Ostracods from freshwater and brackish environments of the Carboniferous of the Midland Valley of Scotland : the early colonization of terrestrial water bodies

The Mississippian Strathclyde Group of the Midland Valley of Scotland yields some of the earliest non-marine ostracods. The succession records shallow marine, deltaic, estuarine, lagoonal, lacustrine, fluvial and swamp environments representing a series of staging-posts between fully marine and limnetic settings. Macrofossils and ostracods are assigned to marine, marginal marine, brackish and freshwater environments based on their faunal assemblage patterns. Key brackish to freshwater ostracods are Geisina arcuata, Paraparchites circularis n. sp., Shemonaella ornata n. sp. and Silenites sp. A, associated with the bivalves Anthraconaia, Carbonicola, Cardiopteridium, Curvirimula, Naiadites, the microconchid ‘Spirorbis’, Spinicaudata and fish. Many Platycopina and Paraparchiticopina ostracods are interpreted as euryhaline, which corresponds with their occurrence in marine to coastal plain water bodies, and supports the ‘estuary effect’ hypothesis of non-marine colonization. The success of non-marine colonization by ostracods was dependent on the intrinsic adaptations of ostracod species to lower salinities, such as new reproductive strategies and the timing of extrinsic mechanisms to drive non-marine colonization, such as sea-level change. The genus Carbonita is the oldest and most common freshwater ostracod, and went on to dominate freshwater environments in the Late Palaeozoic

Short-term results of a new self-locking cementless femoral stem: a prospective cohort study of the Lima MasterSL

Background: Total hip arthroplasty is a successful treatment for hip osteoarthritis. Primary and secondary implant fixation is dependent on implant design and plays an important role in the longevity of an implant. In this study, we assessed the self-locking cementless MasterSL femoral stem. Materials and methods: In this single-centre prospective study, 50 consecutive hips with the indication for total hip arthroplasty, who met the inclusion criteria, received the MasterSL stem from LIMA Corporate. Patients had pre- and post-operative clinical and radiological assessment and completed patient-reported outcome measures [Oxford Hip Score (OHS), Harris Hip Score (HHS) and Forgotten Joint Score (FJS)] at the 6-week and 6-, 12- and 24-month mark. Post-operative X-rays were assessed for osteointegration (Engh Score), alignment and subsidence. Results: After 2 years, aseptic survival was 100%. One hip had to be explanted due to early deep infection and was excluded from the study. At 2 years, the patients reported a significant improved HHS and OHS of 95.3 ± 5.8 and 46.1 ± 3.6 (mean ± standard deviation), respectively, compared to preoperatively. The mean ± standard deviation for the FJS was 86.4 ± 18.7 with two-thirds of the patients reporting a score above 85. The mean Engh score is 15.1 ± 5.9 (mean ± standard deviation) with no patient scoring below 1 which suggests good osteointegration in all femoral stems. Conclusions: The MasterSL femoral stem performed well in this short-term follow-up study, with high patient satisfaction and good signs of osteointegration. Long-term follow-up will be necessary to evaluate longevity

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

Normal tissue complication probability (NTCP) parameters for breast fibrosis: pooled results from two randomised trials

Introduction: the dose–volume effect of radiation therapy on breast tissue is poorly understood. We estimate NTCP parameters for breast fibrosis after external beam radiotherapy.Materials and methods: we pooled individual patient data of 5856 patients from 2 trials including whole breast irradiation followed with or without a boost. A two-compartment dose volume histogram model was used with boost volume as the first compartment and the remaining breast volume as second compartment. Results from START-pilot trial (n?=?1410) were used to test the predicted models.Results: 26.8% patients in the Cambridge trial (5?years) and 20.7% patients in the EORTC trial (10?years) developed moderate-severe breast fibrosis. The best fit NTCP parameters were BEUD3(50)?=?136.4?Gy, ?50?=?0.9 and n?=?0.011 for the Niemierko model and BEUD3(50)?=?132?Gy, m?=?0.35 and n?=?0.012 for the Lyman Kutcher Burman model. The observed rates of fibrosis in the START-pilot trial agreed well with the predicted rates.Conclusions: this large multi-centre pooled study suggests that the effect of volume parameter is small and the maximum RT dose is the most important parameter to influence breast fibrosis. A small value of volume parameter ‘n’ does not fit with the hypothesis that breast tissue is a parallel organ. However, this may reflect limitations in our current scoring system of fibrosi

Patient-reported measurement of time to diagnosis in cancer: development of the Cancer Symptom Interval Measure (C-SIM) and randomised controlled trial of method of delivery

Background: The duration between first symptom and a cancer diagnosis is important because, if shortened, may lead to earlier stage diagnosis and improved cancer outcomes. We have previously developed a tool to measure this duration in newly-diagnosed patients. In this two-phase study, we aimed further improve our tool and to conduct a trial comparing levels of anxiety between two modes of delivery: self-completed versus researcher-administered. Methods: In phase 1, ten patients completed the modified tool and participated in cognitive debrief interviews. In phase 2, we undertook a Randomised Controlled Trial (RCT) of the revised tool (Cancer Symptom Interval Measure (C-SIM)) in three hospitals for 11 different cancers. Respondents were invited to provide either exact or estimated dates of first noticing symptoms and presenting them to primary care. The primary outcome was anxiety related to delivery mode, with completeness of recording as a secondary outcome. Dates from a subset of patients were compared with GP records. Results: After analysis of phase 1 interviews, the wording and format were improved. In phase 2, 201 patients were randomised (93 self-complete and 108 researcher-complete). Anxiety scores were significantly lower in the researcher-completed group, with a mean rank of 83.5; compared with the self-completed group, with a mean rank of 104.0 (Mann-Whitney U = 3152, p = 0.007). Completeness of data was significantly better in the researcher-completed group, with no statistically significant difference in time taken to complete the tool between the two groups. When comparing the dates in the patient questionnaires with those in the GP records, there was evidence in the records of a consultation on the same date or within a proscribed time window for 32/37 (86%) consultations; for estimated dates there was evidence for 23/37 consultations (62%). Conclusions: We have developed and tested a tool for collecting patient-reported data relating to appraisal intervals, help-seeking intervals, and diagnostic intervals in the cancer diagnostic pathway for 11 separate cancers, and provided evidence of its acceptability, feasibility and validity. This is a useful tool to use in descriptive and epidemiological studies of cancer diagnostic journeys, and causes less anxiety if administered by a researcher

Reconstructing the Antarctic ice-sheet shape at the Last Glacial Maximum using ice-core data

The Antarctic ice sheet (AIS) is the Earth’s largest store of frozen water; understanding how it changed in the past allows us to improve projections of how it, and sea levels, may change. Here, we use previous AIS reconstructions, water isotope ratios from ice cores, and simulator predictions of the relationship between the ice-sheet shape and isotope ratios to create a model of the AIS at the Last Glacial Maximum. We develop a prior distribution that captures expert opinion about the AIS, generate a designed ensemble of potential shapes, run these through the climate model HadCM3, and train a Gaussian process emulator of the link between ice-sheet shape and isotope ratios. To make the analysis computationally tractable, we develop a preferential principal component method that allows us to reduce the dimension of the problem in a way that accounts for the differing importance we place in reconstructions, allowing us to create a basis that reflects prior uncertainty. We use Markov chain Monte Carlo to sample from the posterior distribution, finding shapes for which HadCM3 predicts isotope ratios closely matching observations from ice cores. The posterior distribution allows us to quantify the uncertainty in the reconstructed shape, a feature missing in other analyses

Attachment Styles Within the Coach-Athlete Dyad: Preliminary Investigation and Assessment Development

The present preliminary study aimed to develop and examine the psychometric properties of a new sport-specific self-report instrument designed to assess athletes’ and coaches’ attachment styles. The development and initial validation comprised three main phases. In Phase 1, a pool of items was generated based on pre-existing self-report attachment instruments, modified to reflect a coach and an athlete’s style of attachment. In Phase 2, the content validity of the items was assessed by a panel of experts. A final scale was developed and administered to 405 coaches and 298 athletes (N = 703 participants). In Phase 3, confirmatory factor analysis of the obtained data was conducted to determine the final items of the Coach-Athlete Attachment Scale (CAAS). Confirmatory factor analysis revealed acceptable goodness of fit indexes for a 3-first order factor model as well as a 2-first order factor model for both the athlete and the coach data, respectively. A secure attachment style positively predicted relationship satisfaction, while an insecure attachment style was a negative predictor of relationship satisfaction. The CAAS revealed initial psychometric properties of content, factorial, and predictive validity, as well as reliability

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

Spatial Stability of Incompressible Attachment-Line Flow

Linear stability analysis of incompressible attachment-line flow is presented within the spatial framework. The system of perturbation equations is solved using spectral collocation. This system has been solved in the past using the temporal approach and the current results are shown to be in excellent agreement with neutral temporal calculations. Results amenable to direct comparison with experiments are then presented for the case of zero suction. The global solution method utilized for solving the eigenproblem yields, aside from the well-understood primary mode, the full spectrum of least-damped waves. Of those, a new mode, well separated from the continuous spectrum is singled out and discussed. Further, relaxation of the condition of decaying perturbations in the far-field results in the appearance of sinusoidal modes akin to those found in the classical Orr-Sommerfeld problem. Finally, the continuous spectrum is demonstrated to be amenable to asymptotic analysis. Expressions are derived for the location, in parameter space, of the continuous spectrum, as well as for the limiting cases of practical interest. In the large Reynolds number limit the continuous spectrum is demonstrated to be identical to that of the Orr-Sommerfeld equation