Breast cancer worry in higher-risk women offered preventive therapy: a UK multicentre prospective study

PURPOSE: Women's worry about developing breast cancer may influence their decision to use preventive therapy. However, the direction of this relationship has been questioned. We prospectively investigated the relationship between breast cancer worry and uptake of preventive therapy. The socio-demographic and clinical factors associated with high breast cancer worry were also investigated. METHODS: Women at increased risk of developing breast cancer were recruited from clinics across England (n = 408). Participants completed a survey on their breast cancer worry, socio-demographic and clinical factors. Uptake of tamoxifen was recorded at 3 months (n = 258 women, 63.2%). Both primary and sensitivity analyses were conducted using different classifications of low, medium and high worry. RESULTS: 39.5% of respondents reported medium breast cancer worry at baseline and 21.2% reported high worry. Ethnic minority women were more likely to report high worry than white women (OR = 3.02, 95%CI 1.02, 8.91, p = 0.046). Women educated below degree level were more likely to report high worry than those with higher education (OR = 2.29, 95%CI 1.28, 4.09, p = 0.005). No statistically significant association was observed between worry and uptake. In the primary analysis, fewer respondents with medium worry at baseline initiated tamoxifen (low worry = 15.5%, medium = 13.5%, high = 15.7%). In the sensitivity analysis, participants with medium worry reported the highest uptake of tamoxifen (19.7%). CONCLUSIONS: No association was observed between worry and uptake, although the relationship was affected by the categorisation of worry. Standardised reporting of the classification of worry is warranted to allow transparent comparisons across cohorts

An audit of acute oncology services: patient experiences of admission procedures and staff utilisation of a new telephone triage system.

OBJECTIVES: In 2010, St. James Institute of Oncology (Leeds, UK) created a new acute oncology service (AOS) consisting of a new admissions unit with a nurse-led telephone triage (TT) system. This audit cycle (March 2011 and June 2013) evaluated patient experiences of the reconfigured AOS and staff use of the TT system. METHODS: Patient views were elicited via a questionnaire and semi-structured interviews. The TT forms were analysed descriptively evaluating completion and data quality, reported symptoms and their severity and advice given (including admission rates). RESULTS: Patients (n = 40) reported high satisfaction with the new AOS. However, 56 % of patients delayed 2 days or more before contacting the unit. In 2011, 26 % of all the admitted patients were triaged via the TT system; 133 TT forms were completed. In June 2013, 49 % of the admitted patients were triaged; 264 forms were completed. The most commonly reported symptoms on the TT forms were pain, pyrexia/rigors/infection, diarrhoea, vomiting and dyspnoea. Half of the patients using the TT system were admitted (52 % in 2011, 49 % in 2013). CONCLUSIONS: Our audit provided evidence of successful implementation of the TT system with the number of TT forms doubling from 2011 to 2013. The new AOS was endorsed by patients, with the majority satisfied with the care they received

Protostellar collapse: A comparison between SPH and AMR calculations

The development of parallel supercomputers allows today the detailed study of the collapse and the fragmentation of prestellar cores with increasingly accurate numerical simulations. Thanks to the advances in sub-millimeter observations, a wide range of observed initial conditions enable us to study the different modes of low-mass star formation. The challenge for the simulations is to reproduce the observational results. Two main numerical methods, namely AMR and SPH, are widely used to simulate the collapse and the fragmentation of prestellar cores. We compare thoroughly these two methods within their standard framework. We use the AMR code RAMSES and the SPH code DRAGON. Our physical model is as simple as possible and consists of an isothermal sphere rotating around the z-axis. We first study the conservation of angular momentum as a function of the resolution. Then, we explore a wide range of simulation parameters to study the fragmentation of prestellar cores. There seems to be a convergence between the two methods, provided resolution in each case is sufficient. Resolution criteria adapted to our physical cases, in terms of resolution per Jeans mass, for an accurate description of the formation of protostellar cores are deduced from the present study. This convergence is encouraging for future work in simulations of low-mass star formation, providing the aforementioned criteria are fulfilled. Higher resolution figures can be downloaded at http://www-dapnia.cea.fr/Projets/COAST/paper_amrvssph.pdfComment: 16 pages, 16 figures, accepted for publication in A&

AMRA: An Adaptive Mesh Refinement Hydrodynamic Code for Astrophysics

Implementation details and test cases of a newly developed hydrodynamic code, AMRA, are presented. The numerical scheme exploits the adaptive mesh refinement technique coupled to modern high-resolution schemes which are suitable for relativistic and non-relativistic flows. Various physical processes are incorporated using the operator splitting approach, and include self-gravity, nuclear burning, physical viscosity, implicit and explicit schemes for conductive transport, simplified photoionization, and radiative losses from an optically thin plasma. Several aspects related to the accuracy and stability of the scheme are discussed in the context of hydrodynamic and astrophysical flows.Comment: 41 pages, 21 figures (9 low-resolution), LaTeX, requires elsart.cls, submitted to Comp. Phys. Comm.; additional documentation and high-resolution figures available from http://www.camk.edu.pl/~tomek/AMRA/index.htm

Short survey on aspirin use for cancer prevention among the UK general public

Australian guidance recommends aspirin for colorectal cancer prevention among people aged 50-70 at population risk. The medication could be offered more widely in the future in the UK and other countries. We conducted an online survey to investigate aspirin use, and awareness of aspirin for cancer prevention among the UK general population. We recruited 400 UK respondents aged 50-70 through a market research company to an online survey

Formation and Evolution of Early-Type Galaxies: Spectro-Photometry from Cosmo-Chemo-Dynamical Simulations

One of the major challenges in modern astrophysics is to understand the origin and the evolution of galaxies, the bright, massive early type galaxies (ETGs) in particular. Therefore, these galaxies are likely to be good probes of galaxy evolution, star formation and, metal enrichment in the early Universe. In this context it is very important to set up a diagnostic tool able to combine results from chemo-dynamical N-Body-TSPH (NB-TSPH) simulations of ETGs with those of spectro-photometric population synthesis and evolution so that all key properties of galaxies can be investigated. The main goal of this paper is to provide a preliminary validation of the software package before applying it to the analysis of observational data. The galaxy models in use where calculated by the Padova group in two different cosmological scenarios: the SCDM, and the Lambda CDM. For these models, we recover their spectro-photometric evolution through the entire history of the Universe. We computed magnitudes and colors and their evolution with the redshift along with the evolutionary and cosmological corrections for the model galaxies at our disposal, and compared them with data for ETGs taken from the COSMOS and the GOODS databases. Starting from the dynamical simulations and photometric models at our disposal, we created synthetic images from which we derived the structural and morphological parameters. The theoretical results are compared with observational data of ETGs selected form the SDSS database. The simulated colors for the different cosmological scenarios follow the general trend shown by galaxies of the COSMOS and GOODS. Within the redshift range considered, all the simulated colors reproduce the observational data quite well.Comment: 28 pages, 28 figures, accepted for pubblication by A&

Access to palliative care for patients with advanced cancer: A longitudinal population analysis

Background The UK National Health Service is striving to improve access to palliative care for patients with advanced cancer however limited information exists on the level of palliative care support currently provided in the UK. We aimed to establish the duration and intensity of palliative care received by patients with advanced cancer and identify which cancer patients are missing out. Methods Retrospective cancer registry, primary care and secondary care data were obtained and linked for 2474 patients who died of cancer between 2010 and 2012 within a large metropolitan UK city. Associations between the type, duration, and amount of palliative care by demographic characteristics, cancer type, and therapies received were assessed using Chi-squared, Mann-Whitney or Kruskal-Wallis tests. Multinomial multivariate logistic regression was used to assess the odds of receiving community and/or hospital palliative care compared to no palliative care by demographic characteristics, cancer type, and therapies received. Results Overall 64.6% of patients received palliative care. The average palliative care input was two contacts over six weeks. Community palliative care was associated with more palliative care events (p<0.001) for a longer duration (p<0.001). Patients were less likely to receive palliative care if they were: male (p = 0.002), aged 80 years or over (p<0.05), diagnosed with lung cancer (p<0.05), had not received an opioid prescription (p<0.001), or had not received chemotherapy (p<0.001). Patients given radiotherapy were more likely to receive community only palliative care compared to no palliative care (Odds Ratio = 1.49, 95% Confidence Interval = 1.16–1.90). Conclusion Timely supportive care for cancer patients is advocated but these results suggest that older patients and those who do not receive anti-cancer treatment or opioid analgesics miss out. These patients should be targeted for assessment to identify unmet needs which could benefit from palliative care input

Kidney disease pathways, options and decisions: an environmental scan of international patient decision aids

Background: Conservative management is recognized as an acceptable treatment for people with worsening chronic kidney disease; however, patients consistently report they lack understanding about their changing disease state and feel unsupported in making shared decisions about future treatment. The purpose of this review was to critically evaluate patient decision aids (PtDAs) developed to support patient–professional shared decision-making between dialysis and conservative management treatment pathways. Methods: We performed a systematic review of resources accessible in English using environmental scan methods. Data sources included online databases of research publications, repositories for clinical guidelines, research projects and PtDAs, international PtDA expert lists and reference lists from relevant publications. The resource selection was from 56 screened records; 17 PtDAs were included. A data extraction sheet was applied to all eligible resources, eliciting resource characteristics, decision architecture to boost/bias thinking, indicators of quality such as International Standards for Patient Decision Aids Standards checklist and engagement with health services. Results: PtDAs were developed in five countries; eleven were publically available via the Internet. Treatment options described were dialysis (n = 17), conservative management (n = 9) and transplant (n = 5). Eight resources signposted conservative management as an option rather than an active choice. Ten different labels across 14 resources were used to name ‘conservative management’. The readability of the resources was good. Six publications detail decision aid development and/or evaluation research. Using PtDAs improved treatment decision-making by patients. Only resources identified as PtDAs and available in English were included. Conclusions: PtDAs are used by some services to support patients choosing between dialysis options or end-of-life options. PtDAs developed to proactively support people making informed decisions between conservative management and dialysis treatments are likely to enable services to meet current best practice

Impact of infection with human immunodeficiency virus-1 (HIV) on the risk of cancer among children in Malawi - preliminary findings

<p>Abstract</p> <p>Background</p> <p>The impact of infection with HIV on the risk of cancer in children is uncertain, particularly for those living in sub-Saharan Africa. In an ongoing study in a paediatric oncology centre in Malawi, children (aged ≤ 15 years) with known or suspected cancers are being recruited and tested for HIV and their mothers or carers interviewed. This study reports findings for children recruited between 2005 and 2008.</p> <p>Methods</p> <p>Only children with a cancer diagnosis were included. Odds ratios (OR) for being HIV positive were estimated for each cancer type (with adjustment for age (<5 years, ≥ 5 years) and sex) using children with other cancers and non-malignant conditions as a comparison group (excluding the known HIV-associated cancers, Kaposi sarcoma and lymphomas, as well as children with other haematological malignancies or with confirmed non-cancer diagnoses).</p> <p>Results</p> <p>Of the 586 children recruited, 541 (92%) met the inclusion criteria and 525 (97%) were tested for HIV. Overall HIV seroprevalence was 10%. Infection with HIV was associated with Kaposi sarcoma (29 cases; OR = 93.5, 95% CI 26.9 to 324.4) and with non-Burkitt, non-Hodgkin lymphoma (33 cases; OR = 4.4, 95% CI 1.1 to 17.9) but not with Burkitt lymphoma (269 cases; OR = 2.2, 95% CI 0.8 to 6.4).</p> <p>Conclusions</p> <p>In this study, only Kaposi sarcoma and non-Burkitt, non-Hodgkin lymphoma were associated with HIV infection. The endemic form of Burkitt lymphoma, which is relatively frequent in Malawi, was not significantly associated with HIV. While the relatively small numbers of children with other cancers, together with possible limitations of diagnostic testing may limit our conclusions, the findings may suggest differences in the pathogenesis of HIV-related malignancies in different parts of the world.</p