Evaluation of the “Shared Community Follow‐up” after a germ cell tumour—A novel initiative for remote cancer follow‐up enhanced by online patient‐reported outcome measures

Objective: Replying to germ cell tumour patients' needs, we implemented “Shared Community Follow‐up”—a collaborative initiative, enabling remote delivery of specialist cancer care across large geographical areas. Blood, radiological investigations and patient‐reported outcome measures (PROMs) are completed remotely and integrated within the electronic patient records for specialist review without patients requiring appointments. We describe the service evaluation estimating the feasibility, safety and acceptability of this initiative versus traditional Standard Follow‐up. Methods: This cross‐sectional evaluation estimated feasibility (uptake, adherence) and safety (via missed appointments, timeliness, cancellations) using routinely collected service process data. An acceptability questionnaire, evaluating patient satisfaction, was administered to 91 patients. Results: The new service is feasible. Across 2 years (2014–2016), uptake increased 54% (N = 123 to N = 270) and only 4.8% (N = 13) of patients were non‐adherent. Fewer missed/cancelled investigations (N = 39, 5.9% vs. N = 566, 85.5%), timelier investigations (seven vs. 14 timely investigations) and equal relapse detection suggest its safety. PROMs replaced 3 appointments/patient. Patients were as satisfied with both services (3.4/4 vs. 3.6/4). Conclusion: New follow‐up services, with investigations completed remotely and shared between community providers and cancer centres, offer an alternative to traditional appointments with advantages for patients and the National Health Service

Coupled three-dimensional discrete element-lattice Boltzmann methods for fluid-solid interaction with polyhedral particles

Interaction between solid particles and fluid is of fundamental interest to scientists and engineers in many different applications—cardiopulmonary flows, aircraft and automobile aerodynamics, and wind loading on buildings to name a few. In geomechanics, particle shape significantly affects both particle-particle and particle-fluid interaction. Herein, we present a generalized method for modeling the interaction of arbitrarily shaped polyhedral particles and particle assemblages with fluid using a coupled discrete element method (DEM) and lattice Boltzmann method (LBM) formulation. The coupling between DEM and LBM is achieved through a new algorithm based on a volume-fraction approach to consider three-dimensional convex polyhedral particles moving through fluid. The algorithm establishes the interaction using linear programming and simplex integration and is validated against experimental data. This approach to modeling the interaction between complex polyhedral particles and fluid is shown to be accurate for directly simulating hydrodynamic forces on the particles

Cold Exposure Partially Corrects Disturbances in Lipid Metabolism in a Male Mouse Model of Glucocorticoid Excess

High glucocorticoid concentrations are accompanied by metabolic side effects such as high plasma triglyceride (TG) concentrations. Liver, brown adipose tissue (BAT) and white adipose tissue are important regulators of plasma TG. Exposure to 4 degrees C reduces plasma TG concentrations, and we therefore aimed to study the interaction between glucocorticoid excess and 24 hours of exposure to 4 degrees C on lipid metabolism. For this, mice were implanted with 50-mg corticosterone or control pellets and housed for 24 hours at 23 degrees C or 4 degrees C 1 week later, after which various aspects of TG metabolism in liver, BAT, and white adipose tissue were studied. Corticosterone treatment resulted in a 3.8-fold increase of plasma TG concentrations. Increased TG was normalized by cold exposure, an effect still present 24 hours after cold exposure. Corticosterone treatment increased hepatic TG content by 3.5-fold and provoked secretion of large, TG-rich very low density lipoprotein particles. Cold exposure reduced very low density lipoprotein-TG secretion by approximately 50%. Corticosterone strongly decreased BAT activity: BAT weight increased by 3.5-fold, whereas uncoupling protein 1 (Ucp1) mRNA expression and Ucp1 protein content of BAT were reduced by 75% and 60%, respectively. Cold exposure partially normalized these parameters of BAT activity. The uptake of TG by BAT was not affected by corticosterone treatment but was increased 4.5-fold upon cold exposure. In conclusion, cold exposure normalizes corticosterone-induced hypertriglyceridemia, at least partly via activating BAT