Through the Clock's Workings

A world first! The first remixed and remixable anthology of literature. This anthology of short stories is not some textual tome, frozen in time and space. It is alive, evolving organically in a constant state of flux. Why? Because each story is available under a Creative Commons licence, giving you rights to share and reuse the book as you see fit. So how do you use a remixable anthology? Simple. Step 1 - Read. Thumb your way through the pages at will. Find the stories you love, the ones you hate, the ones that could be better. Step 2 - Re/create. Each story is yours to share and to remix. Use only one paragraph or character or just make subtle changes. Change the genre, alter its formal or stylistic characteristics, or revise its message. Use as little or as much as you like - as long as it works. Step 3 - Share. Be part of a growing community of literature remixing. Post your remixes to the Remix My Lit website, remixmylit.com, and start sharing. The entire anthology can be remixed - the original stories, the remixes, and even the fonts. Through the Clock's Workings is Read&Write

Effects of exercise in breast cancer patients: implications of the trials within cohorts (TwiCs) design in the UMBRELLA Fit trial

Purpose The Trials within Cohorts (TwiCs) design aims to overcome problems faced in conventional RCTs. We evaluated the TwiCs design when estimating the effect of exercise on quality of life (QoL) and fatigue in inactive breast cancer survivors. Methods UMBRELLA Fit was conducted within the prospective UMBRELLA breast cancer cohort. Patients provided consent for future randomization at cohort entry. We randomized inactive patients 12-18 months after cohort enrollment. The intervention group (n = 130) was offered a 12-week supervised exercise intervention. The control group (n = 130) was not informed and received usual care. Six-month exercise effects on QoL and fatigue as measured in the cohort were analyzed with intention-to-treat (ITT), instrumental variable (IV), and propensity scores (PS) analyses. Results Fifty-two percent (n = 68) of inactive patients accepted the intervention. Physical activity increased in patients in the intervention group, but not in the control group. We found no benefit of exercise for dimensions of QoL (ITT difference global QoL: 0.8, 95% CI = - 2.2; 3.8) and fatigue, except for a small beneficial effect on physical fatigue (ITT difference: - 1.1, 95% CI = - 1.8; - 0.3; IV: - 1.9, 95% CI = - 3.3; - 0.5, PS: - 1.2, 95% CI = - 2.3; - 0.2). Conclusion TwiCs gave insight into exercise intervention acceptance: about half of inactive breast cancer survivors accepted the offer and increased physical activity levels. The offer resulted in no improvement on QoL, and a small beneficial effect on physical fatigue.Clinical epidemiolog

Screening for psychological distress before radiotherapy for painful bone metastases may be useful to identify patients with high levels of distress

Biological, physical and clinical aspects of cancer treatment with ionising radiatio

What is the prevalence of fear of cancer recurrence in cancer survivors and patients?:A systematic review and individual participant data meta-analysis

OBJECTIVE: Care for fear of cancer recurrence (FCR) is considered the most common unmet need among cancer survivors. Yet the prevalence of FCR and predisposing factors remain inconclusive. To support targeted care, we provide a comprehensive overview of the prevalence and severity of FCR among cancer survivors and patients, as measured using the short form of the validated Fear of Cancer Recurrence Inventory (FCRI-SF). We also report on associations between FCR and clinical and demographic characteristics. METHODS: This is a systematic review and individual participant data (IPD) meta-analysis on the prevalence of FCR. In the review, we included all studies that used the FCRI-SF with adult (≥18 years) cancer survivors and patients. Date of search: 7 February 2020. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. RESULTS: IPD were requested from 87 unique studies and provided for 46 studies comprising 11,226 participants from 13 countries. 9311 respondents were included for the main analyses. On the FCRI-SF (range 0-36), 58.8% of respondents scored ≥13, 45.1% scored ≥16 and 19.2% scored ≥22. FCR decreased with age and women reported more FCR than men. FCR was found across cancer types and continents and for all time periods since cancer diagnosis. CONCLUSIONS: FCR affects a considerable number of cancer survivors and patients. It is therefore important that healthcare providers discuss this issue with their patients and provide treatment when needed. Further research is needed to investigate how best to prevent and treat FCR and to identify other factors associated with FCR. The protocol was prospectively registered (PROSPERO CRD42020142185)

Medical and Behavioural Interventions in COPD. The COPE study.

Item does not contain fulltextKUN, 19 februari 2004Promotores : Zielhuis, G.A., Herwaarden, C.L.A. van Co-promotor : Palen, J.A.M. van de

Non-compliance in lifestyle intervention studies: the instrumental variable method provides insight into the bias.

Objective: In lifestyle intervention trials, participants of the control group often change their behavior despite the request to maintain their usual lifestyle pattern. These changes in the control group and changes in addition to the intended in the intervention group can lead to undesirable confounding effects. Study Design and Setting: We address several considerations for study design to prevent noncompliance or minimize its effects. Furthermore, we demonstrate how the instrumental variable method can give insight into the extent of bias introduced by noncompliance in randomized trials, within the context of the Sex Hormones and Physical Exercise study. Results: Noncompliance can be prevented by measures taken in the design phase of a study, for example, limited duration of the study, clear recommendations, power calculation, intensity of the intervention, involvement of the control group, waiting-list control group, and single-consent design nested within an observational study. When nevertheless noncompliance does occur, the instrumental variable method estimates the intervention effect of treatment among the compliers. Conclusion: Noncompliance can seriously affect validity of lifestyle trial results. Its occurrence should be prevented by taking measures during the design phase of a study. The instrumental variable method can give insight into confounding by noncompliance in randomized trials. © 2010 Elsevier Inc. All rights reserved

Behavioral changes after a 1-year exercise program and predictors of maintenance.

Purpose: Public health strategies attempt to stimulate participation in physical activity, aiming at permanent behavior change. We assessed the sustained effect of participating in an exercise program on physical activity behavior 1 yr after completion of the program. Furthermore, we aimed to identify factors that predict sustained exercise participation. Methods: Previously low-active, postmenopausal women originally participating in an exercise intervention study (the Sex Hormones and Physical Exercise study) were recontacted 1 yr after finishing the study. Their current level of physical activity was assessed by the Modified Baecke Questionnaire. MET-hours per week spent on at least moderate-intensity activities were calculated and used to assess compliance to the international physical activity recommendation. Multivariable linear regression analysis was applied to investigate which factors predict a higher level of physical activity in the intervention group 1 yr after the study. Results: Participation in the Sex Hormones and Physical Exercise study resulted in an increased level of physical activity in both the intervention (median at baseline and at 12 months = 4.9 and 19.8 MET•h•w

Exercise affects body composition but not weight in postmenopausal women.

OBJECTIVE: The aim of this study was to investigate the effect of a 12-month moderate-to-vigorous exercise program combining aerobic and muscle strength training on body composition among sedentary, postmenopausal women. METHODS: A randomized controlled trial was conducted. A total of 189 sedentary postmenopausal women (age 50-69 y, body mass index 22-40 kg/m) were randomly assigned to an exercise (n = 96) or a control group (n = 93). Study parameters measured at baseline, 4 months, and 12 months were as follows: body weight and body height (body mass index), waist and hip circumference (body fat distribution), and dual-energy x-ray absorptiometry (total body fat and lean mass). Differences in changes in study parameters between exercise and control group were examined with generalized estimating equations analysis. RESULTS: The exercise program did not result in significant effects on weight, body mass index, and hip circumference. The exercise group experienced a statistically significant greater loss in total body fat, both absolute (-0.33 kg) (borderline) as in a percentage (-0.43%) compared with the control group. In addition, lean mass increased significantly (+0.31 kg), whereas waist circumference (-0.57 cm) decreased significantly compared with the control group. CONCLUSIONS: We conclude that a 12-month exercise program combining aerobic and muscle strength training did not affect weight but positively influenced body composition of postmenopausal women. Affecting body fat distribution and waist circumference may have important health implications because it is an independent risk factor in obese but also in nonobese people. Therefore, this study gives further credence to efforts of public health and general practitioners aiming to increase physical activity levels of postmenopausal women. © 2009 The North American Menopause Society