Wolverhampton Intellectual Repository and E-Theses: Recent submissions
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Perioperative exercise training for patients with gastrointestinal cancer undergoing surgery: A systematic review and meta-analysisExercise training is emerging as a supportive treatment strategy in surgical oncology, but its effects remain uncertain in patients with gastrointestinal cancer. The primary objective of this systematic review and meta-analysis was to evaluate the effects of perioperative exercise training on gastrointestinal cancer-specific mortality, recurrence, and surgical outcomes (postoperative complications, hospitalization, surgical stress) in patients with gastrointestinal cancer. Randomized or quasi-randomized controlled trials evaluating the effects of perioperative exercise training versus control in patients with GI cancer were eligible. MEDLINE, EMBASE, CENTRAL, CINAHL, PEDro, and SPORTDiscus were systematically searched on June 20, 2020. Data were synthesized using random-effects meta-analyses. Risk of bias was assessed using the Cochrane risk of bias tool 2, and the certainty of evidence was assessed using GRADE. Study selection, data extraction, risk of bias, and GRADE assessments were performed independently by two authors. Ten randomized controlled trials comprising 448 participants with gastrointestinal cancer were eligible. Meta-analyses indicated no statistical effects of exercise on postoperative complications (risk ratio: 1.11, 95% CI: 0.84; 1.47), readmissions (risk ratio: 2.76; 95% CI: 0.00, 9394.76), or postoperative length of stay (difference in means: −0.47, 95% CI: −17.2; 16.2 days). None of the eligible studies assessed gastrointestinal cancer-specific mortality or recurrence. Overall risk of bias was high or of some concerns in all studies, and the certainty of evidence was very low. The effects of perioperative exercise on cancer-specific and surgical outcomes are unknown in patients with gastrointestinal cancer due to lack of studies and very low certainty of evidence.
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Harms of exercise training in patients with cancer undergoing systemic treatment: a systematic review and meta-analysis of published and unpublished controlled trialsBackground: Exercise is recommended for people with cancer. The aim of this study was to evaluate the harms of exercise in patients with cancer undergoing systemic treatment. Methods: This systematic review and meta-analysis included published and unpublished controlled trials comparing exercise interventions versus controls in adults with cancer scheduled to undergo systemic treatment. The primary outcomes were adverse events, health-care utilization, and treatment tolerability and response. Eleven electronic databases and trial registries were systematically searched with no date or language restrictions. The latest searches were performed on April 26, 2022. The risk of bias was judged using RoB2 and ROBINS-I, and the certainty of evidence for primary outcomes was assessed using GRADE. Data were statistically synthesised using pre-specified random-effect meta-analyses. The protocol for this study was registered in the PROESPERO database (ID: CRD42021266882). Findings: 129 controlled trials including 12,044 participants were eligible. Primary meta-analyses revealed evidence of a higher risk of some harms, including serious adverse events (risk ratio [95% CI]: 1.87 [1.47–2.39], I2 = 0%, n = 1722, k = 10), thromboses (risk ratio [95% CI]: 1.67 [1.11–2.51], I2 = 0%, n = 934, k = 6), and fractures (risk ratio [95% CI]: 3.07 [3.03–3.11], I2 = 0%, n = 203, k = 2) in intervention versus control. In contrast, we found evidence of a lower risk of fever (risk ratio [95% CI]: 0.69 [0.55–0.87], I2 = 0% n = 1109, k = 7) and a higher relative dose intensity of systemic treatment (difference in means [95% CI]: 1.50% [0.14–2.85], I2 = 0% n = 1110, k = 13) in intervention versus control. For all outcomes, we downgraded the certainty of evidence due to imprecision, risk of bias, and indirectness, resulting in very low certainty of evidence. Interpretation: The harms of exercise in patients with cancer undergoing systemic treatment are uncertain, and there is currently insufficient data on harms to make evidence-based risk-benefits assessments of the application of structured exercise in this population. Funding: There was no funding for this study.
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Too hot to handle: African Caribbean pupils and students as toxic consumers and commodities in the educational marketSecondary sources are used in this paper to highlight how African Caribbean pupils and students – the Black British-born descendants of post-war Caribbean migrants – are victims of symbolic violence, because they are denied the educational capital needed to improve their social status. Since African Caribbean children entered the 1960s British educational sector, their learning has been perceived as problematic by the State. Although assimilation, integration and multicultural education policies were implemented to supposedly address the ‘problem’ of educating Black children, subsequent government reports identified racism as a significant barrier in their education. I argue here that the contemporary marketisation of education makes it increasingly difficult to distinguish between racism and competition, as causal factors of ethnic differences in educational attainment. Moreover, due to increasing private sector intervention and decreasing mediation by the State, racism is now hidden within the vicissitudes of the educational market. School exclusions and discriminatory practices in universities are viewed in this paper as major barriers to the economic success and future social mobility of Black Caribbean pupils and students. I conclude by suggesting that marketisation policies can be appropriated to ameliorate racism in education, but only if the political will to do so exists.
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Women in the UK construction industry: Are we still clinging to the ‘old boys club’?Purpose: The construction industry is famous for gender imbalance and reluctance in initiating change. In recent years, construction is becoming an attractive career choice for women. However, this change has been gradual. The purpose of this research was to understand the challenges women are facing in construction sector after a decade of implementation of the Equality Act 2010 in the UK and how women in the sector feel the industry could be further improved. This research investigated real life experiences to identify where the industry needs to make viable improvements. Design/methodology/approach: A qualitative research methodology was adopted. In total, 31 semi-structured interviews were conducted to collect data, which was then analysed using content analysis for inference and conclusion. Findings: This research revealed that women still experience adversity forcing them to work harder than usual to prove their belonging in construction sector. The ‘man’s world’ culture is still widespread. However, women have seen improvements over recent years but believe more can be done from an intersectionality perspective. This is pertinent due to the Brexit and Covid-19 situation. Originality/value: The study contributes to the field of equality and diversity in the construction sector. Women believe that factors such as bespoke initiatives, equal pay, flexible working hours (considering childcare and caring responsibilities), mental health and wellbeing support, and equality and diversity policies will enable the construction sector to create conducive environment for women now and in the future.
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Can first or last name uniqueness help to identify diaspora researchers from any country?Purpose: Diaspora researchers work in one country but have ancestral origins in another, either through moves during a research career (mobile diaspora researchers) or by starting research in the target country (embedded diaspora researchers). Whilst mobile researchers might be tracked through affiliation changes in bibliometric databases, embedded researchers cannot. This article reports an evidence-based discussion of which countries’ diaspora researchers can be partially tracked using first or last names, addressing this limitation. Design/methodology/approach: A frequency analysis of first and last names of authors of all Scopus journal articles 2001-2021 for 200 countries or territories. Findings: There are great variations in the extent to which first or last names are uniquely national, from Monserrat (no unique first names) to Thailand (81% unique last names). Nevertheless, most countries have a subset of first or last names that are relatively unique. For the 50 countries with the most researchers, authors with relatively national names are always more likely to research their name-associated country, suggesting a continued national association. Lists of researchers’ first and last name frequencies and proportions are provided for 200 countries.
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Digital consultations for weight management in the NHS: A qualitative evaluationReceiving digital healthcare consultations for weight management, in place of in-person appointments, has proliferated in recent years, accelerated by the COVID-19 pandemic. The objective of the present study was to investigate patients’ experiences of digital weight management services (DWMS) provided by the National Health Service (NHS). Particular emphasis was placed on examining the perceived benefits and limitations of DWMS so as to identify potential means of improving provision. Sixteen patients (eight male; eight female) accessing digital consultations at one of two West Midlands (UK) NHS trusts, participated in semi-structured interviews. Interviews were transcribed verbatim and analysed via thematic analysis. We identified three overarching themes and associated sub-themes that reflect the perceived benefits and limitations of service provision as identified by patients. These were technology acceptability (sub-themes ‘challenges’, ‘requirements/facilitators’, and ‘beneficial features’); treatment acceptability (sub-themes ‘treatment features’, ‘patient attributes’, and ‘practitioner skills’); and treatment efficacy (sub-themes ‘treatment features’, ‘patient attributes’, and ‘practitioner skills’). Themes identified in this study have informed recommendations intended to enhance acceptability of DWMS technology and treatment, potentially encouraging engagement and increasing treatment efficacy. Limitations of the present study and recommendations for further research are also presented.
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Watery bodies, natures mortes, lost backgrounds and decapitated heads: contemporary painting practice in the AnthropoceneThis research project uses the concept of the Anthropocene as a catalyst for contemporary painting practice and motors a theoretical enquiry apportioned into written chapters and visual essays. The implication of this approach is that painting practice springboards theoretical research in turn stimulating art practice. Using a practice-based methodology and a semio-materialist perspective, I expand the still life genre and depart from artistic practices that default to landscape, site, environment and place when responding to the concept of the Anthropocene. To sidestep the Anthropocene's scalar vastness, abstraction and representational obstacles, I locate practice within an 'everyday' enquiry, where the objects painted and the artistic artefacts created, are manifestations of the Anthropocene. The research develops what I call the Painting-Anthropocene Nexus, where painting and the Anthropocene intersect. This framework conscripts the themes of agency, materiality, subjects and objects, foregrounds and backgrounds and the representation of nature to identify how early modern European painting has contributed to the concept and condition of the Anthropocene: its anthropocenics. The anthropocenics investigated are the human enticed into narcissism through still and reflective water; subjects and objects severed in visual representations of decapitation; and the backgrounding of nature through linear perspective. In each case my painting practice offers alternatives through a range of media, techniques and motifs.
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An empirical study of establishing guidelines for evaluation and adoption of secure and cost effective cloud computingThis research investigates the factors influencing large enterprises, small and medium-sized enterprises (SMEs) behavioural intention toward adopting cloud computing (CC) services. The increasing adoption of CC services is changing how businesses maintain, select, update, and manage information and communication technology. In particular, CC services have the potential to improve IT systems reliability and scalability, allowing large enterprises and SMEs to use their limited resources on their core business and strategy. Many factors and variables influence technology adoption and usage decisions in the large enterprises and SMEs context. Despite the extensive literature, there still needs to be more research on the factors influencing large enterprises and SMEs uptakes CC services adoption. Therefore, examining large enterprises and SMEs adoption of CC is essential for successfully implementing this system. This thesis uses environmental, human, organisational, and technological factors to model the relationship between the variables considered and CC services adoption to increase the probability that large enterprises, and SMEs adopt CC services successfully. The study considers the influence of eleven variables: external support, competitive pressure, senior management support, employee's cloud knowledge, adequate resources, information intensity, relative advantage, complexity, compatibility, security/privacy, and cost-effectiveness. A quantitative research approach was applied using an online questionnaire. A conceptual model of CC services adoption by large enterprises and SMEs has been developed. Research factors and variables identified to influence the likelihood that large enterprises and SMEs would adopt CC services successfully. In particular, we found nine research variables to be statistically significant, and two adequate support and complexity non-significant. It was found that CC services adoption variances among the size of organisations to differ and be statistically significant towards adopting CC services. Hence, this result is important to owners and decision makers of large enterprises, and SMEs enterprises, service providers, service consultants, and governments to assist them in facilitating the adoption of CC services by large enterprises, and SMEs. Further, this may help to establish strategies for large enterprises, and SMEs to confirm a better adoption of CC services.
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Hypertextuality in the diegesis of the megamusical: the aesthetic and cognitive relationship between silent era film and contemporary musical theatreThis research regards the West End/Broadway musical as a hypertextual performance form through which early cinema aesthetics can be seen and felt by spectators. The ‘closed fictional worlds’ (Slugan, 2021: 142) presented by silent fiction films made between 1895 and 1930 echo those of stage megamusicals by virtue of their joint musicality and metatheatricality. From this understanding, the thesis offers a unique perspective on musical theatre by examining its conventions through the lens of silent era cinema. Accordingly, visual tropes, performance techniques and sound phenomena that are shared between European and North American silent films and contemporary musical theatre practices are uncovered throughout its chapters. Additionally, the study aims to confirm its interpretation of contemporary musicals as a ‘transmodalization’ (Genette, 1997: 395) of silent era cinema by grounding the mediums’ theatrical spaces in the corresponding bodily spaces of the hypothetical spectator. It achieves this with reference to Jean Piaget’s theory of cognitive development (Piaget, 1962; Piaget and Inhelder, 1969). Specific songs, scenes, and theatrical moments are extracted from an eclectic variety of musical theatre and silent film texts and are subjected to close readings across three theory chapters. Two case studies then illustrate the importance of musical theatre’s transtextuality in determining its unspoken link to cinema’s silent era. The first case study concerns a single narrative that is depicted in both The Sealed Room (Griffith, 1909) and the ‘Il Muto’ scene from Lloyd Webber’s The Phantom of the Opera (1989). Through comparison, it argues that the stage musical’s apparatus is analogous to that of silent film making. The other case study elucidates the metatextual process of revision that characterises Joe Brooks and Dusty Hughes’ score for the short-lived British stage musical Metropolis (1989). It approaches the musical’s sound stimuli as a critical conflation of two contrasting silent film accompaniments, as opposed to a straightforward adaptation of Fritz Lang’s 1927 science-fiction classic. The collective findings of the thesis conclude that vestiges of silent film’s audio-visual aesthetic can be experienced through performances of many popular West End and Broadway productions in varying degrees of visibility. They indicate that megamusicals and silent films both present a distinctive type of diegesis that is palimpsestic, topographic, reflexive and postdramatic. Musical theatre’s hypertextuality is the key to accessing the elusive relationship and understanding that silent film felt much like the megamusical for its early twentieth century audiences.
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Exploring clients’ and therapists’ experiences of compassion focused therapy in fostering post-traumatic growthIntroduction: Within the trauma-based literature, research has started to highlight how some individuals may experience positive, life-changing responses following traumatic life events which have been described as post-traumatic growth (PTG). Research has started to focus on the role of trauma-based psychotherapy approaches in the facilitation of PTG for individuals who have experienced trauma, with limited research focusing specifically on sexual abuse. Aim: This research aims to capture two different perspectives through two separate studies. The first study sets out to explore clients’ experiences of compassion-focused therapy in facilitating post-traumatic growth following experiencing sexual abuse. The second study sets to explore Compassion-focused therapists’ experience of compassion-focused therapy facilitating post-traumatic growth for clients who have experienced sexual abuse. Methodology: Interpretative Phenomenological Analysis (IPA) was employed as an approach to understand lived experiences and the meanings/understandings which my participants have ascribed to those experiences. IPA was employed due to the limited amount of qualitative research which has focused on this phenomenon. Method: Semi-structured interviews were carried out with participants to examine their phenomenological experiences online. Participants: Three client participants were interviewed for the client study and eight therapist participants were interviewed for the therapist study. Findings: For the client study, four superordinate themes were found: Life before therapy, the therapeutic process, changes within oneself and regaining aspects of their life back. For the therapist study, four superordinate themes were also found: Working through the therapeutic process, the witnessing of changes, maintenance of PTG post-therapy and knowing CFT works at a personal level. Conclusions: Within both studies, the important role of de-shaming and taming the inner critic was discussed. The facilitation of PTG was experienced and witnessed by both sets of participants and the maintenance of PTG post-therapy was explored. Implications: The findings highlight the importance of further research into this phenomenon, exploring different types of trauma with CFT and different study designs. Implications for practice are discussed, which include the use of CFT-based work within Improving access to psychological therapies (IAPT).
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“Anything I do now feels like an act of resilience”: adversity, resilience, and wellbeing in female survivors of domestic abuseBackground: The study sought to explore the under-researched areas of adversity, resilience, and wellbeing in female survivors of Domestic Abuse (DA). We employed a multi-phase mixed-methods research design comprising a cross-sectional online quantitative survey in phase one and qualitative remote interviews in phase two. Method: In phase one, a convenience sample of 119 adult female participants, 63 who had experienced DA and 56 in a control group, completed the Adverse Childhood Experiences (ACE) Questionnaire, the Short Warwick-Edinburgh Mental Well-being Scale, the Depression, Anxiety, and Stress Scale, and the Connor-Davidson Resilience scale. In phase two, 8 of the participants from phase one who had experienced DA were recruited for semi-structured interviews to explore their experiences in depth and these were analysed using thematic analysis. Results: In phase one, survivors of DA were found to have experienced significantly more ACEs and to have higher levels of anxiety and stress than the control group. Survivors of DA were more likely to have experienced emotional, physical, and sexual abuse and emotional neglect and be exposed to substance abuse or alcoholism and mental illness within their household in childhood than the control group. Resilience was found to moderate the relationship between ACEs and mental wellbeing, such that resilience is less protective against poor wellbeing in those with high ACEs. Resilience was also found to be a stronger predictor of mental wellbeing than ACEs. In phase two, the thematic framework included five major themes: Early life challenges and adversity, Coping strategies, Support and judgement, Resilience and development, and Psychological distress, health, and wellbeing. Conclusion: Results indicate that early life adversity is an additional concern for adult female survivors of DA. They also highlight the importance of resilience, coping, and support and indicate areas of psychological distress and need where services and helping professionals can support survivors.
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The scent enriched primateZoos worldwide play an important role in both in situ and ex situ conservation, such as providing breeding programmes and reintroductions into the wild. Zoo populations are crucial as a buffer against extinction. However, a mismatch between the wild and zoo environments can lead to psychological as well as physiological health issues, such as stress, boredom, diabetes, and obe-sity. These problems, in turn, can impact the reproductive success of individuals. Consequently, some primate species have reduced breeding success when housed in zoos compared to their wild counterparts. To prevent the onset of behavioural, physiological and cognitive, negative effects and to continually improve the welfare of their animals, zoos widely implement different types of environmental enrichment. There are many forms enrichment can take, such as feeding, puzzles and training, but sensory enrichments, including implementing the use of scents, are currently understudied. Scent enrichments are less utilized despite their promise in multiple re-search studies showing that they may have positive effects on welfare for zoo-housed animal species, including non-human primates. Despite being traditionally considered to be microsmatic, various lines of evidence suggest that olfaction plays a larger role in primates than previously thought. This review is therefore aimed to focus on scent-based enrichment and the specifics of captive primates.
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Age-related differences in trunk kinematics and interplanar decoupling with the pelvis during gait in healthy older versus younger menThis study investigated age-related differences in trunk kinematics during walking in healthy men. Secondary aims were to investigate the covarying effects of physical activity (PA) and lumbar paravertebral muscle (LPM) morphology on trunk kinematics, and the effect of age on interplanar coupling between the trunk and pelvis. Three-dimensional (3D) trunk and pelvis motion data were obtained for 12 older (67.3 ± 6.0 years) and 12 younger (24.7 ± 3.1 years) healthy men during walking at a self-selected speed along a 10 m walkway. Phase-specific differences were observed in the coronal and transverse planes, with midstance and swing phases highlighted as instances when trunk and pelvic kinematics differed significantly (p < 0.05) between the younger group and older group. Controlling for age, fewer significant positive correlations were revealed between trunk and pelvic ranges and planes of motion. LPM morphology and PA were not significant covariates of age-related differences in trunk kinematics. Age-related differences in trunk kinematics were most apparent in the coronal and transverse planes. The results further indicate ageing causes an uncoupling of interplanar upper body movements during gait. These findings provide important information for rehabilitation programmes in older adults designed to improve trunk motion, as well as enable identification of higher-risk movement patterns related to falling.
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Teaching programming in the computer science strand of the 2014 National Curriculum for computing at key stage 4: challenges, difficulties and prospectsA national curriculum for the study of computing became compulsory in English secondary schools in September 2014, replacing the study of information and communications technology with computer science (CS). This posed difficulties for teachers and students who did not have knowledge or experience of programming. Teachers faced a variety of challenges, including lack of subject knowledge and confidence. For many students, programming is among the most demanding aspects of CS. This study was designed to investigate and gain a critical understanding of the teaching of computer programming (CP) at Key Stage 4 (KS4; year 10 - 11) of the CS curriculum, including assessing the impact of learning CP and students' perceptions of CS and their overall performance in the subject. The study also explored how teachers managed the teaching of CP and the challenges they faced in implementing the national curriculum for computing. Furthermore, the study investigated the measures to improve the teaching of CP and the factors that have an impact on the effective teaching of the CP curriculum. The study sample comprised 400 teachers and students. The findings indicate that the main challenges for teachers in implementing the programming curriculum include time, financial and moral support, and being able to keep up to date with emerging developments in the field. In addition, the study found that the issues faced by students learning programming include a lack of time, the perceptions that it is a ‘difficult’ subject and students’ insufficient understanding of programming. The findings also suggest that schools have made efforts to overcome these challenges and are willing to adopt programming as a subject and to help, encourage, develop and improve students’ ability to learn programming; however, the results indicate that it is essential that schools address the shortage of teaching staff with specialised knowledge of CP. This study revealed that six factors can help to overcome the challenges and difficulties where three factors are for students (perceptions towards learning and teaching programming, benefits, and support) and the other three factors are for teachers (effect of supportive attributes on the teaching of programming, benefits of teaching programming in school and Implementation of the programming curriculum). The findings of this study will be useful for both teachers who are teaching programming and students who are learning programming in secondary schools.
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Plasma membrane calcium ATPase 4 (PMCA4) and inflammation of the aortic endotheliumBackground: The inflammatory response relies on the well-coordinated trafficking of leukocytes from the circulation to sites of tissue injury. The endothelial expression of cell adhesion molecules, namely the selectin family, mediates the initial adhesive interactions between leukocytes and the endothelium. Immune cell infiltration is often involved in the initiation and progression of several vascular diseases, including atherosclerosis. Plasma Membrane Calcium ATPase 4 (PMCA4) belongs to a family of transmembrane ion transporters that extrude calcium from the cytosol to the extracellular environment (Strehler, 2015). They are the only high-affinity Ca2+ extrusion system in mammalian cells encoded by the ATP2B1-4 genes (PMCA1–4) (Strehler, 2015). PMCA4 acts as a structural protein providing a scaffold to interacting proteins at the plasma membrane of endothelial cells. Several of these interactions demonstrate functional significance, accounting for its emerging role in signal transduction. This work contributes to the delineation of PMCA4 in the physiology of the vascular endothelium and characterises a role in leukocyte adhesion and trafficking. Methods and Results: The effect of the pro-inflammatory cytokine IL-1β on the expression of PMCA4 was examined. A time and dose-dependent downregulation of PMCA4 mRNA and protein expression in human Aortic Endothelial Cells (AoEC) was observed. Differential gene expression was determined in PMCA4 silenced AoEC using an ECM-CAM array and RNA-sequencing. The siRNA-mediated knockdown of PMCA4 induced the expression of cell adhesion molecules, Selectin P (SELP) and SELL. The knockdown enhanced the IL-1β-induced expression of the metalloproteinases ADAMTS1 and -4. Ingenuity pathway analysis (IPA) revealed a role in immune cell trafficking with a propensity to develop aneurysms (activation z-score,-1.177). Similarly, silencing PMCA4 enhanced the VEGF-induced expression of ADAMTS1, VCAM-1 and SELE. Cyclosporin A partially ablated this enhancement through VEGF, implicating CN/NFAT transcriptional activity. Consistent with the IPA, a significant decrease in PMCA4 mRNA expression was observed in abdominal aortic lesions from hypercholesterolaemic ApoE-deficient mice infused with angiotensin II. Conclusion: The downregulation of PMCA4 is associated with a state of endothelial activation, indicated by the induction of cell adhesion molecules. Our results demonstrate that PMCA4 regulates intracellular signalling in the endothelium in response to leukocyte-derived inputs. Reinforced by bioinformatic analysis, our findings suggest that PMCA4 may influence leukocyte adhesion and trafficking on the endothelium.
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The experience of navigating mental health difficulties in the workplace, with a focus on disclosureMental health difficulties are a prevalent source of distress and disability in the UK. To gain support to maintain employment, disclosure of mental health difficulties is often required. Research indicates that fears of discrimination can inhibit disclosure, but that when disclosure does occur this can be a positive experience. Nevertheless, the literature review presents a gap in current understanding of experiencing, navigating, and disclosing mental health difficulties in the workplace. The aim of this research is to present a detailed and illustrative narrative of employees’ experiences of mental health difficulties and how they have navigated these experiences, often through disclosure, at work. Seven one-to-one semi-structured interviews were conducted with employees from different professions. Interpretative Phenomenological Analysis (IPA) was used to facilitate an in-depth exploration of participants’ experiences and provide insight into how participants made sense of their mental health difficulties and the revelation of their distress. This produced four superordinate themes and 12 subordinate themes. The superordinate theme of Power consisted of three subthemes: Being Heard, Stigma and Financial Culture. Convergence of Work and Home Life comprised of an Accumulation of Adverse Life Events, Spillover and Adapting to the Restrictions during the Pandemic. The third superordinate theme of Connection to Others related to Nurturing Colleagues, Feeling Valued and Relationship to Management. The Recovery Journey pertained to subthemes of Accessing Mental Health Care, Barriers to Coping and Resilience. The insights gathered by this study are reviewed in comparison with existing literature to facilitate better understanding of employees with mental health difficulties’ unique and specific needs. Implications for counselling psychology and occupational mental health are discussed, in order that professionals can offer better-tailored forms of psychological support for employees experiencing mental health difficulties. Avenues for further research are also explored.
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Abiraterone acetate plus prednisolone with or without enzalutamide for patients with metastatic prostate cancer starting androgen deprivation therapy: final results from two randomised phase 3 trials of the STAMPEDE platform protocolBackground Abiraterone acetate plus prednisolone (herein referred to as abiraterone) or enzalutamide added at the start of androgen deprivation therapy improves outcomes for patients with metastatic prostate cancer. Here, we aimed to evaluate long-term outcomes and test whether combining enzalutamide with abiraterone and androgen deprivation therapy improves survival. Methods We analysed two open-label, randomised, controlled, phase 3 trials of the STAMPEDE platform protocol, with no overlapping controls, conducted at 117 sites in the UK and Switzerland. Eligible patients (no age restriction) had metastatic, histologically-confirmed prostate adenocarcinoma; a WHO performance status of 0–2; and adequate haematological, renal, and liver function. Patients were randomly assigned (1:1) using a computerised algorithm and a minimisation technique to either standard of care (androgen deprivation therapy; docetaxel 75 mg/m2 intravenously for six cycles with prednisolone 10 mg orally once per day allowed from Dec 17, 2015) or standard of care plus abiraterone acetate 1000 mg and prednisolone 5 mg (in the abiraterone trial) orally or abiraterone acetate and prednisolone plus enzalutamide 160 mg orally once a day (in the abiraterone and enzalutamide trial). Patients were stratified by centre, age, WHO performance status, type of androgen deprivation therapy, use of aspirin or non-steroidal anti-inflammatory drugs, pelvic nodal status, planned radiotherapy, and planned docetaxel use. The primary outcome was overall survival assessed in the intention-to-treat population. Safety was assessed in all patients who started treatment. A fixed-effects meta-analysis of individual patient data was used to compare differences in survival between the two trials. STAMPEDE is registered with ClinicalTrials.gov (NCT00268476) and ISRCTN (ISRCTN78818544). Findings Between Nov 15, 2011, and Jan 17, 2014, 1003 patients were randomly assigned to standard of care (n=502) or standard of care plus abiraterone (n=501) in the abiraterone trial. Between July 29, 2014, and March 31, 2016, 916 patients were randomly assigned to standard of care (n=454) or standard of care plus abiraterone and enzalutamide (n=462) in the abiraterone and enzalutamide trial. Median follow-up was 96 months (IQR 86–107) in the abiraterone trial and 72 months (61–74) in the abiraterone and enzalutamide trial. In the abiraterone trial, median overall survival was 76·6 months (95% CI 67·8–86·9) in the abiraterone group versus 45·7 months (41·6–52·0) in the standard of care group (hazard ratio [HR] 0·62 [95% CI 0·53–0·73]; p<0·0001). In the abiraterone and enzalutamide trial, median overall survival was 73·1 months (61·9–81·3) in the abiraterone and enzalutamide group versus 51·8 months (45·3–59·0) in the standard of care group (HR 0·65 [0·55–0·77]; p<0·0001). We found no difference in the treatment effect between these two trials (interaction HR 1·05 [0·83–1·32]; pinteraction=0·71) or between-trial heterogeneity (I2 p=0·70). In the first 5 years of treatment, grade 3–5 toxic effects were higher when abiraterone was added to standard of care (271 [54%] of 498 vs 192 [38%] of 502 with standard of care) and the highest toxic effects were seen when abiraterone and enzalutamide were added to standard of care (302 [68%] of 445 vs 204 [45%] of 454 with standard of care). Cardiac causes were the most common cause of death due to adverse events (five [1%] with standard of care plus abiraterone and enzalutamide [two attributed to treatment] and one (<1%) with standard of care in the abiraterone trial). Interpretation Enzalutamide and abiraterone should not be combined for patients with prostate cancer starting long-term androgen deprivation therapy. Clinically important improvements in survival from addition of abiraterone to androgen deprivation therapy are maintained for longer than 7 years.
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Management of patients with advanced prostate cancer—metastatic and/or castration-resistant prostate cancer: report of the Advanced Prostate Cancer Consensus Conference (APCCC) 2022Background: Innovations in imaging and molecular characterisation together with novel treatment options have improved outcomes in advanced prostate cancer. However, we still lack high-level evidence in many areas relevant to making management decisions in daily clinical practise. The 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) addressed some questions in these areas to supplement guidelines that mostly are based on level 1 evidence. Objective: To present the voting results of the APCCC 2022. Design, setting, and participants: The experts voted on controversial questions where high-level evidence is mostly lacking: locally advanced prostate cancer; biochemical recurrence after local treatment; metastatic hormone-sensitive, non-metastatic, and metastatic castration-resistant prostate cancer; oligometastatic prostate cancer; and managing side effects of hormonal therapy. A panel of 105 international prostate cancer experts voted on the consensus questions. Outcome measurements and statistical analysis: The panel voted on 198 pre-defined questions, which were developed by 117 voting and non-voting panel members prior to the conference following a modified Delphi process. A total of 116 questions on metastatic and/or castration-resistant prostate cancer are discussed in this manuscript. In 2022, the voting was done by a web-based survey because of COVID-19 restrictions. Results and limitations: The voting reflects the expert opinion of these panellists and did not incorporate a standard literature review or formal meta-analysis. The answer options for the consensus questions received varying degrees of support from panellists, as reflected in this article and the detailed voting results are reported in the supplementary material. We report here on topics in metastatic, hormone-sensitive prostate cancer (mHSPC), non-metastatic, castration-resistant prostate cancer (nmCRPC), metastatic castration-resistant prostate cancer (mCRPC), and oligometastatic and oligoprogressive prostate cancer. Conclusions: These voting results in four specific areas from a panel of experts in advanced prostate cancer can help clinicians and patients navigate controversial areas of management for which high-level evidence is scant or conflicting and can help research funders and policy makers identify information gaps and consider what areas to explore further. However, diagnostic and treatment decisions always have to be individualised based on patient characteristics, including the extent and location of disease, prior treatment(s), co-morbidities, patient preferences, and treatment recommendations and should also incorporate current and emerging clinical evidence and logistic and economic factors. Enrolment in clinical trials is strongly encouraged. Importantly, APCCC 2022 once again identified important gaps where there is non-consensus and that merit evaluation in specifically designed trials. Patient summary: The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with healthcare providers worldwide. At each APCCC, an expert panel votes on pre-defined questions that target the most clinically relevant areas of advanced prostate cancer treatment for which there are gaps in knowledge. The results of the voting provide a practical guide to help clinicians discuss therapeutic options with patients and their relatives as part of shared and multidisciplinary decision-making. This report focuses on the advanced setting, covering metastatic hormone-sensitive prostate cancer and both non-metastatic and metastatic castration-resistant prostate cancer. Twitter summary: Report of the results of APCCC 2022 for the following topics: mHSPC, nmCRPC, mCRPC, and oligometastatic prostate cancer. Take-home message: At APCCC 2022, clinically important questions in the management of advanced prostate cancer management were identified and discussed, and experts voted on pre-defined consensus questions. The report of the results for metastatic and/or castration-resistant prostate cancer is summarised here.
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Quality of life measurements from the patient perspective: capturing the heterogeneity of the patient experience in a standardised wayFor patients, quality of life is the confluence and interaction of multiple factors related to both the disease and to how life is lived with and beyond the disease. When tasked with completing a quality-of-life questionnaire, patients may well wonder for whose benefit this is, which really needs to be made clear. We discuss some of the issues around quality-of-life questionnaires and the challenge of the heterogeneity of the patient experience. Patient summary: This mini-review discusses quality-of-life measurements from the patient perspective and the need to take account of the patient's life and not just the disease.
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In which fields do higher impact journals publish higher quality articles?The Journal Impact Factor (JIF) and other indicators that assess the average citation rate of articles in a journal are consulted by many academics and research evaluators, despite initiatives against overreliance on them. Undermining both practices, there is limited evidence about the extent to which journal impact indicators in any field relate to human judgements about the quality of the articles published in the field’s journals. In response, we compared average citation rates of journals against expert judgements of their articles in all fields of science. We used preliminary quality scores for 96,031 articles published 2014-18 from the UK Research Excellence Framework (REF) 2021. Unexpectedly, there was a positive correlation between expert judgements of article quality and average journal citation impact in all fields of science, although very weak in many fields and never strong. The strength of the correlation varied from 0.11 to 0.43 for the 27 broad fields of Scopus. The highest correlation for the 94 Scopus narrow fields with at least 750 articles was only 0.54, for Infectious Diseases, and there was only one negative correlation, for the mixed category Computer Science (all), probably due to the mixing. The average citation impact of a Scopus-indexed journal is therefore never completely irrelevant to the quality of an article but is also never a strong indicator of article quality. Since journal citation impact can at best moderately suggest article quality it should never be relied on for this, supporting the San Francisco Declaration on Research Assessment (DORA).
