A single centre service evaluation of patients' experiences participating in radiotherapy clinical trials during and post COVID-19 in Northern Ireland, UK.

INTRODUCTION: Radiotherapy (RT) clinical trials allow patients to access cutting-edge innovative cancer treatments. Clinical Research Therapy Radiographers (CRRs) play an important role in the management and care of RT trial patients. The COVID-19 pandemic caused major disruption to RT trial delivery. Measures to mitigate COVID-19 risk continue to have an effect on patient contact and communication within cancer centres in the United Kingdom (UK). This study aimed to explore patient perspectives regarding their recent RT trial experience in Northern Ireland (NI), UK. METHODS: A single centre service evaluation was conducted in NI. Patients who were recruited into a RT clinical trial from January 2020 to January 2023 were invited to participate. Surveys were posted to 50 participants in April 2023. Quantitative and qualitative data was captured and analysed using descriptive statistics and Braun and Clarke's six-step thematic analysis framework respectively. Ethical approval was obtained through Ulster University and the NHS Trust. RESULTS: Forty-three of the 50 invited participants responded (86%). Forty-two respondents (79%) had a prostate cancer diagnosis. Forty-one (98%) participants indicated that CRRs were always approachable, polite and courteous and would recommend taking part in a RT trial to friends and family. Identified areas for improvement included aspects regarding consent and participant decision-making. CONCLUSION: This study suggests that despite the implemented measures to suspend research and mitigate COVID-19 risk, patients remained highly satisfied with the quality of care that they received through their participation in RT trials. IMPLICATIONS FOR PRACTICE: The results of this service evaluation will facilitate maintenance and improvement of patient focused delivery of cancer trials within the host centre. This study builds on evidence highlighting the importance of the CRR role and role development for radiographers.

Valley Networks and the Record of Glaciation on Ancient Mars.

The lack of evidence for large-scale glacial landscapes on Mars has led to the belief that ancient glaciations had to be frozen to the ground. Here we propose that the fingerprints of Martian wet-based glaciation should be the remnants of the ice sheet drainage system instead of landforms generally associated with terrestrial ice sheets. We use the terrestrial glacial hydrology framework to interrogate how the Martian surface gravity affects glacial hydrology, ice sliding, and glacial erosion. Taking as reference the ancient southern circumpolar ice sheet that deposited the Dorsa Argentea formation, we compare the theoretical behavior of identical ice sheets on Mars and Earth and show that, whereas on Earth glacial drainage is predominantly inefficient, enhancing ice sliding and erosion, on Mars the lower gravity favors the formation of efficient subglacial drainage. The apparent lack of large-scale glacial fingerprints on Mars, such as drumlins or lineations, is to be expected.

Fluvial Depositional Systems of the African Humid Period: An Analog for an Early, Wet Mars in the Eastern Sahara.

A widely hypothesized but complex transition from widespread fluvial activity to predominantly aeolian processes is inferred on Mars based on remote sensing data observations of ancient landforms. However, the lack of analysis of in situ martian fluvial deposits hinders our understanding of the flow regime nature and sustainability of the martian fluvial activity and the hunt for ancient life. Studying analogs from arid zones on Earth is fundamental to quantitatively understanding geomorphic processes and climate drivers that might have dominated during early Mars. Here we investigate the formation and preservation of fluvial depositional systems in the eastern Sahara, where the largest arid region on Earth hosts important repositories of past climatic changes. The fluvial systems are composed of well-preserved single-thread sinuous to branching ridges and fan-shaped deposits interpreted as deltas. The systems' configuration and sedimentary content suggest that ephemeral rivers carved these landforms by sequential intermittent episodes of erosion and deposition active for 10-100s years over ∼10,000 years during the late Quaternary. Subsequently, these landforms were sculpted by a marginal role of rainfall and aeolian processes with minimum erosion rates of 1.1 ± 0.2 mm/yr, supplying ∼96 ± 24 × 1010 m3 of disaggregated sediment to adjacent aeolian dunes. Our results imply that similar martian fluvial systems preserving single-thread, short distance source-to-sink courses may have formed due to transient drainage networks active over short durations. Altogether, this study adds to the growing recognition of the complexity of interpreting climate history from orbital images of landforms.

Depicting corrosion-born defects in pipelines with combined neutron/γ ray backscatter: a biomimetic approach.

The identification of corrosion, cracks and defects in pipelines used for transporting oil and gas can reduce the possibility of leaks, and consequently, it can limit the extent of an environmental disaster, public hazard and the associated financial impact of such events. Typically, corrosion in oil pipelines is measured with non-destructive ultrasonic or electromagnetic techniques, on the basis that corrosion and defects are often manifest as a change of thickness in the steel from which pipelines are made. However, such approaches are not practical for underground pipelines and their deployment can be complicated for the case of pipelines covered by insulation. In this paper, we present an innovative, non-destructive testing technique, which exploits the backscatter of a combination of fast-neutron and γ radiation from steel samples of a variety of thicknesses consistent with changes that might arise due to corrosion of a pipe wall. Our research demonstrates the potential to measure and characterise different steel thicknesses by detecting both the elastic, fast-neutron backscatter and the Compton-scattered γ radiations, simultaneously. Further, we demonstrate that the presence of insulation yields a consistent and separable influence on the experimental, wall-thickness measurements. The data from experimental measurements are supported by a comprehensive Monte Carlo computer simulation study.

Initiation and Flow Conditions of Contemporary Flows in Martian Gullies.

Understanding the initial and flow conditions of contemporary flows in Martian gullies, generally believed to be triggered and fluidized by CO2 sublimation, is crucial for deciphering climate conditions needed to trigger and sustain them. We employ the RAMMS (RApid Mass Movement Simulation) debris flow and avalanche model to back calculate initial and flow conditions of recent flows in three gullies in Hale crater. We infer minimum release depths of 1.0-1.5 m and initial release volumes of 100-200 m3. Entrainment leads to final flow volumes that are ∼2.5-5.5 times larger than initially released, and entrainment is found necessary to match the observed flow deposits. Simulated mean cross-channel flow velocities decrease from 3-4 m/s to ∼1 m/s from release area to flow terminus, while flow depths generally decrease from 0.5-1 to 0.1-0.2 m. The mean cross-channel erosion depth and deposition thicknesses are ∼0.1-0.3 m. Back-calculated dry-Coulomb friction ranges from 0.1 to 0.25 and viscous-turbulent friction between 100 and 200 m/s2, which are values similar to those of granular debris flows on Earth. These results suggest that recent flows in gullies are fluidized to a similar degree as are granular debris flows on Earth. Using a novel model for mass flow fluidization by CO2 sublimation we are able to show that under Martian atmospheric conditions very small volumetric fractions of CO2 of ≪1% within mass flows may indeed yield sufficiently large gas fluxes to cause fluidization and enhance flow mobility.

Atmospheric implications of large C2-C5 alkane emissions from the U.S. oil and gas industry.

Emissions of C2-C5 alkanes from the U.S. oil and gas sector have changed rapidly over the last decade. We use a nested GEOS-Chem simulation driven by updated 2011NEI emissions with aircraft, surface and column observations to 1) examine spatial patterns in the emissions and observed atmospheric abundances of C2-C5 alkanes over the U.S., and 2) estimate the contribution of emissions from the U.S. oil and gas industry to these patterns. The oil and gas sector in the updated 2011NEI contributes over 80% of the total U.S. emissions of ethane (C2H6) and propane (C3H8), and emissions of these species are largest in the central U.S. Observed mixing ratios of C2-C5 alkanes show enhancements over the central U.S. below 2 km. A nested GEOS-Chem simulation underpredicts observed C3H8 mixing ratios in the boundary layer over several U.S. regions and the relative underprediction is not consistent, suggesting C3H8 emissions should receive more attention moving forward. Our decision to consider only C4-C5 alkane emissions as a single lumped species produces a geographic distribution similar to observations. Due to the increasing importance of oil and gas emissions in the U.S., we recommend continued support of existing long-term measurements of C2-C5 alkanes. We suggest additional monitoring of C2-C5 alkanes downwind of northeastern Colorado, Wyoming and western North Dakota to capture changes in these regions. The atmospheric chemistry modeling community should also evaluate whether chemical mechanisms that lump larger alkanes are sufficient to understand air quality issues in regions with large emissions of these species.

The 2018 rift eruption and summit collapse of Kilauea Volcano.

In 2018, Kilauea Volcano experienced its largest lower East Rift Zone (LERZ) eruption and caldera collapse in at least 200 years. After collapse of the Pu'u 'O'o vent on 30 April, magma propagated downrift. Eruptive fissures opened in the LERZ on 3 May, eventually extending ~6.8 kilometers. A 4 May earthquake [moment magnitude (M w) 6.9] produced ~5 meters of fault slip. Lava erupted at rates exceeding 100 cubic meters per second, eventually covering 35.5 square kilometers. The summit magma system partially drained, producing minor explosions and near-daily collapses releasing energy equivalent to M w 4.7 to 5.4 earthquakes. Activity declined rapidly on 4 August. Summit collapse and lava flow volume estimates are roughly equivalent-about 0.8 cubic kilometers. Careful historical observation and monitoring of Kilauea enabled successful forecasting of hazardous events.

"Neurophobia": More Nurture than Nature?

AIM: "Neurophobia" is the fear of neurology experienced by medical students. The aim of this study was to investigate if neurology now has a stigma attached to it causing a preconceived negative perception of neurology by students. METHODS: An online questionnaire was distributed to medical students via social media and email. Questions focused on students' perceptions of neurology before and after exposure to the subject. RESULTS: There were one hundred and thirty-seven responses. Twenty percent of preclinical students, twenty-six percent of early clinical students and fifty-six percent of clinical students said that they would not consider neurology as a speciality in the future. Neurophysiology and neuroanatomy were considered to be the most difficult aspects of neurology. Integration of preclinical academic training with clinical training was highlighted as a point of difficulty for students. DISCUSSION: Contrary to our initial hypothesis, "neurophobia" does not appear to be innate in medical students but is acquired during the course of their medical training.

Assessing the influence of working hours on general health by migrant status and family structure: the case of Ecuadorian-, Colombian-, and Spanish-born workers in Spain.

OBJECTIVES: The purpose of this study was to analyze the relationship between working hours (WHs) and the likelihood of poor self-reported general health (SRGH) in the first data wave from a cohort of immigrant and native workers in Spain. STUDY DESIGN: Cross-sectional analyses from a prospective cohort study. METHODS: Data were drawn from the first wave of the Platform of Longitudinal Studies on Immigrant Families. The selected sample was composed of 217 immigrant workers and 89 native-born workers. We explored differences by immigrant status and family structure, assessing prevalences and Poisson regression models; an additional analysis explored statistically optimized work hour cut points. RESULTS: Highest prevalence of poor SRGH (72.7%) was reported by immigrant, single-parent workers working >40 WH/week. Immigrant single-parent families were more likely to report poor SRGH for three WH categories: ≤20 WH/week (prevalence ratio [PR] = 3.3, 95% confidence interval [CI] 1.6-7.2), >30-≤40 WH/week (PR = 2.8, 95% CI 1.3-6.4), and >40 WH/week (PR = 4.2, 95% CI 1.8-10.1). In two-parent families, immigrants working standard hours (i.e. >30-≤40) and native-born workers in the highest and lowest categories of WHs (i.e. ≤20 and >40) had similar PRs for poor SRGH compared with native-born workers working standard hours. Findings suggested that native-born workers residing in two-parent families were able to work more than 10 h longer per week than immigrant workers before reporting equivalent prevalences of poor SRGH. CONCLUSIONS: Differences in the association of WHs and poor SRGH among immigrants in Spain seem to be explained by family structure, which suggests that the influence of WHs on health differentially affects vulnerable groups, such as immigrant workers residing in single-parent families.

The IL-13/periostin/IL-24 pathway causes epidermal barrier dysfunction in allergic skin inflammation.

BACKGROUND: Barrier dysfunction is an important feature of atopic dermatitis (AD) in which IL-4 and IL-13, signature type 2 cytokines, are involved. Periostin, a matricellular protein induced by IL-4 or IL-13, plays a crucial role in the onset of allergic skin inflammation, including barrier dysfunction. However, it remains elusive how periostin causes barrier dysfunction downstream of the IL-13 signal. METHODS: We systematically identified periostin-dependent expression profile using DNA microarrays. We then investigated whether IL-24 downregulates filaggrin expression downstream of the IL-13 signals and whether IL-13-induced IL-24 expression and IL-24-induced downregulation of filaggrin expression are dependent on the JAK/STAT pathway. To build on the significance of in vitro findings, we investigated expression of IL-24 and activation of STAT3 in mite-treated mice and in AD patients. RESULTS: We identified IL-24 as an IL-13-induced molecule in a periostin-dependent manner. Keratinocytes are the main IL-24-producing tissue-resident cells stimulated by IL-13 in a periostin-dependent manner via STAT6. IL-24 significantly downregulated filaggrin expression via STAT3, contributing to barrier dysfunction downstream of the IL-13/periostin pathway. Wild-type mite-treated mice showed significantly enhanced expression of IL-24 and activation of STAT3 in the epidermis, which disappeared in both STAT6-deficient and periostin-deficient mice, suggesting that these events are downstream of both STAT6 and periostin. Moreover, IL-24 expression was enhanced in the epidermis of skin tissues taken from AD patients. CONCLUSIONS: The IL-13/periostin pathway induces IL-24 production in keratinocytes, playing an important role in barrier dysfunction in AD.

Earth-like aqueous debris-flow activity on Mars at high orbital obliquity in the last million years.

Liquid water is currently extremely rare on Mars, but was more abundant during periods of high obliquity in the last few millions of years. This is testified by the widespread occurrence of mid-latitude gullies: small catchment-fan systems. However, there are no direct estimates of the amount and frequency of liquid water generation during these periods. Here we determine debris-flow size, frequency and associated water volumes in Istok crater, and show that debris flows occurred at Earth-like frequencies during high-obliquity periods in the last million years on Mars. Results further imply that local accumulations of snow/ice within gullies were much more voluminous than currently predicted; melting must have yielded centimetres of liquid water in catchments; and recent aqueous activity in some mid-latitude craters was much more frequent than previously anticipated.

Quantitative hopanoid analysis enables robust pattern detection and comparison between laboratories.

Hopanoids are steroid-like lipids from the isoprenoid family that are produced primarily by bacteria. Hopanes, molecular fossils of hopanoids, offer the potential to provide insight into environmental transitions on the early Earth, if their sources and biological functions can be constrained. Semiquantitative methods for mass spectrometric analysis of hopanoids from cultures and environmental samples have been developed in the last two decades. However, the structural diversity of hopanoids, and possible variability in their ionization efficiencies on different instruments, have thus far precluded robust quantification and hindered comparison of results between laboratories. These ionization inconsistencies give rise to the need to calibrate individual instruments with purified hopanoids to reliably quantify hopanoids. Here, we present new approaches to obtain both purified and synthetic quantification standards. We optimized 2-methylhopanoid production in Rhodopseudomonas palustris TIE-1 and purified 2Me-diplopterol, 2Me-bacteriohopanetetrol (2Me-BHT), and their unmethylated species (diplopterol and BHT). We found that 2-methylation decreases the signal intensity of diplopterol between 2 and 34% depending on the instrument used to detect it, but decreases the BHT signal less than 5%. In addition, 2Me-diplopterol produces 10× higher ion counts than equivalent quantities of 2Me-BHT. Similar deviations were also observed using a flame ionization detector for signal quantification in GC. In LC-MS, however, 2Me-BHT produces 11× higher ion counts than 2Me-diplopterol but only 1.2× higher ion counts than the sterol standard pregnane acetate. To further improve quantification, we synthesized tetradeuterated (D4) diplopterol, a precursor for a variety of hopanoids. LC-MS analysis on a mixture of (D4)-diplopterol and phospholipids showed that under the influence of co-eluted phospholipids, the D4-diplopterol internal standard quantifies diplopterol more accurately than external diplopterol standards. These new quantitative approaches permit meaningful comparisons between studies, allowing more accurate hopanoid pattern detection in both laboratory and environmental samples.

The development and deployment of integrated electronic care records in a regional adult and paediatric cystic fibrosis unit.

BACKGROUND: Electronic care records (ECRs) for cystic fibrosis (CF) provide a basis for accurate, reliable capture of clinical measures and interventions, and epidemiological trends, providing the basis for improved efficiency and patient safety. METHODS: A primary care system was modified for hospital use and clinical codes devised for all aspects of CF care. Performance and usability were assessed. RESULTS: Of a total of 620 patients 619 consented to their data being recorded in the system. Five hundred and twenty three new codes were created and embedded behind 60 new templates. Following introduction of ECR, completion of annual assessments increased from 43% to 92%, retrieval of drug costs rose significantly and time to correspondence with primary care fell from 34days to <2days. Staff satisfaction was high. CONCLUSION: The system is fully operational allowing the unit to function as a paperless service. Efficiencies of staffing activity, process management and cost retrievals are evident. Sharing of coding structures is important in future care.

The role of respiratory viruses in adult patients with cystic fibrosis receiving intravenous antibiotics for a pulmonary exacerbation.

BACKGROUND: Respiratory viruses have become increasingly recognised as important agents in pulmonary exacerbations in infants and children with CF. The aim of this study was to determine the prevalence of respiratory viruses during acute pulmonary exacerbations in adults and compare the severity of these exacerbations with non-viral associated exacerbations. METHODS: This was a retrospective case control study. Viral throat swabs were taken from all patients presenting with an acute pulmonary exacerbation requiring intravenous antibiotic treatment over a 12 month period. RESULTS: There were 432 pulmonary exacerbations in 180 adults. A positive viral PCR in 42 exacerbations indicated a prevalence of 9.7%. The commonest virus isolated was rhinovirus (n = 29, 69%) with influenza A/H1N1 in seven patients (16.7%). Exacerbations associated with a positive viral PCR had a greater fall in lung function at presentation with higher levels of inflammatory markers. They received more days of intravenous antibiotics, showed less response to treatment and had a shorter time to next pulmonary exacerbation compared to matched controls. CONCLUSION: Viral associated pulmonary exacerbations in adults with CF are associated with more severe pulmonary involvement and respond less well to standard treatment.

Enteral tube feeding in adults with cystic fibrosis; patient choice and impact on long term outcomes.

BACKGROUND: Enteral tube feeding (ETF) has been evaluated in paediatric and mixed child and adult populations with cystic fibrosis, demonstrating positive outcomes from 6 months to 2 years post insertion. No studies have examined the longer term nutritional and clinical outcomes in an exclusively adult population with cystic fibrosis or compared the outcomes for those who meet standard criteria and opt to undertake or decline ETF. METHODS: Twenty three out of 380 patients attending the Leeds Regional Adult CF unit fulfilled the standard criteria for commencing ETF (CF Trust, 2002) between 2004 and 2008. Weight, BMI, FEV1, FVC, CFRD, and number of intravenous antibiotic treatment days were collected at 1 year pre baseline, at baseline, and at 1, 2, and 3 years post baseline for all these patients whether they accepted or declined ETF. RESULTS: Seventeen of the 23 patients agreed to accept a programme of ETF, two of whom died within the first year of ETF. In the remaining patients (n=15), weight increased by 19.5% from baseline (p<0.001), BMI increased to within the normal range and lung function stabilised. There was no reduction in the requirement for intravenous antibiotic treatment. The six patients who declined ETF had a decline in lung function and no weight gain. CONCLUSION: Supplemental enteral tube feeding improves clinical outcomes when administered over 3 years, resulting in significant weight gain, a normal BMI and stabilisation of lung function. It does not reduce intravenous antibiotic treatment days. In contrast those patients eligible for, but who declined ETF, showed a deterioration in lung function and a failure to gain weight and to achieve normal BMI status.

Impact of a cleaner-burning cookstove intervention on blood pressure in Nicaraguan women.

Few studies have evaluated the cardiovascular-related effects of indoor biomass burning or the role of characteristics such as age and obesity status, in this relationship. We examined the impact of a cleaner-burning cookstove intervention on blood pressure among Nicaraguan women using an open fire at baseline; we also evaluated heterogeneity of the impact by subgroups of the population. We evaluated changes in systolic and diastolic blood pressure from baseline to post-intervention (range: 273-383 days) among 74 female cooks. We measured indoor fine particulate matter (PM(2.5); N = 25), indoor carbon monoxide (CO; N = 32), and personal CO (N = 30) concentrations. Large mean reductions in pollutant concentrations were observed for all pollutants; for example, indoor PM(2.5) was reduced 77% following the intervention. However, pollution distributions (baseline and post-intervention) were wide and overlapping. Although substantial reductions in blood pressure were not observed among the entire population, a 5.9 mmHg reduction [95% confidence interval (CI): -11.3, -0.4] in systolic blood pressure was observed among women aged 40 or more years and a 4.6 mmHg reduction (95% CI: -10.0, 0.8) was observed among obese women. Results from this study provide an indication that certain subgroups may be more likely to experience improvements in blood pressure following a cookstove intervention.

Prevalence and associations with hepatitis B and hepatitis C infection among HIV-infected adults in South Africa.

We assessed prevalence and factors associated with hepatitis B in a cross section of HIV-infected primary care and antinatal clinic patients in South Africa and evaluated a rapid hepatitis B surface antigen (HBsAg) assay. We enrolled 998 patients; 88% were women, median age was 29 years and median CD4 count was 354 cells/mm(3). HBsAg enzyme-linked immunosorbent assay (ELISA), anti-hepatitis B core (HBc) antibodies and hepatitis C virus antibody were positive among 4.2%, 37% and 0.1% of subjects, respectively. Univariate and multivariate associations were assessed using logistic regression. Anti-HBc antibodies were associated with alcohol use, traditional medicines and higher CD4 counts; HBsAg positivity was associated with lower CD4. Compared with the HBsAg ELISA, a rapid HBsAg test had a sensitivity of 75.0% and specificity of 99.6%. In conclusion, we identified a moderate prevalence of both HBsAg and anti-HBc. Importantly, we found that subjects with HBsAg positivity had lower CD4 counts.

Patient indicators of a pulmonary exacerbation: preliminary reports from school aged children map onto those of adults.

BACKGROUND: Despite the importance of identifying and managing a pulmonary exacerbation, and its use as an outcome measure in interventions, there is no standardised definition in cystic fibrosis. In achieving standardised criteria it is important to identify patient-reported indicators. METHODS: Interviews were undertaken with 35 school aged children. They reported symptoms experienced during a pulmonary exacerbation in two ways: the first symptoms they become aware of, and how they recognised when they were improving. Interviews were taped, transcribed verbatim and the data analysed thematically. RESULTS: For many children, the onset of an exacerbation was characterised by 'cold' symptoms, tiredness, and changes in cough. For those with moderate or severe disease, sleep disruption, activity induced breathlessness, changes in mood, sputum volume and lack of appetite were common. When describing improvement children focused initially on activities they were now able to perform accompanied by improvements in tiredness and cough. Those with moderate or severe disease also reported improvements in sleep and mood, breathlessness, sputum volume and colour. CONCLUSIONS: Child-reported indicators of a pulmonary exacerbation tend to map onto those reported by adults. These results provide the rationale for the development of a single scale for school age children and adults that could be sensitive to progressive stages of CF disease.