Health-Related Internet Use Among Men With Prostate Cancer in Canada: Cancer Registry Survey Study.

BACKGROUND: After a prostate cancer diagnosis, men want information about their disease and treatment options. The internet offers a convenient means to deliver health information to patients with prostate cancer. However, there are concerns about the use of the internet among this largely senior population. OBJECTIVE: This study aimed to determine the patterns and factors associated with the use of the internet as a source of health information among Canadian men with prostate cancer and the features and information required in a website. METHODS: Population surveys were conducted in four Canadian provinces (British Columbia, Alberta, Saskatchewan, and Ontario) in 2014-2015. Data analyses included descriptive, bivariable, and multivariable analyses. The Pearson Chi-square and univariable regression were used to examine associations between independent variables and health-related internet use. Correlates of health-related internet use were analyzed using multivariable logistic regression. RESULTS: A total of 1362 patients responded across the four provinces. The mean age of respondents was 69 years (SD 8.2). In addition, 82% (n=1071) were internet users and 71% (n=910) used the internet daily. Further, 65% (n=784) used the internet as a source of prostate cancer information, and 40% (n=521) were confident about using information obtained from the internet to make health decisions. Men who used the internet to obtain prostate cancer information were more likely to be active information seekers (odds ratio [OR]: 4.5, 95% CI 2.6-7.8), be confident using information from the internet to make health decisions (OR: 3.6, 95% CI 2.3-5.7), have broadband internet access (OR: 1.8, 95% CI 1.2-2.7), and have more unmet supportive care needs (OR: 1.05, 95% CI 1.0-1.1). Top features wanted in a website, reported by more than 50% of respondents, were a library of resources (n=893, 65.6%), tools to support treatment decision making (n=815, 59.8%), and tools to help navigate the prostate cancer journey (n=698, 51.2%). Top three topics of information wanted in such a website were treatment options (n=916, 67.3%), disease progression (n=904, 66.4%), and management of side effects (n=858, 63%). CONCLUSIONS: Over two-thirds of Canadian patients with prostate cancer surveyed use the internet as a source of health information about prostate cancer, but over half did not feel confident using information from the internet to make health decisions. Being an active information seeker, having confidence in using information from the internet to make health decisions, having broadband internet, and having more unmet supportive care needs were significantly associated with health-related internet use. Future work should examine electronic health literacy interventions as a means to boost men's confidence in using information from the internet and design websites that include information and features that help men navigate the prostate cancer journey and support treatment decision making and management of side effects.

Piloting prostate cancer patient-reported outcomesin clinical practice.

PURPOSE: The expanded prostate cancer index composite-26 (EPIC-26) instrument is a validated research tool used for capturing patient-reported quality-of-life outcomes related to the domains of bowel, bladder, and sexual functioning for men undergoing curative treatment for prostate cancer. The purpose of this pilot study was to explore the perceptions and experiences of clinicians with using EPIC-26 in a clinical setting for patients receiving curative radiotherapy. METHODS: Ten clinicians reviewed EPIC-26 scores either before or during weekly clinical encounters with patients receiving curative radiation treatment for prostate cancer. After a period of 2 months, clinicians underwent individual semi-structured interviews where they were asked about their views on measuring patient-reported outcomes in practice, the value of EPIC-26, impressions on patient acceptability, and operational issues. RESULTS: There was a general willingness and acceptance by clinicians to use EPIC-26 for routine clinical practice. Clinician participants found EPIC-26 to be generally informative, and added value to the clinical encounter by providing additional information that was specific to prostate cancer patients. EPIC-26 was also felt to improve overall communication and provide additional insight into the patient experience. CONCLUSIONS: Our qualitative findings suggest that there may be a role for incorporating patient-reported outcome measure assessment tools like EPIC-26 routinely into clinical practice. However, further qualitative and quantitative research is required in order to assess the impact of patient-reported outcome information on communication, patient and clinician satisfaction, and how these and other related outcomes can be used for guiding treatment decision-making.

Myeloma plasma cells alter the bone marrow microenvironment by stimulating the proliferation of mesenchymal stromal cells.

Multiple myeloma is an incurable hematologic cancer characterized by the clonal proliferation of malignant plasma cells within the bone marrow. Numerous studies suggest that the myeloma plasma cells occupy and alter the stromal tissue of the bone marrow as a means of enhancing their survival and growth. However, the nature and magnitude of the changes to the stromal cell tissue remain to be determined. In this study, we used mesenchymal stromal cell and osteoblast-related cell surface marker expression (STRO-1 and alkaline phosphatase, respectively) and flow cytometry to enumerate mesenchymal stromal cell and osteoblast numbers in bone marrow recovered from myeloma patients at the time of diagnosis. Using this approach, we identified an increase in the number of STRO-1 positive colony forming mesenchymal stromal cells and a concomitant decrease in alkaline phophatase osteoblasts. Notably, this increase in mesenchymal stromal cell numbers correlated closely with plasma cell burden at the time of diagnosis. In addition, in comparison with the osteoblast population, the STRO-1+ mesenchymal stromal cell population was found to express higher levels of plasma cell- and osteoclast-activating factors, including RANKL and IL-6, providing a mechanism by which an increase in mesenchymal stromal cells may promote and aid the progression of myeloma. Importantly, these findings were faithfully replicated in the C57BL/KaLwRij murine model of myeloma, suggesting that this model may present a unique and clinically relevant system in which to identify and therapeutically modulate the bone microenvironment and, in turn, alter the progression of myeloma disease.

Monitoring microplastic-contaminant sorption processes in real-time using membrane introduction mass spectrometry.

Microplastics are environmentally ubiquitous and their role in the fate and distribution of trace contaminants is of emerging concern. We report the first use of membrane introduction mass spectrometry to directly monitor the rate and extent of microplastic-contaminant sorption. Target contaminant (naphthalene, anthracene, pyrene, and nonylphenol) sorption behaviours were examined at nanomolar concentrations with four plastic types: low density polyethylene (LDPE), high density polyethylene (HDPE), polypropylene (PP), and polystyrene (PS). Under the conditions employed here, short-term sorption kinetics were assessed using on-line mass spectrometry for up to one hour. Subsequent sorption was followed by periodically measuring contaminant concentrations for up to three weeks. Short-term sorption followed first order kinetics with rate constants that scaled with hydrophobicity for the homologous series of polycyclic aromatic hydrocarbons (PAHs). Sorption rate constants on LDPE for equimolar solutions of naphthalene, anthracene, and pyrene were 0.5, 2.0, and 2.2 h-1, respectively, while nonylphenol did not sorb to pristine plastics over this time period. Similar trends among contaminants were observed for other pristine plastics with 4- to 10-fold faster sorption rates associated with LDPE when compared to PS and PP. Sorption was largely complete after three weeks, with the percent analyte sorbed ranging from 40-100% across various microplastic-contaminant combinations. Photo-oxidative ageing of LDPE had little effect on PAH sorption. However, a marked increase in nonylphenol sorption was consistent with increased hydrogen-bonding interactions. This work provides kinetic insights into surface interactions and describes a powerful experimental platform to directly observe contaminant sorption behaviours in complex samples under a variety of environmentally relevant conditions.

Oligoether-strapped calix[4]pyrrole: an ion-pair receptor displaying cation-dependent chloride anion transport.

A ditopic ion-pair receptor (1), which has tunable cation- and anion-binding sites, has been synthesized and characterized. Spectroscopic analyses provide support for the conclusion that receptor 1 binds fluoride and chloride anions strongly and forms stable 1:1 complexes ([1·F](-) and [1·Cl](-)) with appropriately chosen salts of these anions in acetonitrile. When the anion complexes of 1 were treated with alkali metal ions (Li(+), Na(+), K(+), Cs(+), as their perchlorate salts), ion-dependent interactions were observed that were found to depend on both the choice of added cation and the initially complexed anion. In the case of [1·F](-), no appreciable interaction with the K(+) ion was seen. On the other hand, when this complex was treated with Li(+) or Na(+) ions, decomplexation of the bound fluoride anion was observed. In contrast to what was seen with Li(+), Na(+), K(+), treating [1·F](-) with Cs(+) ions gave rise to a stable, host-separated ion-pair complex, [F·1·Cs], which contains the Cs(+) ion bound in the cup-like portion of the calix[4]pyrrole. Different complexation behavior was seen in the case of the chloride complex, [1·Cl](-). Here, no appreciable interaction was observed with Na(+) or K(+). In contrast, treating with Li(+) produces a tight ion-pair complex, [1·Li·Cl], in which the cation is bound to the crown moiety. In analogy to what was seen for [1·F](-), treatment of [1·Cl](-) with Cs(+) ions gives rise to a host-separated ion-pair complex, [Cl·1·Cs], in which the cation is bound to the cup of the calix[4]pyrrole. As inferred from liposomal model membrane transport studies, system 1 can act as an effective carrier for several chloride anion salts of Group 1 cations, operating through both symport (chloride+cation co-transport) and antiport (nitrate-for-chloride exchange) mechanisms. This transport behavior stands in contrast to what is seen for simple octamethylcalix[4]pyrrole, which acts as an effective carrier for cesium chloride but does not operates through a nitrate-for-chloride anion exchange mechanism.

Characterizing photochemical ageing processes of microplastic materials using multivariate analysis of infrared spectra.

Microplastics in the environment are an emerging concern due to impacts on human and environmental health. In addition to direct effects on biota, microplastics influence the fate and distribution of trace organic contaminants through sorption and transport. Environmental weathering may influence the rate and extent of chemical sorption. Changes in the surface characteristics of four common plastics including low-density polyethylene (LDPE), high-density polyethylene (HDPE), polypropylene (PP), and polystyrene (PS) were followed under the influence of both artificial light (UV-B) and natural sunlight for up to six months. Attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectra were collected at regular intervals. Principal component analysis (PCA) of the full dataset of UV-B weathered samples (n >500 spectra) simultaneously discriminated plastic type and extent of photochemical weathering. The magnitude of PCA scores correlated with exposure time and the loadings were consistent with surface chemistry changes including photooxidation. Projecting sunlight and UV-C exposed samples onto this PCA model demonstrated that similar chemical changes occurred, albeit at different rates. The results were compared to the carbonyl index (CI) with similar weathering trends indicating PP weathered at a faster initial rate than LDPE and HDPE. We propose that a multivariate approach is more widely applicable than CI as illustrated by PS, which lacked a stable reference peak. Kinetic analysis of the time series indicated that outdoor weathering occurred 5-12 times slower than the artificial exposure used here, depending on the plastic and the light source employed. The results provide unique insights into weathering processes and the photochemical age of naturally weathered plastics.

Information that affects patients' treatment choices for early stage prostate cancer: a review.

INTRODUCTION: We conducted a systematic review of primary evidence to clarify what information influences treatment selection by patients with early stage prostate cancer. MATERIALS AND METHODS: We conducted a systematic review of the Web of Knowledge, using the ALL DATABASES option. Papers were then triaged out on the basis of the title and/or abstract, leaving 120 papers. Reviewing the full papers resulted in a final corpus of 21 papers. RESULTS: The data suggest that patients typically balance potential benefits against potential side effects but in a complex way with large variation across patients. For some patients, potential benefits relate to chances of survival but, for others, relate to control over cancer spread. The most common potential harm is effect on bladder functioning but even that is not a concern of all patients. Similarly, potential impact on bowel and on sexual functioning affects some patients' decisions but not others. Patient decisions are also affected by information not typically identified as affecting this decision. These include aspects of treatment and decision processes, competencies, and others' opinions, again, with wide variation across patients. The patient's view of which information items affect his decision may also change over time, consistent with a dynamic decision-making process. CONCLUSIONS: Decision support interventions are needed to optimally tailor information for decision-making to the individual patient, and should be designed to accommodate the illustrated variation in patients' needs.

Perceptual expertise with Chinese characters predicts Chinese reading performance among Hong Kong Chinese children with developmental dyslexia.

This study explores the theoretical proposal that developmental dyslexia involves a failure to develop perceptual expertise with words despite adequate education. Among a group of Hong Kong Chinese children diagnosed with developmental dyslexia, we investigated the relationship between Chinese word reading and perceptual expertise with Chinese characters. In a perceptual fluency task, the time of visual exposure to Chinese characters was manipulated and limited such that the speed of discrimination of a short sequence of Chinese characters at an accuracy level of 80% was estimated. Pair-wise correlations showed that perceptual fluency for characters predicted speeded and non-speeded word reading performance. Exploratory hierarchical regressions showed that perceptual fluency for characters accounted for 5.3% and 9.6% variance in speeded and non-speeded reading respectively, in addition to age, non-verbal IQ, phonological awareness, morphological awareness, rapid automatized naming (RAN) and perceptual fluency for digits. The findings suggest that perceptual expertise with words plays an important role in Chinese reading performance in developmental dyslexia, and that perceptual training is a potential remediation direction.

Octafluorocalix[4]pyrrole: a chloride/bicarbonate antiport agent.

meso-Octamethyloctafluorocalixpyrrole, a simple tetrapyrrolic macrocycle, has been shown to function as both a chloride/nitrate and a chloride/bicarbonate antiport agent for lipid bilayer transmembrane anion transport. This is the first example of a synthetic macrocyclic pyrrole-based receptor capable of transmembrane bicarbonate transport.

Calix[4]pyrrole-based anion transporters with tuneable transport properties.

Three new bis-1,2,3-triazole strapped calix[4]pyrroles have been prepared via'click' chemistry and their anion complexation and lipid bilayer transport properties studied by a combination of single crystal X-ray diffraction studies, (1)H NMR titration techniques, isothermal titration calorimetry and lipid bilayer anion transport studies in POPC vesicles. Bilayer transport efficiency for transmembrane chloride transport was found to directly depend on the length of the alkyl chain present in the bis-triazole strap.

Selective extraction and transport of the [PtCl6]2- anion through outer-sphere coordination chemistry.

A series of tripodal receptors designed to recognise the outer coordination sphere of the hexachlorometallate anion [PtCl(6)](2-), and thus show selectivity for ion-pair formation over chloride binding, has been synthesised and characterised. The tripodal ligands contain urea, amido or sulfonamido hydrogen-bond donors, which are aligned to bind to the regions of greatest electron density along the faces and edges of the octahedral anion. The ligand structure incorporates a protonatable bridgehead nitrogen centre that provides a positive charge to ensure the solubility of a neutral 2:1 [LH](+)/[PtCl(6)](2-) complex in water-immiscible solvents. The extraction of [PtCl(6)](2-) from acidic chloride solutions was evaluated by using a pH-swing mechanism to control the loading and stripping of the metallate anion. The ligands L(1)-L(3), L(5)-L(9), L(11)-L(13) and L(15) showed extremely high loading (up to 95% in some cases) and high selectivity for [PtCl(6)](2-) over chloride ions (present in a 60-fold excess) compared with trioctylamine, a model Alamine reagent, which, under identical conditions, only extracted 10% of the Pt(IV) anions. Generally, extraction was observed to be greater for urea-containing ligands than their amido analogues, and a quantitative recovery of platinum from feed solutions was achieved. The formation of neutral ([LH](+))(2)[PtCl(6)](2-) packages in organic media is supported by single-crystal X-ray structure determinations of [(L(2)H)(2)PtCl(6)] x 2 CH(3)CN, [(L(8)H)(2)PtCl(6)(MeOH)(2)], [(L(12)H)(2)PtCl(6)] x 2 CH(3)CN and [(L(14)H)(2)PtCl(6)], which confirm the presence of significant hydrogen bonding between the anion and urea or amido moieties of the protonated ligand and the anion. The structure of [(L(1)H)(H(3)O)PtCl(6)] x C(6)H(6) x CH(3)CN shows hydrogen bonding of a H(3)O(+) cation to the receptor and confirms that other stoichiometries are also possible, indicating that speciation in solution may be more complex.

Outer-sphere amidopyridyl extractants for zinc(ii) and cobalt(ii) chlorometallates.

Protonated amidopyridyl ligands show high selectivity for the extraction of [CoCl(4)](2-) or [ZnCl(4)](2-) over chloride ion into organic media via the formation of N-H and C-H hydrogen-bond donors to the outer coordination spheres of the chlorometallates.

1,2,3-triazole-strapped calix[4]pyrrole: a new membrane transporter for chloride.

A new triazole-strapped calix[4]pyrrole synthesised via'click' chemistry shows high affinity for chloride and lipid bilayer chloride transport properties.

meso-octamethylcalix[4]pyrrole: an old yet new transmembrane ion-pair transporter.

The first example of lipid bilayer membrane transport of a salt by a calix[4]pyrrole is reported.

Prostate cancer patients' experience and preferences for acquiring information early in their care.

INTRODUCTION: Prostate cancer patients' information needs are well-described, but little is known about their preferred sources and media for obtaining information. We sought to determine prostate cancer patients' experiences and preferences for acquiring information after diagnosis, a time of high information need. METHODS: Population surveys were conducted in four Canadian provinces in 2014-2015. Each provincial cancer registry surveyed a random sample of prostate cancer patients diagnosed in late 2012. RESULTS: A total of 1366 patients responded across provinces. Respondents most frequently tried to obtain information from their urologist; 86% found that easy and 9% found it difficult. Seventy-nine percent of respondents who saw only a urologist felt well-informed compared to 86% of those who saw both a urologist and a radiation oncologist. Eighty-five percent of respondents wanted printed information; 68% wanted it electronically. Respondents' most frequent barriers to obtaining information from physicians were: not actually having enough time (31%), worrying about having enough time (23%), and worrying about asking too many questions (18%). Their most frequent barriers related to internet/printed information, respectively, were uncertainty about quality (63%/49%) and unclear if personally applicable (56%/49%). Recommended facilitators were having a navigator (85%), providing printed information (85%), and someone to answer questions: in person (90%), by phone (66%), or via email (58%). CONCLUSIONS: Prostate cancer patients want urologists to provide them with information and are more likely to report being informed if they see both a urologist and a radiation oncologist. Optimal information provision requires that it be provided both on the internet and in print.

Making their decisions for prostate cancer treatment: Patients' experiences and preferences related to process.

INTRODUCTION: We sought to determine the experiences and preferences of prostate cancer patients related to the process of making their treatment decisions, and to the use of decision support. METHODS: Population surveys were conducted in four Canadian provinces in 2014-2015. Each provincial cancer registry mailed surveys to a random sample of their prostate cancer patients diagnosed in late 2012. Three registries' response rates were 46-55%; the fourth used a different recruiting strategy, producing a response rate of 13% (total n=1366). RESULTS: Overall, 90% (n=1113) of respondents reported that they were involved in their treatment decisions. Twenty-three percent (n=247) of respondents wanted more help with the decision than they received and 52% of them (n=128) reported feeling well-informed. Only 51% (n=653) of all respondents reported receiving any decision support, but an additional 34% (n=437) would want to if they were aware of its existence. A quarter (25%, n=316) of respondents found it helpful to use a decision aid, a type of decision support that provides assistance to decision processes and provides information, but 64% (n=828) reported never having heard of decision aids; 26% (n=176) of those who had never heard of decision aids wanted more help with the decision than they received compared to 13% (n=36) of those who had used a decision aid. CONCLUSIONS: The majority of respondents wanted to participate in their treatment decisions, but a portion wanted more help than they received. Half of those who wanted more help felt well-informed, thus, needed support beyond information. Decision aids have potential to provide information and support to the decision process.

Kinematics and dynamics are not represented independently in motor working memory: evidence from an interference study.

Our capacity to learn multiple dynamic and visuomotor tasks is limited by the time between the presentations of the tasks. When subjects are required to adapt to equal and opposite position-dependent visuomotor rotations (Krakauer et al., 1999) or velocity-dependent force fields (Brashers-Krug et al., 1996) in quick succession, interference occurs that prevents the first task from being consolidated in memory. In contrast, such interference is not observed between learning a position-dependent visuomotor rotation and an acceleration-dependent force field. On the basis of this finding, it has been argued that internal models of kinematic and dynamic sensorimotor transformations are learned independently (Krakauer et al., 1999). However, these findings are also consistent with the perturbations interfering only if they depend on the same kinematic variable. We evaluated this hypothesis using kinematic and dynamic transformations matched in terms of the kinematic variable on which they depend. Subjects adapted to a position-dependent visuomotor rotation followed 5 min later by a position-dependent rotary force field either with or without visual feedback of arm position. The force field tended to rotate the hand in the direction opposite to the visuomotor rotation. To assess learning, all subjects were retested 24 hr later on the visuomotor rotation, and their performance was compared with a control group exposed only to the visuomotor rotation on both days. Adapting to the position-dependent force field, both with and without visual feedback, impaired learning of the visuomotor rotation. Thus, interference between our kinematic and dynamic transformations was observed, suggesting that the key determinant of interference is the kinematic variable on which the transformation depends.

Visuomotor rotations of varying size and direction compete for a single internal model in motor working memory.

When participants adapt to equal and opposite visuomotor rotations in close temporal proximity, memory of the 1st is not consolidated. The authors investigated whether this retrograde interference depends on the use of equal and opposite rotations. On Day 1, different groups of participants adapted to a -30 degrees rotation followed 5 min later by rotations of +30 degrees, +60 degrees, or -60 degrees. On Day 2, all groups were retested on the -30 degrees rotation. Either retrograde interference (in groups who adapted to rotations of opposite sign on Day 1) or retrograde facilitation (in the remaining group) was observed. In all groups, learning of the 2nd rotation resulted in unlearning of the first, indicating that all visuomotor rotations compete for common working memory resources.

Information for decision making by post-menopausal women with hormone receptor positive early-stage breast cancer considering adjuvant endocrine therapy.

PURPOSE: To identify the information that post-menopausal women with hormone-receptor positive, early-stage breast cancer want, to help them decide among six treatment options for adjuvant-endocrine therapy. METHODS: We surveyed women with early-stage breast cancer who were eligible for adjuvant endocrine-therapy 3-18 months earlier. Participants rated the importance of getting each of 95 questions answered before this decision is made (options: essential/desired/not important/avoid). For questions rated essential or desired, participants identified the purpose(s) for having the question answered: to help them understand, make the decision, plan, or other. Participants indicated the role they played in their actual decision and the role they would prefer if the decision was made today. They also indicated whether they felt they had had a choice of endocrine therapy treatments. RESULTS: 188 of 343 questionnaires were returned (response rate 55%). Mean age was 67 yr (range 38-88 yr); 76% were married, and 39% had secondary school education or less. On average, respondents rated 18 questions (range 0-94) essential for decision making. Each question was rated essential for decision making by ≥ 7% of participants but only 1 question by >50%. Regarding roles, 89% of respondents had participated in their actual decision and would want to again; an additional 9% had not participated in their actual decision but would want to at the time of the survey. The percentage of respondents who felt they had no choice of endocrine therapy treatments varied between centres, 25% vs 41% and 49%. CONCLUSIONS: Most patients want to participate in the decision but they vary widely in the amount and which specific details they want to help them make the decision. IMPLICATION: The wide variation in questions considered important means the support should be tailored to the needs of the individual patient.