Deciding to Enrol in a Cancer Trial: A Systematic Review of Qualitative Studies.

Background:Clinical trials are essential for the advancement of cancer treatments; however, participation by patients is suboptimal. Currently, there is a lack of synthesized qualitative review evidence on the patient experience of trial entry from which to further develop decision support. The aim of this review is to synthesise literature reporting experiences of participants when deciding to enrol in a cancer clinical trial in order to inform practice. Methods:A systematic review and meta-synthesis of qualitative studies were conducted to describe the experiences of adult cancer patients who decided to enrol in a clinical trial of an anti-cancer treatment. Results:Forty studies met eligibility criteria for inclusion. Three themes were identified representing the overarching domains of experience when deciding to enrol in a cancer trial: 1) need for trial information; (2) trepidation towards participation; and (3) justifying the decision. The process of deciding to enrol in a clinical trial is one marked by uncertainty, emotional distress and driven by the search for a cure. Conclusion:Findings from this review show that decision support modelled by shared decision-making and the quality of a shared decision needs to be accompanied by tailored or personalised psychosocial and supportive care. Although the decision process bears similarities to theoretical processes outlined in decision-making frameworks, there are a lack of supportive interventions for cancer patients that are adapted to the clinical trial context. Theory-based interventions are urgently required to support the specific needs of patients deciding whether to participate in cancer trials

Experimental and theoretical study of vibrations of a cantilevered beam using a ZnO piezoelectric sensor

Piezoelectric sensors can measure vibrations of solid structures very accurately. A model of a cantilevered beam, with a ZnO film on one side is presented. Both viscous and internal damping are considered. The output of the sensor is modeled and matched with experimental results by adjusting the damping parameters. A theoretical formulation for damage is introduced. Experimental results for a damaged beam confirm the shift in frequencies to lower values. The model is used to identify the extent of the damage

Training volume and injury incidence in a professional rugby union team

Objective. To describe the incidence of injuries in a professional rugby team, and to identify any associations between injury rates and training volume. Methods. This retrospective, descriptive study included all injuries diagnosed as grade 1 and above in a South African Super 12 rugby team. Injury incidence and injury rates were calculated and compared with training volume and hours of match play. Results. Thirty-eight male rugby players were injured during the study period. The total number of annual injuries decreased from 50 (2002) to 38 (2004) (χ2=0.84, p=0.36). The number of new injuries showed a similar trend (χ2=2.81, p=0.09), while the number of recurring injuries increased over the 3-year period. There was a tendency for total in-season injury rates to decrease over the 3 years (χ2=2.89, p=0.09). The pre-season injury rate increased significantly over the 3 years (χ2=12.7, p<0.01), coupled with a reduction in training exposure over the pre-season phase. Conclusions. One has to be cognisant of the balance between performance improvement and injury risk when designing training programmes for elite rugby players. Although the reduction in training volume was associated with a slight reduction in the number of acute injuries and in-season injury rates over the three seasons, the performance of the team changed from 3rd to 7th (2002 and 2004, respectively). Further studies are required to determine the optimal training necessary to improve rugby performance while reducing injury rates

"The difference that makes a difference": highlighting the role of variable contexts within an HIV Prevention Community Randomised Trial (HPTN 071/PopART) in 21 study communities in Zambia and South Africa.

This paper explores contextual heterogeneity within a community randomised trial HPTN 071 (Population Effects of Antiretroviral Treatment to Reduce HIV Transmission) carried out in 21 study communities (12 Zambian, 9 South African). The trial evaluates the impact of a combination HIV prevention package (including household-based HIV counselling and testing and anti-retroviral treatment (ART) eligibility regardless of CD4-count) on HIV incidence. The selection, matching and randomisation of study communities relied on key epidemiological and demographic variables and community and stakeholder support. In 2013, following the selection of study communities, a "Broad Brush Survey" (BBS) approach was used to rapidly gather qualitative data on each study community, prior to the implementation of the trial intervention. First-year process indicator intervention data (2014-2015) were collected during the household-based intervention by community lay workers. Using an open/closed typology of urban communities (indicating more or less heterogeneity), this qualitative inquiry presents key features of 12 Zambian communities using a list of four meta-indicators (physical features, social organisation, networks and community narratives). These indicators are then compared with four intervention process indicators in a smaller set of four study communities. The process indicators selected for this analysis indicate response to the intervention (uptake) amongst adults. The BBS qualitative data are used to interpret patterns of similarity and variability in the process indicators across four communities. We found that meta-indicators of local context helped to interpret patterns of similarity and variability emerging across and within the four communities. Features especially significant for influencing heterogeneity in process indicators include proportion of middle-class residents, proximity to neighbouring communities and town centre, the scale of the informal economy, livelihood-linked mobility, presence of HIV stakeholders over time and commitment to community action. Future interdisciplinary analysis is needed to explore if these patterns of difference continue to hold up over the full intervention period and all intervention communities

Advanced prostate cancer experimental radioactive treatment-clinical trial decision making: patient experiences.

ObjectivesNested qualitative studies within clinical trials provide the opportunity to better understand participant experiences of participation and identify areas where improved support is required. The purpose of this qualitative study is to describe the lived experiences of men with advanced prostate cancer participating in the TheraP trial; a randomised trial of 177Lu-PSMA-617 compared with cabazitaxel chemotherapy.MethodsFifteen men with advanced prostate cancer were recruited from the TheraP clinical trial and interviewed at three time points during the trial. Interviews were inductively analysed using thematic analysis. This research paper reports the results from the baseline interview at commencement of the trial, focusing specifically on participants' enrolment experiences.ResultsFour themes were identified representing the lived experiences of men with advanced prostate cancer deciding to participate in the TheraP trial: (1) hoping to survive; (2) needing to feel informed; (3) choosing to participate and (4) being randomised. The process of deciding to enrol in a clinical trial is filled with indecision, emotional difficulties and focused on a desire to live.ConclusionsFor men with advanced prostate cancer, the experience of deciding to enrol in a clinical trial is principally driven by a desire to survive but interlinked with the need to make an informed decision as participants in this study expressed a preference for allocation to the experimental arm. Men seeking to enrol in clinical trials of new prostate cancer treatments would benefit from improved informational and decision support.Trial registration numberNCT03392428, ANZUP1603

Cyclooxygenase inhibitors and the exercise-induced stress response

Objective. This study investigated the effects of single dosages of the non-steroidal anti-inflammatory drug (NSAID) naproxen, and of the coxib, rofecoxib, on the exercise-induced stress response. Design. Eight subjects (age 20.9 ± 1.1 years, weight 70.4 ± 3.9 kg, height 170.9 ± 6.7 cm, body surface area 1.82 ± 0.09 m2, body mass index 24.1 ± 1.3 kg.m-2) took part in a double-blind, drug-placebo, cross-over design study. The experimental procedures were performed on 3 occasions on each volunteer, i.e. once on placebo, once on naproxen (single dose of 1 000 mg) and once on rofecoxib (single dose of 50 mg). Results. Mean post-exercise cortisol values were significantly higher than pre-exercise values with the subjects on placebo (p = 0.0365) and rofecoxib (p = 0.0208), but not on naproxen (p = 0.0732). Post-exercise oral temperatures were significantly higher than pre-exercise temperature values on placebo (p = 0.0153) and rofecoxib (p = 0.0424), but not on naproxen (p = 0.5444). Conclusion. The results of this study suggest a role for cyclooxygenase-1 (COX-1) in the exercise-induced cortisol and temperature response to exercise. South African Journal of Sports Medicine Vol. 18 (1) 2006: pp. 4-

Popular progression differences in vector spaces II

Green used an arithmetic analogue of Szemer\'edi's celebrated regularity lemma to prove the following strengthening of Roth's theorem in vector spaces. For every $\alpha>0$, $\beta<\alpha^3$, and prime number $p$, there is a least positive integer $n_p(\alpha,\beta)$ such that if $n \geq n_p(\alpha,\beta)$, then for every subset of $\mathbb{F}_p^n$ of density at least $\alpha$ there is a nonzero $d$ for which the density of three-term arithmetic progressions with common difference $d$ is at least $\beta$. We determine for $p \geq 19$ the tower height of $n_p(\alpha,\beta)$ up to an absolute constant factor and an additive term depending only on $p$. In particular, if we want half the random bound (so $\beta=\alpha^3/2$), then the dimension $n$ required is a tower of twos of height $\Theta \left((\log p) \log \log (1/\alpha)\right)$. It turns out that the tower height in general takes on a different form in several different regions of $\alpha$ and $\beta$, and different arguments are used both in the upper and lower bounds to handle these cases.Comment: 34 pages including appendi

Some classifications of biharmonic hypersurfaces with constant scalar curvature

We give some classifications of biharmonic hypersurfaces with constant scalar curvature. These include biharmonic Einstein hypersurfaces in space forms, compact biharmonic hypersurfaces with constant scalar curvature in a sphere, and some complete biharmonic hypersurfaces of constant scalar curvature in space forms and in a non-positively curved Einstein space. Our results provide additional cases (Theorem 2.3 and Proposition 2.8) that supports the conjecture that a biharmonic submanifold in a sphere has constant mean curvature, and two more cases that support Chen's conjecture on biharmonic hypersurfaces (Corollaries 2.2,2.7).Comment: 11 page

The politics of rurality (editorial)

Guest edited special issue of Landscape Research

Clinoform architecture and along-strike variability through an exhumed erosional to accretionary basin margin transition

Exhumed basin margin‐scale clinothems provide important archives for understanding process interactions and reconstructing the physiography of sedimentary basins. However, studies of coeval shelf through slope to basin‐floor deposits are rarely documented, mainly due to outcrop or subsurface dataset limitations. Unit G from the Laingsburg depocentre (Karoo Basin, South Africa) is a rare example of a complete basin margin scale clinothem (>60 km long, 200 m‐high), with >10 km of depositional strike control, which allows a quasi‐3D study of a preserved shelf‐slope‐basin floor transition over a ca. 1200 km2 area. Sand‐prone, wave‐influenced topset deposits close to the shelf‐edge rollover zone can be physically mapped down dip for ca. 10 km as they thicken and transition into heterolithic foreset/slope deposits. These deposits progressively fine and thin over 10s of km farther down dip into sand‐starved bottomset/basin floor deposits. Only a few km along strike, the coeval foreset/slope deposits are bypass‐dominated with incisional features interpreted as minor slope conduits/gullies. The margin here is steeper, more channelized, and records a stepped profile with evidence of sand‐filled intraslope topography, a preserved base‐of‐slope transition zone and sand‐rich bottomset/basin‐floor deposits. Unit G is interpreted as part of a composite depositional sequence that records a change in basin margin style from an underlying incised slope with large sand‐rich basin‐floor fans to an overlying accretion‐dominated shelf with limited sand supply to slope and basin‐floor. The change in margin style is accompanied with decreased clinoform height/slope and increased shelf width. This is interpreted to reflect a transition in subsidence style from regional sag, driven by dynamic topography/inherited basement configuration, to early foreland basin flexural loading. Results of this study caution against reconstructing basin margin successions from partial datasets without accounting for temporal and spatial physiographic changes, with potential implications on predictive basin evolution models