Implementation of Stereotactic MRI-Guided Adaptive Radiotherapy (SMART) for Hepatobiliary and Pancreatic Cancers in the United Kingdom - Fifty in Five.

The first MRIdian® MR linear accelerator (MR-Linac; ViewRay, Oakwood Village, Ohio) in the United Kingdom went live in December 2019 following a record installation time. Stereotactic MRI-guided Adaptive Radiotherapy (SMART) has since been implemented and has advantages of excellent soft tissue definition of both target and organs at risk (OARs), real-time target and OAR visualisation on cine-MRI, daily recontouring of target and critical OARs with live online plan adaptation/re-optimisation, and automatic respiratory-gated treatment delivery. We present a multi-disciplinary narrative and technical description of how this innovative technique was implemented for hepatobiliary (HPB) cancers. In particular, we explain how a collaborative approach and desire to push the boundaries and improve outcomes enabled 50 patients to be treated in the first five months, many with technically challenging tumours not always deliverable on other platforms. Physics, dosimetry, radiographer, and clinician perspectives on implementing SMART are presented. MRIdian® single fraction lung stereotactic ablative radiotherapy (SABR) will shortly be implemented along with innovative research in conjunction with our academic partners.

Intergenerational exchange of healthful eating encouragement: Consideration of family ancestry and disease history.

INTRODUCTION: Improving diet is a prime target for the prevention and management of chronic disease. The communal coping model suggests that families can mitigate shared risk of chronic disease through encouragement of healthful eating, eliciting preventive behaviors. METHOD: Using network data from 69 Australian families across three ancestry groups (Anglo, Italian, and Asian) with varied family health histories, the present study applied social network analysis to identify patterns of intergenerational encouragement of healthful eating behavior within families, and assess whether patterns varied by family ancestry or disease density. RESULTS: Findings indicated variation in patterns of health encouragement by ancestry such that Asian-Australian families were most distinct from the other ancestry groups. While there was no main effect of familial disease history, it moderated the effect of Italian ancestry on intergenerational encouragement patterns. DISCUSSION: These results provide important context for future family based interventions that leverage normative patterns of intergenerational exchange of encouragement or aim to modify such patterns in an effort to improve family health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Randomized Controlled Trial Testing Provision of Fecal and Blood Test Options on Participation for Colorectal Cancer Screening.

Suboptimal participation is commonly observed in colorectal cancer screening programs utilizing fecal tests. This randomized controlled trial tested whether the offer of a blood test as either a "rescue" strategy for fecal test nonparticipants or an upfront choice, could improve participation. A total of 1,800 people (50-74 years) were randomized to control, rescue, or choice groups (n = 600/group). All were mailed a fecal immunochemical test (FIT, OC-Sensor, Eiken Chemical Company) and a survey assessing awareness of the screening tests. The rescue group was offered a blood test 12 weeks after FIT nonparticipation. The choice group was given the opportunity to choose to do a blood test (Colvera, Clinical Genomics) instead of FIT at baseline. Participation with any test after 24 weeks was not significantly different between groups (control, 37.8%; rescue, 36.9%; choice, 33.8%; P > 0.05). When the rescue strategy was offered after 12 weeks, an additional 6.5% participated with the blood test, which was greater than the blood test participation when offered as an upfront choice (1.5%; P < 0.001). Awareness of the tests was greater for FIT than for blood (96.2% vs. 23.1%; P < 0.0001). In a population familiar with FIT screening, provision of a blood test either as a rescue of FIT nonparticipants or as an upfront choice did not increase overall participation. This might reflect a lack of awareness of the blood test for screening compared with FIT.

Can we address cancer disparities in immigrants by improving cancer literacy through English as a second language instruction?

In many Western countries, immigrants exhibit disparities in cancer incidence and mortality, and variable uptake of cancer prevention services. New immigrants may not be aware of cancer risks pertinent to their new country, or prevention resources. Traditional cancer prevention health messaging may not be accessible for cultural, language, or literacy reasons. New methods are needed. In North America, health message delivery via English classes for immigrants is showing potential as an efficacious and a feasible way to reach immigrants at the same time improving language skills. Interventions published to date are promising but limited in their ability to generalize or be adapted to a variety of populations and settings. This concept paper aims to synthesize previous findings and identify ways to improve and advance the translation potential of this approach. We propose that this could be achieved by (i) using a translation framework to guide intervention planning, development, implementation, and evaluation; (ii) encouraging and evaluating health message spread throughout language learners' social networks; and (iii) incorporating cultural sensitivity into the curriculum. A pilot project following these recommendations is planned for Australia and will be discussed. These recommendations could serve as a framework to fit the requirements of immigrant language programs in other countries and other health topics.

Patterns of participation over four rounds of annual fecal immunochemical test-based screening for colorectal cancer: what predicts rescreening?

BACKGROUND: Participation at the recommended intervals is critical for screening to be effective in reducing colorectal cancer (CRC) incidence. This study describes patterns of screening participation over four rounds of fecal immunochemical testing (FIT) to identify whether demographic variables and prior screening satisfaction are significantly associated with patterns of re-participation. METHODS: Baseline surveys were mailed to 4000 South Australians randomly selected from the electoral-roll. Respondents (n = 1928/48.2%) were offered four annual FIT rounds. Screening participation and satisfaction at each round were recorded. RESULTS: Study participation was 58.5, 66.9, 73.1 and 71.4% respectively over four rounds. Three participation patterns were described: consistent participation (43.1%), consistent non-participation (26.4%) and inconsistent participation (changeable; 30.5%), including intermittent and sustained change patterns. Sustained change described those who changed participatory behavior and then maintained for at least two rounds (n = 375/19.5%). Older people, and those not working were most likely to sustain participation. Younger invitees, especially men, were more likely to change participatory behavior and sustain the change. People with higher disadvantage, less education, not working and with no prior (pre-trial) screening experience were more likely to start participating and drop out. People dissatisfied with a prior screening test, including finding aspects embarrassing or unpleasant, were also more likely not to participate in annual screening or to drop out. CONCLUSIONS: The findings identify those at risk of non- or inconsistent participation in rescreening. They should aid targeting of interventions for demographic groups at risk and ensuring screening experiences are not perceived as unpleasant or difficult.

Use of the Distress Thermometer in a cancer helpline context: Can it detect changes in distress, is it acceptable to nurses and callers, and do high scores lead to internal referrals?

PURPOSE: To improve understanding about; (1) the validity of the Distress Thermometer (DT) as a measure of changes in distress after a cancer helpline call, (2) the impact of a helpline call on callers' distress, (3) caller and helpline nurses' comfort with use of the DT, and (4) the extent to which DT scores over the critical threshold, are associated with referral to internal support services for follow-up psychosocial care. METHODS: Callers (people diagnosed with cancer and their family/friends: N = 100) completed a questionnaire that included DT ratings (three time-points), the Depression Anxiety and Stress Scale-21 (DASS-21) and measures of comfort with the DT tool. Nurses recorded referrals to internal services and their comfort in using the DT in each call. RESULTS: The DT correlated with the DASS-21 depression (r = 0.45, p < 0.001), anxiety (r = 0.56, p < 0.001) and stress (r = 0.64, p < 0.001) subscales demonstrating validity. Callers' self-rated distress was significantly lower after the call, regardless of gender or caller type (F(2, 97) = 63.67, p < 0.01, partial eta squared = 0.57). Over 74% of people diagnosed with cancer, 80% family/friends and 89.3% of nurses felt comfortable with DT use. Only 16% of participants were referred on to follow-up internal support services despite 90% of people with cancer and 75% of family/friends' DT scores' suggesting they required follow-up care. CONCLUSIONS: The DT is a valid and acceptable tool for use by cancer helplines. Improved documentation of referrals is required to better understand referral patterns.

Design of Customized Mobile Application for Patient Adherence to Oral Anticancer Medications Utilizing User-Centered Design.

Adherence and compliance to oral anticancer medications (OAMs) can be challenging for patients due to their complex regimens. The goal of this research project was to design an effective and engaging user interface (UI), based on user-centered design (UCD) and incorporate animations, to reinforce and improve patient's understanding of the key aspects of taking OAMs. This current paper encompasses the development process and describes the initial phase of the project, which focused on the design and development of the tablet-based educational application (app). A UCD approach was implemented by consulting with oncology clinicians and patients at an early stage of development. Animations were developed and incorporated to convey complex medical concepts and information. An iterative design process will help ensure that the tool is customized for patient engagement.

Protocol for a randomized controlled trial testing the impact of feedback on familial risk of chronic diseases on family-level intentions to participate in preventive lifestyle behaviors.

BACKGROUND: Common disease risk clusters in families due to shared genetics, exposure to environmental risk factors, and because many health behaviours are established and maintained in family environments. This randomised controlled trial will test whether the provision of a family health history (FHH) risk assessment tool increases intentions and engagement in health behaviors. Message distribution and collective behavior change within family networks will be mapped using social network analysis. The relative intervention impact will be compared between families from different ethnic backgrounds. METHODS: One hundred and fifty mothers (50 Anglo-Australian, 50 Italian-Australian, 50 Vietnamese-Australian) will be recruited, with four or more other family members across three generations, including a child (aged 10-18 years). Each family is randomly assigned to intervention or control. At baseline and 6-month follow-up, all participants complete surveys to assess dietary and physical activity intentions and behaviors, attitudes towards food, and perceived disease risk. Intervention families receive a visual pedigree detailing their FHH of diabetes, heart disease, breast and bowel cancer, a health education workbook to ascertain members' disease risk (i.e. average or above average risk), and screening and primary prevention recommendations. After completion of follow-up assessments, controls will receive their pedigree and workbook. The primary hypothesis is that attitudes and lifestyle behaviors will improve more within families exposed to FHH feedback, although the extent of this improvement may vary between families from different ethnic backgrounds. Additionally, the extent of improvement in the treatment group will be moderated by the level of family disease risk, with above-average risk leading to greater improvement. A secondary aim will explore different family members' roles in message distribution and collective responses to risk using social network approaches and to compare network functioning between families with different ethnic backgrounds. DISCUSSION: Results will guide future health promotion programs aimed at improving lifestyle factors. This research will assess whether FHH can motivate families to adopt family-level strategies to support health promoting behaviors. Secondary analyses aim to identify change agents within the family who are particularly effective in shifting normative behaviors. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613001033730 . Retrospectively registered: 17 September, 2013.

Challenges associated with recruiting multigenerational, multicultural families into a randomised controlled trial: Balancing feasibility with validity.

Recruitment of participants into research studies has become an increasingly difficult task with justifiable criticisms of representativeness of samples. The difficulties of recruitment are exacerbated when the study is longitudinal, requires multiple members from one family and incorporates people from non-dominant ethnic backgrounds. This paper describes a complex trial's recruitment process. Family groups were required for a longitudinal randomised controlled trial investigating links between health and dietary behaviours with an aim to improve primary prevention health messages and initiatives. To be representative of the multi-ethnic composition of the South Australian population, families from three of South Australia's largest ethnic backgrounds were invited to participate. Of these, only families with participating members spanning three generations were enrolled, so that links between health and lifestyle behaviours with possible generational ties could be investigated. Immense difficulties were faced during recruitment and significant modifications to the initial recruitment plan were necessary to enable the enrolment of 96 families. Challenges faced included lack of response to recruitment materials displaying complex eligibility criteria and different response outcomes from different communities. Solutions implemented included simplifying materials and tailoring recruitment activities to specific communities' needs. This trial's recruitment journey will be used as a case study to highlight the practicalities of recruiting for complex trials. Recommendations will be provided for future researchers seeking to recruit multigenerational, multi-ethnic families into the same study, along with issues to consider regarding the implications of the recruitment journey on the integrity of a complex trial and the potential threats to internal validity.

Effect of a 12-mo micronutrient intervention on learning and memory in well-nourished and marginally nourished school-aged children: 2 parallel, randomized, placebo-controlled studies in Australia and Indonesia.

BACKGROUND: Little is known about the combined effect of micronutrients and essential fatty acids on cognitive function in school-aged children. OBJECTIVE: We assessed the effect of micronutrients, long-chain n-3 fatty acids, or both on indicators of cognitive performance in well-nourished and marginally nourished school-aged children. DESIGN: Two 2-by-2 factorial randomized controlled double-blind trials were performed home-based in Adelaide, South Australia, and at 6 primary schools in Jakarta, Indonesia. A total of 396 children (aged 6-10 y) in Australia and 384 children in Indonesia were randomly allocated to receive a drink with a micronutrient mix (iron, zinc, folate, and vitamins A, B-6, B-12, and C), with docosahexanoic acid (DHA, 88 mg/d) and eicosapentaenoic acid (EPA, 22 mg/d), or with both or placebo 6 d/wk for 12 mo. Biochemical indicators were determined at baseline and 12 mo. Cognitive performance was measured at baseline, 6 mo, and 12 mo. RESULTS: The micronutrient treatment significantly improved plasma micronutrient concentrations in Australian and Indonesian children. DHA+EPA treatment increased plasma DHA and total plasma n-3 fatty acids in both countries. The micronutrient treatment resulted in significant increases in scores on tests representing verbal learning and memory in Australia (estimated effect size: 0.23; 95% CI: 0.01, 0.46). A similar effect was observed among Indonesian girls (estimated effect size: 0.32; 95% CI: -0.01, 0.64). No effects were found on tests measuring general intelligence or attention. No effects of DHA+EPA on the factors of cognitive tests were observed. CONCLUSION: In well-nourished school-aged children, fortification with multiple micronutrients can result in improvements in verbal learning and memory.

Modern-day comfort women: the U.S. Military, transnational crime, and the trafficking of women.

The trafficking of women has been a lucrative moneymaker for transnational organized crime networks, ranking third, behind drugs and arms, in criminal earnings. The U.S. military bases in South Korea were found to form a hub for the transnational trafficking of women from the Asia Pacific and Eurasia to South Korea and the United States. This study, conducted in 2002, examined three types of trafficking that were connected to U.S. military bases in South Korea: domestic trafficking of Korean women to clubs around the military bases in South Korea, transnational trafficking of women to clubs around military bases in South Korea, and transnational trafficking of women from South Korea to massage parlors in the United States.

Nutrients for cognitive development in school-aged children.

This review considers the research to date on the role of nutrition in cognitive development in children, with a particular emphasis on the relatively neglected post-infancy period. Undernutrition and deficiencies of iodine, iron, and folate are all important for the development of the brain and the emergent cognitive functions, and there is some evidence to suggest that zinc, vitamin B12, and omega-3 polyunsaturated fatty acids may also be important. Considerations for future research include a focus on the interactions between micronutrients and macronutrients that might be influential in the optimization of cognitive development; investigation of the impact of nutritional factors in children after infancy, with particular emphasis on effects on the developing executive functions; and selection of populations that might benefit from nutritional interventions, for example, children with nutrient deficiencies or those suffering from attention deficit-hyperactivity disorder and dyslexia.

The assessment of cognitive performance in children: considerations for detecting nutritional influences.

The accurate assessment of cognitive performance in children is critical for detecting the effects of micronutrient deficiency or supplementation on the developing brain and its functions. Relatively little attention has been paid to the selection of culturally appropriate measures that are sensitive enough to detect the subtle cognitive changes that could be expected following nutritional intervention. Normal brain development and the emergence of cognitive abilities throughout infancy and childhood is discussed in this paper, followed by a description of the more pertinent and sensitive neuropsychological tests that can be used to assess cognitive performance and investigate the effects of micronutrient deficiency and supplementation on cognitive development among children in a variety of cultures.

Adult age differences in strategy use during verbal fluency performance.

This study investigated adult age differences in strategy use during verbal fluency performance among 60 older and 60 younger adults. Clustering and switching, strategic components of fluency, were investigated as predictors of performance along with cognitive processes thought to underlie these strategies, namely verbal ability, speed of processing and executive function (strategic planning, performance monitoring, etc.). Two measures of verbal fluency were used: initial and excluded letter (words produced not containing a designated letter). These tasks both require search for words based on a phonemic cue but are thought to reflect a differential reliance on strategic retrieval search processes for successful performance. The number of clusters produced accounted for age differences in excluded, but not initial, letter fluency. Performance on both fluency tasks was associated with the number of clusters and switches participants produced and initial letter fluency was associated with cluster size for older adults and a ratio index of effective search for both age groups. In general, both fluency tasks relied on verbal ability and articulation speed, and excluded letter fluency performance relied more on speed and executive function than did initial letter fluency, especially for older adults.

Short-term folate, vitamin B-12 or vitamin B-6 supplementation slightly affects memory performance but not mood in women of various ages.

Based on research demonstrating associations between folate, B-12 and B-6 vitamins and cognition and mood, we investigated the effects of short-term supplementation in 211 healthy younger, middle-aged and older women who took either 750 microg of folate, 15 microg of vitamin B-12, 75 mg of vitamin B-6 or a placebo daily for 35 d. In addition, we examined associations between dietary intake of these vitamins and cognition and mood. Usual dietary intake status was estimated using a retrospective, self-report, quantified food frequency questionnaire. Participants completed alternate forms of standardized tests of cognitive processing resources, memory, executive function, verbal ability and self-report mood measures before and after supplementation. Supplementation had a significant positive effect on some measures of memory performance only, and no effect on mood. Dietary intake status was associated with speed of processing, recall and recognition and verbal ability.

ANALYSIS OF THE GENETIC STRUCTURE OF LIFE HISTORY OF DROSOPHILA MELANOGASTER USING RECOMBINANT EXTRACTED LINES.

A model for the evolution of senescence known as "antagonistic pleiotropy" makes the specific prediction that there should be a negative genetic correlation between early- and late-age traits associated with fitness. This model has previously been tested by classical quantitative-genetic means including sib-analysis and artificial selection. We used the approach of chromosome extraction, which has both advantages and disadvantages compared to classical techniques, to test the model further. From four isogenic lines of Drosophila melanogaster, four sets of recombinant extracted lines were constructed using standard balancer-chromosome techniques. The four parental lines and 53 recombinants were reared under controlled laboratory conditions and isolated as pairs for scoring daily fecundity and longevity. Even though the design is not optimal for estimating classical components of genetic variance, it afforded a uniquely direct test of the magnitude of environmental covariances, while giving a detailed genetic picture of part of the genome. There were clear differences among the recombinant series in the distribution of mean longevity and early fecundity. The genetic correlation between early fecundity (sum of egg production for the first five days posteclosion) and female longevity was significantly negative in only one of the recombinant series. When all lines were considered together, the phenotypic correlation between these traits was significantly negative (P < 0.02), while the broad-sense genetic correlation was -0.219 (P < 0.11). This result may be viewed as weakly consistent with the model of antagonistic pleiotropy, but other aspects of the data are at odds with the model.