An international review of the patterns and determinants of health service utilisation by adult cancer survivors

Background: There is a need to review factors related to health service utilisation by the increasing number of cancer survivors in order to inform care planning and the organisation and delivery of services.

Methods: Studies were identified via systematic searches of Medline, PsycINFO, CINAHL, Social Science Citation Index and the SEER-MEDICARE library. Methodological quality was assessed using STROBE; and the Andersen Behavioural Model was used as a framework to structure, organise and analyse the results of the review.

Results: Younger, white cancer survivors were most likely to receive follow-up screening, preventive care, visit their physician, utilise professional mental health services and least likely to be hospitalised. Utilisation rates of other health professionals such as physiotherapists were low. Only studies of health service use conducted in the USA investigated the role of type of health insurance and ethnicity. There appeared to be disparate service use among US samples in terms of ethnicity and socio-demographic status, regardless of type of health insurance provisions- this may be explained by underlying differences in health-seeking behaviours. Overall, use of follow-up care appeared to be lower than expected and barriers existed for particular groups of cancer survivors.

Conclusions: Studies focussed on the use of a specific type of service rather than adopting a whole-system approach and future health services research should address this shortcoming. Overall, there is a need to improve access to care for all cancer survivors. Studies were predominantly US-based focussing mainly on breast or colorectal cancer. Thus, the generalisability of findings to other health-care systems and cancer sites is unclear. The Andersen Behavioural Model provided an appropriate framework for studying and understanding health service use among cancer survivors. The active involvement of physicians and use of personalised care plans are required in order to ensure that post-treatment needs and recommendations for care are met.

Seasonal patterns of body temperature daily rhythms in group-living cape ground squirrels Xerus inauris

Organisms respond to cyclical environmental conditions by entraining their endogenous biological rhythms. Such physiological responses are expected to be substantial for species inhabiting arid environments which incur large variations in daily and seasonal ambient temperature (T). We measured core body temperature (T) daily rhythms of Cape ground squirrels Xerus inauris inhabiting an area of Kalahari grassland for six months from the Austral winter through to the summer. Squirrels inhabited two different areas: an exposed flood plain and a nearby wooded, shady area, and occurred in different social group sizes, defined by the number of individuals that shared a sleeping burrow. Of a suite of environmental variables measured, maximal daily T provided the greatest explanatory power for mean T whereas sunrise had greatest power for T acrophase. There were significant changes in mean T and T acrophase over time with mean T increasing and T acrophase becoming earlier as the season progressed. Squirrels also emerged from their burrows earlier and returned to them later over the measurement period. Greater increases in T, sometimes in excess of 5°C, were noted during the first hour post emergence, after which T remained relatively constant. This is consistent with observations that squirrels entered their burrows during the day to 'offload' heat. In addition, greater T amplitude values were noted in individuals inhabiting the flood plain compared with the woodland suggesting that squirrels dealt with increased environmental variability by attempting to reduce their T-T gradient. Finally, there were significant effects of age and group size on T with a lower and less variable T in younger individuals and those from larger group sizes. These data indicate that Cape ground squirrels have a labile T which is sensitive to a number of abiotic and biotic factors and which enables them to be active in a harsh and variable environment.

Patterns of synchrony in natterjack toad breeding activity and reproductive success at local and regional scales

Empirical studies of the spatiotemporal dynamics of populations are required to better understand natural fluctuations in abundance and reproductive success, and to better target conservation and monitoring programmes. In particular, spatial synchrony in amphibian populations remains little studied. We used data from a comprehensive three year study of natterjack toad Bufo calamita populations breeding at 36 ponds to assess whether there was spatial synchrony in the toad breeding activity (start and length of breeding season, total number of egg strings) and reproductive success (premetamorphic survival and production of metamorphs). We defined a novel approach to assess the importance of short-term synchrony at both local and regional scales. The approach employs similarity indices and quantifies the interaction between the temporal and spatial components of populations using mixed effects models. There was no synchrony in the toad breeding activity and reproductive success at the local scale, suggesting that populations function as individual clusters independent of each other. Regional synchrony was apparent in the commencement and duration of the breeding season and in the number of egg strings laid (indicative of female population size). Regional synchrony in both rainfall and temperature are likely to explain the patterns observed (e.g. Moran effect). There was no evidence supporting regional synchrony in reproductive success, most likely due to spatial variability in the environmental conditions at the breeding ponds, and to differences in local population fitness (e.g. fecundity). The small scale asynchronous dynamics and regional synchronous dynamics in the number of breeding females indicate that it is best to monitor several populations within a subset of regions. Importantly, variations in the toad breeding activity and reproductive success are not synchronous, and it is thus important to consider them both when assessing the conservation status of pond-breeding amphibians. © 2012 The Authors. Ecography © 2012 Nordic Society Oikos.

Newly Acquired Fear of Falling Leads to Altered Eye Movement Patterns and Reduced Stepping Safety: A Case Study

This opportune case study describes visual and stepping behaviours of an 87 year old female (P8), both prior to, and following two falls. Before falling, when asked to walk along a path containing two stepping guides positioned before and after an obstacle, P8 generally visually fixated the first stepping guide until after foot contact inside it. However, after falling P8 consistently looked away from the stepping guide before completing the step into it in order to fixate the upcoming obstacle in her path. The timing of gaze redirection away from the target (in relation to foot contact inside it) correlated with absolute stepping error. No differences in eyesight, cognitive function, or balance were found between pre- and post-fall recordings. However, P8 did report large increases in fall-related anxiety and reduced balance confidence, supporting previously suggested links between anxiety/increased fear or falling and maladaptive visual/stepping behaviours. The results represent a novel insight into how psychological and related behavioural factors can change in older adults following a fall, and provide a possible partial rationalisation for why recent fallers are more likely to fall again in the following 12 months. These findings highlight novel possibilities for falls prevention and rehabilitation.

The ParaPhrase Project:Parallel patterns for adaptive heterogeneous multicore systems

This paper describes the ParaPhrase project, a new 3-year targeted research project funded under EU Framework 7 Objective 3.4 (Computer Systems), starting in October 2011. ParaPhrase aims to follow a new approach to introducing parallelism using advanced refactoring techniques coupled with high-level parallel design patterns. The refactoring approach will use these design patterns to restructure programs defined as networks of software components into other forms that are more suited to parallel execution. The programmer will be aided by high-level cost information that will be integrated into the refactoring tools. The implementation of these patterns will then use a well-understood algorithmic skeleton approach to achieve good parallelism. A key ParaPhrase design goal is that parallel components are intended to match heterogeneous architectures, defined in terms of CPU/GPU combinations, for example. In order to achieve this, the ParaPhrase approach will map components at link time to the available hardware, and will then re-map them during program execution, taking account of multiple applications, changes in hardware resource availability, the desire to reduce communication costs etc. In this way, we aim to develop a new approach to programming that will be able to produce software that can adapt to dynamic changes in the system environment. Moreover, by using a strong component basis for parallelism, we can achieve potentially significant gains in terms of reducing sharing at a high level of abstraction, and so in reducing or even eliminating the costs that are usually associated with cache management, locking, and synchronisation. © 2013 Springer-Verlag Berlin Heidelberg.

Liquid crystal based Rotman lens antenna with switchable monopulse patterns

An electronically reconfigurable Rotman lens is described which generates multiple beams that can be switched from monopulse sum to difference radiation patterns when used in conjunction with a six element Vivaldi antenna array. This is achieved by exploiting the voltage-dependent dielectric anisotropy property of nematic state liquid crystals to provide switched 0 degrees and 180 degrees phase shifts in the array feed lines. The viability of the concept is demonstrated by designing an antenna which exhibits dynamically reconfigurable monopulse radiation patterns over the frequency band 6-10 GHz. Measured and simulated results are shown to be in good agreement. (c) 2013 Wiley Periodicals, Inc.

Dimensions of religious and national identity among Irish adolescents growing up in two jurisdictions

This poster explores the impact of growing up in different socio-political environments in the border areas of the Republic of Ireland (RoI) and Northern Ireland (NI) on adolescents’ evaluations of their religious and national identities. The vast majority of the population of the Republic of Ireland are Catholic and Irish whereas in Northern Ireland, the majority are Protestant and British. 713 adolescents (NI= 415; RoI=298), who categorised their religious identity as Catholic and their nationality as Irish completed the Collective Self – Esteem (CSE) scale (Crocker & Luhtanen, 1990) with reference to either their religious (N=350) or national identity (n=363). The overall rating of CSE for the Irish identity was significantly higher than the rating of CSE for the Catholic Identity. This result was modified by a significant interaction - adolescents in the Republic of Ireland rated the CSE of their Irish nationality higher than those in Northern Ireland (20.99 vs. 19.95), whereas adolescents in Northern Ireland rated the CSE of their Catholic religious identity higher than their peers in the Republic of Ireland (19.97 vs 18.87). Further analysis of the CSE subscales revealed differing patterns of relationships according to the scale. The evaluation of the Public Collective Self-Esteem of national and religious identities were significantly higher in the Republic of Ireland than in Northern Ireland, however Private Collective Self-esteem did not differ according to jurisdiction. These findings are discussed in relation to the social context and current theoretical accounts of collective identification processes.

Physicochemical tolerance, habitat use and predation are drivers of patterns of coexistence and exclusion among invasive and resident amphipods

1. Patterns of coexistence and exclusion among resident and invading species in freshwaters may be generated by direct biotic interactions well as by indirect interactions with the broader abiotic and biotic environments. The North American ‘shrimp’ Crangonyx pseudogracilis (Crustacea: Amphipoda) is invasive in Europe where it forms complex patterns of apparent exclusion and coexistence with resident Gammarus spp. amphipods. Using a comprehensive integrated approach, we investigated the potential biotic and interacting abiotic factors driving these distribution patterns.
2. A 2009 of 69 sites revealed that of 56 river sites containing amphipods only 6 contained C. pseudogracilis and these always co-occurred with Gammarus spp.. In contrast, C. pseudogracilis was the only species present in the 12 ponds/reservoirs containing amphipods.
3. Field transplant experiments in ponds and laboratory oxygen tolerance experiments revealed that C. pseudogracilis tolerates physicochemical regimes which Gammarus spp. are incapable of surviving.
4. River microhabitat sampling showed C. pseudogracilis dominating in slower, more pooled and macrophyte-dense patches, while Gammarus spp. were dominant in faster, more riffled areas.
5. Field bioassays indicated that predation of C. pseudogracilis by Gammarus spp. may be frequent in patches of rivers if/when the species meet.
6. River drift sampling revealed that C. pseudogracilis was greatly underrepresented in night/day drift relative to the Gammarus spp.. Laboratory studies showed C. pseudogracilis to be more photophobic and less active than Gammarus spp., both behaviours potentially contributing to low drift prevalence and consequent reduced exposure to shared drift predators.
7. These interacting factors may ultimately contribute to the coexistence, exclusion and relative distributions of C. pseudogracilis and Gammarus spp.. The former is potentially subject to intense predation from the latter if they encounter one another in the same microhabitat. However, with C. pseudogracilis being more physicochemically tolerant and displaying different habitat utilisation patterns than the Gammarus spp. in respect of the benthos and drift, such encounters are probably minimised. Hence C. pseudogracilis can persist in the same sites with the Gammarus spp., albeit in different microhabitats.

The Holocene vegetation cover of Britain and Ireland: overcoming problems of scale and discerning patterns of openness

The vegetation of Europe has undergone substantial changes during the course of the Holocene epoch, resulting from range expansion of plants following climate amelioration, competition between taxa and disturbance through anthropogenic activities. Much of the detail of this pattern is understood from
decades of pollen analytical work across Europe, and this understanding has been used to address questions relating to vegetation-climate feedback, biogeography and human impact. Recent advances in modelling the relationship between pollen and vegetation now make it possible to transform pollen
proportions into estimates of vegetation cover at both regional and local spatial scales, using the Landscape Reconstruction Algorithm (LRA), i.e. the REVEALS (Regional Estimates of VEgetation Abundance from Large Sites) and the LOVE (LOcal VEgetation) models. This paper presents the compilation and analysis of 73 pollen stratigraphies from the British Isles, to assess the application of the LRA and describe the pattern of landscape/woodland openness (i.e. the cover of low herb and bushy vegetation) through the Holocene. The results show that multiple small sites can be used as an effective replacement for a single large site for the reconstruction of regional vegetation cover. The REVEALS vegetation estimates imply that the British Isles had a greater degree of landscape/woodland openness at the regional scale than areas on the European mainland. There is considerable spatial bias in the British Isles dataset towards wetland areas and uplands, which may explain higher estimates of landscape openness compared with Europe. Where multiple estimates of regional vegetation are available from within the same region inter-regional differences are greater than intra-regional differences, supporting the use of the REVEALS model to the estimation of regional vegetation from pollen data.