5 års mini-studier af cyklistadfærd: Hvad er de største udfordringer for trafiksikkerheden? Artikel

Artiklen beskriver et studie, der sammenfatter en række mini-studier af cyklistadfærd, som Via Trafik har foretaget de seneste fem år. Formålet med sammenfatningen er at komme et skridt nærmere, hvad der er nogle af de større udfordringer, når der fokuseres på cyklisters adfærd og risikovillighed i trafikken.Mini-studierne omhandler bl.a. risikoen ved manglende brug af cykelhjelm og cykellys, uopmærksomhed under kørslen (fx pga. mobiltelefon), risikovillig kørsel og manglende tegngivning under svingning. Resultaterne er sammenfattet i en risikomatrice, hvor hyppigheden er sammenlignet med den vurderede sikkerhedsmæssige risiko ved en given adfærd.Studiet peger på, at der er størst sikkerhedsmæssig ”gevinst” ved fortsat at arbejde målrettet for at flere cyklister benytter cykelhjelm. Risikoen for at få en alvorlig hovedskade, hvis man som cyklist er involveret i en ulykke, øges markant ved ikke at benytte hjelm. Derfor er det også glædeligt, at hjelmbrugen er steget markant de seneste 15 år (siden Rådet for Sikker Trafik startede deres registrering), og fortsat ser ud til at stige.Sekundært peger studiet på, at der er stort sikkerhedspotentiale i at sætte ind over for chancebetonet kørsel over for rødt lys, at få flere cyklister til at huske (at tænde) lyset på cyklen og at give tegn før svingning i kryds.Det bemærkes, at studiet ikke skal ses som et endeligt facit, men som et oplæg til diskussion om mulige (og fortsatte) indsatsområder, justering af lovkrav mv

Evaluering af trafiksikkerhed ved hævede krydsflader: Artikel

Projektet omhandlende trafiksikkerhed ved hævede krydsflader i vigepligtskryds har haft til formål at undersøge den sikkerhedsmæssige effekt af at etablere hævede krydsflader i vigepligtsregulerede kryds i byzone. Dvs. at undersøgelsen er ende ud med et estimat for størrelsen på den isolerede sikkerhedseffekt af at etablere en hævet krydsflade i et enkelt prioriteret vejkryds i byzone. Projektet er lavet som et samarbejde mellem Via Trafik og Trafikforskningsgruppen ved BUILD på Aalborg Universitet (AAU BUILD)

CANcer BEhavioural nutrition and exercise feasibility trial (CanBenefit); phase I qualitative interview findings

Background: Older people with lung cancer are often frail and unfit due to their cancer and co-morbidities and may tolerate cancer treatments poorly. Physical activity (PA) and a healthy diet offer quality of life benefit to people with cancer before, during, and post treatment. However, older adults are poorly represented in the clinical trials on which recommendations were made. Objective: To assess the acceptability, usefulness, and practicality of delivering a tailored wellbeing (PA and nutrition) intervention for older adults with lung cancer before, during, and after cancer treatments (chemotherapy and/or immunotherapy). Methods: Semi-structured interviews conducted with nine patients with lung cancer and three patients with mesothelioma, ≥70 years and ten informal carers, and nine Multidisciplinary Team (MDT) members. A topic guide covered the acceptability, usefulness, and practicality of a wellbeing intervention as well as specific feedback on individual components. Data were subjected to thematic analysis. Findings: Four themes were generated: current lack of wellbeing care in clinical work; preferred “can have” dietary and “can do” PA advice; peer support as facilitating factor; and barriers to compliance including patients' psychological and physical issues as well as current cancer pathway and staffing issues. Conclusion: Older adults with lung cancer would welcome a proactive, clear and instructive, wellbeing intervention. Many barriers to compliance exist, particularly before and during cancer treatments due to the psycho-social impact of diagnosis, and the effects of cancer treatment. The intervention must be tailored to individual need and address physical limitations, psychological and social welfare in addition to PA and nutritional advice

Clinical response to primary letrozole therapy in elderly patients with early breast cancer : possible role for p53 as a biomarker

Primary tamoxifen therapy has been widely used to treat elderly women with ER-positive breast cancer in the past. Aromatase inhibitors may be more beneficial than tamoxifen when used as primary endocrine therapy in elderly patients. We aimed to retrospectively evaluate a series of elderly women with ER-positive breast cancer treated with primary letrozole therapy as sole therapy with a minimum of 5 years follow up. To identify possible predictive biomarkers a pilot immunohistochemical analysis was performed to assess the expression of PR, HER2, EGFR, BCL2 and p53. A total of 45 women, aged more than 70 years with a diagnosis of ER-positive breast cancer that was treated with primary letrozole therapy were identified. A case note review was undertaken to obtain clinical information. Formalin fixed paraffin embedded tumour tissue from diagnostic core biopsies was available for all patients. Immunohistochemical analysis was performed to establish the protein expression status of p53, PR, HER2, EGFR and BCL2. The mean age of the 45 patients was 87 years (range 70–101). Clinical benefit was seen in 60% of the patients. Median progression free survival was 53 months (95% CI – 34–72) and the median time to progression was 43 months (95% CI – 22–64). BCL2 was expressed in 45/45 (100%); PR in 38/45 (84%); EGFR in 13/45 (28%); HER2 in 9/45 (20%) and p53 in 5/45 (11%) of tissue samples. Positive expression of p53 was associated with poor progression free survival (p = 0.03) in this pilot study. This study demonstrates that letrozole as sole treatment appears to be a suitable treatment option for elderly patients with ER-positive breast cancer who are not fit for, or decline, surgery. The analysis of p53 in a larger study is warranted in order to assess its role as a biomarker in this patient group

Physical activity and nutrition interventions for older adults with cancer: a systematic review

Purpose: The aim of this review was to summarize the current literature for the effectiveness of activity and nutritional based interventions on health-related quality of life (HRQoL) in older adults living with and beyond cancer (LWBC). Methods: We conducted systematic structured searches of CINAHL, Embase, Medline, Cochrane CENTRAL databases, and bibliographic review. Two independent researchers selected against inclusion criteria: (1) lifestyle nutrition and/or activity intervention for people with any cancer diagnosis, (2) measured HRQoL, (3) all participants over 60years of age and (4) randomized controlled trials. Results: Searches identified 5179 titles; 114 articles had full text review, with 14 studies (participant n = 1660) included. Three had nutrition and activity components, one, nutrition only and ten, activity only. Duration ranged from 7days to 1year. Interventions varied from intensive daily prehabilitation to home-based gardening interventions. Studies investigated various HRQoL outcomes including fatigue, general and cancer-specific quality of life (QoL), distress, depression, global side-effect burden and physical functioning. Eight studies reported significant intervention improvements in one or more QoL measure. Seven studies reported using a psychosocial/theoretical framework. There is a gap in tailored nutrition advice. Conclusions: Among the few studies that targeted older adults with cancer, most were activity-based programmes with half reporting improvements in QoL. Future research should focus on or include tailored nutrition components and consider appropriate behaviour change techniques to maximize potential QoL improvement. Implications for Cancer Survivors: More research is needed to address the research gap regarding older adults as current recommendations are derived from younger populations

NASA advanced aeronautics design solar powered remotely piloted vehicle

Environmental problems such as the depletion of the ozone layer and air pollution demand a change in traditional means of propulsion that is sensitive to the ecology. Solar powered propulsion is a favorable alternative that is both ecologically harmless as well as cost effective. Integration of solar energy into designs ranging from futuristic vehicles to heating is beneficial to society. The design and construction of a Multi-Purpose Remotely Piloted Vehicle (MPRPV) seeks to verify the feasibility of utilizing solar propulsion as a primary fuel source. This task has been a year long effort by a group of ten students, divided into five teams, each dealing with different aspects of the design. The aircraft was designed to take-off, climb to the design altitude, fly in a sustained figure-eight flight path, and cruise for approximately one hour. This mission requires flight at Reynolds numbers between 150,000 and 200,000 and demands special considerations in the aerodynamic design in order to achieve flight in this regime. Optimal performance requires a light weight configuration with both structural integrity and maximum power availability. The structure design and choice of solar cells for the propulsion was governed by the weight, efficiency, and cost considerations. The final design is a MPRPV weighting 35 N which cruises 7 m/s at the design altitude of 50 m. The configuration includes a wing composed of balsa and foam NACA 6409 airfoil sections and carbon fiber spars, a tail of similar construction, and a truss structure fuselage. The propulsion system consists of 98 10 percent efficient solar cells donated by Mobil Solar, a NiCad battery for energy storage, and a folding propeller regulated by a lightweight and efficient control system. The airfoils and propeller chosen for the design were research and tested during the design process

Implementation of geriatric assessment in oncology settings: A systematic realist review

Older adults with cancer are more likely to have worse clinical outcomes than their younger counterparts, and shared decision-making can be difficult, due to both complexity from adverse ageing and under-representation in clinical trials. Geriatric assessment (GA) has been increasingly recognised as a predictive and prehabilitative tool for older adults with cancer. However, GA has been notoriously difficult to implement in oncological settings due to workforce, economic, logistical, and practical barriers. We aimed to review the heterogenous literature on implementation of GA in oncology settings to understand the different implementation context configurations of GA and the mechanisms they trigger to enable successful implementation. A systematic realist review was undertaken in two stages: i) systematic searches with structured data extraction combined with iterative key stakeholder consultations to develop programme theories for implementing GA in oncology settings; ii) synthesis to refine programme theories. Medline, Embase, PsycInfo, Cochrane Library, CINAHL, Web of Science, Scopus, ASSIA, Epistemonikos, JBI Database of Systematic Reviews and Implementation Reports, DARE and Health Technology Assessment were searched. Four programme theories were developed from 53 included articles and 20 key stakeholder consultations addressing the major barriers of GA implementation in oncology practice: time (leveraging non-specialists), funding (creating favourable health economics), practicalities (establishing the use of GA in cancer care), and managing limited resources. We demonstrate that a whole system approach is required to improve the implementation of GA in cancer settings. This review will help inform policy decisions regarding implementation of GA and provide a basis for further implementation research

The investigation of lipoxygenases as therapeutic targets in malignant pleural mesothelioma

Advanced malignant pleural mesothelioma (MPM) has an extremely poor prognosis with limited chemotherapy options, therefore the identification of new therapeutic targets would aid in disease management. Arachidonic acid is metabolised by cyclooxygenase and lipoxygenase enzymes. The lipoxygenase isoenzymes 5-LOX and 12-LOX have been implicated in carcinogenesis. We aimed to examine 5-LOX and 12-LOX protein expression in a large retrospective series of mesothelioma samples. Further to this, the in vitro cytotoxic effects of lipoxygenase pathway inhibitors were investigated in mesothelioma cells. Archival samples from 83 patients with MPM were examined by immunohistochemistry for expression of the 5-LOX and 12-LOX proteins. The MTS assay was used to assess cell viability following 72h treatment with the lipoxygenase pathway inhibitors baicalein, licofelone, MK-886 and zileuton in the MPM cell lines NCI-H2052, NCI-H2452 and MSTO-211H. Positive 12-LOX protein expression was recorded in 69/83 (83%) and positive 5-LOX expression was observed in 56/77 (73%) of MPM tissue samples. Co-expression of 5-LOX with 12-LOX was seen in 46/78 (58%) of MPM samples. Positive expression of 5-LOX, 12-LOX and COX-2 proteins was identified in the NCI-H2052, NCI-H2452 and MSTO-211H MPM cell lines. Baicalein (12-LOX and 15-LOX inhibitor) was effective in 3/3 MPM cell lines at low concentrations with an IC50 range of 9.6μM to 20.7μM. We have demonstrated that the 5-LOX and 12-LOX proteins are expressed in a significant proportion of MPM samples (73% and 83% respectively) and may represent novel therapeutic targets in this disease. We have demonstrated that the inhibition of the LOX pathway using baicalein may be effective as a novel treatment for MPM, however further human pharmacokinetic studies are required in order to establish whether the concentration used in vitro is clinically achievable

CAMERA - complete assessment of elderly patients with cancer: A non-randomised feasibility study

One of the primary risk factors in the development of cancer is older age. The demographic shift to an ageing population has given rise to an increased number of older patients with cancer. The extreme heterogeneity within this population renders applying standardised treatment pathways hazardous [1]. Disparities in physiological reserve and an increased risk of multiple comorbidities further exacerbates the complexity of cancer treatment management in older patients [2]. Individual modifications to tailor treatment for each specific patient would be the gold standard; thus, detailed patient assessment providing a comprehensive health profile in addition to existing diagnostic test results are paramount when devising a personalised treatment care approach [3]

High procedure volume is strongly associated with improved survival after lung cancer surgery

PurposeStudies have reported an association between hospital volume and survival for non–small-cell lung cancer (NSCLC). We explored this association in England, accounting for case mix and propensity to resect.MethodsWe analyzed data on 134,293 patients with NSCLC diagnosed in England between 2004 and 2008, of whom 12,862 (9.6%) underwent surgical resection. Hospital volume was defined according to number of patients with resected lung cancer in each hospital in each year of diagnosis. We calculated hazard ratios (HRs) for death in three predefined periods according to hospital volume, sex, age, socioeconomic deprivation, comorbidity, and propensity to resect.ResultsThere was increased survival in hospitals performing > 150 surgical resections compared with those carrying out < 70 (HR, 0.78; 95% CI, 0.67 to 0.90; Ptrend < .01). The association between hospital volume and survival was present in all three periods of follow-up, but the magnitude of association was greatest in the early postoperative period.ConclusionHigh-volume hospitals have higher resection rates and perform surgery among patients who are older, have lower socioeconomic status, and have more comorbidities; despite this, they achieve better survival, most notably in the early postoperative period