Understanding the needs and preferences for cancer care among First Nations people: An integrative review.

AIM: This systematic review aimed to identify the needs and preferences for cancer care services among Australian First Nations people. DESIGN: Integrative review. DATA SOURCES: An integrative review was conducted. A wide range of search terms were used to increase the sensitivity and specificity of the searches in electronic databases. Methodological quality assessment, data extraction, was conducted independently by two reviewers, and a narrative synthesis was conducted. RESULTS: Forty-two studies were included. A total of 2965 Australian First Nations adults, both men and women of various ages across the lifespan, were represented; no First Nations children affected by cancer were represented in the studies. Three themes emerged which included: (1) discrimination, racism and trauma, resulting from colonization, directly impacted First National people's cancer care experience; (2) cultural ways of knowing, being and doing are fundamental to how First Nations people engage with cancer care services; and (3) First Nations people need culturally safe person-centred cancer care services that address practical needs. CONCLUSION: Most participants represented in this review experienced discrimination, racism and trauma, resulting from colonization, which directly negatively impacted Aboriginal peoples' cancer care experience. While the Optimal Cancer Pathway (OCP) was launched in Australia several years ago, people with cancer may continue to experience distressing unmet care needs. PATIENT OR PUBLIC CONTRIBUTION: Our team includes both First Nations people, non-First Nations researchers and healthcare professionals with expertise in cancer care. The researchers employed decolonizing restorative approaches to ensure voice, respect, accountability and reciprocity in this review work. IMPLICATIONS FOR NURSING PRACTICE: Members of the multidisciplinary team including nurses and policymakers should reflect on these findings, ensure that they have up-to-date cultural safety training and stand together with Indigenous and non-Indigenous cancer leaders to take proactive steps to stamp out and dismantle oppression in health, and safely implement the OCP.

Training support workers about the overmedication of people with intellectual disabilities: an Australian pre-post pilot study.

BACKGROUND: There is evidence that psychotropic medications are overprescribed and overused to manage behaviours of concern for people with intellectual disabilities. Disability support workers and support staff lack education and training on the administration and safety of psychotropic medication use. This study aimed to test the applicability and preliminary efficacy of SPECTROM, an education programme developed in the UK, in an Australian context. METHODS: The training comprises two parts: Module 1 encompasses psychotropic medications, their use and side effects. Module 2 focuses on non-pharmacological interventions for supporting people with behaviours of concern. Thirty-three participants attended the training course and completed pre-training and post-training surveys on the Psychotropic Knowledge Questionnaire and Management of Aggression and Violence Attitude Scale-Revised at four time points: pre-training, 2 weeks, 3 months and 5 months post-training. RESULTS: Psychotropic Knowledge Questionnaire scores showed statistically significant post-training improvement at all post-training time points (P < 0.05). Management of Aggression and Violence Attitude Scale-Revised scores were high at pre-training and did not change significantly at any of the post-training survey time points. A 2-week post-training feedback questionnaire reported 80% agreement that the training programme was appropriate, useful and valid. Only 36% of participants completed questionnaires at all time points. CONCLUSIONS: SPECTROM training increased staff knowledge of psychotropic medications, yet loss of participants was high. Further refinement of the applicability of the training for the Australian context and evaluation of the feasibility of implementation, clinical and cost-effectiveness of the programme are required.

To understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer: a systematic review of qualitative studies.

PURPOSE: This study aimed to understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer. METHODS: A qualitative systematic review has been reported according to PRISMA guidelines. A comprehensive search was conducted across multiple databases (APA PsycINFO, CINAHL, and Medline) and citation searches. Studies were screened according to pre-determined inclusion and exclusion criteria. Methodological quality was evaluated. Findings were extracted in relation to the context of interest of experiences, needs, and preferences of supportive care. Each finding was accompanied by a qualitative verbatim illustration representing the participant's voice. RESULTS: 4449 publications were screened, and 44 studies were included. Cancer populations represented in the included studies included lymphoma, leukaemia, brain cancer, sarcomas, and neuroblastoma. Two overarching synthesised findings were identified as (1) coping, caring relationships, communication, and impact of the clinical environment, and (2) experiences of isolation, fear of the unknown, restricted information, and changing self. Children and adolescents articulated that cancer care would be enhanced by developing a sense of control over their body and healthcare, being involved in communication and shared decision-making, and ensuring the clinical environment is age-appropriate. Many experienced a sense of disconnection from the rest of the world (including peers, school, and experiences of prejudice and bullying), and a lack of tailored support and information were identified as key unmet care needs that require further intervention. CONCLUSIONS: Children and adolescent who are diagnosed with cancer are a unique and understudied group in oncological survivorship research, with the slowest progress in improvement of care over time. This review will facilitate the development of future interventions and promote the importance of tailored support for children and adolescents at all stages of the cancer journey. IMPLICATIONS FOR CANCER SURVIVORS: Children and adolescents continue to experience a range of difficulties despite routine contact with cancer healthcare professionals. Children and adolescents should be carefully assessed about their individual circumstances and preferences for support given the clear implications from this review that "one size" does not fit all.

p38/RK is essential for stress-induced nuclear responses: JNK/SAPKs and c-Jun/ATF-2 phosphorylation are insufficient.

The ERK, JNK/SAPK and p38/RK MAP kinase subtypes (reviewed in [1]) are differentially activated in mammalian cells by various stimuli, which elicit induction of immediate-early (IE) genes, such as c-fos and c-jun (reviewed in [1-3]), as well as phosphorylation of histone H3 [4] and HMG-14 [5]. Anisomycin and UV radiation have been suggested to induce c-fos and c-jun transcription via JNK/SAPK-mediated phosphorylation of TCF (ternary complex factor), for c-fos induction [6-8], and c-Jun and/or ATF-2 for c-jun induction [9-11] [12,13]. We report here that anisomycin and ultraviolet radiation (UV) activate MAP kinase kinase-6 (MKK6) [14,15], p38/RK [16] [17,18] and MAPKAP kinase-2 (MAPKAP K-2) [17-19]. By using the p38/RK inhibitor SB 203580 [20,21], we show that activation of p38/RK and/or its downstream effectors are essential for anisomycin- and UV-stimulated c-fos/c-jun induction and histone H3/HMG-14 phosphorylation, whereas JNK/SAPK activation and phosphorylation of c-Jun and ATF-2 are insufficient for these responses.

The interaction of 3,3',4',5-tetrachlorosalicylanilide with phosphatidylcholine bilayers.

1. The interaction of the germicide 3,3',4',5-tetrachlorosalicylanilide (T4CS) with vesicles and dispersions of egg phosphatidylcholine has been studied by gel permeation chromatography, electron microscopy, electron spin resonance spin labelling and ion permeability measurements. 2. Incorporation of T4CS into vesicles of egg phosphatidylcholine gives rise to a large increase in the permeability rate of the paramagnetic cation N,N-dimethyl-N-(1'-oxyl-2',2',6',6'-tetramethyl-4'-piperidyl)-2-hydroxyethylammonium chloride through the lipid bilayer but has no significant effect on the vesicle sizes as measured by gel permeation chromatography or electron microscopy. 3. ESR studies using a spin-labelled fatty acid have demonstrated the presence of two different environments for the spin label when T4CS is incorporated into phosphatidylcholine bilayers. These two environments are identified as (a) highly ordered areas of the bilayer, rich in T4CS and (b) areas with very similar ordering to that in pure egg phosphatidylcholine. 4. The effectiveness of very low concentrations of the germicide in increasing vesicle permeability is explained in terms of its clustering to give rigid patches, rich in T4CS, rather than being evenly distributed throughout the bilayer. It is proposed that the increased ion permeability arises from leakage at the interfaces between the rigid and flexible regions of the lipid bilayer. 5. Comparisons between the effective levels of T4CS in phosphatidylcholine vesicles and its minimum inhibitory concentration with a Gram-positive bacterium confirm the validity of phospholipid vesicles as a model for studies of germicidal activity.

Differences in the interaction of inorganic and organic (hydrophobic) cations with phosphatidylserine membranes.

The interaction of phosphatidylserine dispersions with "hydrophobic", organic cations (acetylcholine, tetraethylammonium ion) is compared with that of simple inorganic cations (Na+, Ca2+); differences in the hydration properties of the two classes of ions exist in the bulk phase as evident from spin-lattice relaxation time T1 measurements. It is shown that the reaction products (cation-phospholipid) differ markedly in their physicochemical behaviour. With increasing concentration both classes of ions reduce the zota-potential of phosphatidylserine surfaces, the monovalent inorganic cations being only slightly more effective than the hydrophobic cations. Inorganic cations cause precipitation of the lipid once the surface charge of the bilayer is reduced to a certain threshold value. This is not the case with the organic cations. The difference is probably associated with the different hydration properties of the resulting complexes. Thus binding of Ca2+ causes displacement of water of hydration and formation of an anhydrous, hydrophobic calcium-phosphatidylserine complex which is insoluble in water, whereas the product of binding of the organic cations is hydrated, hydrophilic and water soluble. The above findings are consistent with NMR results which show that the phosphodiester group is involved in the binding of both classes of cations as well as being the site of the primary hydration shell. Besides affecting interbilayer membrane interactions such as those involved in cell adhesion and membrane fusion, the binding of both classes of cation can affect the molecular packing within a bilayer.

A study of Folch-Pi apoprotein. II. Relation between polymerization state and conformation.

A comparison of the conformation of Folch-Pi apoprotein in organic solvent and in aqueous solutions has been made by ESR, infrared and circular dichroism spectroscopy studies. Electrophoresis and ultracentrifugation have been carried out in order to correlate molecular weight and charge of the molecule with its conformation. It appears that the protein is monomeric in organic solution. In water, only one component is present but the molecules behave as a polydisperse system of associating molecules. Hydrophobic interacitons seem to be important for this polymerisation which does not appear to be accompanied by the formation of beta-structure. After the transfer of the protein from organic solution to water, the ESR spectra of the protein labelled on the free SH groups show an heterogeneity in the motional environment of the label which permits to assume that different areas of association exist in the polymeric molecule.

The computational prediction of toxicity.

Recent developments in the prediction of toxicity from chemical structure have been reviewed. Attention has been drawn to some of the problems that can be encountered in the area of predictive toxicology, including the need for a multi-disciplinary approach and the need to address mechanisms of action. Progress has been hampered by the sparseness of good quality toxicological data. Perhaps too much effort has been devoted to exploring new statistical methods rather than to the creation of data sets for hitherto uninvestigated toxicological endpoints and/or classes of chemicals.

Radicals involved in photoallergen/protein interactions.

Aqueous solutions (pH = 8) of both 3,3'-dimethyl and 4,4'-dimethyl substituted analogues of the photoallergen fentichlor (bis(2-hydroxy-5-chlorophenyl)sulphide) produced stable semiquinone radicals when irradiated with u.v. light (greater than 310 nm). These radicals have been characterised using electron spin resonance techniques: the results confirm the assignment of hyperfine coupling constants for the parent fentichlor radical. The binding of fentichlor to HSA was found to be partly oxygen dependent demonstrating a role for semiquinone type radicals in the binding mechanism. The stoichiometry and specificity of the binding of the dimethyl analogues to soluble proteins were found to be similar to that of fentichlor itself.

Antioxidants may contribute in the fight against ageing: an in vitro model.

Elderly humans have altered cellular redox levels and dysregulated immune responses, both of which are key events underlying the progression of chronic degenerative diseases of ageing, such as atherosclerosis and Alzeimer's disease. Poorly maintained cellular redox levels lead to elevated activation of nuclear transcription factors such as NFkB and AP-1. These factors are co-ordinately responsible for a huge range of extracellular signalling molecules responsible for inflammation, tissue remodelling, oncogenesis and apoptosis, progessess that orchestrate many of the degenerative processess associated with ageing. It is now clear that levels of endogenous anti-oxidants such as GSH decrease with age. This study aimed to investigate the potential of exogenous anti-oxidants to influence inflammatory responses and the ageing process itself. We investigated the potential of the dietary antioxidant, quercetin, to reverse the age related influences of GSH depletion and oxidative stress using in vitro human umbilical vein endothelial cells (HUVEC) and human skin fibroblast (HSF) cell models. Oxidative stress-induced inflammatory responses were investigated in a GSH depletion and a Phorbol 12-myristate 13-acetate (PMA)-induced stress model. As measured with a sensitive HPLC fluorescence method, GSH in HUVEC was depleted by the addition of L-buthionine-[S,R]-sulfoxiniine (BSO), a gamma-glutamylcysteine synthetase inhibitor, to the culture medium at a concentration of 0.25 mM. Time course studies revealed that the GSH half-life was 4.6 h in HUVEC. GSH depletion by BSO for 24 h led to a slight increase in intracellular adhesion molecule - 1 (ICAM1) expression and prostaglandin E2 (PGE2) secretion in both types of cells. However, GSH depletion markedly enhanced PMA-induced ICAM and PGE2 production in HUVEC. Responses were progressively elevated following prolonged BSO treatment. Inhibition studies showed that 1-(5-Isoquinolinylsulfonyl)-2-methylpiperazine (H7), a protein kinase C (PKC) inhibitor, not only abolished most of PMA-induced ICAM-1 expression and PGE2, production, but also eliminated GSH depletion-enhanced PMA stimulation. This enhancement was also inhibited by supplementation with quercetin. The results clearly demonstrate that GSH depletion increased the susceptibility of vascular endothelial cells and fibroblasts to oxidative stress associated inflammatory stimuli. This increased in vitro susceptibility may be extrapolated to the in vivo situation of ageing, providing a useful model to study the influence of micronutrients on the ageing process. In conclusion, these data suggest that dietary antioxidants could play a significant role in the reduction of inflammatory responses.

Binding of a spin label analogue of compound 48/80 to rat peritoneal mast cells: correlation of binding properties with surface topography.

A spin label analogue of compound 48/80 has been synthesized and its binding to purified rat peritoneal mast cells has been studied by electron spin resonance spectroscopy. The spin label analogue (SL-48/80) had almost identical biological activity to unlabeled compound 48/80. SL-48/80 was used to estimate the number of binding sites per cell on normal mast cells (7.25 X 10(10)), on mast cells deactivated by sodium azide and 2-deoxyglucose or by heating to 46 degrees for 30 min (1 X 10(10)) and cells from animals actively-sensitized to ovalbumin (5.2 X 10(10)). SL-48/80 was also shown to bind to isolated mast cell granules. Differences in the binding properties of mast cells after the different treatments are related to their surface topography as seen by scanning electron microscopy, and the contribution of the granules to the number of binding sites is discussed.

The photochemical binding of bithionol to soluble proteins and peptides.

The photochemical reactions of the bacteriocide bithionol (a known photoallergen in man) with soluble proteins and peptides, were investigated. Solutions of human serum albumin (HSA), human gamma-globulin, bovine insulin and poly-L-lysine were irradiated with ultraviolet light of wavelength 313 nm in the presence of [35S]-bithionol and the extent of photochemical (covalent) binding determined. HSA bound at least four molecules of bithionol per molecule of HSA. Bithionol was also found to bind to gamma-globulin to a similar extent; lower levels of binding were achieved with bovine insulin and poly-L-lysine. A bithionol-HSA photoadduct was treated with cyanogen bromide to determine the selectivity of binding. Fractionation after cyanogen bromide treatment showed that bithionol was bound to both major fragments of HSA, with a preference for the N-terminal region of the protein.

Integration of QSAR and in vitro toxicology.

The principles of quantitative structure-activity relationships (QSAR) are based on the premise that the properties of a chemical are implicit in its molecular structure. Therefore, if a mechanistic hypothesis can be proposed linking a group of related chemicals with a particular toxic end point, the hypothesis can be used to define relevant parameters to establish a QSAR. Ways in which QSAR and in vitro toxicology can complement each other in development of alternatives to live animal experiments are described and illustrated by examples from acute toxicological end points. Integration of QSAR and in vitro methods is examined in the context of assessing mechanistic competence and improving the design of in vitro assays and the development of prediction models. The nature of biological variability is explored together with its implications for the selection of sets of chemicals for test development, optimization, and validation. Methods are described to support the use of data from in vivo tests that do not meet today's stringent requirements of acceptability. Integration of QSAR and in vitro methods into strategic approaches for the replacement, reduction, and refinement of the use of animals is described with examples.

13th meeting of the Scientific Group on Methodologies for the Safety Evaluation of Chemicals (SGOMSEC): alternative testing methodologies and conceptual issues.

Substantial world-wide resources are being committed to develop improved toxicological testing methods that will contribute to better protection of human health and the environment. The development of new methods is intrinsically driven by new knowledge emanating from fundamental research in toxicology, carcinogenesis, molecular biology, biochemistry, computer sciences, and a host of other disciplines. Critical evaluations and strong scientific consensus are essential to facilitate adoption of alternative methods for use in the safety assessment of drugs, chemicals, and other environmental factors. Recommendations to hasten the development of new alternative methods included increasing emphasis on the development of mechanism-based methods, increasing fundamental toxicological research, increasing training on the use of alternative methods, integrating accepted alternative methods into toxicity assessment, internationally harmonizating chemical toxicity classification schemes, and increasing international cooperation to develop, validate, and gain acceptance of alternative methods.

Soya protein antibodies in man: their occurrence and possible relevance in coeliac disease.

Circulating antibodies to soya-derived protein antigens have been measured in patients with duodenitis, Crohn's disease, ulcerative colitis and coeliac disease. Significantly raised antibody titres were found frequently in the coeliac group, particularly those patients showing a suboptimal response to a gluten-free diet, but rarely in subjects with other gastrointestinal diseases. Antisoya activity was not necessarily accompanied by antibodies to other common dietary antigens. We suggest that some coeliacs may have an associated dietary soya sensitivity which could adversely influence their response to gluten withdrawal.

Pediatric resident and faculty knowledge of the Denver II.

OBJECTIVE: To assess knowledge of the Denver II, the revised developmental screening tool recommended by the American Academy of Pediatrics, in residents and faculty, and to evaluate a teaching intervention for incoming postgraduate year 1 (PGY-1) trainees. DESIGN: A cross-sectional test of knowledge for all subjects and pretesting and posttesting of the incoming PGY- 1 trainees. SETTING: University of Texas-Houston Medical School Department of Pediatrics. PARTICIPANTS: Faculty (n = 9) and residents (n = 78), including an intervention group (n = 45), of incoming PGY-1 trainees over 2 years. INTERVENTIONS: Postgraduate year 1 trainees in both 1994 through 1995 and 1995 through 1996 viewed the Denver II training videotape on entry into a continuity clinic. Trainees were encouraged to perform Denver II evaluations on at least 1 appropriate patient at each pediatric clinic session and had access to Denver II support materials. MAIN OUTCOME MEASURES: Scores on the Denver II Proficiency Written Test, self-reported measures of comfort, and number of Denver II evaluations performed. RESULTS: The mean (SD) test scores for incoming, preintervention PGY-1 trainees (n = 45) (41.3 [9.6]) did not differ from scores for outgoing PGY-1 trainees (n = 13) (38.5 [10.4]) who had not received the intervention. Postintervention PGY-1 test results were significantly improved (59.4 [10.6]) (P<.001). Test scores for upper-level residents who had participated in the developmental pediatrics rotation (n = 14) were better (55.3 [9.31), but all scored below passing. Residents who had not yet participated in the developmental pediatrics rotation (n = 19) and members of the general pediatric faculty (n = 9) had scores similar to those of PGY-1 trainees (40.9 [13.4] and 39.0 [15.1], respectively). CONCLUSIONS: Residents had a greater knowledge of the Denver II after completing a developmental pediatrics rotation. Our intervention produced significant improvement in PGY-1 trainees' knowledge, raising it to levels similar to those of upper-level residents exposed to developmental pediatrics. Faculty were not expert in using the Denver II.

Measurement of glomerular filtration rate in children with insulin-dependent diabetes mellitus.

51Cr-EDTA, inulin and creatinine clearances were measured simultaneously in 11 diabetic children and 12 healthy young adults. The clearances in all individuals were 115 +/- 24 ml/min per 1.73 m2SA for 51Cr-EDTA, 118 +/- 25 ml/min per 1.73 m2SA for inulin and 157 +/- 35 ml/min per 1.73 m2SA for creatinine. Values were higher in the diabetic children but the differences were not significant. 51Cr-EDTA clearance significantly underestimated that of inulin by a mean of -7.4 +/- 2.5 (SEM) ml/min per 1.73 m2SA (p less than 0.01) and creatinine clearance significantly overestimated that of inulin by 37.6 +/- 3.3 (SEM) ml/min per 1.73 m2SA (p less than 0.0001). Similarly, the mean ratio of 51Cr-EDTA to inulin clearance was 0.94 (95% CI 0.90-0.98) and that of creatinine to inulin clearance was 1.32 (95% CI 1.27-1.37); the differences between diabetics and controls were not significant. Correlation coefficients were 0.93 between 51Cr-EDTA and inulin clearances, and 0.95 between inulin and creatinine clearances. The pooled coefficient of variation between clearances within an individual was higher with inulin, 10.3 +/- 6.5% (SD), than 51Cr-EDTA, 7.3 +/- 5.1% (p less than 0.001, t test). These results show that 51Cr-EDTA clearance underestimates that of inulin to a similar extent in both diabetic children and healthy controls and creatinine clearance overestimates inulin clearance to a greater but similar extent in both groups. The methodological variation in 51Cr-EDTA measurement is less than with the other 2 methods. Therefore, we recommend the use of the renal clearance of 51Cr-EDTA for the measurement of GFR in diabetic children.

Binding of a spin-labelled photoallergen to human serum albumin.

The binding site for 3,3',4',5-tetrachlorosalicylanilide (T4CS), a potent photoallergen, on human serum albumin (HSA) was studied by electron spin resonance spectroscopy using a spin-labelled analogue 3,5-dichlorosalicylamido-4-(2,2,6,6-tetramethylpiperidine 1-oxyl) (DCS-TEMPO) of T4CS in the absence of ultraviolet irradiation. DCS-TEMPO bound non-covalently (K = 5.8 X 10(6) M-1) to one major binding site on HSA. This binding site could be blocked by the photochemical binding of T4CS to the protein. Limited tryptic digestion of HSA or chemical modification of its single tryptophan residue with 2-hydroxy-5-nitrobenzyl bromide was found to reduce the binding constant of the T4CS/DCS-TEMPO-binding site. These observations are in good agreement with earlier conclusions on the nature of the T4CS-binding site and suggest a location for this site close to the single tryptophan residue of the HSA molecule.

Computer prediction of possible toxic action from chemical structure: an update on the DEREK system.

Computer-based assessment of potential toxicity has become increasingly popular in recent years. The knowledge-base system DEREK is developed under the guidance of a multinational Collaborative Group of expert toxicologists and provides a qualitative approach to toxicity prediction. Major developments of the DEREK program and knowledge-base have taken place in the last 3 years. Program developments include improvements in both the user interface and data processing. Work on the knowledge-base has concentrated on the areas of genotoxicity and skin sensitisation. DEREK's predictive capabilities for these toxicological end-points has been demonstrated. In addition to the continued expansion of the knowledge-base, a number of enhancements are planned in the DEREK program. In particular, work is in progress to develop further DEREK's ability to report the reasoning behind its predictions.

Use of reversed-phase high-performance liquid chromatography on polystyrene-divinylbenzene columns for the rapid separation and purification of acid-soluble nuclear proteins.

The suitability of polystyrene-divinylbenzene reversed-phase HPLC columns for rapid separation and purification of acid-soluble nuclear proteins was evaluated. We used a polystyrene-divinylbenzene reversed-phase HPLC column (PLRP-S) for purification of nuclear proteins extracted with 0.3 M HCl or 5% HClO4. We are able to obtain electrophoretically pure fractions for a number of nuclear proteins including HMG14, HMG17 and variants of histone H3. The identity of proteins in these fractions was confirmed by immunochemical analysis, protein sequencing, mass spectrometry and migration on two-dimensional polyacrylamide gel electrophoresis. These methods do not require special preparation of the sample and are quicker than similar published methods.