Protocol for a longitudinal qualitative interview study: maintaining psychological well-being in advanced cancer - what can we learn from patients' and carers' own coping strategies?

IntroductionPeople with advanced cancer and their carers experience stress and uncertainty which affects the quality of life and physical and mental health. This study aims to understand how patients and carers recover or maintain psychological well-being by exploring the strategies employed to self-manage stress and uncertainty.Methods and analysisA longitudinal qualitative interview approach with 30 patients with advanced cancer and 30 associated family or informal carers allows the exploration of contexts, mechanisms and outcomes at an individual level. Two interviews, 4–12?weeks apart, will not only enable the exploration of individuals’ evolving coping strategies in response to changing contexts but also how patients’ and carers’ strategies inter-relate. Patient and Carer focus groups will then consider how the findings may be used in developing an intervention. Recruiting through two major tertiary cancer centres in the North West and using deliberately broad and inclusive criteria will enable the sample to capture demographic and experiential breadth.Ethics and disseminationThe research team will draw on their considerable experience to ensure that the study is sensitive to a patient and carer group, which may be considered vulnerable but still values being able to contribute its views. Public and patient involvement (PPI) is integral to the design and is evidenced by: a research advisory group incorporating patient and carers, prestudy consultations with the PPI group at one of the study sites and a user as the named applicant. The study team will use multiple methods to disseminate the findings to clinical, policy and academic audiences. A key element will be engaging health professionals in patient and carer ideas for promoting self-management of psychological well-being. The study has ethical approval from the North West Research Ethics Committee and the appropriate NHS governance clearance.RegistrationNational Institute for Health Research (NIHR) Clinical Studies Portfolio, UK Clinical Research Network (UKCRN) Study number 11725

Undiagnosed asthma in older people: an underestimated problem

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.WHAT WE NEED TO KNOW: Are older people with respiratory symptoms aware this could be asthma? Which explanations for undiagnosed asthma apply most commonly in older Australians with asthma? Can we improve awareness of asthma in older people with undiagnosed asthma? Is the possibility of asthma in older people firmly established on the general practitioners’ radar screen? What reasons most often determine whether GPs perform spirometry in their practice? WHAT WE NEED TO DO: Conduct a representative population study to assess whether older Australians recognise respiratory symptoms as being asthma and are reporting these symptoms. Conduct and evaluate a pilot asthma health promotion program for older people. Conduct a controlled therapeutic trial of people with undiagnosed asthma to assess treatment benefits and produce treatment recommendations. Identify whether the prominence of asthma in older people can be brought to the attention of GPs. Analyse more carefully the issues associated with innovation of office spirometry.David H Wilson, Sarah L Appleton, Robert J Adams and Richard E Ruffi

IRAC Observations of M81

IRAC images of M81 show three distinct morphological constituents: a smooth distribution of evolved stars with bulge, disk, and spiral arm components; a clumpy distribution of dust emission tracing the spiral arms; and a pointlike nuclear source. The bulge stellar colors are consistent with M-type giants, and the disk colors are consistent with a slightly younger population. The dust emission generally follows the blue and ultraviolet emission, but there are large areas that have dust emission without ultraviolet and smaller areas with ultraviolet but little dust emission. The former are presumably caused by extinction, and the latter may be due to cavities in the gas and dust created by supernova explosions. The nucleus appears fainter at 8 um than expected from ground-based 10 um observations made four years ago.Comment: ApJS in press (Spitzer special issue); 15 pages, 3 figures. Changes: unused references removed, numbers and labels in Table 1 change

A Spitzer Unbiased Ultradeep Spectroscopic Survey

We carried out an unbiased, spectroscopic survey using the low-resolution module of the infrared spectrograph (IRS) on board Spitzer targeting two 2.6 square arcminute regions in the GOODS-North field. IRS was used in spectral mapping mode with 5 hours of effective integration time per pixel. One region was covered between 14 and 21 microns and the other between 20 and 35 microns. We extracted spectra for 45 sources. About 84% of the sources have reported detections by GOODS at 24 microns, with a median F_nu(24um) ~ 100 uJy. All but one source are detected in all four IRAC bands, 3.6 to 8 microns. We use a new cross-correlation technique to measure redshifts and estimate IRS spectral types; this was successful for ~60% of the spectra. Fourteen sources show significant PAH emission, four mostly SiO absorption, eight present mixed spectral signatures (low PAH and/or SiO) and two show a single line in emission. For the remaining 17, no spectral features were detected. Redshifts range from z ~ 0.2 to z ~ 2.2, with a median of 1. IR Luminosities are roughly estimated from 24 microns flux densities, and have median values of 2.2 x 10^{11} L_{\odot} and 7.5 x 10^{11} L_{\odot} at z ~ 1 and z ~ 2 respectively. This sample has fewer AGN than previous faint samples observed with IRS, which we attribute to the fainter luminosities reached here.Comment: Published in Ap

Deep Herschel view of obscured star formation in the Bullet cluster

We use deep, five band (100–500 μm) data from the Herschel Lensing Survey (HLS) to fully constrain the obscured star formation rate, SFR_(FIR), of galaxies in the Bullet cluster (z = 0.296), and a smaller background system (z = 0.35) in the same field. Herschel detects 23 Bullet cluster members with a total SFRFIR = 144±14 M_☉ yr^(-1). On average, the background system contains brighter far-infrared (FIR) galaxies, with ~50% higher SFRFIR (21 galaxies; 207 ± 9 M_☉ yr^(-1)). SFRs extrapolated from 24 μm flux via recent templates (SFR_(24 µm)) agree well with SFRFIR for ~60% of the cluster galaxies. In the remaining ~40%, SFR24 µm underestimates SFR_(FIR) due to a significant excess in observed S_(100)/S_(24) (rest frame S_(75)/S_(18)) compared to templates of the same FIR luminosity

High-Resolution Measurements of the Dark Matter Halo of NGC 2976: Evidence for a Shallow Density Profile

We have obtained two-dimensional velocity fields of the dwarf spiral galaxy NGC 2976 in Halpha and CO. The high spatial (~75 pc) and spectral (13 km/s and 2 km/s, respectively) resolution of these observations, along with our multicolor optical and near-infrared imaging, allow us to measure the shape of the density profile of the dark matter halo with good precision. We find that the total (baryonic plus dark matter) mass distribution of NGC 2976 follows a rho_tot ~ r^(-0.27 +/- 0.09) power law out to a radius of 1.8 kpc, assuming that the observed radial motions provide no support. The density profile attributed to the dark halo is even shallower, consistent with a nearly constant density of dark matter over the entire observed region. A maximal disk fit yields an upper limit to the K-band stellar mass-to-light ratio (M*/L_K) of 0.09^{+0.15}_{-0.08} M_sun/L_sun,K (including systematic uncertainties), with the caveat that for M*/L_K > 0.19 M_sun/L_sun,K the dark matter density increases with radius, which is unphysical. Assuming 0.10 M_sun/L_sun,K < M*/L_K < 0.19 M_sun/L_sun,K, the dark matter density profile lies between rho_dm ~ r^-0.17 and rho_dm ~ r^-0.01. Therefore, independent of any assumptions about the stellar disk or the functional form of the density profile, NGC 2976 does not contain a cuspy dark matter halo. We also investigate some of the systematic effects that can hamper rotation curve studies, and show that 1) longslit rotation curves are far more vulnerable to systematic errors than two-dimensional velocity fields, 2) NGC 2976 contains large radial motions at small radii, and 3) the Halpha and CO velocity fields of NGC 2976 agree within their uncertainties. [slightly abridged]Comment: 30 pages, 4 tables, 13 figures (7 in color; Figures 1 and 3 are low-resolution to save space). Accepted for publication in ApJ. Version with full-resolution figures available at http://astro.berkeley.edu/~bolatto/ngc2976rotation.ps (46 MB

An algorithmic approach to diagnosing asthma in older patients in general practice

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.WHAT WE NEED TO KNOW: How effective would an algorithm be in helping general practitioners diagnose asthma? What proportion of older people with undiagnosed asthma fail to recognise symptoms? What proportion of the population believe asthma does not occur in the older population? What systems or supports do GPs need to diagnose asthma more effectively? WHAT WE NEED TO DO: Work on developing a gold standard for asthma diagnosis. Develop prototype algorithms for general practice discussion. Conduct a general practice study to assess the effectiveness of an algorithm. In conjunction with GPs, develop a pilot program to increase awareness of the current asthma problem. Conduct focus-group research to identify why some people do not believe they can develop asthma for the first time in adult life. Conduct focus-group research to identify why some adults do not attribute asthma symptoms to asthma. Conduct focus groups with GPs to identify what support is needed to diagnose asthma more effectively. Consult with all stakeholders before an intervention is used. Evaluate any interventions used.Richard E Ruffin, David H Wilson, Sarah L Appleton and Robert J Adam