16, 95% CI -0.31 to - 0.02) wellbeing over time compared to those living in neighbourhoods with less change. For mental wellbeing, a significant interaction by baseline perception of financial strain indicated a larger reduction in those experiencing greater financial strain (MCS-8: -0.22, 95% CI -0.39 to - 0.06). However, this relationship was reversed in those experiencing lower financial strain, whereby living in neighbourhoods with a greater amount of change was associated with significantly improved mental wellbeing over time (MCS-8: 0.38, 95% CI 0.04 to 0.72). CONCLUSIONS: Overall, we found some evidence that living in neighbourhoods experiencing higher levels of physical change worsened wellbeing in local residents. However, we found a stronger negative relationship in those with lower financial security and a positive relationship in those with higher financial security. This is one of few studies exploring the longitudinal relationship between the environment and health

Proline-Rich Homeodomain protein (PRH/HHEX) is a suppressor of breast tumour growth

Breast tumours progress from hyperplasia to ductal carcinoma in situ (DCIS) and invasive breast carcinoma (IBC). PRH/HHEX (Proline Rich Homeodomain/Haematopoietically expressed homeobox) is a transcription factor that displays both tumour suppressor and oncogenic activity in different disease contexts however, the role of PRH in breast cancer is poorly understood. Here we show that nuclear localisation of the PRH protein is decreased in DCIS and IBC compared to normal breast. Our previous work has shown that PRH phosphorylation by protein kinase CK2 prevents PRH from binding to DNA and regulating the transcription of multiple genes encoding growth factors and growth factor receptors. Here we show that transcriptionally inactive phosphorylated PRH is elevated in DCIS and IBC compared to normal breast. To determine the consequences of PRH loss of function in breast cancer cells we generated inducible PRH depletion in MCF-7 cells. We show that PRH depletion results in increased MCF-7 cell proliferation in part at least due to increased vascular endothelial growth factor signaling. Moreover we demonstrate that PRH depletion increases the formation of breast cancer cells with cancer stem cell-like properties. Finally, and in keeping with these findings, we show that PRH over-expression inhibits the growth of mammary tumours in mice. Collectively these data indicate that PRH plays a tumour suppressive role in the breast and they provide an explanation for the finding that low PRH mRNA levels are associated with a poor prognosis in breast cancer

Enhancing practitioners’ confidence in recruitment and consent in the EcLiPSE trial: A mixed-method evaluation of site training – a Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI) study

Background: EcLiPSE (Emergency treatment with Levetiracetam or Phenytoin in Status Epilepticus in children) is a randomised controlled trial (RCT) in the United Kingdom. Challenges to success include the need to immediately administer an intervention without informed consent and changes in staffing during trial conduct, mainly due to physician rotations. Using literature on parents' perspectives and research without prior consent (RWPC) guidance, we developed an interactive training package (including videos, simulation and question and answer sessions) and evaluated its dissemination and impact upon on practitioners' confidence in recruitment and consent. Methods: Questionnaires were administered before and immediately after training followed by telephone interviews (mean 11 months later), focus groups (mean 14 months later) and an online questionnaire (8 months before trial closure).Results: One hundred and twenty-five practitioners from 26/30 (87%) participating hospitals completed a questionnaire before and after training. We conducted 10 interviews and six focus groups (comprising 36 practitioners); 199 practitioners working in all recruiting hospitals completed the online questionnaire. Before training, practitioners were concerned about recruitment and consent. Confidence increased after training for explaining (all scale 0-5, 95% CIs above 0 and p values < 0.05): the study (66% improved mean score before 3.28 and after 4.52), randomisation (47% improvement, 3.86 to 4.63), RWPC (72% improvement, 2.98 to 4.39), and addressing parents' objections to randomisation (51% improvement, 3.37 to 4.25). Practitioners rated highly the content and clarity of the training, which was successfully disseminated. Some concerns about staff availability for training and consent discussions remained.Conclusions: Training improved practitioners' confidence in recruitment and RWPC. Our findings highlight the value of using parents' perspectives to inform training and to engage practitioners in trials that are at high risk of being too challenging to conduct

Ambient temperature CO oxidation using palladium-platinum bimetallic catalysts supported on tin oxide/alumina

A series of Pt-based catalysts were synthesised and investigated for ambient temperature CO oxidation with the aim to increase catalytic activity and improve moisture resistance through support modification. Initially, bimetallic PtPd catalysts supported on alumina were found to exhibit superior catalytic activity compared with their monometallic counterparts for the reaction. Following an investigation into the effect of Pt/Pd ratio, a composition of 0.1% Pt/0.4% Pd was selected for further studies. Following this, SnO2/Al2O3 supports were synthesised from a variety of tin oxide sources. Catalytic activity was improved using sodium stannate and tin oxalate precursors compared with a traditional tin oxide slurry. Catalytic activity versus tin concentration was found to vary significantly across the three precursors, which was subsequently investigated by X-ray photoelectron spectroscopy (XPS) and energy-dispersive X-ray spectroscopy (EDX)