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PURPOSE: Despite evidence of clinical benefits, widespread implementation of remote symptom monitoring has been limited. We describe a process of adapting a remote symptom monitoring intervention developed in a research setting to a real-world clinical setting at two cancer centers. METHODS: This formative evaluation assessed core components and adaptations to improve acceptability and fit of remote symptom monitoring using Stirman's Framework for Modifications and Adaptations. Implementation outcomes were evaluated in pilot studies at the two cancer centers testing technology (phase I) and workflow (phase II and III) using electronic health data; qualitative evaluation with semistructured interviews of clinical team members; and capture of field notes from clinical teams and administrators regarding barriers and recommended adaptations for future implementation. RESULTS: Core components of remote symptom monitoring included electronic delivery of surveys with actionable symptoms, patient education on the intervention, a system to monitor survey compliance in real time, the capacity to generate alerts, training nurses to manage alerts, and identification of personnel responsible for managing symptoms. In the pilot studies, while most patients completed > 50% of expected surveys, adaptations were identified to address barriers related to workflow challenges, patient and clinician access to technology, digital health literacy, survey fatigue, alert fatigue, and data visibility. CONCLUSION: Using an implementation science approach, we facilitated adaptation of remote symptom monitoring interventions from the research setting to clinical practice and identified key areas to promote effective uptake and sustainability.

Funding Acknowledgements None Background Patients undergoing angiography and percutaneous coronary intervention (PCI) were historically reviewed post procedure by a member of the medical team who assesses the patient’s suitability for discharge and completes the discharge letter. Over the past 10 years, the number of patients admitted for these procedures as day cases has increased significantly. In addition, there has been an expansion in nursing roles in the UK with the development of a variety of clinical nurse specialist (CNS) posts which have taken over many of the traditional medical roles. The majority of patients undergoing elective angiography and PCI are admitted to a day case unit at this tertiary cardiac centre. There is no designated medical cover for the unit and medical staff from the acute cardiac unit are called to review patients and complete their discharge paperwork in addition to their other duties. This frequently results in delayed discharge and patients going home without a discharge summary. It was therefore proposed that suitably qualified CNSs could be trained to discharge these patients and others undergoing day case cardiology procedures. From June 2017, the CNS team took over the role of reviewing patients post procedure and completing the discharge letter. Purpose The aim of the study was to evaluate if CNSs were able to discharge patients and provide a timely and effective service following elective cardiology procedures and to obtain patient feedback. Method Data on the number of patients reviewed by the CNSs from June 2017 to the end of December 2019, were prospectively collected in a dedicated database. A pilot study of patient experience was carried out in January 2020. Patients were given a questionnaire which asked about the explanation they received from the CNS regarding the procedure they had undergone, if their medication was reviewed and discussed with them, and if they received a discharge summary to take home. Results 1287 patients were reviewed by the CNS team during the above period. 811 (63.0%) patients had undergone angiography and 423 (32.9%) PCI. Informal feedback from the staff working on the day case unit included that patients were discharged earlier, had improved knowledge about their procedure and that the discharge letter was more detailed when completed by the CNS team. Eight patients completed the pilot questionnaire. Six were discharged by one of the CNS team, one by a doctor and one patient was not sure who did their discharge. All patients were very satisfied with the process and the information they were given. Conclusion Experienced CNSs can deliver high-quality, timely discharge of patients following cardiology procedures. This process is being used as a template to expand nurse-led discharge to other areas in cardiology. Patient experience will continue to be audited with a larger sample size in 2020.

Funding Acknowledgements None Background Rapid Access Chest Pain clinics (RACPCs) were established in the UK in 2000 following the publication of the National Service Framework for Coronary Heart Disease. Patients underwent an exercise test (ETT) in the clinic as part of a ‘one-stop’ protocol with follow-up only if further investigation was required. In 2010, the National Institute for Health and Care Excellence (NICE) produced guidelines for the assessment and diagnosis of chest pain of recent onset (CG95), replacing the recommendation for ETT with non-invasive functional testing for patients with an intermediate pre-test probability of coronary artery disease (CAD), necessitating multiple appointments to evaluate the patient’s symptoms. The guidelines were updated in 2016, with a new recommendation that patients with atypical or typical chest pain should undergo CT coronary angiography (CTCA) as the first diagnostic test. Purpose The aim of this study was to investigate the feasibility and potential benefit of performing same -day CTCA in the RACPC. Method From November 2016 all patients with atypical or typical chest pain attending the RACPC at this tertiary cardiac centre were referred for CTCA unless alternative investigation was clinically indicated. From February 2018, same day CTCA was offered to some patients. Up to two scans could be performed in each clinic, which was increased to up to three in June 2018. Results A total of 985 patients were seen in the nurse-led clinic between 12/02/2018 and 30/11/2019. 473 patients were referred for CTCA (48.0%) and 314 scans were carried out in the clinic (66.4%). Of those scans carried out in clinic, 128 patients had a CTCA which showed no evidence of CAD (40.8%) and 34.4% of scans showed non-obstructive CAD. In 18.2% of patients, the CTCA showed significant CAD and in 21 patients (6.7%) the scan was inconclusive. Patient with inconclusive scans underwent further testing which was negative in all cases. The outcome for patients with significant CAD (57 patients) is shown in the table. Conclusion CTCA on the same day as the RACPC appointment is feasible and facilitates rapid further investigation and treatment of patients with potentially significant CAD. It also enables patients with non-significant or no CAD to be reassured that their symptoms are unlikely to be cardiac which will reduce anxiety and allow timely investigation of other causes of the chest pain. Nurses need training in the risks of radiation in order to be able to request the scans and enable the clinic to be nurse-led.

The use of X-ray and neutron scattering techniques for the study of spread films and deposited Langmuir Blodgett (LB) films are discussed The implications for LB deposition of reflectivity results from docosanoic acid films spread on cadmium chloride solution are discussed. Recent X-ray reflectivity studies of spread films of three phthalocyanine derivatives are used to explain the shapes of their surface pressure-surface area isotherm: and their deposition properties. Neutron reflectivity from 4 cyano 4n-pentyl terphenyl have shown the possibility of monolayer to multilayer transition: on the aqueous subphase surface. Other types of scattering measurement and their future applications are briefly discussed.

SUMMARY Hypophysectomized red-spotted newts [Notophthalmus (Triturus, Diemictylus) viridescens viridescens Rafinesque] received autoplastic, homoplastic or xenoplastic grafts of pituitary glands beneath the lower jaw. Autografted animals, in accord with previous observations, survived indefinitely. Homografted animals had a mean survival time several times longer than either that of unimplanted, hypophysectomized animals or that of homografts of skin. No difference between rates of iodine turnover was found between thyroid glands of animals with homografts and animals with autografts but in both groups the rates of iodine turnover were lower than in intact controls. Great variation was found among the mean survival times of animals with xenografts. Newts with pituitary grafts from the frog, Rana pipiens, survived about as long as unimplanted hypophysectomized animals. Pituitary grafts from the salamander, Desmognathus monticola, apparently gave rise to some toxic reaction since their host newts died within short periods of time, yet newts with grafts from the mudpuppy, Necturus maculosus, lived longer than hypophysectomized control animals and some newts grafted with glands from a west coast newt, Taricha torosa, lived indefinitely.

A LTHOUGH the coagulation of blood has been widely studied in avian and mammalian subjects, relatively little attention has been directed toward the phenomenon as it appears in the lower vertebrates. The Amphibia, however, have not been entirely neglected. The various investigations of Tait and his collaborators (cf. Tait and Green, 1926), as well as those of a few earlier workers cited by them, have brought forth certain information concerning the coagulation of blood in the frog. All amphibian blood thus far described has been found to contain delicate structures

Several neurotransmitters and hormones with potential to trigger a simultaneous contraction of the oviducts and the spermathecal myoepithelium were examined. Saline (0.05 ml), or 0.05 ml saline plus acetylcholine (9 mg), norepinephrine (50 micrograms), arginine-vasotocin (25 units), prostaglandin F2 alpha (3 micrograms) were injected into the spermathecal region of female newts (n = 24 per group). The numbers of sperm present in the cloacae of prostaglandin-injected animals (107 +/- 30 SEM) were significantly greater than the numbers detected in saline (27 +/- 5 SEM) and in uninjected (14 +/- 3 SEM) controls. Smaller and less consistent increases in the numbers of sperm were detected in the vasotocin- and norepinephrine-injected groups. Study of sections from ovulating female newts failed to produce evidence that pressure from the passage of ova through the posterior portion of the oviduct forced sperm from the spermatheca. Observations indicate an active role for the spermathecal myoepithelium in the discharge of stored sperm and of a role for prostaglandin F2 alpha in triggering that discharge.

Thyroidal function in the red-spotted newt was assessed both in 125 I tracer studies and in the measurement of glandular and circulating thyroxine (T 4 ) and triiodothyronine (T 3 ) by radioimmunoassay (RIA). Thyroidal uptake of 125 I was low, being 0.6% at 2 days and 3.6% at 14 days following injection of the tracer. A significant fraction of the injected dose continued to circulate as inorganic iodide at 7 and 14 days following injection, indicating a low rate of renal clearance for iodine. [ 125 I]T 4 represented only 6.2% of thyroidal 125 I at 2 days post-injection, but this figure had increased to 14% by 14 days, suggesting a slow but significant synthesis of hormone. By RIA the T 4 content in thyroids of animals freshly collected in the field was 3.42 ± 0.16 ug/mg protein, a level comparable to that found in beef thyroids. In contrast T 3 stores in the thyroid of the newt were only 9.1 ± 1.2 ng/mg protein. Although no [ 125 I]T 4 was detected in the serum of animals for as long as 21 days after injection, circulating thyroid hormones were detected by RIA at levels of 3.0 ± 0.3 ng T4hn1 and 0.28–0.72 ng T 3 /ml in freshly collected animals. The data suggest that T 4 in the serum may arise mainly from peripheral deiodination of T 4 . Large amounts of an iodoprotein with electrophoretic properties of thyroglobulin were found in the serum of newts. This protein contained 5% of the serum 125 I at 2 days postinjection and accounted for 30% of the serum radioactivity at 14 days. In captive newts, serum T 4 levels were three times greater and glandular T 4 levels approximately two times lower than those of freshly collected animals, suggesting that the newt thyroid responds to the stresses of captivity by accelerated release of thyroid hormone.

ALTHOUGH the thyroid gland is of extreme importance in the metamorphosis of amphibians, its function in cold blooded vertebrates in general is still obscure1. Several workers have suggested that thyroid hormones enable poikilotherms to withstand changes in environmental temperature. For example, Evropeitzeva2 reported that larvae of Coregonus lavaretus ludoga withstood exposure to 29° C for 5 min after treatment with 0.033 per cent thiourea, whereas untreated animals died. Suhrmann3 found that immersion in a solution of thiourea increases the upper lethal temperature in the goldfish, Carassius auratus. Dent and Lynn4 also indicated that the thyroid may play a part in tolerance to changes in temperature. But the most striking report in this field comes from the work of Fortune5,6, who has reported that in the minnow, Phoxinus phoxinus L., the thermal death point is raised some 10° C by treatment with thiourea. She states: “Phoxinus already treated with thiourea for 3 days, were subjected to a rise in temperature of 10° C (that is, to 33° C) over 2 days. They survived indefinitely at this temperature and appeared normal, the controls dying under such conditions between 23° C and 24° C”. On the other hand, La Roche and Leblond7 state that the ability of salmon parr to withstand rising temperatures is impaired by radiological thyroidectomy and is restored by the administration of thyroid powder.

The cytology of pigment-bearing cells is followed in the integument of the red-spotted newt, Notophthalmus viridescens viridescens Rafinesque, with observations beginning in the late embryo and continuing through to the adult. Dermal melanophores appear in late tailbud stages, and dermal xanthophores differentiate prior to hatching. In young larvae, both become widely and evenly distributed in the dorsal skin, but in older larvae a pattern develops so that melanophores are absent from certain circumscribed lateral regions designated as melanophore voids. Iridophores differentiate and accumulate among the xanthophores which have remained in the voids. Those xanthophores then are transformed into proerythrophores; that is, their form is altered from stellate to punctate, their nuclei change from fusiform to ovoid, and their pterinosomes are largely replaced by lipid droplets. In some of the voids, the proerythrophores migrate into the epidermis to become the erythrophores of the red spots. The remaining voids cease to exist when their proerythrophores disappear and are replaced by dermal melanophores. At the same time, some dermal melanophores accumulate to form dorsal black spots, and a morphologically different type of melanophore differentiates within the epidermis. In the interspot regions of the eft, xanthophores hypertrophy and pack the dermis, giving an orange color to the skin. In the interspot regions of the adult newt, xanthophores with fewer organelles produce a yellow color on the ventral surface, and, in combination with melanophores and iridophores, produce a greenish color in the dorsum.

A high incidence of glomerulosclerosis has been noted in rodents surviving more than 1 year after mid-lethal whole-body irradiation (1-4). This experiment was a study of X-ray-induced glomerulosclerosis in mice as influenced by such factors as radiation exposures (300 to 1200 R), part of body irradiated (whole body, lumbar exposure, or lumbar area shielded), age at time of exposure (10 weeks or 1 year), and administration of the radioprotective chemical S,2-aminoethylisothiouronium Br. HBr (AET). Information is also included on other delayed effects of radiation, including life shortening, neoplasm incidence, nonneoplastic effects, and graying of the hair.