Background. Community-associated methicillin-resistant S. aureus (CA-MRSA) is the most common organism isolated from purulent skin infections. Antibiotics are usually not beneficial for skin abscess, ...and national guidelines do not recommend CA-MRSA coverage for cellulitis, except purulent cellulitis, which is uncommon. Despite this, antibiotics targeting CA-MRSA are prescribed commonly and increasingly for skin infections, perhaps due, in part, to lack of experimental evidence among cellulitis patients. We test the hypothesis that antibiotics targeting CA-MRSA are beneficial in the treatment of cellulitis. Methods. We performed a randomized, multicenter, double-blind, placebo-controlled trial from 2007 to 2011. We enrolled patients with cellulitis, no abscesses, symptoms for <1 week, and no diabetes, immunosuppression, peripheral vascular disease, or hospitalization (clinicaltrials.gov NCT00676130). All participants received cephalexin. Additionally, each was randomized to trimethoprim-sulfamethoxazole or placebo. We provided 14 days of antibiotics and instructed participants to continue therapy for ≥1 week, then stop 3 days after they felt the infection to be cured. Our main outcome measure was the risk difference for treatment success, determined in person at 2 weeks, with telephone and medical record confirmation at 1 month. Results. We enrolled 153 participants, and 146 had outcome data for intent-to-treat analysis. Median age was 29, range 3–74. Of intervention participants, 62/73 (85%) were cured versus 60/73 controls (82%), a risk difference of 2.7% (95% confidence interval, −9.3% to 15%; P = .66). No covariates predicted treatment response, including nasal MRSA colonization and purulence at enrollment. Conclusions. Among patients diagnosed with cellulitis without abscess, the addition of trimethoprim-sulfamethoxazole to cephalexin did not improve outcomes overall or by subgroup. Clinical Trials Registration. NCT00676130.
ObjectivesTherapeutic radiographers (TRs) are well placed to deliver health behaviour change advice to those living with and beyond cancer (LWBC). However, there is limited research on the opinions ...of TRs around delivering such advice to those LWBC. This study aimed to explore TRs’ practices and facilitators in delivering advice on physical activity, healthy eating, alcohol intake, smoking and weight management.Setting and participantsFifteen UK-based TRs took part in a telephone interview using a semi‐structured interview guide. Data was analysed using the framework analysis method.ResultsEmergent themes highlighted that TRs are mainly aware of the benefits of healthy behaviours in managing radiotherapy treatment related side effects, with advice provision lowest for healthy eating and physical activity. Participants identified themselves as well placed to deliver advice on improving behaviours to those LWBC, however reported a lack of knowledge as a limiting factor to doing so. The TRs reported training and knowledge as key facilitators to the delivery of advice, with a preference for online training.ConclusionsThere is a need for education resources, clear referral pathways and in particular training for TRs on delivering physical activity and healthy eating advice to those LWBC.
The full LEP-1 data set collected with the ALEPH detector at the
Z pole during 1991–1995 is analysed in order to measure the
τ
decay branching fractions. The analysis follows the global method used ...in the published study based on 1991–1993 data, but several improvements are introduced, especially concerning the treatment of photons and
π
0
's. Extensive systematic studies are performed, in order to match the large statistics of the data sample corresponding to over 300
000 measured and identified
τ
decays. Branching fractions are obtained for the two leptonic channels and 11 hadronic channels defined by their respective numbers of charged particles and
π
0
's. Using previously published ALEPH results on final states with charged and neutral kaons, corrections are applied to the hadronic channels to derive branching ratios for exclusive final states without kaons. Thus the analyses of the full LEP-1 ALEPH data are combined to yield a complete description of
τ
decays, encompassing 22 non-strange and 11 strange hadronic modes. Some physics implications of the results are given, in particular related to universality in the leptonic charged weak current, isospin invariance in
a
1
decays, and the separation of vector and axial-vector components of the total hadronic rate. Finally, spectral functions are determined for the dominant hadronic modes and updates are given for several analyses. These include: tests of isospin invariance between the weak charged and electromagnetic hadronic currents, fits of the
ρ
resonance lineshape, and a QCD analysis of the non-strange hadronic decays using spectral moments, yielding the value
α
s
(
m
τ
2
)
=
0.340
±
0
.
005
exp
±
0
.
014
th
. The evolution to the
Z mass scale yields
α
s
(
M
Z
2
)
=
0.1209
±
0.0018
. This value agrees well with the direct determination from the
Z width and provides the most accurate test to date of asymptotic freedom in the QCD gauge theory.
Supporting self-management is one strategy to help cancer survivors optimise their quality of life. Low grade non-Hodgkin's lymphoma is often incurable with a chronic disease trajectory requiring ...lifelong self-management. This study explored the views on self-management and preferences for self-management support among survivors of low grade non-Hodgkin's lymphoma and their informal caregivers more than 6 months after completion of systemic anti-cancer therapy.
In-depth semi-structured telephone interviews were conducted. Key themes and subthemes were determined using inductive and deductive thematic analysis.
The sample included eight survivors of low grade non-Hodgkin's lymphoma and two family caregivers. There were four themes. 1) The chronic nature of low grade non-Hodgkin's lymphoma shapes perceptions of self-management; participants described their cancer as a chronic condition and self-management strategies reflected this. 2) Social networks enable self-management; participants emphasised the importance of making low grade non-Hodgkin's lymphoma survivors aware of social networks. 3) Support and monitoring are needed immediately after the initial treatment phase ends. 4) Preferred components of self-management support; this included regular review with monitoring, advice on diet, and strategies to manage the psychosocial consequences of low grade non-Hodgkin's lymphoma.
Providing self-management support to those diagnosed with low grade non-Hodgkin's lymphoma is relevant given the chronic trajectory of the disease. Findings suggest that necessary components of a self-management support programme for those with low grade non-Hodgkin's lymphoma should include regular review with monitoring and practical support around facilitating engagement with social networks.
•Self-management support is relevant given the chronic trajectory of low grade non-Hodgkin's Lymphoms (LGNHL)•This study is an in-depth qualitative study focusing on LGNHL survivors' self-management support needs.•Social support enables those diagnosed with LGNHL to self-manage.•Self-management support should include regular review with monitoring, and facilitate engagement with social networks.
Background
Supporting those living with and beyond cancer to self‐manage their health can optimise health‐related quality of life and reduce symptom burden. Self‐management support (SMS) programmes ...have been shown to be effective, but uptake is often low. This qualitative study aimed to identify experienced and perceived enablers and barriers to accessing SMS services among those who had completed primary cancer treatment and were living with and beyond cancer.
Methods
Participants were recruited through social media and cancer advocacy groups. Semi‐structured telephone and online interviews were conducted. Transcripts were coded inductively based on participants' reported experiences. Statements related to factors that enable or inhibit access to SMS were then mapped to the Theoretical Domains Framework (TDF).
Results
Twenty‐six people participated. Six themes explain the factors that act as barriers and enablers which mapped to 11 TDF domains. Lack of knowledge of available SMS was a prominent barrier, as well as inaccessible services due to timing and place of delivery. Lack of confidence and emotional factors including fear were barriers to seeking SMS. Social influences shaped knowledge, attitudes and readiness to access SMS. Perceptions of SMS service goals and if in alignment with self‐identity, intentions and goals also shaped decisions around accessing support.
Conclusions
While lack of knowledge and provider signposting were common barriers, findings suggest that other psychosocial and emotional factors may be barriers, even if SMS services are accessible. Findings are relevant for oncology healthcare services developing strategies to increase reach of SMS for those living with and beyond cancer.
Andexanet alfa is a modified recombinant inactive form of human factor Xa developed for reversal of factor Xa inhibitors.
We evaluated 352 patients who had acute major bleeding within 18 hours after ...administration of a factor Xa inhibitor. The patients received a bolus of andexanet, followed by a 2-hour infusion. The coprimary outcomes were the percent change in anti-factor Xa activity after andexanet treatment and the percentage of patients with excellent or good hemostatic efficacy at 12 hours after the end of the infusion, with hemostatic efficacy adjudicated on the basis of prespecified criteria. Efficacy was assessed in the subgroup of patients with confirmed major bleeding and baseline anti-factor Xa activity of at least 75 ng per milliliter (or ≥0.25 IU per milliliter for those receiving enoxaparin).
Patients had a mean age of 77 years, and most had substantial cardiovascular disease. Bleeding was predominantly intracranial (in 227 patients 64%) or gastrointestinal (in 90 patients 26%). In patients who had received apixaban, the median anti-factor Xa activity decreased from 149.7 ng per milliliter at baseline to 11.1 ng per milliliter after the andexanet bolus (92% reduction; 95% confidence interval CI, 91 to 93); in patients who had received rivaroxaban, the median value decreased from 211.8 ng per milliliter to 14.2 ng per milliliter (92% reduction; 95% CI, 88 to 94). Excellent or good hemostasis occurred in 204 of 249 patients (82%) who could be evaluated. Within 30 days, death occurred in 49 patients (14%) and a thrombotic event in 34 (10%). Reduction in anti-factor Xa activity was not predictive of hemostatic efficacy overall but was modestly predictive in patients with intracranial hemorrhage.
In patients with acute major bleeding associated with the use of a factor Xa inhibitor, treatment with andexanet markedly reduced anti-factor Xa activity, and 82% of patients had excellent or good hemostatic efficacy at 12 hours, as adjudicated according to prespecified criteria. (Funded by Portola Pharmaceuticals; ANNEXA-4 ClinicalTrials.gov number, NCT02329327.).
The US Food and Drug Administration has scrutinized clinical trial methodology in cellulitis, partly because the definition and timing of cure are debatable. We analysed the validity of telephone ...self-report as a proxy for in-person follow up in a cellulitis treatment trial comparing cephalexin alone with cephalexin-plus-trimethoprim/sulfamethoxazole. Our results demonstrate poor agreement between these two methods of outcome determination and have implications for future cellulitis clinical trial design and clinical management.
Testbeam studies of production modules of the ATLAS Tile Calorimeter Alexa, C.; Anderson, K.; Biscarat, C. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
07/2009, Letnik:
606, Številka:
3
Journal Article
Recenzirano
Odprti dostop
We report test beam studies of 11% of the production ATLAS Tile Calorimeter modules. The modules were equipped with production front-end electronics and all the calibration systems planned for the ...final detector. The studies used muon, electron and hadron beams ranging in energy from 3 to 350GeV.
Two independent studies showed that the light yield of the calorimeter was ∼70pe/GeV, exceeding the design goal by 40%. Electron beams provided a calibration of the modules at the electromagnetic energy scale. Over 200 calorimeter cells the variation of the response was 2.4%. The linearity with energy was also measured. Muon beams provided an intercalibration of the response of all calorimeter cells. The response to muons entering in the ATLAS projective geometry showed an RMS variation of 2.5% for 91 measurements over a range of rapidities and modules. The mean response to hadrons of fixed energy had an RMS variation of 1.4% for the modules and projective angles studied. The response to hadrons normalized to incident beam energy showed an 8% increase between 10 and 350GeV, fully consistent with expectations for a noncompensating calorimeter. The measured energy resolution for hadrons of σ/E=52.9%/E⊕5.7% was also consistent with expectations.
Other auxiliary studies were made of saturation recovery of the readout system, the time resolution of the calorimeter and the performance of the trigger signals from the calorimeter.
Therapeutic radiographers (TRs) are well-placed to deliver advice to cancer patients; however, limited research exists on their practices in providing advice on healthy lifestyle behaviours. Through ...an online survey, this study aimed to explore TRs’ current practices, barriers, and facilitators around delivering healthy behaviour advice to cancer patients. An online survey was sent to 72 radiotherapy departments in the UK and 583 TRs responded to the survey. Findings showed that levels of enquiry and provision of advice on healthy behaviours were low, with less than 25% advising patients on physical activity, healthy eating, weight management, smoking cessation, and reducing alcohol intake as standard practice. Lack of knowledge, resources, and training were identified as barriers, in addition to perceived lack of patient interest and lack of time. TRs reported a strong desire to undergo training to enable them to deliver health behaviour advice to patients, with an identified preference for online training. Cancer patients look to healthcare professionals for advice on health behaviours, and TRs are well-placed to deliver this advice. The findings of this study provide insight into the areas that need addressing to enable TRs to support positive health behaviours among cancer patients.
PDF
