Developing a digital intervention for cancer survivors: an evidence-, theory- and person-based approach

This paper illustrates a rigorous approach to developing digital interventions using an evidence-, theory- and person-based approach. Intervention planning included a rapid scoping review which identified cancer survivors’ needs, including barriers and facilitators to intervention success. Review evidence (N=49 papers) informed the intervention’s Guiding Principles, theory-based behavioural analysis and logic model. The intervention was optimised based on feedback on a prototype intervention through interviews (N=96) with cancer survivors and focus groups with NHS staff and cancer charity workers (N=31). Interviews with cancer survivors highlighted barriers to engagement, such as concerns about physical activity worsening fatigue. Focus groups highlighted concerns about support appointment length and how to support distressed participants. Feedback informed intervention modifications, to maximise acceptability, feasibility and likelihood of behaviour change. Our systematic method for understanding user views enabled us to anticipate and address important barriers to engagement. This methodology may be useful to others developing digital interventions

Clustering patterns of physical activity, sedentary and dietary behavior among European adolescents: The HELENA study

<p>Abstract</p> <p>Background</p> <p>Evidence suggests possible synergetic effects of multiple lifestyle behaviors on health risks like obesity and other health outcomes. A better insight in the clustering of those behaviors, could help to identify groups who are at risk in developing chronic diseases. This study examines the prevalence and clustering of physical activity, sedentary and dietary patterns among European adolescents and investigates if the identified clusters could be characterized by socio-demographic factors.</p> <p>Methods</p> <p>The study comprised a total of 2084 adolescents (45.6% male), from eight European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Physical activity and sedentary behavior were measured using self-reported questionnaires and diet quality was assessed based on dietary recall. Based on the results of those three indices, cluster analyses were performed. To identify gender differences and associations with socio-demographic variables, chi-square tests were executed.</p> <p>Results</p> <p>Five stable and meaningful clusters were found. Only 18% of the adolescents showed healthy and 21% unhealthy scores on all three included indices. Males were highly presented in the cluster with high levels of moderate to vigorous physical activity (MVPA) and low quality diets. The clusters with low levels of MVPA and high quality diets comprised more female adolescents. Adolescents with low educated parents had diets of lower quality and spent more time in sedentary activities. In addition, the clusters with high levels of MVPA comprised more adolescents of the younger age category.</p> <p>Conclusion</p> <p>In order to develop effective primary prevention strategies, it would be important to consider multiple health indices when identifying high risk groups.</p

Manipulation of polarisations for broadband terahertz waves emitted from laser plasma filaments

Polarization control of broadband terahertz waves is essential for applications in many areas such as material sciences, medical and biological diagnostics, near-field communications and public securities. Conventional methods for polarization control are limited to narrow bandwidth and often with low efficiency. Here based upon theoretical and experimental studies, we demonstrate that the two-colour laser scheme in gas plasma can provide effective control of elliptically polarized terahertz waves, including their ellipticity, azimuthal angle, and chirality. This is achieved with a circularly-polarized laser at the fundamental frequency and its linearly polarized second harmonic, a controlled phase difference between these two laser components, as well as a suitable length of the laser plasma filament. A flexible control of their ellipticity and azimuthal angle is demonstrated with our theoretical model and systematic experiments. This offers a unique and flexible technique on the polarization control of broadband terahertz radiation suitable for wide applications

Adaptive tip-enhanced nano-spectroscopy

Tip-enhanced nano-spectroscopy, such as tip-enhanced photoluminescence (TEPL) and tip-enhanced Raman spectroscopy (TERS), generally suffers from inconsistent signal enhancement and difficulty in polarization-resolved measurement. To address this problem, we present adaptive tip-enhanced nano-spectroscopy optimizing the nano-optical vector-field at the tip apex. Specifically, we demonstrate dynamic wavefront shaping of the excitation field to effectively couple light to the tip and adaptively control for enhanced sensitivity and polarization-controlled TEPL and TERS. Employing a sequence feedback algorithm, we achieve similar to 4.4x10(4)-fold TEPL enhancement of a WSe2 monolayer which is &gt;2x larger than the normal TEPL intensity without wavefront shaping. In addition, with dynamical near-field polarization control in TERS, we demonstrate the investigation of conformational heterogeneity of brilliant cresyl blue molecules and the controllable observation of IR-active modes due to a large gradient field effect. Adaptive tip-enhanced nano-spectroscopy thus provides for a systematic approach towards computational nanoscopy making optical nano-imaging more robust and widely deployable. Tip-enhanced nano-spectroscopy suffers from inconsistent signal and difficulty in polarization-resolved measurement. Here, the authors present adaptive tip-enhanced nano-spectroscopy, which enables the additional signal enhancement and near-field polarization control via dynamic wavefront shaping

Nonlinear spin control by terahertz-driven anisotropy fields

Future information technologies, such as ultrafast data recording, quantum computation or spintronics, call for ever faster spin control by light. Intense terahertz pulses can couple to spins on the intrinsic energy scale of magnetic excitations. Here, we explore a novel electric dipole-mediated mechanism of nonlinear terahertz-spin coupling that is much stronger than linear Zeeman coupling to the terahertz magnetic field. Using the prototypical antiferromagnet thulium orthoferrite (TmFeO3), we demonstrate that resonant terahertz pumping of electronic orbital transitions modifies the magnetic anisotropy for ordered Fe3+ spins and triggers large-amplitude coherent spin oscillations. This mechanism is inherently nonlinear, it can be tailored by spectral shaping of the terahertz waveforms and its efficiency outperforms the Zeeman torque by an order of magnitude. Because orbital states govern the magnetic anisotropy in all transition-metal oxides, the demonstrated control scheme is expected to be applicable to many magnetic materials

Rationale, design and baseline characteristics of a randomized controlled trial of a web-based computer-tailored physical activity intervention for adults from Quebec City

Background: The relationship between physical activity and cardiovascular disease (CVD) protection is well documented. Numerous factors (e.g. patient motivation, lack of facilities, physician time constraints) can contribute to poor PA adherence. Web-based computer-tailored interventions offer an innovative way to provide tailored feedback and to empower adults to engage in regular moderate-to vigorous-intensity PA. To describe the rationale, design and content of a web-based computer-tailored PA intervention for Canadian adults enrolled in a randomized controlled trial (RCT). Methods/Design: 244 men and women aged between 35 and 70 years, without CVD or physical disability, not participating in regular moderate-to vigorous-intensity PA, and familiar with and having access to a computer at home, were recruited from the Quebec City Prospective Urban and Rural Epidemiological (PURE) study centre. Participants were randomized into two study arms: 1) an experimental group receiving the intervention and 2) a waiting list control group. The fully automated web-based computer-tailored PA intervention consists of seven 10- to 15-min sessions over an 8-week period. The theoretical underpinning of the intervention is based on the I-Change Model. The aim of the intervention was to reach a total of 150 min per week of moderate-to vigorous-intensity aerobic PA. Discussion: This study will provide useful information before engaging in a large RCT to assess the long-term participation and maintenance of PA, the potential impact of regular PA on CVD risk factors and the cost-effectiveness of a web-based computer-tailored intervention

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Scanning probe microscopy: Close-up on spin coherence

Ultrafast, coherent spin dynamics in semiconductor heterostructures can be measured with a scanning tunnelling microscope by using femtosecond pulses of circularly polarized light