A pilot randomised controlled trial of personalised care after treatment for prostate cancer (TOPCAT-P): nurse-led holistic-needs assessment and individualised psychoeducational intervention: study protocol

INTRODUCTION. Prostate cancer is common and the incidence is increasing, but more men are living longer after diagnosis, and die with their disease rather than of it. Nonetheless, specific and substantial physical, sexual, emotional and mental health problems often lead to a poor quality of life. Urology services increasingly struggle to cope with the demands of follow-up care, and primary care is likely to play the central role in long-term follow-up. The present phase II trial will evaluate the feasibility and acceptability of a nurse-led, person-centred psychoeducational intervention, delivered in community or primary care settings. METHODS AND ANALYSIS. Prostate cancer survivors diagnosed in the past 9-48 months and currently biochemically stable will be identified from hospital records by their treating clinician. Eligible men would have either completed radical treatment, or would be followed up with prostate specific antigen monitoring and symptom reporting. We will recruit 120 patients who will be randomised to receive either an augmented form of usual care, or an additional nurse-led intervention for a period of 36 weeks. Following the health policy in Wales, the intervention is offered by a key worker, is promoting prudent healthcare and is using a holistic needs assessment. Outcome measures will assess physical symptoms, psychological well-being, confidence in managing own health and quality of life. Healthcare service use will be measured over 36 weeks. Feedback interviews with patients and clinicians will further inform the acceptability of the intervention. Recruitment, attrition, questionnaire completion rates and outcome measures variability will be assessed, and results will inform the design of a future phase III trial and accompanying economic evaluation. ETHICS AND DISSEMINATION. Ethics approval was granted by Bangor University and North Wales REC (13/WA/0291). Results will be reported in peer-reviewed publications, at scientific conferences, and directly through national cancer and primary care networks. TRIAL REGISTRATION NUMBER. ISRCTN 34516019

Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR):study protocol for a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture [ ISRCTN22464643 ]

Background Proximal femoral fracture is a common, major health problem in old age resulting in loss of functional independence and a high-cost burden on society, with estimated health and social care costs of £2.3 billion per year in the UK. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of effectiveness is lacking. Usual rehabilitation care is delivered by a multi-disciplinary team in the hospital and in the community. An ‘enhanced rehabilitation’ intervention has been developed consisting of a workbook, goal-setting diary and extra therapy sessions, designed to improve self-efficacy and increase the amount and quality of the practice of physical exercise and activities of daily living. Methods/design This paper describes the design of a phase II study comprising an anonymous cohort of all proximal femoral fracture patients admitted to the three acute hospitals in Betsi Cadwaladr University Health Board over a 6-month period with a randomised feasibility study comparing the enhanced rehabilitation intervention with usual care. These will assess the feasibility of a future definitive randomised controlled trial and concurrent economic evaluation in terms of recruitment, retention, outcome measure completion, compliance with the intervention and fidelity of delivery, health service use data, willingness to be randomised and effect size for a future sample size calculation. Focus groups will provide qualitative data to contribute to the assessment of the acceptability of the intervention amongst patients, carers and rehabilitation professionals and the feasibility of delivering the planned intervention. The primary outcome measure is function assessed by the Barthel Index. Secondary outcomes measure the ability to perform activities of daily living, anxiety and depression, potential mediators of outcomes such as hip pain, self-efficacy and fear of falling, health utility, health service use, objectively assessed physical function and adverse events. Participants’ preference for rehabilitation services will be assessed in a discrete choice experiment. Discussion Phase II studies are an opportunity to not only assess the feasibility of trial methods but also to compare different methods of outcome measurement and novel methods of obtaining health service use data from routinely collected patient information. Trial registration Current Controlled Trials ISRCTN22464643, UKCRN16677

Signatures of chaotic tunnelling

Recent experiments with cold atoms provide a significant step toward a better understanding of tunnelling when irregular dynamics is present at the classical level. In this paper, we lay out numerical studies which shed light on the previous experiments, help to clarify the underlying physics and have the ambition to be guidelines for future experiments.Comment: 11 pages, 9 figures, submitted to Phys. Rev. E. Figures of better quality can be found at http://www.phys.univ-tours.fr/~mouchet

Comparison of exact and approximate cross-sections in relativistic Coulomb excitation

We present a new method of obtaining time-dependent matrix elements of the electromagnetic pulse produced by a highly-relativistic projectile. These matrix elements are used in a coupled-channel calculation to predict the cross-sections for population of 1- and 2-phonon states of the giant dipole resonance. Comparisons are made with the predictions of the long-wavelength and Born approximations.Comment: 26 pages, LaTex2

Chaos assisted tunnelling with cold atoms

In the context of quantum chaos, both theory and numerical analysis predict large fluctuations of the tunnelling transition probabilities when irregular dynamics is present at the classical level. We consider here the non-dissipative quantum evolution of cold atoms trapped in a time-dependent modulated periodic potential generated by two laser beams. We give some precise guidelines for the observation of chaos assisted tunnelling between invariant phase space structures paired by time-reversal symmetry.Comment: submitted to Phys. Rev. E ; 16 pages, 13 figures; figures of better quality can be found at http://www.phys.univ-tours.fr/~mouchet

Windowed 4D inversion for near real-time geoelectrical monitoring applications

Many different approaches have been developed to regularise the time-lapse geoelectrical inverse problem. While their advantages and limitations have been demonstrated using synthetic models, there have been few direct comparisons of their performance using field data. We test four time-lapse inversion methods (independent inversion, temporal smoothness-constrained 4D inversion, spatial smoothness constrained inversion of temporal data differences, and sequential inversion with spatial smoothness constraints on the model and its temporal changes). We focus on the applicability of these methods to automated processing of geoelectrical monitoring data in near real-time. In particular, we examine windowed 4D inversion, the use of short sequences of time-lapse data, without which the 4D method would not be suitable in the near real-time context. We develop measures of internal consistency for the different methods so that the effects of the use of short time windows or the choice of baseline data set can be compared. The resulting inverse models are assessed against qualitative and quantitative ground truth information. Our findings are that 4D inversion of the full data set performed best, and that windowed 4D inversion retained the majority of its benefits while also being applicable to applications requiring near real-time inversion

Probing the upper end of intracontinental earthquake magnitude: a prehistoric example from the Dzhungarian and Lepsy faults of Kazakhstan

The study of surface ruptures is key to understanding the earthquake occurrence of faults especially in the absence of historical events. We present a detailed analysis of geomorphic displacements along the Dzhungarian Fault, which straddles the border of China and Kazakhstan. We use digital elevation models derived from structure-from-motion analysis of Pléiades satellite imagery and drone imagery from specific field sites to measure surface offsets. We provide direct age constraints from alluvial terraces displaced by faulting and indirect dating from morphological analysis of the scarps. We find that the southern 250 km of the fault likely ruptured in a single event in the last 4,000 years, with displacements of 10–15 m, and potentially up to 20 m at one site. We infer that this Dzhungarian rupture is likely linked with a previously identified paleo-earthquake rupture on the Lepsy Fault through a system of splays in the intervening highlands. Though there are remaining uncertainties regarding consistency in age constraints between the two fault ruptures, most of the sites along the two faults are consistent with a most recent event 2,000–4,000 years ago. Rupture on the Dzhungarian Fault alone is likely to have exceeded Mw 8, and the combined Lepsy-Dzhungarian rupture scenario may have been up to Mw 8.4. Despite being at the upper end of known or inferred continental earthquake magnitudes, our proposed scenario combining the 375 km of the Dzhungarian and Lepsy ruptures yields a slip-to-length ratio consistent with global averages and so do other historical intracontinental earthquakes in Central Asia

Turnover of passerine birds on islands in the Aegean Sea (Greece)

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73442/1/j.1365-2699.2007.01695.x.pd

Can forest management based on natural disturbances maintain ecological resilience?

Given the increasingly global stresses on forests, many ecologists argue that managers must maintain ecological resilience: the capacity of ecosystems to absorb disturbances without undergoing fundamental change. In this review we ask: Can the emerging paradigm of natural-disturbance-based management (NDBM) maintain ecological resilience in managed forests? Applying resilience theory requires careful articulation of the ecosystem state under consideration, the disturbances and stresses that affect the persistence of possible alternative states, and the spatial and temporal scales of management relevance. Implementing NDBM while maintaining resilience means recognizing that (i) biodiversity is important for long-term ecosystem persistence, (ii) natural disturbances play a critical role as a generator of structural and compositional heterogeneity at multiple scales, and (iii) traditional management tends to produce forests more homogeneous than those disturbed naturally and increases the likelihood of unexpected catastrophic change by constraining variation of key environmental processes. NDBM may maintain resilience if silvicultural strategies retain the structures and processes that perpetuate desired states while reducing those that enhance resilience of undesirable states. Such strategies require an understanding of harvesting impacts on slow ecosystem processes, such as seed-bank or nutrient dynamics, which in the long term can lead to ecological surprises by altering the forest's capacity to reorganize after disturbance

Search for a W' boson decaying to a bottom quark and a top quark in pp collisions at sqrt(s) = 7 TeV

Results are presented from a search for a W' boson using a dataset corresponding to 5.0 inverse femtobarns of integrated luminosity collected during 2011 by the CMS experiment at the LHC in pp collisions at sqrt(s)=7 TeV. The W' boson is modeled as a heavy W boson, but different scenarios for the couplings to fermions are considered, involving both left-handed and right-handed chiral projections of the fermions, as well as an arbitrary mixture of the two. The search is performed in the decay channel W' to t b, leading to a final state signature with a single lepton (e, mu), missing transverse energy, and jets, at least one of which is tagged as a b-jet. A W' boson that couples to fermions with the same coupling constant as the W, but to the right-handed rather than left-handed chiral projections, is excluded for masses below 1.85 TeV at the 95% confidence level. For the first time using LHC data, constraints on the W' gauge coupling for a set of left- and right-handed coupling combinations have been placed. These results represent a significant improvement over previously published limits.Comment: Submitted to Physics Letters B. Replaced with version publishe