Breaking barriers: Indigenous nurse navigator role in oncology care for the Inuit.

Individuals who live in the north of Canada face many challenges when they are diagnosed with cancer. Accessing cancer care usually means having to travel to a cancer centre in southern facilities and stay in a city away from family, local community, language and culture. The Indigenous Cancer Program atThe Ottawa Hospital was established to assist these individuals in navigating a complex and unfamiliar system of care. The First Nations, Inuit, Métis Nurse Navigator role was designed to collaborate with these patients and develop interventions to meet their unique needs. Recently, a satellite oncology clinic was opened in the territory of Baffin Island Nunavut where patients can be assessed, receive cancer immunotherapy therapy treatment, if required, and be followed after their primary treatment is finished. Holding the clinic in the local setting reduces the travel and time away from home for cancer patients. It is hoped this type of care can be expanded in the remote areas of the country.

Variability in Body Shape, Superficial Soft Tissue Geometry, and Seatbelt Fit Relative to the Pelvis in Automotive Postures-Methods for Volunteer Data Collection With Open Magnetic Resonance Imaging.

Variability in body shape and soft tissue geometry have the potential to affect the body's interaction with automotive safety systems. In this study, we developed a methodology to capture information on body shape, superficial soft tissue geometry, skeletal geometry, and seatbelt fit relative to the skeleton-in automotive postures-using Open Magnetic Resonance Imaging (MRI). Volunteer posture and belt fit were first measured in a vehicle and then reproduced in a custom MRI-safe seat (with an MR-visible seatbelt) placed in an Open MR scanner. Overlapping scans were performed to create registered three-dimensional reconstructions spanning from the thigh to the clavicles. Data were collected with ten volunteers (5 female, 5 male), each in their self-selected driving posture and in a reclined posture. Examination of the MRIs showed that in the males with substantial anterior abdominal adipose tissue, the abdominal adipose tissue tended to overhang the pelvis, narrowing in the region of the Anterior Superior Iliac Spine (ASIS). For the females, the adipose tissue depth around the lower abdomen and pelvis was more uniform, with a more continuous layer superficial to the ASIS. Across the volunteers, the pelvis rotated rearward by an average of 62% of the change in seatback angle during recline. In some cases, the lap belt drew nearer to the pelvis as the volunteer reclined (as the overhanging folds of adipose tissue stretched). In others, the belt-to-pelvis distance increased as the volunteer reclined. These observations highlight the importance of considering both interdemographic and intrademographic variability when developing tools to assess safety system robustness.

Methodology to measure seat belt fit in relation to skeletal geometry using an upright open MRI.

OBJECTIVE: Poor seat belt fit can result in submarining behavior and injuries to the lower extremity and abdomen. While previous studies have explored seat belt fit relative to skeletal landmarks using palpation, medical imaging remains the gold standard for visualizing and locating skeletal landmarks and soft tissues. The goal of this study was to create a method to image automotive postures and seat belt fit from the pelvis to the clavicle using an Upright Open MRI. METHODS: The posture and belt fit of 10 volunteers (5M, 5F) were measured in an Acura TLX in each subject's preferred driving posture and a standard reclined posture, and then reproduced in a custom non-ferromagnetic seat replica in the MR scanner with an MRI-visible seat belt. The MRI sequence and coil placement were designed to yield clear visualization of bone, soft tissue borders, and the seat belt markers in separate scans of the pelvis, lumbar, thoracolumbar, and thoracic regions. A process was developed to precisely register the scans, and methods for digitizing spinal and pelvic landmarks were established to quantify belt fit. CONCLUSIONS: This method creates opportunities to study variation in seat belt fit in different automotive postures, for occupants of different sexes, ages, BMIs, anthropometries, and for pregnant occupants.

Experiences of Inuit in Canada who travel from remote settings for cancer care and impacts on decision making.

BACKGROUND: Inuit experience the highest cancer mortality rates from lung cancer in the world with increasing rates of other cancers in addition to other significant health burdens. Inuit who live in remote areas must often travel thousands of kilometers to large urban centres in southern Canada and negotiate complex and sometimes unwelcoming health care systems. There is an urgent need to improve Inuit access to and use of health care. Our study objective was to understand the experiences of Inuit in Canada who travel from a remote to an urban setting for cancer care, and the impacts on their opportunities to participate in decisions during their journey to receive cancer care. METHODS: We are an interdisciplinary team of Steering Committee and researcher partners ("the team") from Inuit-led and/or -specific organizations that span Nunavut and the Ontario cancer health systems. Guided by Inuit societal values, we used an integrated knowledge translation (KT) approach with qualitative methods. We conducted semi-structured interviews with Inuit participants and used process mapping and thematic analysis. RESULTS: We mapped the journey to receive cancer care and related the findings of client (n = 8) and medical escort (n = 6) ("participant") interviews in four themes: 1) It is hard to take part in decisions about getting health care; 2) No one explains the decisions you will need to make; 3) There is a duty to make decisions that support family and community; 4) The lack of knowledge impacts opportunities to engage in decision making. Participants described themselves as directed, with little or no support, and seeking opportunities to collaborate with others on the journey to receive cancer care. CONCLUSIONS: We describe the journey to receive cancer care as a "decision chain" which can be described as a series of events that lead to receiving cancer care. We identify points in the decision chain that could better prepare Inuit to participate in decisions related to their cancer care. We propose that there are opportunities to build further health care system capacity to support Inuit and enable their participation in decisions related to their cancer care while upholding and incorporating Inuit knowledge.

Sensitivity of scale factor choice on injury response for equal-stress equal-velocity scaling.

OBJECTIVE: This study aims to evaluate the assumption of geometric similitude inherent to equal-stress equal-velocity scaling by determining if scale factors created with different anthropometry metrics result in different scaled injury tolerance predictions. This assumption will be evaluated when equal-stress equal-velocity scaling is employed across dissimilar (e.g., 50th male to small female) and similar (e.g., small female to a reference small female anthropometry) anthropometries. METHODS: Three average male and three small female lower extremity specimens that were tested in ankle inversion/eversion were selected for scaling analysis. Three additional female specimens were selected as a reference dataset, such that the accuracy of the scaled data could be compared to an independent measured dataset. The failure moments, total height and total weight for these donors were determined from literature. Additional anthropometry metrics (leg length, calcaneus height, and bimalleolar width) were taken from each of their respective CT scans. Scale factors were calculated from these previously determined anthropometric metrics for the six donors selected for scaling analysis by targeting the averaged anthropometry metrics of the reference small female dataset. Equal-stress equal-velocity scaling was applied to the failure moments from literature using different scale factors. The mean predicted failure tolerance and standard deviation for scaled data using different scale factors were compared to one another and to the mean failure tolerance from the reference (unscaled) small female dataset. RESULTS: When using average male data to predict ankle failure moment for a small female anthropometry, scaled moments were statistically significantly different from measured small female failure moment. Furthermore, scaled failure moments predicted using scale factors based on different anthropometry metrics were found to be significantly different from one another. Conversely, predicted mean failure moment using scaled female data of a similar size to the reference data was not significantly different from measured female failure moment, and the predicted failure moments were not significantly affected by choice of scale factor. CONCLUSIONS: This study shows that an injury metric predicted with equal-stress equal-velocity scaling is sensitive to choice of scale factor when employing scaling across occupants of dissimilar size and sex. This conclusion suggests error can be introduced into scaled response due to choice of anthropometry metric used to create a scale factor, and therefore, anthropometry metrics used to create scale factors should be justified mechanistically and shown to apply across size and sex before being employed.

Cervical spine injury in rollover crashes: Anthropometry, excursion, roof deformation, and ATD prediction.

While rollover crashes are rare, approximately one third of vehicle occupant fatalities occur in rollover crashes. Most severe-to-fatal injuries resulting from rollover crashes occur in the head or neck region, due to head and neck interaction with the roof during the crash. While many studies have used anthropomorphic test devices (ATDs) to predict head and neck injury, the biofidelity of ATDs in rollover has not been established. This study aims to build on previous research to compare the dynamic response and injuries sustained by four post mortem human surrogates (PMHS) to those predicted by six different ATDs in full-scale rollover crash tests. Additionally, this study evaluates injuries sustained by PMHS relative to possible contributing factors including occupant kinematics, occupant anthropometry, and vehicle roof deformation. While the vehicle kinematics and roof deformation were comparable for all tests, three out of the four PMHS sustained cervical spine injury, but only the tallest specimen sustained cervical spine fracture. Neck flexion at the time of head-to-roof contact appears to have affected cervical spine injury risk in these cases. Despite the injuries sustained in the PMHS, none of the six ATDs measured forces or accelerations that exceeded injury assessment reference values (IARVs), which adds to recent literature illustrating substantial differences between ATDs and PMHS in a rollover-like scenario.

Constrained Laboratory vs. Unconstrained Steering-Induced Rollover Crash Tests.

OBJECTIVE: The goal of this study was to evaluate how well an in-laboratory rollover crash test methodology that constrains vehicle motion can reproduce the dynamics of unconstrained full-scale steering-induced rollover crash tests in sand. METHODS: Data from previously-published unconstrained steering-induced rollover crash tests using a full-size pickup and mid-sized sedan were analyzed to determine vehicle-to-ground impact conditions and kinematic response of the vehicles throughout the tests. Then, a pair of replicate vehicles were prepared to match the inertial properties of the steering-induced test vehicles and configured to record dynamic roof structure deformations and kinematic response. RESULTS: Both vehicles experienced greater increases in roll-axis angular velocities in the unconstrained tests than in the constrained tests; however, the increases that occurred during the trailing side roof interaction were nearly identical between tests for both vehicles. Both vehicles experienced linear accelerations in the constrained tests that were similar to those in the unconstrained tests, but the pickup, in particular, had accelerations that were matched in magnitude, timing, and duration very closely between the two test types. Deformations in the truck test were higher in the constrained than the unconstrained, and deformations in the sedan were greater in the unconstrained than the constrained as a result of constraints of the test fixture, and differences in impact velocity for the trailing side. CONCLUSIONS: The results of the current study suggest that in-laboratory rollover tests can be used to simulate the injury-causing portions of unconstrained rollover crashes. To date, such a demonstration has not yet been published in the open literature. This study did, however, show that road surface can affect vehicle response in a way that may not be able to be mimicked in the laboratory. Lastly, this study showed that configuring the in-laboratory tests to match the leading-side touchdown conditions could result in differences in the trailing side impact conditions.

Decision-Making and Depressive Symptomatology.

Difficulty making decisions is a core symptom of depressive illness, but the nature of these difficulties has not been well characterized. The two studies presented herein use the same hypothetical scenarios that call for a decision. In Study 1, participants were asked to make and explain their decisions in a free-response format, as well as to describe their prior experiences with similar situations. The results suggest that those with more depressive symptoms make decisions that are less likely to further their interests. We also identified several interesting associations between features of decision-making and the presence of depressive symptoms. In Study 2, participants were guided through their decisions with simple decision tools to investigate whether the association between depressive symptoms and poor decisions is better accounted for by failure to use of good decision-making strategies, or by other factors, such as differences in priorities or goals. With this minimal intervention the quality of decisions no longer declined significantly as a function of depressive symptom severity. Moreover, few associations between depressive symptom severity and decision-related goals and priorities were evident, suggesting that the previously-exposed difficulties of depressed individuals with decision-making were largely the result of their failure to use effective decision-making techniques.

Nine years of the freebase cocaine epidemic in the Bahamas: emergence of a new pattern

Nine years the beginning of the first reported nationwide epidemic of freebase (crack) cocaine abuse, which occurred in the Bahamas, a follow-up study was done to determine the pattern of the epidemic and the effectiveness of control measures. Data included the incidence of new cases at the only psychiatric hospital in the Bahamas and the primary community pschiatric clinic in the nation. Data on police arrests, drug seizures, and results for urine screenings for cocaine abuse came from the reports of the Royal Bahamas Police Force. The number of new cases of crack abuse presenting for treatment fell from 1987 to mid-1991, with a corresponding reduction of load at the treatment facilities. However, hospitalized cocaine abuse cases began rising again in mid-1991. This paper analyzes correlates of the fall and partial resurgences of the epidemic. In 1992, crack is much more difficult to obtain than in the early and middle 1980's. The Bahamian reponse to the epidemic - including 1) demand reduction, 2) supply reduction and 3) reduction of money laundering - played an important role in the decline of new cases. Crack has not been replaced by other illegal drugs, but alcohol has resumed its former place of preference. However, despite a reduction in the rate of new crack abuse cases appearing for treatment, there has been a recent rise in violent, robberies and gang activity. This apparently is due to chronic cocainism, a pattern of long term use of crack and other forms cocaine that is resistant to treatment (AU)

Nine years of the freebase cocaine epidemic in the Bahamas: emergence of a new pattern

Nine years the beginning of the first reported nationwide epidemic of freebase (crack) cocaine abuse, which occurred in the Bahamas, a follow-up study was done to determine the pattern of the epidemic and the effectiveness of control measures. Data included the incidence of new cases at the only psychiatric hospital in the Bahamas and the primary community pschiatric clinic in the nation. Data on police arrests, drug seizures, and results for urine screenings for cocaine abuse came from the reports of the Royal Bahamas Police Force. The number of new cases of crack abuse presenting for treatment fell from 1987 to mid-1991, with a corresponding reduction of load at the treatment facilities. However, hospitalized cocaine abuse cases began rising again in mid-1991. This paper analyzes correlates of the fall and partial resurgences of the epidemic. In 1992, crack is much more difficult to obtain than in the early and middle 1980's. The Bahamian reponse to the epidemic - including 1) demand reduction, 2) supply reduction and 3) reduction of money laundering - played an important role in the decline of new cases. Crack has not been replaced by other illegal drugs, but alcohol has resumed its former place of preference. However, despite a reduction in the rate of new crack abuse cases appearing for treatment, there has been a recent rise in violent, robberies and gang activity. This apparently is due to chronic cocainism, a pattern of long term use of crack and other forms cocaine that is resistant to treatment