Promoting physical exercise in breast cancer care

This article is intended to promote awareness of physical exercise as a safe, advantageous and feasible intervention for the individual who has or has had breast cancer. It will specify the numerous and varied benefits of exercise and focus on the implications for nursing practice in light of current research evidence.</p

The utility of convection-permitting ensembles for the prediction of stationary convective bands

This study examines convection-permitting numerical simulations of four cases of terrain-locked quasi-stationary convective bands over the UK. For each case, a 2.2-km grid-length 12-member ensemble and 1.5-km grid-length deterministic forecast are analyzed, each with two different initialization times. Object-based verification is applied to determine whether the simulations capture the structure, location, timing, intensity and duration of the observed precipitation. These verification diagnostics reveal that the forecast skill varies greatly between the four cases. Although the deterministic and ensemble simulations captured some aspects of the precipitation correctly in each case, they never simultaneously captured all of them satisfactorily. In general, the models predicted banded precipitation accumulations at approximately the correct time and location, but the precipitating structures were more cellular and less persistent than the coherent quasi-stationary bands that were observed. Ensemble simulations from the two different initialization times were not significantly different, which suggests a potential benefit of time-lagging subsequent ensembles to increase ensemble size. The predictive skill of the upstream larger-scale flow conditions and the simulated precipitation on the convection-permitting grids were strongly correlated, which suggests that more accurate forecasts from the parent ensemble should improve the performance of the convection-permitting ensemble nested within it

Translation to practice: a randomised controlled study of an evidenced based booklet targeted at breast care nurses in the United Kingdom

BACKGROUND: In the United Kingdom (UK), it was documented that a problem of knowledge transfer existed within the speciality of breast-cancer care, thus depriving patients of receiving optimal care. Despite increasingly robust research evidence indicating recommendation of whole body exercise for people affected by breast cancer, commensurate changes to practice were not noted amongst breast-care nurses (BCNs). AIM: To evaluate the effect of a targeted booklet, Exercise and Breast Cancer: A Booklet for Breast-Care Nurses, on changes in knowledge, reported practice, and attitudes of BCNs in the UK. METHOD: A prospective, experimental approach was used for designing a pre- and post-test randomised controlled study. Comparisons of knowledge, reported practice, and attitudes based on responses to a questionnaire were made at two time-points in two groups of BCNs (control and experimental). The unit of randomisation and analysis was hospital clusters of BCNs. The sample comprised 92 nurses from 62 hospitals. Analysis consisted of descriptive statistics and clustered regression techniques: clustered logistic regression for knowledge items, clustered linear regression for knowledge scores, ologit for attitude and reported practice items, and clustered multiple regression for paired and multiple variable analysis. RESULTS: A statistically significant increase in knowledge and changes in reported practice and attitudes were found. Robust variables affecting knowledge acquisition were: promotion of health, promotion of exercise, and understanding how exercise can reduce cancer-related fatigue. DISCUSSION: The study has shown that evidence-based printed material, such as an information booklet, can be used as an effective research dissemination method when developed for needs, values, and context of a target audience. CONCLUSIONS: This practical approach to research dissemination could be replicated and applied to other groups of nurses.</p

Climatology of banded precipitation over the contiguous United States

A climatology of banded-precipitation features over the contiguous United States from 2003–2014 is constructed. A band is defined as a precipitation feature with a major axis of 100 km or greater and a ratio of major axis length to minor axis length (hereafter, aspect ratio) of 3:1 or greater. By applying an automated feature-based detection algorithm to composite radar imagery, a database of 48,916,844 precipitation features is created, of which 7,213,505 (14.8%) are bands. This algorithm produces the first climatology of precipitation bands over the contiguous United States. Banded precipitation occurrence is broadly similar to total precipitation occurrence, with a maximum of 175 hours of banded precipitation annually over the Ohio River Valley. In the warm season, there is a strong diurnal signature associated with convective storm development for both precipitation feature area and total area covered by precipitation, but little diurnal signature in aspect ratio. A strong west-east gradient in both precipitation occurrence and banded precipitation occurrence exist, as areas west of the Rockies receive less frequent precipitation, which is much less likely to be banded. East of the Rockies, precipitation features are banded 30% of the time, versus 10–15% west of the Rockies. Areas downwind of the Great Lakes show prominent late autumn and winter maxima in banded precipitation associated with lake-effect snowbands. Local maxima of banded precipitation percentage occur in the Dakotas and east of the Colorado Rockies during winter. Although banded-precipitation features comprise only 14.8% of all precipitation features, they contribute 21.9% of the annual precipitation occurrence over the contiguous United States

The variability of refractivity in the atmospheric boundary layer of a tropical island volcano measured by ground-based interferometric radar

For 24 h we measured continuously the variability of atmospheric refractivity over a volcano on the tropical island of Montserrat using a ground-based radar interferometer. We observed variations in phase that we interpret as due to changing water vapour on the propagation path between the radar and the volcano and we present them here in the context of the behaviour of the atmospheric boundary layer over the island. The water vapour behaviour was forced by diurnal processes, the passage of a synoptic-scale system and the presence of a plume of volcanic gas. The interferometer collected images of amplitude and phase every minute. From pairs of phase images, interferograms were calculated and analyzed every minute and averaged hourly, together with contemporaneous measurements of zenith delays estimated from a network of 14 GPS receivers. The standard deviation of phase at two sites on the volcano surface spanned a range of about 1–5 radians, the lowest values occurring at night on the lower slopes and the highest values during the day on the upper slopes. This was also reflected in spatial patterns of variability. Two-dimensional profiles of radar-measured delays were modelled using an atmosphere with water vapour content decreasing upwards and water vapour variability increasing upwards. Estimates of the effect of changing water vapour flux from the volcanic plume indicate that it should contribute only a few percent to this atmospheric variability. A diurnal cycle within the lower boundary layer producing a turbulence-dominated mixed layer during the day and stable layers at night is consistent with the observed refractivity

Climatology of size, shape and intensity of precipitation features over Great Britain and Ireland

A climatology of precipitation features (or objects) from the Great Britain and Ireland radar-derived precipitation mosaic from 2006–2015 is constructed, with features defined as contiguous areas of nonzero precipitation rates. Over the ten years, there are 54,811,747 non-unique precipitating features over 100 km2 in area, with a median precipitation-feature area of 249 km2, median major axis length of 29.2 km, median aspect ratio of 2.0, median feature mean precipitation rate of 0.49 mm h-1, and median feature maximum precipitation rate of 2.4 mm h-1. Small-scale precipitating systems are most common, but larger systems exceeding 10,000 km2 contribute close to 70% of the annual precipitation across the study region. Precipitation feature characteristics are sensitive to changes in annual and diurnal environment, with feature intensities peaking during the afternoon in summer and the largest precipitation features occurring during winter. Precipitation intensities less than 5 mm h-1 comprise 97.3% of all precipitation occurrence and contribute 83.6% of the total precipitation over land. Banded-precipitation features (defined as precipitation features with aspect ratio at least 3:1 and major axis length at least 100 km) comprise 3% of all precipitation features by occurrence, but contribute 23.7% of the total precipitation. Mesoscale banded features (defined as banded-precipitation features with major axis length at least 100 km and total area not exceeding 10,000 km2) and mesoscale convective banded features (defined as banded-precipitation features with at least 100 km2 of precipitation rates exceeding 10 mm h-1) are most prevalent in southwestern England with mesoscale convective banded features contributing up to 2% of precipitation

The BARRIERS scale -- the barriers to research utilization scale: A systematic review

<p>Abstract</p> <p>Background</p> <p>A commonly recommended strategy for increasing research use in clinical practice is to identify barriers to change and then tailor interventions to overcome the identified barriers. In nursing, the BARRIERS scale has been used extensively to identify barriers to research utilization.</p> <p>Aim and objectives</p> <p>The aim of this systematic review was to examine the state of knowledge resulting from use of the BARRIERS scale and to make recommendations about future use of the scale. The following objectives were addressed: To examine how the scale has been modified, to examine its psychometric properties, to determine the main barriers (and whether they varied over time and geographic locations), and to identify associations between nurses' reported barriers and reported research use.</p> <p>Methods</p> <p>Medline (1991 to September 2009) and CINHAL (1991 to September 2009) were searched for published research, and ProQuest^®digital dissertations were searched for unpublished dissertations using the BARRIERS scale. Inclusion criteria were: studies using the BARRIERS scale in its entirety and where the sample was nurses. Two authors independently assessed the study quality and extracted the data. Descriptive and inferential statistics were used.</p> <p>Results</p> <p>Sixty-three studies were included, with most using a cross-sectional design. Not one study used the scale for tailoring interventions to overcome identified barriers. The main barriers reported were related to the setting, and the presentation of research findings. Overall, identified barriers were consistent over time and across geographic locations, despite varying sample size, response rate, study setting, and assessment of study quality. Few studies reported associations between reported research use and perceptions of barriers to research utilization.</p> <p>Conclusions</p> <p>The BARRIERS scale is a nonspecific tool for identifying general barriers to research utilization. The scale is reliable as reflected in assessments of internal consistency. The validity of the scale, however, is doubtful. There is no evidence that it is a useful tool for planning implementation interventions. We recommend that no further descriptive studies using the BARRIERS scale be undertaken. Barriers need to be measured specific to the particular context of implementation and the intended evidence to be implemented.</p