Reducing the time before consulting with symptoms of lung cancer:a randomised controlled trial in primary care

Background: Most individuals with lung cancer have symptoms for several months before presenting to their GP. Earlier consulting may improve survival. Aim: To evaluate whether a theory-based primary care intervention increased timely consulting of individuals with symptoms of lung cancer. Design and setting: Open randomised controlled trial comparing intervention with usual care in two general practices in north-east Scotland. Method: Smokers and ex-smokers aged ≥55 years were randomised to receive a behavioural intervention or usual care. The intervention comprised a single nurse consultation at participants' general practice and a self-help manual. The main outcomes were consultations within target times for individuals with new chest symptoms (≤3 days haemoptysis, ≤3 weeks other symptoms) in the year after the intervention commenced, and intentions about consulting with chest symptoms at 1 and 6 months. Results: Two hundred and twelve participants were randomised and 206 completed the trial. The consultation rate for new chest symptoms in the intervention group was 1.19 (95% confidence interval [CI] = 0.92 to 1.53; P = 0.18) times higher than in the usual-care group and the proportion of consultations within the target time was 1.11 (95% CI = 0.41 to 3.03; P = 0.83) times higher. One month after the intervention commenced, the intervention group reported intending to consult with chest symptoms 31 days (95% CI = 7 to 54; P = 0.012) earlier than the usual care group, and at 6 months this was 25 days (95% CI = 1.5 to 48; P = 0.037) earlier. Conclusion: Behavioural intervention in primary care shortened the time individuals at high risk of lung disease intended to take before consulting with new chest symptoms (the secondary outcome of the study), but increases in consultation rates and the proportions of consultations within target times were not statistically significant. © British Journal of General Practice.

The role and relevance of non-government aid:a case study of Kenya

How effective are non-government organisations (NG0s) in their response to Third World poverty? That is the question which this thesis examines. The thesis begins with an overview of the problems facing Third World communities, and notes the way in which people in Britain have responded through NG0s. A second part of the thesis sets out the issues on which the analysis of NGOs has been made. These are: - the ways in which NGOs analyse the process of development; - the use of 'improving nutrition' and 'promoting self-reliance' as special objectives by NG0s; and - the nature of rural change, and the implications for NGOs as agents of rural development. Kenya is taken as a case study. Firstly the political and economic structure of the country is studied, and the natures of development, nutritional problems and self-reliance in the Kenyan context are noted. The study then focusses attention onto Kitui District, an area of Kenya which at the time of the study was suffering from drought. However, it is argued that the problems of Kitui District and the constraints to change there are as much a consequence of Kenya's structural underdevelopment as of reduced rainfall. Against this background the programmes of some British NGOs in the country are examined, and it is concluded that much of their work has little relevance to the principal problems which have been identified. A final part of the thesis takes a wider look at the policies and practices of NG0s. Issues such as the choice of countries in which NGOs work, how they are represented overseas, and their educational role in Britain are considered. It is concluded that while all NGOs have a concern for the conditions in which the poorest communities of the Third World live, many NGOs take a quite narrow view of development problems, giving only little recognition to the international and intranational political and economic systems which contribute to Third World poverty.

Developing a complex intervention to reduce time to presentation with symptoms of lung cancer

Background - Lung cancer is the commonest cause of cancer in Scotland and is usually advanced at diagnosis. Median time between symptom onset and consultation is 14 weeks, so an intervention to prompt earlier presentation could support earlier diagnosis and enable curative treatment in more cases. Aim - To develop and optimise an intervention to reduce the time between onset and first consultation with symptoms that might indicate lung cancer. Design and setting - Iterative development of complex healthcare intervention according to the MRC Framework conducted in Northeast Scotland. Method - The study produced a complex intervention to promote early presentation of lung cancer symptoms. An expert multidisciplinary group developed the first draft of the intervention based on theory and existing evidence. This was refined following focus groups with health professionals and high-risk patients. Results - First draft intervention components included: information communicated persuasively, demonstrations of early consultation and its benefits, behaviour change techniques, and involvement of spouses/partners. Focus groups identified patient engagement, achieving behavioural change, and conflict at the patient–general practice interface as challenges and measures were incorporated to tackle these. Final intervention delivery included a detailed self-help manual and extended consultation with a trained research nurse at which specific action plans were devised. Conclusion -The study has developed an intervention that appeals to patients and health professionals and has theoretical potential for benefit. Now it requires evaluation.

Effects of dynamic strain ageing on fatigue crack propagation and threshold behaviour in a Ni-base superalloy

In the temperature range 200-400 degree C the Ni-base superalloy, N901, develops marked dynamic strain ageing effects in its tensile behavior. These include inverse strain rate sensitivity, especially in UTS values, strongly serrated stress-strain curves and a heavily sheared failure mode at the higher test-temperatures. As for steels these effects seem to be due to interactions between the dislocations and the interstitial carbon atoms present. The results of tensile and fatigue threshold tests carried out between 20 degree C and 420 degree C are reported and the fatigue behavior is discussed in terms of the effects of surface roughness induced closure, temperature and strain aging interactions.

Growth of short fatigue cracks in titanium alloys

The initiation and early propagation of short fatigue cracks has been studied in detail in two alpha / beta titanium alloys as a function of microstructure. Detailed metallography is presented relating short crack growth rates to the microstructural features present. The work shows the significant differences in short crack propagation rates which can be achieved by microstructural changes within a single alloy.

Relevance of microstructural influences in the short crack regime to overall fatigue resistance

The behaviour of short fatigue cracks is shown to be relevant only to a limited number of engineering situations. Within these situations, further restrictions on the extent to which metallurgical control can be exerted to improve fatigue crack growth behaviour are identified. The degree of control remaining is discussed in terms of two separate regimes which are described as intrinsic and extrinsic crack growth resistance. These separate effects are highlighted by comparisons both within and between a wide range of alloy systems. The implications of such an analysis are discussed in terms of aerospace applications.

Quantum dot-based terahertz photoconductive antennas

We present novel Terahertz (THz) emitting optically pumped Quantum Dot (QD) photoconductive (PC) materials and antenna structures on their basis both for pulsed and CW pumping regimes. Full text Quantum dot and microantenna design - Presented here are design considerations for the semiconductor materials in our novel QD-based photoconductive antenna (PCA) structures, metallic microantenna designs, and their implementation as part of a complete THz source or transceiver system. Layers of implanted QDs can be used for the photocarrier lifetime shortening mechanism[1,2]. In our research we use InAs:GaAs QD structures of varying dot layer number and distributed Bragg reflector(DBR)reflectivity range. According to the observed dependence of carrier lifetimes on QD layer periodicity [3], it is reasonable to assume that electron lifetimes can be potentially reduced down to 0.45ps in such structures. Both of these features; long excitation wavelength and short carriers lifetime predict possible feasibility of QD antennas for THz generation and detection. In general, relatively simple antenna configurations were used here, including: coplanar stripline (CPS); Hertzian-type dipoles; bow-ties for broadband and log-spiral(LS)or log-periodic(LP)‘toothed’ geometriesfor a CW operation regime. Experimental results - Several lasers are used for antenna pumping: Ti:Sapphire femtosecond laser, as well as single-[4], double-[5] wavelength, and pulsed [6] QD lasers. For detection of the THz signal different schemes and devices were used, e.g. helium-cooled bolometer, Golay cell and a second PCA for coherent THz detection in a traditional time-domain measurement scheme.Fig.1shows the typical THz output power trend from a 5 um-gap LPQD PCA pumped using a tunable QD LD with optical pump spectrum shown in (b). Summary - QD-based THz systems have been demonstrated as a feasible and highly versatile solution. The implementation of QD LDs as pump sources could be a major step towards ultra-compact, electrically controllable transceiver system that would increase the scope of data analysis due to the high pulse repetition rates of such LDs [3], allowing real-time THz TDS and data acquisition. Future steps in development of such systems now lie in the further investigation of QD-based THz PCA structures and devices, particularly with regards to their compatibilitywith QD LDs as pump sources. [1]E. U. Rafailov et al., “Fast quantum-dot saturable absorber for passive mode-locking of solid-State lasers,”Photon.Tech.Lett., IEEE, vol. 16 pp. 2439-2441(2004) [2]E. Estacio, “Strong enhancement of terahertz emission from GaAs in InAs/GaAs quantum dot structures. Appl.Phys.Lett., vol. 94 pp. 232104 (2009) [3]C. Kadow et al., “Self-assembled ErAs islands in GaAs: Growth and subpicosecond carrier dynamics,” Appl. Phys. Lett., vol. 75 pp. 3548-3550 (1999) [4]T. Kruczek, R. Leyman, D. Carnegie, N. Bazieva, G. Erbert, S. Schulz, C. Reardon, and E. U. Rafailov, “Continuous wave terahertz radiation from an InAs/GaAs quantum-dot photomixer device,” Appl. Phys. Lett., vol. 101(2012) [5]R. Leyman, D. I. Nikitichev, N. Bazieva, and E. U. Rafailov, “Multimodal spectral control of a quantum-dot diode laser for THz difference frequency generation,” Appl. Phys. Lett., vol. 99 (2011) [6]K.G. Wilcox, M. Butkus, I. Farrer, D.A. Ritchie, A. Tropper, E.U. Rafailov, “Subpicosecond quantum dot saturable absorber mode-locked semiconductor disk laser, ” Appl. Phys. Lett. Vol 94, 2511 © 2014 IEEE.