Comparing hospital and telephone follow-up after treatment for breast cancer: randomised equivalence trial

Objective To compare traditional hospital follow-up with telephone follow-up by specialist nurses after treatment for breast cancer. Design A two centre randomised equivalence trial in which women remained in the study for a mean of 24 months. Setting Outpatient clinics in two NHS hospital trusts in the north west of England Participants 374 women treated for breast cancer who were at low to moderate risk of recurrence. Interventions Participants were randomised to traditional hospital follow-up (consultation, clinical examination, and mammography as per hospital policy) or telephone follow-up by specialist nurses (consultation with structured intervention and mammography according to hospital policy). Main outcome measures Psychological morbidity (state-trait anxiety inventory, general health questionnaire (GHQ-12)), participants’ needs for information, participants’ satisfaction, clinical investigations ordered, and time to detection of recurrent disease. Results The 95% confidence interval for difference in mean state-trait scores adjusted for treatment received (−3.33 to 2.07) was within the predefined equivalence region (−3.5 to 3.5). The women in the telephone group were no more anxious as a result of foregoing clinic examinations and face-to-face consultations and reported higher levels of satisfaction than those attending hospital clinics (intention to treat P<0.001). The numbers of clinical investigations ordered did not differ between groups. Recurrences were few (4.5%), with no differences between groups for time to detection (median 60.5 (range 37-131) days in hospital group v 39.0 (10-152) days in telephone group; P=0.228). Conclusions Telephone follow-up was well received by participants, with no physical or psychological disadvantage. It is suitable for women at low to moderate risk of recurrence and those with long travelling distances or mobility problems and decreases the burden on busy hospital clinics

Understanding the Gap between University Ambitions to Teach and Deliver Climate Change Education

This paper aims to determine why there is a gap between university ambitions to teach climate change education, even where formal commitments and institutional incentives exist to encourage action. To explore this, acknowledgement of prior conceptual work is considered. A new matrix emerges, which conceptualizes the influences of organizational values, organisational culture, personal values and positionality-identity on the integration of climate change education into the curriculum. The role and influence of the researcher is addressed using an auto-ethnographic approach. A thematic analysis is applied to data collected from program leaders for an undergraduate curriculum review at a medium-sized university Business School, in north-west England. Five clusters are used to structure the results and explore the narrative, before applying these to the new matrix for illustrative purposes. The discussion suggests a lack of knowledge by staff or confusion over the communicated organizational values; an organizational culture that perceives sustainability and climate change are not priorities for the institution; and an attitude-behavior gap that can be attributed to personal values. In conclusion, organizational culture can be changed to increase the priority of sustainability and climate change through an objective in staff annual Personal Development Reviews, for example. Recommendations are made for further research

A Formalization of the Theorem of Existence of First-Order Most General Unifiers

This work presents a formalization of the theorem of existence of most general unifiers in first-order signatures in the higher-order proof assistant PVS. The distinguishing feature of this formalization is that it remains close to the textbook proofs that are based on proving the correctness of the well-known Robinson's first-order unification algorithm. The formalization was applied inside a PVS development for term rewriting systems that provides a complete formalization of the Knuth-Bendix Critical Pair theorem, among other relevant theorems of the theory of rewriting. In addition, the formalization methodology has been proved of practical use in order to verify the correctness of unification algorithms in the style of the original Robinson's unification algorithm.Comment: In Proceedings LSFA 2011, arXiv:1203.542

Values and motivations in tourist perceptions of last-chance tourism

Tourists’ perceptions of climate change affect decisions and choices to visit destinations, which are disappearing because of climate change impacts. Values and motivations are two of the personal variables underpinning tourists’ decisions. The study addresses both the limited values research in tourism and reveals unconscious motives by using projective techniques. Projective techniques avoid some of the social desirability bias present in much ethical research. Choice ordering technique and the list of values assist by assigning importance, with narrative responses providing meaning. The construction technique builds a story from a stimulus, with photo-elicitation using participants’ personal holiday photographs. A sample of pre, during and post visit tourists to the Arctic and Venice were interviewed. Results, which provide a more nuanced understanding of how the personal variables of values and motivations are underpinned by selfinterest, in

Ethics and influences in tourist perceptions of climate change

Ethical decisions to visit disappearing destinations are self-serving and influences feed into self-interest. Data were collected from a sample of pre-, during- and post-visit tourists to Venice and Svalbard, using expressive techniques and scenarios using the Hunt–Vitell model to understand ethical decisions, and the constructive technique and collage to understand influences. The results show that travel decisions are driven by individual selfishness, and any threat to freedom (i.e. the right to travel) is underplayed. The preferred scenario for long-term benefit for planet and people is via short-term economic and social negative impacts on the destination's locals, rather than the tourists' own experience. Respondents believe that they are blameless for their purchasing habits as they lack perceived behavioural control, and instead corporations ought to be providing sustainable products as the norm and not sell products that harm. In the scenarios, where respondents express concern for the locals in a disappearing destination (i.e. if we do not visit, they will not benefit from our expenditure), individual selfishness to visit could be the driver, rather than an altruistic act to provide support. Theoretical and policy implications are discussed

Understanding tourists’ reactance to the threat of a loss of freedom to travel due to climate change: A new alternative approach to encouraging nuanced behavioural change

This article proposes that reactance theory can be used to better understand how tourists’ perceptions of climate change affect their travel decisions. Reactance theory explains how individuals value their perceived freedom to make choices, and why they react negatively to any threats to their freedom. We study the psychological consequences of threatening tourist's freedoms, using a range of projective techniques: directly, using photo-expression, and indirectly, through collage, photo-interviewing and scenarios. We find that reactance theory helps to explain the extent of travel to two destinations: Svalbard and Venice, providing a nuanced understanding of how travellers restore their freedom to travel through three incremental stages: denying the climate change threat, reducing tensions arising from travel and heightening demand particularly for the most visibly threatened destinations. The theory suggests a fourth stage, helplessness, reached when consumers dismiss the value of destinations once they can no longer be enjoyed, but for which we, as yet, have no data. Reactance theory questions the validity of awareness-raising campaigns as behavioural change vehicles, provides alternative explanations of why the most self-proclaimed, environmentally aware individuals travel frequently, and helps identify nuanced, socially acceptable forms of sustainability marketing, capable of reducing resistance to change

Functional asymmetry in the lysyl-tRNA synthetase explored by molecular dynamics, free energy calculations and experiment

BACKGROUND: Charging of transfer-RNA with cognate amino acid is accomplished by the aminoacyl-tRNA synthetases, and proceeds through an aminoacyl adenylate intermediate. The lysyl-tRNA synthetase has evolved an active site that specifically binds lysine and ATP. Previous molecular dynamics simulations of the heat-inducible Escherichia coli lysyl-tRNA synthetase, LysU, have revealed differences in the binding of ATP and aspects of asymmetry between the nominally equivalent active sites of this dimeric enzyme. The possibility that this asymmetry results in different binding affinities for the ligands is addressed here by a parallel computational and biochemical study. RESULTS: Biochemical experiments employing isothermal calorimetry, steady-state fluorescence and circular dichroism are used to determine the order and stoichiometries of the lysine and nucleotide binding events, and the associated thermodynamic parameters. An ordered mechanism of substrate addition is found, with lysine having to bind prior to the nucleotide in a magnesium dependent process. Two lysines are found to bind per dimer, and trigger a large conformational change. Subsequent nucleotide binding causes little structural rearrangement and crucially only occurs at a single catalytic site, in accord with the simulations. Molecular dynamics based free energy calculations of the ATP binding process are used to determine the binding affinities of each site. Significant differences in ATP binding affinities are observed, with only one active site capable of realizing the experimental binding free energy. Half-of-the-sites models in which the nucleotide is only present at one active site achieve their full binding potential irrespective of the subunit choice. This strongly suggests the involvement of an anti-cooperative mechanism. Pathways for relaying information between the two active sites are proposed. CONCLUSIONS: The asymmetry uncovered here appears to be a common feature of oligomeric aminoacyl-tRNA synthetases, and may play an important functional role. We suggest a manner in which catalytic efficiency could be improved by LysU operating in an alternating sites mechanism

An evaluation of a nurse led unit: an action research study

This study is an exemplar of working in a participatory way with members of the public and health and social care practitioners as co-researchers. A Nurse Consultant Older People working in a nurse-led bed, intermediate care facility in a community hospital acted as joint project lead with an academic researcher. From the outset, members of the public were part of a team of 16 individuals who agreed an evaluation focus and were involved in all stages of the research process from design through to dissemination. An extensive evaluation reflecting all these stakeholders’ preferences was undertaken. Methods included research and audit including: patient and carer satisfaction questionnaire surveys, individual interviews with patients, carers and staff, staff surveys, graffiti board, suggestion box, first impressions questionnaire, patient tracking and a bed census. A key aim of the study has been capacity building of the research team members which has also been evaluated. In terms of impact, the co-researchers have developed research skills and knowledge, grown in confidence, developed in ways that have impacted elsewhere in their lives, developed posters, presented at conferences and gained a better understanding of the NHS. The evaluation itself has provided useful information on the processes and outcomes of intermediate care on the ward which was used to further improve the service

Several types of types in programming languages

Types are an important part of any modern programming language, but we often forget that the concept of type we understand nowadays is not the same it was perceived in the sixties. Moreover, we conflate the concept of "type" in programming languages with the concept of the same name in mathematical logic, an identification that is only the result of the convergence of two different paths, which started apart with different aims. The paper will present several remarks (some historical, some of more conceptual character) on the subject, as a basis for a further investigation. The thesis we will argue is that there are three different characters at play in programming languages, all of them now called types: the technical concept used in language design to guide implementation; the general abstraction mechanism used as a modelling tool; the classifying tool inherited from mathematical logic. We will suggest three possible dates ad quem for their presence in the programming language literature, suggesting that the emergence of the concept of type in computer science is relatively independent from the logical tradition, until the Curry-Howard isomorphism will make an explicit bridge between them.Comment: History and Philosophy of Computing, HAPOC 2015. To appear in LNC