Evidence Base

Natalie Doyle and Richard Henry outline the evidence around Charles Campion-Smith's article on primary care after cancer treatment.

Towards Multi-Sensor Spectral Alignment Through Post Measurement Calibration Correction

Semiconductor manufactures are increasing reliant on optical emission spectroscopy (OES) to source information on plasma characteristics and process change. However, nonlinearities in the response of OES sensors and errors in their calibration lead to discrepancies in observed wavelength detector response. This paper presents a technique for the retrospective spectral calibration of multiple OES sensors. Underlying methodology is given, and alignment performance is evaluated using OES recordings from a semiconductor plasma process. The paper concludes with a discussion of results and suggests avenues for future work.

Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.

Understanding the practice nurse’s role in the cancer care tapestry

Background: The are currently 2 million people in the UK living with or
after cancer, and this number is expected to double by 2030 (Maddams et
al, 2012). However, many report unmet physical and psychological needs.

Aim: To determine the learning needs of practice nurses to take on an
enhanced role with people affected by cancer, particularly after primary
treatment, and to develop a course to meet these needs.

Method: The Macmillan Steering Group designed and developed a course for practice
nurses to identify their learning needs, enabling participating practice
nurses to work collaboratively with each other and the course facilitator.
There was strong patient involvement throughout. The course was
evaluated by self-assessment of knowledge, skills and confidence, patient
satisfaction questionnaires and in-depth, qualitative telephone interviews
with the participants and their supporting GPs.

Results: The practice nurses reported changed practice, with increased confidence in discussing
issues relating to cancer and its treatment with patients and relatives.
They understood the importance of supported self-management and were
able to signpost patients to appropriate sources of information and
support. Many of the practice nurses started initiating and undertaking
Cancer Care Reviews, both as planned appointments and opportunistically.
Over the past year, a further nine pilots have been completed throughout
the UK, demonstrating that these results are reproducible in other settings.

Conclusions: With appropriate support and training and protected time
to include cancer care into their everyday work, practice nurses can take
on an important role in the support and care of people affected by cancer

The Well-Aligned Orbit of Wasp-84b: Evidence for Disk Migration of a Hot Jupiter

We report the sky-projected orbital obliquity (spin–orbit angle) of WASP-84 b, a 0.69MJup planet in an 8.52 day orbit around a G9V/K0V star, to be λ = −0.3 ± 1.7°. We obtain a true obliquity of ψ = 17.3 ± 7.7° from a measurement of the inclination of the stellar spin axis with respect to the sky plane. Due to the young age and the weak tidal forcing of the system, we suggest that the orbit of WASP-84b is unlikely to have both realigned and circularized from the misaligned and/or eccentric orbit likely to have arisen from high-eccentricity migration. Therefore we conclude that the planet probably migrated via interaction with the protoplanetary disk. This would make it the first “hot Jupiter” (P d < 10 ) to have been shown to have migrated via this pathway. Further, we argue that the distribution of obliquities for planets orbiting cool stars (Teff < 6250 K) suggests that high-eccentricity migration is an important pathway for the formation of short-orbit, giant planets.

Spindle assembly checkpoint protein expression correlates with cellular proliferation and shorter time to recurrence in ovarian cancer.

Ovarian carcinoma (OC) is the most lethal of the gynecological malignancies, often presenting at an advanced stage. Treatment is hampered by high levels of drug resistance. The taxanes are microtubule stabilizing agents, used as first-line agents in the treatment of OC that exert their apoptotic effects through the spindle assembly checkpoint. BUB1-related protein kinase (BUBR1) and mitotic arrest deficient 2 (MAD2), essential spindle assembly checkpoint components, play a key role in response to taxanes. BUBR1, MAD2, and Ki-67 were assessed on an OC tissue microarray platform representing 72 OC tumors of varying histologic subtypes. Sixty-one of these patients received paclitaxel and platinum agents combined; 11 received platinum alone. Overall survival was available for all 72 patients, whereas recurrence-free survival (RFS) was available for 66 patients. Increased BUBR1 expression was seen in serous carcinomas, compared with other histologies (P = .03). Increased BUBR1 was significantly associated with tumors of advanced stage (P = .05). Increased MAD2 and BUBR1 expression also correlated with increased cellular proliferation (P < .0002 and P = .02, respectively). Reduced MAD2 nuclear intensity was associated with a shorter RFS (P = .03), in ovarian tumors of differing histologic subtype (n = 66). In this subgroup, for those women who received paclitaxel and platinum agents combined (n = 57), reduced MAD2 intensity also identified women with a shorter RFS (P < .007). For the entire cohort of patients, irrespective of histologic subtype or treatment, MAD2 nuclear intensity retained independent significance in a multivariate model, with tumors showing reduced nuclear MAD2 intensity identifying patients with a poorer RFS (P = .05).

miR-433 overexpression attenuates the spindle assembly checkpoint response to paclitaxel

Paclitaxel is a microtubule inhibitory chemotherapeutic drug that is increasingly used for the treatment of solid tumours. In vitro studies have demonstrated that attenuating the spindle assemble checkpoint (SAC) alters the post-mitotic responses to paclitaxel. Furthermore, the aberrant expression of a number of the SAC proteins, MAD2, BUBR1, and Aurora A kinase, are associated with poor patient prognosis. We have identified a microRNA, miR-433, that regulates the expression of MAD2. Overexpression of miR-433 in Hela cells induced downregulation of MAD2 mRNA and protein expression. We have also shown that Hela cells overexpressing miR-433 and treated with paclitaxel are no longer capable of cyclin B stabilisation, and thus have lost the ability to activate the SAC in response to paclitaxel. In addition, cell viability assays showed that Hela cells overexpressing miR-433 and treated with paclitaxel have an attenuated response to paclitaxel compared with microRNA scrambled controls. We have characterised the levels of miR-433, MAD2 gene expression and MAD2 protein levels in a cohort of ovarian cancer cell lines. Cell viability assays on this cohort revealed that responsiveness to paclitaxel is associated with high MAD2 protein expression and lower miR-433 expression. We hypothesise that the expression of miR-433 when deregulated in cancer leads to altered MAD2 expression and a compromised SAC, a key feature underlying drug resistance to paclitaxel. In a pilot study of paired human breast tumour and normal breast tissue samples we have shown that expression levels of miR-433 are elevated in cancer tissue. Targeting this microRNA in cancer may improve the efficacy of paclitaxel in treating breast cancer and ovarian cancer.

Ellerman Bombs with Jets: Cause and Effect

Ellerman Bombs (EBs) are thought to arise as a result of photospheric magnetic reconnection. We use data from the Swedish 1-m Solar Telescope(SST), to study EB events on the solar disk and at the limb. Both datasets show that EBs are connected to the foot-points of forming chromospheric jets. The limb observations show that a bright structure in the H$\alpha$ blue wing connects to the EB initially fuelling it,leading to the ejection of material upwards. The material moves along a loop structure where a newly formed jet is subsequently observed in the red wing of H$\alpha$. In the disk dataset, an EB initiates a jet which propagates away from the apparent reconnection site within the EB flame.The EB then splits into two, with associated brightenings in the inter-granular lanes (IGLs). Micro-jets are then observed, extending to500 km with a lifetime of a few minutes. Observed velocities of themicro-jets are approximately 5-10 km s$^{-1}$, while their chromospheric counterparts range from 50-80 km s$^{-1}$. MURaM simulations of quiet Sun reconnection show that micro-jets with similar properties to that of the observations follow the line of reconnection in the photosphere,with associated H$\alpha$ brightening at the location of increased temperature.

Intensity Enhancement of O VI Ultraviolet Emission Lines in Solar Spectra due to Opacity

Opacity is a property of many plasmas. It is normally expected that if an emission line in a plasma becomes optically thick, then its intensity ratio to that of another transition that remains optically thin should decrease. However, radiative transfer calculations undertaken both by ourselves and others predict that under certain conditions the intensity ratio of an optically thick to an optically thin line can show an increase over the optically thin value, indicating an enhancement in the former. These conditions include the geometry of the emitting plasma and its orientation to the observer. A similar effect can take place between lines of differing optical depths. While previous observational studies have focused on stellar point sources, here we investigate the spatially resolved solar atmosphere using measurements of the I(1032 Å)/I(1038 Å) intensity ratio of O VI in several regions obtained with the Solar Ultraviolet Measurements of Emitted Radiation instrument on board the Solar and Heliospheric Observatory satellite. We find several I(1032 Å)/I(1038 Å) ratios observed on the disk to be significantly larger than the optically thin value of 2.0, providing the first detection (to our knowledge) of intensity enhancement in the ratio arising from opacity effects in the solar atmosphere. The agreement between observation and theory is excellent and confirms that the O VI emission originates from a slab-like geometry in the solar atmosphere, rather than from cylindrical structures.

Numerical modelling of low temperature laser produced magnesium plasma

The two-dimensional laser-plasma-interaction hydrodynamic code POLLUX has been used to simulate the ablation of a magnesium target by a 30-ns, 248-nm KrF excimer laser at low laser fluences of ≤10 J cm2. This code, originally written for much higher laser intensities, has been recently extended to include a detailed description of the equation of state in order to treat changes of phase within the target material, and also includes a Thomas Fermi description of the electrons. The simulated temporal and spatial evolution of the plasma plume in the early phase of the expansion (≤100 ns) is compared with experimental interferometric measurements of electron density. The expansion dynamics are in good agreement, although the simulated electron number density is about 2.5 times higher than the experimental values.

Mapping neutral, ion and electron number densities within laser ablated plasma plumes

Spatially and temporally varying neutral, ion and electron number densities have been mapped out within laser ablated plasma plumes expanding into vacuum. Ablation of a magnesium target was performed using a KrF laser, 30 ns pulse duration and 248 nm wavelength. During the initial stage of plasma expansion (t <EQ 100 ns) interferometry has been used to obtain line averaged electron number densities, for laser power densities on target in the range 1.3 - 3.0 X 108 W/cm2. Later in the plasma expansion (t equals 1 microsecond(s) ) simultaneous absorption and laser induced fluorescence spectroscopy has been used to determine 3D neutral and ion number densities, for a power density equal to 6.7 X 107 W/cm2. Two distinct regions within the plume were identified. One is a fast component (approximately 106 cm-1) consisting of ions and neutrals with maximum number densities observed to be approximately 30 and 4 X 1012 cm-3 respectively, and the second consists of slow moving neutral material at a number density of up to 1015 cm-3. Additionally a Langmuir probe has been used to obtain ion and electron number densities at very late times in the plasma expansion (1 microsecond(s) <EQ t <EQ 15 microsecond(s) ). A copper target was ablated using a Nd:YAG laser, 7.5 ns duration and 532 nm (2 (omega) ) wavelength, with a power density on target equal to 6 X 108 W/cm2. Two regions within the plume with different velocities were observed. Within a fast component (approximately 3 X 106 cms-1) electron and ion number densities of the order 5 X 1012 cm-3 were observed and within the second slower component (approximately 106 cms-1) electron and ion number densities of the order 1 - 2 X 1013 cm-3 were determined.

Turbulent amplification of magnetic fields in laboratory laser-produced shock waves

X-ray and radio observations of the supernova remnant Cassiopeia A reveal the presence of magnetic fields about 100 times stronger than those in the surrounding interstellar medium. Field coincident with the outer shock probably arises through a nonlinear feedback process involving cosmic rays. The origin of the large magnetic field in the interior of the remnant is less clear but it is presumably stretched and amplified by turbulent motions. Turbulence may be generated by hydrodynamic instability at the contact discontinuity between the supernova ejecta and the circumstellar gas9. However, optical observations of Cassiopeia A indicate that the ejecta are interacting with a highly inhomogeneous, dense circumstellar cloud bank formed before the supernova explosion. Here we investigate the possibility that turbulent amplification is induced when the outer shock overtakes dense clumps in the ambient medium. We report laboratory experiments that indicate the magnetic field is amplified when the shock interacts with a plastic grid. We show that our experimental results can explain the observed synchrotron emission in the interior of the remnant. The experiment also provides a laboratory example of magnetic field amplification by turbulence in plasmas, a physical process thought to occur in many astrophysical phenomena.

Statistical Analysis of Small Ellerman Bomb Events

The properties of Ellerman bombs (EBs), small-scale brightenings in the Hα line wings, have proved difficult to establish because their size is close to the spatial resolution of even the most advanced telescopes. Here, we aim to infer the size and lifetime of EBs using high-resolution data of an emerging active region collected using the Interferometric BIdimensional Spectrometer (IBIS) and Rapid Oscillations of the Solar Atmosphere (ROSA) instruments as well as the Helioseismic and Magnetic Imager (HMI) onboard the Solar Dynamics Observatory (SDO). We develop an algorithm to track EBs through their evolution, finding that EBs can often be much smaller (around 0.3″) and shorter-lived (less than one minute) than previous estimates. A correlation between G-band magnetic bright points and EBs is also found. Combining SDO/HMI and G-band data gives a good proxy of the polarity for the vertical magnetic field. It is found that EBs often occur both over regions of opposite polarity flux and strong unipolar fields, possibly hinting at magnetic reconnection as a driver of these events.The energetics of EB events is found to follow a power-law distribution in the range of a nanoflare (1022-25 ergs).

Developed turbulence and nonlinear amplification of magnetic fields in laboratory and astrophysical plasmas

The visible matter in the universe is turbulent and magnetized. Turbulence in galaxy clusters is produced by mergers and by jets of the central galaxies and believed responsible for the amplification of magnetic fields. We report on experiments looking at the collision of two laser-produced plasma clouds, mimicking, in the laboratory, a cluster merger event. By measuring the spectrum of the density fluctuations, we infer developed, Kolmogorov-like turbulence. From spectral line broadening, we estimate a level of turbulence consistent with turbulent heating balancing radiative cooling, as it likely does in galaxy clusters. We show that the magnetic field is amplified by turbulent motions, reaching a nonlinear regime that is a precursor to turbulent dynamo. Thus, our experiment provides a promising platform for understanding the structure of turbulence and the amplification of magnetic fields in the universe.

Characterization of x-ray lens for use in probing high energy density states of matter

By using polycapillary lenses to focus laser-produced x-ray sources to high intensities, an improvement in signal-to-noise ratio can be achieved. Here the He-alpha line emission produced by driving a titanium backlighter target is focused by a polycapillary lens and the output characterized. The x-ray spot is measured to have a peak intensity of 4.5 x 10(7) photons, with a total photon count of 8.8 x 10(8) in 0.13 +/- 0.01 mm(2). This setup is equivalent to placing the backlighter target 3 mm from the sample with a 600 mu m diameter pinhole. The polycapillary lens enables the placement of the backlighter target at a much larger distance from the sample to be studied and therefore has the ability to greatly improve the signal-to-noise ratio on detectors. We demonstrate this with two simple diffraction experiments using pyrolytic graphite and polycrystalline aluminium.