"I might not have cancer if you didn't mention it": a qualitative study on information needed by culturally diverse cancer survivors.

BACKGROUND: Immigrants from culturally and linguistically diverse (CALD) backgrounds diagnosed with cancer face multiple challenges with health systems foreign to them. There is scarce understanding about their needs following cancer treatment in the survivorship phase. Unmet needs were examined in immigrant Chinese and Greek cancer survivors in order to assist development of relevant and useful information resources for these CALD groups. METHODS: Qualitative descriptive design was used. Adult cancer survivors, whose native language was Mandarin, Cantonese or Greek, were recruited through ethnic cancer support groups and cancer specialists in two Australian cities. Six focus groups were conducted, two in each native language group. Recorded responses were transcribed, translated into English, and thematically analysed. RESULTS: Thirty-nine CALD cancer survivors participated from Greek (11), Cantonese (14) and Mandarin (14) backgrounds. Thematic findings included as follows: ongoing cancer-related stressors, cancer misunderstandings, coping strategies, 'survivor' seldom reflects self-appraisal, and additional CALD survivorship information needed. Immigrant cancer survivors may prefer 'recovery' to 'survivorship' descriptors and need information similar to Caucasian cancer survivors alongside as follows: resources for navigating health care, financial and community entitlements; caregiver-directed information to enhance their support; explanations about differences in health care approaches between survivors' original and adopted countries; and acknowledgment of survivorship diversity within CALD groups. CONCLUSIONS: Immigrant cancer survivors' additional requirements to native survivors likely reflect challenges in dealing with foreign environments and varied levels of acculturation within group members. Identification of immigrant cancer survivorship issues may support development of targeted resources for promoting survivors' self-care and capacity for finding, choosing, and using existing support options.

Everybody wants it done but nobody wants to do it: an exploration of the barrier and enablers of critical components towards creating a clinical pathway for anxiety and depression in cancer.

BACKGROUND: This study aimed to explore barriers to and enablers for future implementation of a draft clinical pathway for anxiety and depression in cancer patients in the Australian context. METHODS: Health professionals reviewed a draft clinical pathway and participated in qualitative interviews about the delivery of psychosocial care in their setting, individual components of the draft pathway, and barriers and enablers for its future implementation. RESULTS: Five interrelated themes were identified: ownership; resources and responsibility; education and training; patient reluctance; and integration with health services beyond oncology. CONCLUSIONS: The five themes were perceived as both barriers and enablers and provide a basis for an implementation plan that includes strategies to overcome barriers. The next steps are to design and deliver the clinical pathway with specific implementation strategies that address team ownership, endorsement by leaders, education and training modules designed for health professionals and patients and identify ways to integrate the pathway into existing cancer services.

Using brain-based cognitive measures to support clinical decisions in ADHD.

Measures of cognition support diagnostic and treatment decisions in attention deficit hyperactivity disorder. We used an integrative neuroscience framework to assess cognition and associated brain-function correlates in large attention deficit hyperactivity disorder and healthy groups. Matched groups of 175 attention deficit hyperactivity disorder children/adolescents and 175 healthy control subjects were assessed clinically, with the touch screen-based cognitive assessment battery "IntegNeuro" (Brain Resource Ltd., Sydney, Australia) and the "LabNeuro" (Brain Resource Ltd., Sydney, Australia) platform for psychophysiologic recordings of brain function and body arousal. IntegNeuro continuous performance task measures of sustained attention classified 68% of attention deficit hyperactivity disorder patients with 76% specificity, consistent with previous reports. Our additional cognitive measures of impulsivity, intrusive errors, inhibition, and response variability improved sensitivity to 88%, and specificity to 91%. Positive predictive power was 96%, and negative predictive power, 88%. These metrics were stable across attention deficit hyperactivity disorder subtypes and age. Consistent with their brain-based validity, cognitive measures were correlated with corresponding brain-function and body-arousal measures. We propose a combination of candidate cognitive "markers" that define a signature for attention deficit hyperactivity disorder: "sustained attention," "impulsivity," "inhibition," "intrusions," and "response variability." These markers offer a frame of reference to support diagnostic and treatment decisions, and an objective benchmark for monitoring outcomes of interventions.

A learned flavor preference persists despite the extinction of conditioned hedonic reactions to the cue flavors.

Learned flavor preferences can be strikingly persistent in the face of behavioral extinction. Harris, Shand, Carroll, and Westbrook (2004) suggested that this persistence may be due to flavor preference conditioning's producing a long-lasting change in the hedonic response to the conditioned stimulus (CS+) flavor. In the present study, the CS+ flavor was presented in simultaneous compound with 16% sucrose, whereas the CS- flavor was presented with 2% sucrose. During subsequent two- and one-bottle tests, the CS+ and CS- flavors were presented in 2% sucrose. Hedonic reactions during training and test were assessed using an analysis of the microstructure of licking behavior. Conditioning resulted in greater consumption of the CS+ than of the CS- that did not extinguish over repeated two- and one-bottle tests. The mean lick cluster size was higher for the CS+ than for the CS- only on the first cycle of tests. Since lick cluster size can be used as an index of stimulus palatability, the present results indicate that although the hedonic reaction to the CSs did change, this was not maintained across repeated tests. Thus, changes in the hedonic response to the conditioned flavors cannot explain the resistance to the extinction of learned flavor preferences.

How the associative strengths of stimuli combine in compound: summation and overshadowing.

When two conditioned stimuli (CSs) are presented in compound, the response is typically stronger than to the individual CSs, implying that their associative strengths combine. However, to identify exactly how associative strengths combine requires an accurate description of the relationship between associative strength and responding. The authors have used the delta rule (Rescorla & Wagner, 1972) to constrain the predicted growth of associative strength (V) to identify the relationship between V and responding across the course of Pavlovian conditioning of two CSs (one auditory, one visual). Responding to the compound was best predicted as 0.6xV(CS1)+0.6xV(CS2), suggesting that only 60% of the associative strength of each CS generalized to the compound. A second experiment confirmed this result and additionally showed that summation of responding between two same-modality CSs (both auditory or both visual) declined across training. A third experiment applied the procedure to compound conditioning, showing that responding to the compound was equal to the sum of the response rates to the individual CSs. The results are discussed in terms of configural and elemental models of Pavlovian conditioning.

Interactions between conditioned and unconditioned flavor preferences.

Five experiments investigated how rats' conditioned preferences or aversions for aqueous odors paired with sucrose or salt are affected by their unconditioned response to those tastes. Rats preferred an odor paired with 30% sucrose over an odor paired with 5% sucrose when both were presented in 5% sucrose, but they showed no preference or, if thirsty, showed the reverse preference, when the odors were presented in 30% sucrose. These changes in conditioned preference corresponded to changes in the rats' unconditioned preference for the accompanying sucrose solution. Rats' conditioned aversions for odors paired with salt showed a similar dependence on their reaction to the accompanying salt solution. The results were interpreted as showing that conditioned and unconditioned flavor preferences combine additively, as if mediated by the same sensory representation.

Dissociating detection from localization of tactile stimuli.

In what they described as "a tactile analog of blindsight," Paillard et al. (1983) reported the case of a woman with damage to the left parietal cortex who was profoundly impaired in detecting tactile stimuli but could nonetheless correctly identify their location (also Rossetti et al., 1995). This stands in direct contrast to reports of neurological patients who were unable to accurately locate stimuli that they could successfully detect (Head and Holmes, 1911; Halligan et al., 1995; Rapp et al., 2002). The combination of these findings suggests that detecting and locating tactile stimuli are doubly dissociable processes, presumably mediated by different neural structures. We conducted four psychophysical experiments seeking evidence for such a double dissociation in neurologically intact subjects. We compared people's accuracy in detecting versus locating a tactile stimulus presented to one of four fingers and followed by a vibrotactile mask presented to all four fingers. Accuracy scores for both the yes-no detection and four-alternative forced-choice location judgments were converted to a bias-free measure (d'), which revealed that subjects were better at detecting than locating the stimulus. Detection was also more sensitive than localization to manipulations involving the mask: detection accuracy increased more steeply than localization accuracy as the target-mask interval increased, and detection, but not localization, was affected by changes in the mask frequency. By comparing these results with simulated data generated by computational models, we conclude that detection and localization are not mutually independent as previous neurological studies might suggest, but rather localization is subsequent to detection in a serially organized sensory processing hierarchy.