Protocol for a longitudinal qualitative interview study: maintaining psychological well-being in advanced cancer - what can we learn from patients' and carers' own coping strategies?

IntroductionPeople with advanced cancer and their carers experience stress and uncertainty which affects the quality of life and physical and mental health. This study aims to understand how patients and carers recover or maintain psychological well-being by exploring the strategies employed to self-manage stress and uncertainty.Methods and analysisA longitudinal qualitative interview approach with 30 patients with advanced cancer and 30 associated family or informal carers allows the exploration of contexts, mechanisms and outcomes at an individual level. Two interviews, 4–12?weeks apart, will not only enable the exploration of individuals’ evolving coping strategies in response to changing contexts but also how patients’ and carers’ strategies inter-relate. Patient and Carer focus groups will then consider how the findings may be used in developing an intervention. Recruiting through two major tertiary cancer centres in the North West and using deliberately broad and inclusive criteria will enable the sample to capture demographic and experiential breadth.Ethics and disseminationThe research team will draw on their considerable experience to ensure that the study is sensitive to a patient and carer group, which may be considered vulnerable but still values being able to contribute its views. Public and patient involvement (PPI) is integral to the design and is evidenced by: a research advisory group incorporating patient and carers, prestudy consultations with the PPI group at one of the study sites and a user as the named applicant. The study team will use multiple methods to disseminate the findings to clinical, policy and academic audiences. A key element will be engaging health professionals in patient and carer ideas for promoting self-management of psychological well-being. The study has ethical approval from the North West Research Ethics Committee and the appropriate NHS governance clearance.RegistrationNational Institute for Health Research (NIHR) Clinical Studies Portfolio, UK Clinical Research Network (UKCRN) Study number 11725

How Early Is Early Enough: Correlating Student Performance With Final Grades

Student retention is one of the greatest challenges facing computer science programs. Difficulties in an introductory programming class often snowball, resulting in poor student performance or dropping the major completely. In this paper, we present an analysis of 197 students over 6 semesters from 11 sections of an introductory programming class at a private four-year liberal arts university in the southeastern United States. The goal of this research was to find the earliest point in the assessment sequence which could predict final grade outcomes. Accordingly, we measured the degree of correlation between student performance on quizzes, labs, programs, and tests compared to final course grade. Overall, the results show a strong positive correlation for all four assessment modalities. These results hold significance for educators and researchers insofar as the body of computing education research is extended by evaluating the relative effectiveness of early semester subsets of each of the four categories of student data to model class outcomes

A pilot randomised controlled trial to reduce suffering and emotional distress in patients with advanced cancer

Introduction: A pilot trial was carried out to determine if a focussed narrative interview could alleviate the components of suffering and anxiety and depression in advanced cancer patients. InterventionPatients recruited were invited to participate in a focussed narrative interview and reflect on their perspectives on their sense of “meaning”, regarding suffering and their psychological, physical, social and spiritual well being – the emphasis was on allowing the patient to tell their story. Patients were encouraged to share what resources they themselves had utilised in addition to what professional care they may have received, to maintain a sense of well being. Method: Patients with advanced metastatic disease were recruited from hospices in the North West of England – the only exclusion criteria were not being able to understand written and spoken English and a non cancer diagnosis. At recruitment patients were asked to complete a numerical scale for suffering; the Brief Edinburgh Depression Scale, Edmonton Symptom Assessment Scale (ESAS), FACIT Spiritual well being questionnaire, Demographic information was collected and patients were randomised to either the intervention arm of the trial or the usual care arm of the study. Patients in both groups were invited to complete each measure at 2, 4 and 8 weeks. Results: One hundred people were recruited into the study – 49 were randomised to intervention group and 51 to control group. The median age of patients was 66 years age range (31–89 years) and 68% of patients were female. At baseline the ECOG performance of 75% of patients recruited was 1 or 2. The median survival of all patients in the study was 169.5 days (range 10 days to still alive at end of study). There was no significant difference at any timepoint in scores on suffering measure between intervention group and control group. At each time point the intervention demonstrated mean improvement in scores for depression and anxiety on ESAS – the greatest changes for both depression and anxiety were seen at 4 weeks. Conclusion: This pilot randomised controlled trial of a focussed narrative intervention demonstrated an improvement in mean changes in scores for depression and anxiety at 2, 4, and 8 weeks. We suggest this intervention may have beneficial effects on depression and anxiety, but a larger powered trial is required to determine the full effects

Development and Evaluation of an Intervention to Support Family Caregivers of People with Cancer to Provide Home-based Care at the End of Life: a Feasibility Study

Purpose: To design and evaluate an intervention to address carers’ needs for practical information and support skills when caring for a person with cancer at end of life. Method: Phase I 29 carers were interviewed about need for practical information, support skills and their preferences for information delivery. The preferred format was a booklet. Phase 2 evaluated the booklet. 31 carers and 14 district nurses participated. Validated questionnaires: on perceptions of caregiving and carer health before and after the booklet was used and interviews with both carers and nurses were undertaken.24 carers completed both interviews. Quantitative data were coded using scale manuals and analysed using SPSSv20 and interview data was analysed thematically. Results: Carers were aged 31-82 and cared for people aged 50-92; 8 carers were male and 23 female; 20 cared for a partner, 8 for a parent and 1 for a sibling (2 undisclosed). Carers were positive about the booklet, however many carers would have liked the booklet earlier. Carers reported feeling more positive about caregiving, and more reassured and competent in their role. District nurses found the booklet useful and reported receiving fewer phone calls from study carers than others in similar situations. Conclusions: The booklet intervention was a source of reassurance to carers and it has the potential to be incorporated into everyday practice. The challenge is in when and how to distribute the booklet and more work is required on the timing of delivery in order to maximise the usefulness of booklet to carers

"Until the trial is complete you can't really say whether it helped you or not, can you?": exploring cancer patients' perceptions of taking part in a trial of acupressure wristbands.

BACKGROUND: Nested qualitative studies within clinical trials provide data on patients' experiences of receiving trial interventions and can inform and improve trial designs. The present study explored patients' experiences of participating in a randomised controlled trial of acupressure wristbands for chemotherapy related nausea. METHODS: A randomised three-group sham-controlled trial was carried out to evaluate the effectiveness of acupressure wristbands in the management of chemotherapy-related nausea. A convenience sample of 26 patients volunteered to participate in a qualitative study to explore their experiences of using acupressure wristbands, and taking part in the clinical trial. Participants were recruited from each of the three UK geographical sites from which the trial was conducted: Manchester, Liverpool and Plymouth. In-depth semi-structured interviews were conducted with the participants in their own homes or other location convenient for participating patients. Interviews were audio-taped, transcribed verbatim and analysed using Framework methodology. RESULTS: The main motivational factors influencing participants to take part in the trial were a desire to 'give something back' and limit their own experience of nausea. Participants were largely satisfied with the organisation and running of the acupressure wristband trial. Many participants experienced positive outcomes as a result of taking part in the trial. Lapses in memory, or poor health as a result of their chemotherapy treatment, led to some participants failing to complete trial paperwork on designated days. Two sham wristband participants reported wearing the bands inappropriately resulting in pressure being applied to the acupoint. Almost all of the participants interviewed had only experienced mild nausea or vomiting during the trial. Participants were pragmatic on the extent to which the wristbands were responsible for this lack of nausea and vomiting during the trial. However, many participants, including some patients receiving sham acupressure, believed the wristbands to have had a positive impact on their nausea and vomiting; there was a perception that the wristbands were, at least in part, responsible for the lack of nausea and vomiting they had experienced. CONCLUSIONS: Participants perceive acupressure wristbands as reducing the level of nausea and vomiting experienced during chemotherapy treatment. Reports that some participants wore wristbands inappropriately, and/or delayed completion of trial paperwork could represent confounding variables and have implications for the trial results, and the design of clinical trials within the field of cancer

Development of the Carers’ Alert Thermometer (CAT) to identify family carers struggling with caring for someone dying at home: a mixed method consensus study

Background: There is an increasing international policy direction to promote home death for dying patients which will impact on the demands placed on family carers. The early identification of carer needs and appropriate intervention can help avoid crisis situations for the carer and avoidable hospital admissions which are reported to be a global concern. The aim of the study was to explore what professionals and carers of patients with cancer and advanced progressive illness, in their last year of life, find burdensome and to develop an alert system for use by non-specialist staff. Methods: A mixed-method, multi-phased, consensus study sequentially utilising qualitative and quantitative data to develop and pilot the Carers’ Alert Thermometer (CAT). 245 people (117 carers and 128 professionals) participated in the study across a range of health and social care settings in the North West of England (2011–2014). Results: A number of key domains were identified and prioritised by consensus for inclusion in the CAT. The 8 domains fit within two overarching themes of the reported carer experience; the support needed by the carer to provide care and the support needed for the carer’s own health and well-being. The resultant CAT is an evidence-based alert thermometer consisting of 10 questions, guidance on the possible actions for each alert and space for an action plan to be jointly agreed by the assessor and carer. Preliminary piloting of the CAT has shown it to be valued, fit for purpose and it can be administered by a range of personnel. Conclusions: The CAT enables the identification of current and potential future needs so a proactive approach can be taken to supporting the carer as their role develops over time, with a view to enhancing their well-being and preventing avoidable hospital admissions; ultimately supporting patient choice to remain in their own home

Evidence for ablated flows in the shell of nova DQ Her

High-resolution longslit Halpha spectra of the shell of the old nova DQ Her have been obtained with the William Herschel Telescope using the ISIS spectrograph. An equatorial expansion velocity of 370+/-14 km/s is derived from the spectra which, in conjunction with a narrowband Halpha image of the remnant, allows a distance estimate of 525+/-28 pc. An equatorial ring which exhibits enhanced [NII] emission has also been detected and the inclination angle of the shell is found to be 86.8+/-0.2 degrees with respect to the line of sight. The spectra also reveal tails extending from the clumps in the shell, which have a radial velocity increasing along their length. This suggests the presence of a stellar wind, collimated in the polar direction, which ablates fragments of material from the clumps and accelerates them into its stream up to a terminal velocity of order 800-900 km/s.Comment: 7 pages, 6 figure

Radio emission models of Colliding-Wind Binary Systems

We present calculations of the spatial and spectral distribution of the radio emission from a wide WR+OB colliding-wind binary system based on high-resolution hydrodynamical simulations and solutions to the radiative transfer equation. We account for both thermal and synchrotron radio emission, free-free absorption in both the unshocked stellar wind envelopes and the shocked gas, synchrotron self-absorption, and the Razin effect. The applicability of these calculations to modelling radio images and spectra of colliding-wind systems is demonstrated with models of the radio emission from the wide WR+OB binary WR147. Its synchrotron spectrum follows a power-law between 5 and 15 GHz but turns down to below this at lower and higher frequencies. We find that while free-free opacity from the circum-binary stellar winds can potentially account for the low-frequency turnover, models that also include a combination of synchrotron self-absorption and Razin effect are favoured. We argue that the high-frequency turn down is a consequence of inverse-Compton cooling. We present our resulting spectra and intensity distributions, along with simulated MERLIN observations of these intensity distributions. From these we argue that the inclination of the WR147 system to the plane of the sky is low. We summarise by considering extensions of the current model that are important for models of the emission from closer colliding wind binaries, in particular the dramatically varying radio emission of WR140.Comment: 18 pages, 18 figures; Accepted by Astronomy and Astrophysics, July 8, 200

Lattice dynamics and electron-phonon coupling calculations using nondiagonal supercells

We study the direct calculation of total energy derivatives for lattice dynamics and electronphonon coupling calculations using supercell matrices with non-zero off-diagonal elements. We show that it is possible to determine the response of a periodic system to a perturbation characterized by a wave vector with reduced fractional coordinates (m₁/n₁, m₂/n₂, m₃/n₃) using a supercell containing a number of primitive cells equal to the least common multiple of n₁, n₂, and n₃. If only diagonal supercell matrices are used, a supercell containing n₁n₂n₃ primitive cells is required. We demonstrate that the use of non-diagonal supercells significantly reduces the computational cost of obtaining converged zero-point energies and phonon dispersions for diamond and graphite. We also perform electron-phonon coupling calculations using the direct method to sample the vibrational Brillouin zone with grids of unprecedented size, which enables us to investigate the convergence of the zero-point renormalization to the thermal and optical band gaps of diamond.J. H. L.-W. thanks the Engineering and Physical Sciences Research Council (UK) for a PhD studentship. B. M. thanks Robinson College, Cambridge, and the Cambridge Philosophical Society for a Henslow Research Fellowship. This work used the Cambridge High Performance Computing Service, for which access was funded by the EPSRC [EP/J017639/1], and the ARCHER UK National Supercomputing Service, for which access was obtained via the UKCP consortium and funded by the EPSRC [EP/K013564/1].This is the author accepted manuscript. The final version is available from APS via http://dx.doi.org/10.1103/PhysRevB.92.184301 All relevant data present in this article can be accessed at: https://www.repository.cam.ac.uk/ handle/1810/25142

Prevalence of non-functional overreaching in elite male and female youth academy football players

Purpose: The purpose of this study was to examine the prevalence of non-functional overreaching (NFOR) and overtraining (OT) in elite male and female youth football players. Methods: Two-hundred and forty-two youth football players (n = 138 boys and n = 104 girls) aged between 12 - 17 y completed a questionnaire to identify the occurrence of NFOR/OT and associated symptoms. Results: No players experienced OT. Significant sex differences for NFOR were found between girls 9% compared to boys 27% (p <0.05). For players that experienced NFOR, 33% of girls and 60% of boys experienced multiple bouts. Compared to girls, boys completed higher volumes of football training (16.3 ± 4.5 versus 12.7 ± 5.7 hours per week, p <0.05), but training load was not a significant predictor of NFOR for either sex. In both sexes NFOR was associated with tiredness, a lack of appetite, sore or heavy muscles, feeling in a bad mood, and feeling apathetic. Conclusion: Male and female elite youth football players engaged in high training volumes and experienced similar NFOR symptoms. However, there is a much higher prevalence of NFOR in boys and in those who have suffered previous bouts of NFOR