Colorectal cancer with synchronous liver-limited metastases : the protocol of an Inception Cohort study (CoSMIC)

Introduction Colorectal cancer is the fourth most common cancer in the UK and an important cause of cancer-related death. In 20% of patients, there is metastasis to the liver or beyond at the time of diagnosis. The management of synchronous disease is complex. Conventional surgery removes the colorectal primary first, followed by chemotherapy, with resection of liver metastases as a final step. Advances in the availability and safety of liver surgery, anaesthesia and critical care have made two alternative options feasible. The first is synchronous resection of the primary and liver metastases. The second is resection of the metastatic disease as the first step, termed the reverse or liver-first approach. Currently, evidence is inadequate to inform the selection of care pathway for patients with colorectal cancer and synchronous liver-limited metastases. Specifically, optimal pathways are not defined and there is a dearth of prospectively recorded cohort-defining factors influencing treatment selection or outcome. Methods and analysis Colorectal cancer with Synchronous liver-limited Metastases: an Inception Cohort (CoSMIC) is an inception cohort study of patients with a new diagnosis of colorectal cancer with synchronous liver-limited metastases. The sequence of treatment received, and factors influencing treatment decisions, will be evaluated against European Society of Medical Oncology guidelines. Clinical data will be collected, and quality of life, morbidity, mortality and long-term outcome compared for different treatment sequences adjusted for prognostic factors. Disease-free survival or progression will be measured at 1, 2 and 5 years. A nested qualitative study will ascertain patient experiences and clinician perspectives on delivery of care. Ethics and dissemination The full study protocol was independently peer reviewed by Professor Kees de Jong (University of Maastricht, Holland). CoSMIC has ethical approval from the National Health Service Research Ethics Committee (14/NW/1397). Results will be disseminated to healthcare professionals and patient groups, and may be used to design a definitive trial addressing areas of equipoise in treatment pathways, as well as optimising current pathways to improve outcomes and experiences

Achieving provider engagement: providers' perceptions of implementing and delivering integrated care

The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda

Isospin dependence of the eta' meson production in nucleon--nucleon collisions

According to the quark model, the masses of eta and eta' mesons should be almost equal. However, the empirical values of these masses differ by more than the factor of two. Similarly, though the almost the same quark-antiquark content, the total cross section for the creation of these mesons close to the kinematical thresholds in the pp --> ppX reaction differs significantly. Using the COSY-11 detection setup we intend to determine whether this difference will also be so significant in the case of the production of these mesons in the proton-neutron scattering. Additionally, the comparison of the pp --> pp eta' and pn --> pn eta' total cross sections will allow to learn about the production of the eta' meson in the channels of isospin I = 0 and I = 1 and to investigate aspects of the gluonium component of the eta' meson.Comment: Presented at LEAP05: International conference on Low Energy Antiproton Physics, Bonn - Juelich, Germany, May 16-22, 200

Dynamics of the near threshold eta meson production in proton-proton interaction

We present the results of measurements of the analysing power for the p(pol)p --> pp eta reaction at the excess energies of Q=10 and 36 MeV, and interpret these results within the framework of the meson exchange models. The determined values of the analysing power at both excess energies are consistent with zero implying that the eta meson is produced predominantly in s-wave.Comment: 3 pages, 3 figures, Presented at the Workshop on the physics of excited nucleons (NSTAR 2007), 5-8 September 2007, Bonn, German

COSY-11: an experimental facility for studying meson production in free and quasi-free nucleon-nucleon collisions

The COSY-11 experimental setup is an internal facility installed at the COoler SYnchrotron COSY in Juelich. It allows to investigate meson production in free and quasi-free nucleon-nucleon collisions, eg. pp --> pp meson and pd --> p_sp np meson reactions. Drift chambers and scintillators permit to measure outgoing protons, separated in magnetic field of COSY-11 dipole. Neutrons are registered in the neutron modular detector installed downstream the beam. Recently, the experimental setup has been extended with spectator detector, deuteron drift chamber and polarization monitoring system, and since then meson production can be investigated also as a function of spin and isospin of colliding nucleons.Comment: Presented at LEAP05: International conference on Low Energy Antiproton Physics, Bonn - Juelich, Germany, May 16-22, 200

Associated strangeness production in pp collisions near threshold

Motivated by the ongoing discussion concerning the nature of the scalar resonances f0(980) and a0(980), the COSY-11 collaboration has taken exclusive data on the pp->ppK+K- reaction near the production threshold. A first total cross section sigma=(1.80+-0.27+0.28-0.35)nb for the excess energy Q=17 MeV has been determined. In contrary to the eta, omega and eta' single meson production studies which clearly show the strong pp final state interaction (FSI), the cross section values obtained at COSY-11 and DISTO can be both described by a fit with a four-body phase space including the proton-proton final state interaction as well as with one-meson exchange calculations neglecting FSI effects. Therefore, one might think about a compensation of the strong pp interaction through a pK- FSI effect or an additional degree of freedom caused by the four-body final state. In the latter case, strong FSI effects can be expected at Q-values very close to the K+K- production threshold. Such a motivation triggered -- in combination with the investigation of the kaon-Antikaon interaction being relevant to the structure of the f0(980) -- further measurements at the excess energies Q=10 and Q=28 MeV at COSY-11.Comment: 5 pages, 4 figures, Presented at X. International Conference On Hadron Spectroscopy (Hadron 2003), Aschaffenburg, Germany, 31 Aug - 6 Sep 200

Non-equilibrium emission of complex fragments from p+Au collisions at 2.5 GeV proton beam energy

Energy and angular dependence of double differential cross sections d$^2\sigma$/d$\Omega$dE was measured for reactions induced by 2.5 GeV protons on Au target with isotopic identification of light products (H, He, Li, Be, and B) and with elemental identification of heavier intermediate mass fragments (C, N, O, F, Ne, Na, Mg, and Al). It was found that two different reaction mechanisms give comparable contributions to the cross sections. The intranuclear cascade of nucleon-nucleon collisions followed by evaporation from an equilibrated residuum describes low energy part of the energy distributions whereas another reaction mechanism is responsible for high energy part of the spectra of composite particles. Phenomenological model description of the differential cross sections by isotropic emission from two moving sources led to a very good description of all measured data. Values of the extracted parameters of the emitting sources are compatible with the hypothesis claiming that the high energy particles emerge from pre-equilibrium processes consisting in a breakup of the target into three groups of nucleons; small, fast and hot fireball of $\sim$ 8 nucleons, and two larger, excited prefragments, which emits the light charged particles and intermediate mass fragments. The smaller of them contains $\sim$ 20 nucleons and moves with velocity larger than the CM velocity of the proton projectile and the target. The heavier prefragment behaves similarly as the heavy residuum of the intranuclear cascade of nucleon-nucleon collisions. %The mass and charge dependence of the total production cross %sections was extracted from the above analysis for all observed %reaction products. This dependence follows the power low behavior %(A$^{-\tau}$ or Z$^{-\tau}$)