Activity and advanced cancer:A grounded theory

Background: Cancer-related fatigue and loss of physical functioning are distressing symptoms which negatively impact the quality of life of people with advanced cancer. Physical activity has been shown to have positive effects on these symptoms in early-stage cancer, but previous research demonstrated an incongruence between people with advanced cancer’s expressed interest and actual participation in a physical activity intervention. Aim: To gain an in-depth understanding of the experience of activity and quality of life in people with advanced cancer, using a classic grounded theory approach. Design: Through the post-positivist lens of subtle realism, and informed by classic grounded theory methods, a two-phase, cross-sectional, qualitative study was conducted. For 7 days duration, participants wore an activPAL™ activity monitor and completed a daily record sheet, which were then used as qualitative probes for face-to-face, semi-structured interviews. Setting/participants: A total of 15 people with advanced cancer, aged 18 years or older, and with a median survival of 100 days from time of study consent, were recruited from an outpatient department of a tertiary cancer centre in Alberta, Canada. Findings: Maintaining their responsibilities, no matter how small, was the prime motive for participants’ behaviour. For people with advanced cancer, the minimum level of responsibility was dynamic and unique. It was achieved through a multifaceted interaction between the perceived benefits, prevailing conditions and mechanisms. Conclusion: This grounded theory enables understanding of activity as a mechanism through which responsibility is managed and may inform future behavioural interventions in people with advanced cancer

What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study.

OBJECTIVES: To investigate the deployment of physician associates (PAs); the factors supporting and inhibiting their employment and their contribution and impact on patients' experience and outcomes and the organisation of services. DESIGN: Mixed methods within a case study design, using interviews, observations, work diaries and documentary analysis. SETTING: Six acute care hospitals in three regions of England in 2016-2017. PARTICIPANTS: 43 PAs, 77 other health professionals, 28 managers, 28 patients and relatives. RESULTS: A key influencing factor supporting the employment of PAs in all settings was a shortage of doctors. PAs were found to be acceptable, appropriate and safe members of the medical/surgical teams by the majority of doctors, managers and nurses. They were mainly deployed to undertake inpatient ward work in the medical/surgical team during core weekday hours. They were reported to positively contribute to: continuity within their medical/surgical team, patient experience and flow, inducting new junior doctors, supporting the medical/surgical teams' workload, which released doctors for more complex patients and their training. The lack of regulation and attendant lack of authority to prescribe was seen as a problem in many but not all specialties. The contribution of PAs to productivity and patient outcomes was not quantifiable separately from other members of the team and wider service organisation. Patients and relatives described PAs positively but most did not understand who and what a PA was, often mistaking them for doctors. CONCLUSIONS: This study offers new insights concerning the deployment and contribution of PAs in medical and surgical specialties in English hospitals. PAs provided a flexible addition to the secondary care workforce without drawing from existing professions. Their utility in the hospital setting is unlikely to be completely realised without the appropriate level of regulation and authority to prescribe medicines and order ionising radiation within their scope of practice

Learning from people with long-term conditions: new insights for governance in primary health care

Internationally, system-wide changes to the structures and systems governing health care aim to improve outcomes for patients, quality of care and access to services. The introduction of top-down centrally driven solutions to governance of health care, at the same time as increasing policy emphasis on greater ‘bottom up’ patient and public involvement in all aspects of health care, has set up complex tensions for policy implementation and health care practice. This paper explores the interplay of these agendas in the context of changes in primary health care services provided by the National Health Service (NHS) in England. Specifically, it looks at an example of service user involvement in a study (the PEGI study) of professional response to changes in the governance and incentives in the care of people with long-term conditions. This qualitative study was conducted in three Primary Care Trust sites in England. Service users influenced and guided the study throughout. In-depth interviews with 56 health and social care professionals engaged in the development of local policies and the delivery of care for people with complex long-term illness drew on vignettes developed by 32 members from three Service User Reference Groups (SURG). Themes generated by the cross case analysis were validated through these SURG groups. The findings presented here focus on four themes about risk and comparison of professionals’/service users’ perspectives of the issues: managing risks/consistent support, the risks of letting go/feeling in control, professionalism/helping people to help themselves, and managing expectations/professionals losing out. Service user involvement added value by: validating understandings of governance, framing debates to focus on what matters at the point of care, and enabling perspective sharing and interaction. We suggest that more collaborative forms of governance in health care, that take account of service user perspectives and enable interaction with professional groups, could help to validate processes of quality assurance and provide motivation for continuous quality improvement. We offer a model for ‘opening up’ collaborative projects to evaluation and appraisal and a process for critical reflection of the interrelationships between the PEGI study context, researcher issues, methods/approach and outcomes/impact of service user involvement

A grounded theory approach to physical activity and advanced cancer:a qualitative study protocol

Background: Physical activity has demonstrated benefits in cancer-related fatigue and physical functioning in early-stage cancer patients; however, the role of physical activity at the end stage of cancer has not been established. To challenge positivist–empiricist assumptions, I am seeking to develop a new theoretical framework that is grounded in the advanced cancer patient’s experience of activity. Aim: To gain an in-depth understanding of the experience of activity and quality of life in advanced cancer patients. Objectives: (1) To explore the meaning of activity for advanced cancer patients in the context of their day-to-day life, (2) to elicit advanced cancer patients’ perceptions of activity with respect to their quality of life, and (3) to elicit advanced cancer patients’ views of barriers and facilitators to activity in the context of their day-to-day life. Study Design: A two-phase, crosssectional, qualitative study will be conducted through the postpositivist lens of subtle realism and informed by the principles of grounded theory methods. Study Methods: Advanced cancer patients will be recruited through the outpatient department of a tertiary cancer center. For Phase 1, participants will wear an activPAL™ activity monitor and fill out a daily record sheet for 7-day duration. For Phase 2, the activity monitor output and daily record sheets will be used as qualitative probes for face-to-face, semistructured interviews. Concurrent coding, constant comparative analysis, and theoretical sampling will continue with the aim of achieving as close as possible to theoretical saturation. Ethics and Discussion: Ethical and scientific approval will be obtained by all local institutional review boards prior to study commencement. The findings will generate new mid-level theory about the experience of activity and quality of life in advanced cancer patients and aid in the development of a new theoretical framework for designing interventions for this population

Interventions to promote patients and families' involvement in adult intensive care settings: a protocol for a mixed-method systematic review.

BACKGROUND: There has been an identified need for greater patient and family member involvement in healthcare. This is particularly relevant in an intensive care unit (ICU), as the family provides a key communicative and practical link between patient and clinician. Family members have been deemed a positive beneficial influence on ICU care and recovery processes, yet they themselves are often emotionally affected after discharge. There has been no standardised evidenced-based approach which explores research on family member involvement and the range and quality of contributions remain unclear. This project will undertake a systematic review to assess the evidence base for interventions designed to promote patient and family member involvement in adult intensive care settings and develop a comprehensive typology of interventions for use by clinicians, patients and carers. METHODS: The following databases will be searched without date restriction: MEDLINE, EMBASE and CINAHL, as well as the Cochrane Central Register of Controlled Trials, Joanna Briggs and Cochrane Libraries. Manual searches of recent back issues of leading ICU and patient experience journals will also be undertaken, as will the reference lists of included studies. Unpublished literature will be sought through grey literature databases, including GreyLit and OpenGrey. All evaluation studies that consider intervention activities to promote patient and family member involvement in adult ICUs will be included; all research designs will be eligible. We will seek to include studies that report on a mixture of relevant outcomes for patients and family members. Abstracts and papers will be independently screened by at least two members of the team to determine their inclusion. Included papers will be assessed for methodological rigour using a standard rating approach, which assesses 'quality of study' and 'quality of information'. Quality assessment will be completed by at least two members of the team. Data on interventions, evaluation methods and outcomes will be collated using a predetermined extraction table. These are likely to be heterogeneous in nature, which will mean that the review will follow a narrative approach to synthesis. DISCUSSION: The review will provide valuable and rigorous insight into the range and quality of interventions available to promote patient and family member involvement in ICU. This is the first step towards addressing the absence of a synthesis of research for this context, and will, in addition, develop a typology of available interventions that will help service users and clinicians make informed decisions about the approaches to patient and family member involvement which they might want to adopt. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42018086325)

My heart is racing! Psychophysiological dynamics of skilled racecar drivers

Our purpose was to test the multi-action plan (MAP) model assumptions in which athletes’ psychophysiological patterns differ among optimal and suboptimal performance experiences. Nine professional drivers competing in premier race categories (e.g., Formula 3, Porsche GT3 Cup Challenge) completed the study. Data collection involved monitoring the drivers’ perceived hedonic tone, accuracy on core components of action, posture, skin temperature, respiration rate, and heart rate responses during a 40-lap simulated race. Time marks, gathered at three standardized sectors, served as the performance variable. The A1GP racing simulator (Allinsport, Modena) established a realistic race platform. Specifically, the Barcelona track was chosen due to its inherently difficult nature characterized by intermittent deceleration points. Idiosyncratic analyses showed large individual differences in the drivers’ psychophysiological profile, as well as distinct patterns in regards to optimal and suboptimal performance experiences. Limitations and future research avenues are discussed. Action (e.g., attentional control) and emotion (e.g., biofeedback training) centered applied sport psychology implications are advanced

Use of insulin glargine and cancer incidence in Scotland: a study from the

Abstract Aims/hypothesis The aim of the present study was to examine whether patients with diabetes in Scotland using insulin glargine have a greater cancer risk than patients using other types of insulin. Methods We used a nationwide diabetes clinical database that covers the majority of the Scottish population with diagnosed diabetes, and examined patients with diabetes who were exposed to any insulin therapy between 1 January 2002 and 31 December 2005. Among these we defined a fixed cohort based on exposure during a 4 month period in 2003 (n=36,254, in whom 715 cases of cancer occurred) and a cohort of new insulin users across the period (n=12,852 in whom 381 cancers occurred). Records from these cohorts were linked to cancer registry data up to the end of 2005. We used Cox proportional hazards models for survival analyses. Results Those receiving any insulin glargine (n=3,959) had the same incidence rate for all cancers as those not receiving insulin glargine (HR 1.02, 95% CI 0.77-1.36, p=0.9 in the fixed cohort) The subset of patients using insulin glargine alone (n=447) had a significantly higher incidence of all cancers than those using other insulins only (n=32,295) (HR 1.55, 95% CI 1.01-2.37, p=0.045), and those using insulin glargine with other insulins (n=3,512) had a slightly lower incidence (HR 0.81, 95% CI 0.55-1.18, p=0.26). There were important differences in baseline characteristics between these three groups, although the risk ratios were broadly unaltered on adjustment for these. Overall, there was no increase in breast cancer rates associated with insulin glargine use (HR 1.49, 95% CI 0.79-2.83, though insulin glargine only users had a higher rate than those using non-glargine insulin only (HR 3.39, 95% CI 1.46-7.85, p=0.004). Among type 2 diabetic incident insulin users, no significant difference between the three groups was observed with respect to all cancer or breast cancer. All the above HRs are adjusted for age, calendar time prior cancer and type of diabetes, as appropriate, and are stratified according to sex. Conclusions/interpretation Overall, insulin glargine use was not associated with an increased risk of all cancers or site-specific cancers in Scotland over a 4 year time frame. Given the overall data, we consider the excess of cases of all cancers and breast cancer in the subgroup of insulin glargine only users to more likely reflect allocation bias rather than an effect of insulin glargine itself

An unusual clast in lunar meteorite MacAlpine Hills 88105: a unique lunar sample or projectile debris?

Lunar meteorite MacAlpine Hills (MAC) 88105 is a well-studied feldspathic regolith breccia dominated by rock and mineral fragments from the lunar highlands. Thin section MAC 88105,159 contains a small rock fragment, 400 × 350 μm in size, which is compositionally anomalous compared with other MAC 88105 lithic components. The clast is composed of olivine and plagioclase with minor pyroxene and interstitial devitrified glass component. It is magnesian, akin to samples in the lunar High Mg-Suite, and also alkali-rich, akin to samples in the lunar High Alkali Suite. It could represent a small fragment of late-stage interstitial melt from an Mg-Suite parent lithology. However, olivine and pyroxene in the clast have Fe/Mn ratios and minor element concentrations that are different from known types of lunar lithologies. As Fe/Mn ratios are notably indicative of planetary origin, the clast could either (1) have a unique lunar magmatic source, or (2) have a nonlunar origin (i.e., consist of achondritic meteorite debris that survived delivery to the lunar surface). Both hypotheses are considered and discussed

Three-dimensional structure of a cold-core Arctic eddy interacting with the Chukchi Slope Current

A rapid, high‐resolution shipboard survey, using a combination of lowered and expendable hydrographic measurements and vessel‐mounted acoustic Doppler current profiler data, provided a unique three‐dimensional view of an Arctic anti‐cyclonic cold‐core eddy. The eddy was situated 50 km seaward of the Chukchi Sea shelfbreak over the 1000 m isobath, embedded in the offshore side of the Chukchi Slope Current. The eddy core, centered near 150 m depth, consisted of newly ventilated Pacific winter water which was high in nitrate and dissolved oxygen. Its fluorescence signal was due to phaeopigments rather than chlorophyll, indicating that photosynthesis was no longer active, consistent with an eddy age on the order of months. Subtracting out the slope current signal demonstrated that the eddy velocity field was symmetrical with a peak azimuthal speed of order 10 cm s‐1. Its Rossby number was ~0.4, consistent with the fact that the measured cyclogeostrophic velocity was dominated by the geostrophic component. Different scenarios are discussed regarding how the eddy became embedded in the slope current and what the associated ramifications are with respect to eddy spin‐down and ventilation of the Canada Basin halocline

Modification of turbulent dissipation rates by a deep Southern Ocean eddy

The impact of a mesoscale eddy on the magnitude and spatial distribution of diapycnal ocean mixing is investigated using a set of hydrographic and microstructure measurements collected in the Southern Ocean. These data sampled a baroclinic, mid-depth eddy formed during the disintegration of a deep boundary current. Turbulent dissipation is suppressed within the eddy, but is elevated by up to an order of magnitude along the upper and lower eddy boundaries. A ray-tracing approximation is employed asa heuristic device to elucidate how the internal wave field evolves in the ambient velocity and stratification conditions accompanying the eddy. These calculations are consistent with the observations, suggesting reflection of internal wave energy from the eddy center and enhanced breaking through critical layer processes along the eddy boundaries. These results have important implications for understanding where and how internal wave energy is dissipated in the presence of energetic deep geostrophic flows