Purpose For adolescents and young adults (AYAs), the impact of a cancer diagnosis and subsequent treatment is likely to be distinct from other age groups given the unique and complex psychosocial ...challenges of this developmental phase. In this review of the literature, we report the health-related quality of life (HRQoL) issues experienced by AYAs diagnosed with cancer and undergoing treatment. Methods MEDLINE, EMBASE, CINAHL, PsychINFO and the Cochrane Library Databases were searched for publications reporting HRQoL of AYAs. Issues generated from interviews with AYAs or from responses to patient reported outcome measures (PROMs) were extracted. Results 166 papers were reviewed in full and comprised 72 papers covering 69 primary studies, 49 measurement development or evaluation papers and 45 reviews. Of the 69 studies reviewed, 11 (16%) used interviews to elicit AYAs' descriptions of HRQoL issues. The majority of the PROMs used in the studies represent adaptations of paediatric or adult measures. HRQoL issues were organised into the following categories: physical, cognitive, restricted activities, relationships with others, fertility, emotions, body image and spirituality/outlook on life. Conclusion The HRQoL issues presented within this review are likely to be informative to health care professionals and AYAs. The extensive list of issues suggests that the impact of a cancer diagnosis and treatment during adolescence and young adulthood is widespread and reflects the complexities of this developmental phase.
Abstract Warfarin is frequently administered to hospital patients. The prescription and administration of this medication are particularly susceptible to error. Factors contributing to this include ...the narrow therapeutic index, patient-specific target range, and the need for regular INR monitoring. NICE guidelines state that warfarin should be given at the same time every day and the Bristol Royal Infirmary guidelines are warfarin to be given at 14:00. The 14:00 dosing ensures standardisation of administration; poor adherence to this recommendation may cause patient harm. We noticed that many warfarin doses were often given outside of maximal staffing hours and it was often left to the on call doctor to prescribe warfarin at erratic and inconsistent times. Our primary aim was to reduce the number of adverse outcomes associated with warfarin prescription and administration. We targeted two system measures: the proportion of warfarin administrations occurring within an hour of the 14:00 prescription and the proportion of INR results outside target range. We employed the model for improvement and carried out our project across seven acute medical wards. Baseline data showed that only 24% of doses were being given within an hour of the recommended time and 64% of doses were being given after 17:00 during minimal staffing hours. We successfully introduced a warfarin box within our trust which demonstrated an improvement in warfarin administration from 24% of patients receiving their warfarin within an hour of 14:00 to 49% and this was subsequently associated with a reduction in INRs above target range (23% to 9%).
Connecting electron donors and acceptors to a benzene ring in a meta or para relationship results in quantum interference effects that can strongly influence charge separation (CS) and charge ...recombination (CR) processes in these systems. We report on the energy and electron transfer behavior of chlorophyll-based para- and meta-linked donor-bridge-acceptor (D-B-A) dyads, where the semisynthetic chlorophyll a derivative, zinc methyl 3-ethyl-pyrochlorophyllide a (D), is covalently attached at its 20-position to the para position of one phenyl of diphenylacetylene (B). The meta or para position of the phenyl in B distal to the donor is in turn attached to perylene-3,4:9,10-bis(dicarboximide) (PDI) (A). Photoexcitation of the D-B-A dyads produces long-lived radical ion pairs D(•+)-B-A(•-), which recombine to the ground state and to both (3*)D-B-A and D-B-(3*)A. Time-resolved optical and electron paramagnetic resonance spectroscopies were used to monitor the charge transfer and triplet energy transfer (TEnT) processes. At longer times, TEnT occurs from (3*)D-B-A to D-B-(3*)A. Surprisingly, the D-B-A molecules linked via the meta linkage exhibit faster CS, CR, and TEnT rates than do those with the para linkage in contrast to most other meta/para-linked D-B-A molecules previously examined.
Molecular hydrogen produced through iron oxidation during formation of serpentine and magnetite can sustain terrestrial subsurface ecosystems. The Fe3+ in serpentine partitions into octahedral and ...tetrahedral sites differently as serpentinization proceeds, and tetrahedral Fe3+ is present toward the end of serpentinization. We map Fe oxidation states in a serpentinite to determine the degree to which serpentinization progressed and where hydrogen production has been maximized to assess habitability at an abandoned chrysotile mine in Norbestos, Quebec, in association with the Canadian Space Agency's Mars Methane Analogue Mission. We also analyzed stable isotopes of carbon and oxygen in carbonates to constrain the conditions of water–rock interaction during serpentinization. Iron oxidation and coordination was determined through field imaging of rock walls with a visible hyperspectral imager (420–720 nm), and samples collected from imaged rocks and elsewhere in the mine were imaged in the laboratory (420–1100 nm). Sample chemistry, mineralogy, and oxidation state were determined with laboratory measurements of visible through mid-infrared reflectance spectra, major element chemistry, mineralogy, and Mössbauer spectroscopy. Mapping with hyperspectral imaging of outcrops and hand samples shows that tetrahedral Fe3+ is common in serpentinites at this site, and results are confirmed through other measurements. Major element chemistry and mineralogy are consistent with serpentine plus minor carbonate. Carbonate samples show an exceptional range in δ13C (−13.14 to +16.12‰ VPDB) and δ18O (−15.48 to −3.20‰ VPDB) that vary with location in the mine. Carbonates south of a shear zone (δ13C more positive) likely formed during periods of serpentinization in a carbon-limited reservoir closed to carbon addition but open to methane escape. Carbonates in a shear zone (δ13C more negative) probably formed later at low temperatures through CO2-metasomatism or atmospheric weathering, and isotopic trends are consistent with kinetic fractionation. The extensive presence of tetrahedral Fe3+ in serpentine shows the system liberally produced H2 while the isotope systematics have implications for preservation of indicators of the aqueous conditions that formed serpentinites on Mars and their habitability.
•Hyperspectral imaging maps iron oxidation state and coordination in serpentine.•Spectrally-determined iron oxidation state relates to hydrogen production.•Stable isotopes show that serpentinization occurred in a carbon-limited environment.•Isotopic signatures of serpentinization events are preserved in an ancient deposit.•This is a habitable subsurface environment relevant to Mars.
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