Online prostate cancer screening decision aid for at-risk men: A randomized trial

Objective: This study examines the efficacy of an online decision aid (DA) for men with a family history of prostate cancer. Methods: Unaffected Australian men (40 - 79 years) with at least one affected relative completed the first online questionnaire, were randomized to read either the tailored DA (intervention) or nontailored information about prostate cancer screening (control), then completed a questionnaire postreading and 12 months later. The primary outcome was decisional conflict regarding prostate specific antigen (PSA) testing. The impact of the DA on longitudinal outcomes was analyzed by using random intercept mixed effects models. Logistic and linear regressions were used to analyze the impact of the DA on screening behavior and decision regret. Stage of decision-making was tested as a moderator for decisional conflict and decision regret. The frequency of online material access was recorded. Results: the DA had no effect on decisional conflict, knowledge, inclination toward PSA testing, accuracy of perceived risk, or screening behavior. However, among men considering PSA testing, those who read the DA had lower decision regret compared with men who read the control materials, β=.34 , p \u3c.001, 95% confidence interval (CI) = [.22, .53]. Conclusions: This is the first study to our knowledge to evaluate the uptake and efficacy of an online screening DA among men with a family history of prostate cancer. Men who were undecided about screening at baseline benefitted from the DA, experiencing less regret 12 months later. In relation to decisional conflict, the control materials may have operated as a less complex and equally informative DA

A multiphase model for the cross‐linking of ultra‐high viscous alginate hydrogels

In this study, a model for the cross-linking of ultra-high viscous alginate hydrogels is provided. The model consists of four kinetic equations describing the process, including the local accumulation and the depletion of mobile alginate, cross-linked alginate and cross-linking cations. For an efficient simulation, finite difference schemes with predictor-corrector algorithms were implemente

Cost-effectiveness of psychological interventions for children and young people with post-traumatic stress disorder

Background: PTSD in youth may lead to long‐lasting psychological implications, educational difficulties and increased healthcare costs. Psychological interventions have been shown to be effective in its management. The objective of this study was to assess the cost‐effectiveness of a range of psychological interventions for children and young people with PTSD. / Methods: A decision‐analytic model was constructed to compare costs and quality‐adjusted life years (QALYs) of 10 psychological interventions and no treatment for children and young people with PTSD, from the perspective of the National Health Service and personal social services in England. Effectiveness data were derived from a systematic review and network meta‐analysis. Other model input parameters were based on published sources, supplemented by expert opinion. / Results: Cognitive therapy for PTSD, a form of individual trauma‐focused cognitive behavioural therapy (TF‐CBT), appeared to be the most cost‐effective intervention for children and young people with PTSD (with a probability of .78 amongst the 11 evaluated options at a cost‐effectiveness threshold of £20,000/QALY), followed by narrative exposure (another form of individual TF‐CBT), play therapy, and other forms of individual TF‐CBT. After excluding cognitive therapy from the analysis, narrative exposure appeared to be the most cost‐effective option with a .40 probability of being cost‐effective amongst the remaining 10 options. EMDR, parent training and group TF‐CBT occupied middle cost‐effectiveness rankings. Family therapy and supportive counselling were less cost‐effective than other active interventions. There was limited evidence for some interventions, in particular cognitive therapy for PTSD and parent training. / Conclusions: Individual forms of TF‐CBT and, to a lesser degree, play therapy appear to be cost‐effective in the treatment of children and young people with PTSD. Family therapy and supportive counselling are unlikely to be cost‐effective relative to other interventions. There is a need for well‐conducted studies that examine the long‐term clinical and cost‐effectiveness of a range of psychological treatments for children and young people with PTSD

Isoflurane promotes early spontaneous breathing in ventilated intensive care patients: A post hoc subgroup analysis of a randomized trial

Background: Spontaneous breathing is desirable in most ventilated patients. We therefore studied the influence of isoflurane versus propofol sedation on early spon taneous breathing in ventilated surgical intensive care patients and evaluated poten tial mediation by opioids and arterial carbon dioxide during the first 20 h of study sedation. Methods: We included a single-center subgroup of 66 patients, who participated in a large multi-center trial assessing efficacy and safety of isoflurane sedation, with 33 patients each randomized to isoflurane or propofol sedation. Both sedatives were titrated to a sedation depth of −4 to −1 on the Richmond Agitation Sedation Scale. The primary outcome was the fraction of time during which patients breathed spontaneously. Results: Baseline characteristics of isoflurane and propofol-sedated patients were well balanced. There were no substantive differences in management or treatment aside from sedation, and isoflurane and propofol provided nearly identical sedation depths. The mean fraction of time spent spontaneously breathing was 82% [95% CI: 69, 90] in patients sedated with isoflurane compared to 35% [95% CI: 22, 51] in those assigned to propofol: median difference: 61% [95% CI: 14, 89], p < .001. After ad justments for sufentanil dose and arterial carbon dioxide partial pressure, patients sedated with isoflurane were twice as likely to breathe spontaneously than those se dated with propofol: adjusted risk ratio: 2.2 [95%CI: 1.4, 3.3], p < .001. Conclusions: Isoflurane compared to propofol sedation promotes early spontaneous breathing in deeply sedated ventilated intensive care patients. The benefit appears to be a direct effect isoflurane rather than being mediated by opioids or arterial carbon dioxide

Observation of narrow Autler-Townes components in the resonant response of a dense atomic gas

We have experimentally studied the reflection of a weak probe beam from a dense atomic potassium vapor in the presence of a strong laser field tuned to the atomic resonance transition. We have observed an Autler-Townes doublet under hitherto unexplored conditions, namely that the Rabi frequency induced by the strong laser field is much smaller than the self-broadened width of the resonance transition of the unexcited vapor. We attribute our observation to a reduction of the atomic decoherence by the strong drive field. We present a theoretical model of nonlinear processes in a dense atomic gas to explain the observed results

The PiGeOn project: Protocol for a longitudinal study examining psychosocial, behavioural and ethical issues and outcomes in cancer tumour genomic profiling

© 2018 The Author(s). Background: Genomic sequencing in cancer (both tumour and germline), and development of therapies targeted to tumour genetic status, hold great promise for improvement of patient outcomes. However, the imminent introduction of genomics into clinical practice calls for better understanding of how patients value, experience, and cope with this novel technology and its often complex results. Here we describe a protocol for a novel mixed-methods, prospective study (PiGeOn) that aims to examine patients' psychosocial, cognitive, affective and behavioural responses to tumour genomic profiling and to integrate a parallel critical ethical analysis of returning results. Methods: This is a cohort sub-study of a parent tumour genomic profiling programme enrolling patients with advanced cancer. One thousand patients will be recruited for the parent study in Sydney, Australia from 2016 to 2019. They will be asked to complete surveys at baseline, three, and fivemonths. Primary outcomes are: knowledge, preferences, attitudes and values. A purposively sampled subset of patients will be asked to participate in three semi-structured interviews (at each time point) to provide deeper data interpretation. Relevant ethical themes will be critically analysed to iteratively develop or refine normative ethical concepts or frameworks currently used in the return of genetic information. Discussion: This will be the first Australian study to collect longitudinal data on cancer patients' experience of tumour genomic profiling. Findings will be used to inform ongoing ethical debates on issues such as how to effectively obtain informed consent for genomic profiling return results, distinguish between research and clinical practice and manage patient expectations. The combination of quantitative and qualitative methods will provide comprehensive and critical data on how patients cope with 'actionable' and 'non-actionable' results. This information is needed to ensure that when tumour genomic profiling becomes part of routine clinical care, ethical considerations are embedded, and patients are adequately prepared and supported during and after receiving results

The PiGeOn project: Protocol of a longitudinal study examining psychosocial and ethical issues and outcomes in germline genomic sequencing for cancer

© 2018 The Author(s). Background: Advances in genomics offer promise for earlier detection or prevention of cancer, by personalisation of medical care tailored to an individual's genomic risk status. However genome sequencing can generate an unprecedented volume of results for the patient to process with potential implications for their families and reproductive choices. This paper describes a protocol for a study (PiGeOn) that aims to explore how patients and their blood relatives experience germline genomic sequencing, to help guide the appropriate future implementation of genome sequencing into routine clinical practice. Methods: We have designed a mixed-methods, prospective, cohort sub-study of a germline genomic sequencing study that targets adults with cancer suggestive of a genetic aetiology. One thousand probands and 2000 of their blood relatives will undergo germline genomic sequencing as part of the parent study in Sydney, Australia between 2016 and 2020. Test results are expected within12-15 months of recruitment. For the PiGeOn sub-study, participants will be invited to complete surveys at baseline, three months and twelve months after baseline using self-administered questionnaires, to assess the experience of long waits for results (despite being informed that results may not be returned) and expectations of receiving them. Subsets of both probands and blood relatives will be purposively sampled and invited to participate in three semi-structured qualitative interviews (at baseline and each follow-up) to triangulate the data. Ethical themes identified in the data will be used to inform critical revisions of normative ethical concepts or frameworks. Discussion: This will be one of the first studies internationally to follow the psychosocial impact on probands and their blood relatives who undergo germline genome sequencing, over time. Study results will inform ongoing ethical debates on issues such as informed consent for genomic sequencing, and informing participants and their relatives of specific results. The study will also provide important outcome data concerning the psychological impact of prolonged waiting for germline genomic sequencing. These data are needed to ensure that when germline genomic sequencing is introduced into standard clinical settings, ethical concepts are embedded, and patients and their relatives are adequately prepared and supported during and after the testing process

Linear Paul trap design for an optical clock with Coulomb crystals

We report on the design of a segmented linear Paul trap for optical clock applications using trapped ion Coulomb crystals. For an optical clock with an improved short-term stability and a fractional frequency uncertainty of 10^-18, we propose 115In+ ions sympathetically cooled by 172Yb+. We discuss the systematic frequency shifts of such a frequency standard. In particular, we elaborate on high precision calculations of the electric radiofrequency field of the ion trap using the finite element method. These calculations are used to find a scalable design with minimized excess micromotion of the ions at a level at which the corresponding second- order Doppler shift contributes less than 10^-18 to the relative uncertainty of the frequency standard

Hybrid Mechanical Systems

We discuss hybrid systems in which a mechanical oscillator is coupled to another (microscopic) quantum system, such as trapped atoms or ions, solid-state spin qubits, or superconducting devices. We summarize and compare different coupling schemes and describe first experimental implementations. Hybrid mechanical systems enable new approaches to quantum control of mechanical objects, precision sensing, and quantum information processing.Comment: To cite this review, please refer to the published book chapter (see Journal-ref and DOI). This v2 corresponds to the published versio