Using a whole person approach to support people with cancer: a longitudinal, mixed methods service evaluation

Introduction: Improved models of care are needed to meet all the support needs of people with cancer, which encompass psychological, emotional, physical, spiritual, sexual, occupational, social and existential needs. The aim of this paper is to (1) evaluate short and long-term impacts of using a whole person approach to support people with cancer on the Living Well with the Impact of Cancer Course (LWC); (2) use these data to inform strategic decisions about future service provision at Penny Brohn UK. Methods: Longitudinal mixed-methods service evaluation (n=135). Data collected included health related quality of life (HRQoL) (FACIT-SpEx); Concerns (types and severity - MYCaW); lifestyle behaviour (bespoke questionnaire) and participants’ experiences over 12 months post course. Results: Statistically and clinically significant improvements from baseline - 12 months in severity of MYCaW Concerns (n=64; p<0.000) and mean total HRQoL (n=66; p<0.000). The majority of MYCaW concerns were ‘psychological and emotional’ and about participants’ wellbeing. Spiritual, emotional and functional wellbeing contributed most to HRQoL improvements at 12 months. Barriers to maintaining healthy lifestyle changes included lack of support from family and friends, time constraints, and returning to work. 3-6 months post-course was identified as the time when more support was most likely to be needed. Conclusions: Using a whole person approach for the LWC enabled the needs of participants to be met, and statistically and clinically significant improvements in HRQoL and MYCaW Concerns were reported. Qualitative data analysis explored how experiencing whole person support enabled participants to make and sustain healthy lifestyle changes associated with improved survivorship. Barriers experienced to making health behaviour change were also identified. These data then informed wider and more person-centred clinical provision to increase the maintenance of positive long-term behaviour changes. Comparison of whole person approaches to cancer treatment and support and standard care are now urgently needed

Super Learner

Previous articles (van der Laan and Dudoit (2003); van der Laan et al. (2006); Sinisi et al. (2007)) advertised and theoretically validated the use of cross-validation to select among many candidate estimators to compute a so called super learner which outperforms any of the given candidate estimators. The theoretical basis was provided for this super learner based on oracle results for the cross-validation selector (e.g., van der Laan and Dudoit (2003); van der Laan et al. (2006)) and in Sinisi et al. (2007). In addition, these papers contained a practical demonstration of the adaptivity of this so called super learner in the context of prediction of the fitness of the HIV virus as a function of its mutations. This article proposes a fast algorithm for constructing a super learner in prediction which uses V-fold cross-validation to select a functional form of an initial set of candidate predictors according to a parametric or semi-parametric model, or possibly, data adaptively. The paper contains a proof that the resulting super learner performs asymptotically as well as the oracle selector among the continuum of estimators defined by the (semi-)parametric functional forms of the initial set of candidate estimators. This approach also yields a new class of cross-validation methods to select among a family of candidate estimators by formulating the minimization of the cross-validated risk over the family of candidate estimators as a new least squares regression problem which itself can be carried out with any type of parametric or nonparametric regression methodology (e.g. using cross-validation itself), thereby preventing over-fitting of the cross-validated risk. Simulations and data analysis suggest this new proposed super learner superior to competing methods. This approach for construction of a super learner generalizes to any parameter which can be defined as a minimizer of a loss function

Observation of surface states on heavily indium doped SnTe(111), a superconducting topological crystalline insulator

The topological crystalline insulator tin telluride is known to host superconductivity when doped with indium (Sn$_{1-x}$In$_{x}$Te), and for low indium contents ($x=0.04$) it is known that the topological surface states are preserved. Here we present the growth, characterization and angle resolved photoemission spectroscopy analysis of samples with much heavier In doping (up to $x\approx0.4$), a regime where the superconducting temperature is increased nearly fourfold. We demonstrate that despite strong p-type doping, Dirac-like surface states persist

Impact of Penny Brohn UK’s Living Well course on informal caregivers of people with cancer

Objectives: This study evaluated the change in the concerns, wellbeing and lifestyle behaviours of informal caregivers of people with cancer attending Penny Brohn UK’s Living Well Course (LWC), a self-management education intervention. Design: A pre-post-course design collected self-reported quantitative and qualitative data from informal caregivers attending a LWC. Setting/Location: Penny Brohn UK is a UK based charity (not-for-profit) providing specialist integrative, whole person support, free of charge, to people affected by cancer. Subjects: Informal caregivers taking part in a Penny Brohn UK LWC between June 2014 and May 2016 attending alongside the person with cancer. Intervention: The LWC is a structured 15 hour, multi-modal group self-management educational course, designed to help people affected by cancer learn tools and techniques to help build resilience. Trained facilitators deliver LWCs to around 12 people with various types and stages of cancer, and their informal caregivers. Outcome measures: MYCaW (Measure Yourself Concern and Wellbeing) completed pre-course and at 6 weeks post-course; and bespoke 6 week follow up Patient Reported Experience Measure (PREM). Results: 480 informal caregivers attended a LWC June 2014 to May 2016. 118 completed a 6 week follow up MYCaW: MYCaW Concerns 1 and 2 showed statistically significant improvements (p<.0001), there was no significant improvement in wellbeing. Informal caregivers’ most reported concerns relating to themselves were psychological and emotional issues (59%). The primary concern of the caregiver for the care recipient was related to the physical health of the person with cancer (40%). 87% of responding informal caregivers stated the LWC enabled health self-management. Conclusions: The LWC was followed by an improvement in informal caregivers’ concerns, and increased self-management of their own health needs. More studies, with larger sample size, are needed to explore if better self-management by informal caregivers may also lead to improvements in patients’ health and wellbeing

Wearable Bluetooth Triage Healthcare Monitoring System.

Triage is the first interaction between a patient and a nurse/paramedic. This assessment, usually performed at Emergency departments, is a highly dynamic process and there are international grading systems that according to the patient condition initiate the patient journey. Triage requires an initial rapid assessment followed by routine checks of the patients' vitals, including respiratory rate, temperature, and pulse rate. Ideally, these checks should be performed continuously and remotely to reduce the workload on triage nurses; optimizing tools and monitoring systems can be introduced and include a wearable patient monitoring system that is not at the expense of the patient's comfort and can be remotely monitored through wireless connectivity. In this study, we assessed the suitability of a small ceramic piezoelectric disk submerged in a skin-safe silicone dome that enhances contact with skin, to detect wirelessly both respiration and cardiac events at several positions on the human body. For the purposes of this evaluation, we fitted the sensor with a respiratory belt as well as a single lead ECG, all acquired simultaneously. To complete Triage parameter collection, we also included a medical-grade contact thermometer. Performances of cardiac and respiratory events detection were assessed. The instantaneous heart and respiratory rates provided by the proposed sensor, the ECG and the respiratory belt were compared via statistical analyses. In all considered sensor positions, very high performances were achieved for the detection of both cardiac and respiratory events, except for the wrist, which provided lower performances for respiratory rates. These promising yet preliminary results suggest the proposed wireless sensor could be used as a wearable, hands-free monitoring device for triage assessment within emergency departments. Further tests are foreseen to assess sensor performances in real operating environments

Probability amplitude in quantum like games

Examples of games between two partners with mixed strategies, calculated by the use of the probability amplitude are given. The first game is described by the quantum formalism of spin one half system for which two noncommuting observables are measured. The second game corresponds to the spin one case. Quantum logical orthocomplemented nondistributive lattices for these two games are presented. Interference terms for the probability amplitudes are analyzed by using so called contextual approach to probability (in the von Mises frequency approach). We underline that our games are not based on using of some microscopic systems. The whole scenario is macroscopic.Comment: Quantum-like model

Transcriptome analysis of peripheral blood mononuclear cells in human subjects following a 36 h fast provides evidence of effects on genes regulating inflammation, apoptosis and energy metabolism.

There is growing interest in the potential health benefits of diets that involve regular periods of fasting. While animal studies have provided compelling evidence that feeding patterns such as alternate-day fasting can increase longevity and reduce incidence of many chronic diseases, the evidence from human studies is much more limited and equivocal. Additionally, although several candidate processes have been proposed to contribute to the health benefits observed in animals, the precise molecular mechanisms responsible remain to be elucidated. The study described here examined the effects of an extended fast on gene transcript profiles in peripheral blood mononuclear cells from ten apparently healthy subjects, comparing transcript profiles after an overnight fast, sampled on four occasions at weekly intervals, with those observed on a single occasion after a further 24 h of fasting. Analysis of the overnight fasted data revealed marked inter-individual differences, some of which were associated with parameters such as gender and subject body mass. For example, a striking positive association between body mass index and the expression of genes regulated by type 1 interferon was observed. Relatively subtle changes were observed following the extended fast. Nonetheless, the pattern of changes was consistent with stimulation of fatty acid oxidation, alterations in cell cycling and apoptosis and decreased expression of key pro-inflammatory genes. Stimulation of fatty acid oxidation is an expected response, most likely in all tissues, to fasting. The other processes highlighted provide indications of potential mechanisms that could contribute to the putative beneficial effects of intermittent fasting in humans

Non-Gaussian fixed point in four-dimensional pure compact U(1) gauge theory on the lattice

The line of phase transitions, separating the confinement and the Coulomb phases in the four-dimensional pure compact U(1) gauge theory with extended Wilson action, is reconsidered. We present new numerical evidence that a part of this line, including the original Wilson action, is of second order. By means of a high precision simulation on homogeneous lattices on a sphere we find that along this line the scaling behavior is determined by one fixed point with distinctly non-Gaussian critical exponent nu = 0.365(8). This makes the existence of a nontrivial and nonasymptotically free four-dimensional pure U(1) gauge theory in the continuum very probable. The universality and duality arguments suggest that this conclusion holds also for the monopole loop gas, for the noncompact abelian Higgs model at large negative squared bare mass, and for the corresponding effective string theory.Comment: 11 pages, LaTeX, 2 figure

Individualised and complex experiences of integrative cancer support care: combining qualitative and quantitative data

Objectives: The widespread use of complementary therapies alongside biomedical treatment by people with cancer is not supported by evidence from clinical trials. We aimed to use combined qualitative and quantitative data to describe and measure individualised experiences and outcomes. Materials and methods In three integrative cancer support centres (two breast cancer only) in the UK, consecutive patients completed the individualised outcome questionnaire Measure Yourself Concerns and Wellbeing (MYCaW) before and after treatment. MYCaW collects quantitative data (seven-point scales) and written qualitative data and the qualitative data were analysed using published categories. Results: Seven hundred eighty-two participants, 92% female, mean age 51 years, nominated a wide range of concerns. Psychological and emotional concerns predominated. At follow-up, the mean change (improvement) in scores (n = 588) were: concern 1, 2.06 (95% CI 1.92–2.20); concern 2, 1.74 (95% CI 1.60–1.90); and well-being, 0.64 (95% CI 0.52–0.75). The most common responses to ‘what has been the most important aspect for you?’ were ‘receiving complementary therapies on an individual or group basis’ (26.2%); ‘support and understanding received from therapists’ (17.1%) and ‘time spent with other patients at the centres’ (16.1%). Positive (61.5%) and negative (38.5%) descriptions of ‘other things affecting your health’ correlated with larger and smaller improvement in concerns and well-being, respectively. Conclusions: In a multicentre evaluation, the MYCaW questionnaire provides rich data about patient experience, changes over time and perceptions of what was important to each individual with cancer within that experience. It is unlikely that meaningful evaluations of this complex intervention could be carried out by quantitative methods alone