Piloting a language translation device for Mandarin-speaking patients presenting for radiotherapy treatment-assessing patient and radiation therapist perspectives.

PURPOSE: Culturally and linguistically diverse (CALD) cancer patients report unmet informational and emotional needs when receiving radiotherapy (RT). This feasibility study aimed to evaluate the clinical use of an instant translation device (ITD) to facilitate communication between Mandarin-speaking patients and radiation therapists (RTTs) within the Australian public RT setting. The primary aim was to assess the ability to convey information relating to daily patient care and build rapport using the device. METHODS: A single-arm prospective interventional trial was employed with patient and RTT participants. Eligible patient participants were aged 18 years or older, diagnosed with cancer, referred for RT with self-reported Mandarin as the primary language spoken at home. Patients who had previously received RT were excluded. Consenting patient participants completed a baseline assessment of health literacy (REALM-SF) and English proficiency (LexTALE). Surveys were administered to patients and consenting RTTs at the cessation of treatment, forming two distinct participant groups. Descriptive statistics were used to compare participant groups. RESULTS: Eleven patients and 36 RTTs were recruited to the study. Descriptive statistics demonstrated participant group agreement in conveying treatment instructions, though differing experiences were reported against general conversation. Although the reporting of technical difficulties was inconsistent, both groups recommended the application of the ITD within the RT domain. CONCLUSION: This feasibility study demonstrated encouraging accounts of patients and RTTs with regard to ITD use in the context of RT treatment. Expanded, multi-institutional recruitment is required to yield statistical significance, inform the impact of the device, and determine requisite training requirements. TRIAL REGISTRATION: HREC reference number: LNR/18/PMCC/115 (18/100L). HREC approval date: 10 July 2018.

Genomic prediction in the wild: A case study in Soay sheep.

Genomic prediction, the technique whereby an individual's genetic component of their phenotype is estimated from its genome, has revolutionised animal and plant breeding and medical genetics. However, despite being first introduced nearly two decades ago, it has hardly been adopted by the evolutionary genetics community studying wild organisms. Here, genomic prediction is performed on eight traits in a wild population of Soay sheep. The population has been the focus of a >30 year evolutionary ecology study and there is already considerable understanding of the genetic architecture of the focal Mendelian and quantitative traits. We show that the accuracy of genomic prediction is high for all traits, but especially those with loci of large effect segregating. Five different methods are compared, and the two methods that can accommodate zero-effect and large-effect loci in the same model tend to perform best. If the accuracy of genomic prediction is similar in other wild populations, then there is a real opportunity for pedigree-free molecular quantitative genetics research to be enabled in many more wild populations; currently the literature is dominated by studies that have required decades of field data collection to generate sufficiently deep pedigrees. Finally, some of the potential applications of genomic prediction in wild populations are discussed.

Pedigree-Based Estimation of Reproductive Value.

How successful an individual or cohort is, in terms of their genetic contribution to the future population, is encapsulated in the concept of reproductive value, and is crucial for understanding selection and evolution. Long-term studies of pedigreed populations offer the opportunity to estimate reproductive values directly. However, the degree to which genetic contributions, as defined by a pedigree, may converge on their long-run values within the time frames of available data sets, such that they may be interpreted as estimates of reproductive value, is unclear. We develop a system for pedigree-based calculation of the expected genetic representation that both individuals and cohorts make to the population in the years following their birth. We apply this system to inference of individual and cohort reproductive values in Soay sheep (Ovis aries) from St Kilda, Outer Hebrides. We observe that these genetic contributions appear to become relatively stable within modest time frames. As such, it may be reasonable to consider pedigree-based calculations of genetic contributions to future generations as estimates of reproductive value. This approach and the knowledge that the estimates can stabilize within decades should offer new opportunities to analyze data from pedigreed wild populations, which will be of value to many fields within evolutionary biology and demography.

Complementary therapy use in metropolitan and regional Australian radiotherapy centres; do patients report effective outcomes?

PURPOSE: Complementary and alternative medicine (CAM) is increasingly used with radiotherapy treatment for cancer. This study aimed to explore patient expectations of concurrent CAM, positive/negative outcomes and any variation of use across regional and metropolitan demographics. METHODS: An ethics-approved survey was provided to radiotherapy outpatients in regional and metropolitan Victoria, Australia. The survey enquired about demographical details, CAM uptake, perceived benefits/effects, source of CAM information and disclosure of use. RESULTS: Two hundred sixty-five patients were recruited across both sites. Patients reporting concurrent CAM use were 45 % (regional site, April-August 2012) and 47 % (metropolitan site, January-May 2013). More patients at the regional centre reported living away from home during treatment (35 vs 8 %) though this did not impact upon CAM uptake. For both sites, 60 % of CAM users felt they had been provided with sufficient CAM information with family/friends the most common source. The highest reported rationale for CAM use was the patient's choice (61 and 52 %). Only 19 % of patients at either site claimed the recommendation of a doctor was the reason for CAM use. 'Improving immune system' was the most common expectation of CAM at both sites (39 and 50 %). More than half of CAM users felt that it was effective (51 and 54 %). CONCLUSIONS: CAM use across regional and metropolitan Australia is equivalent, constitutes a substantial proportion of radiotherapy outpatients and is largely considered effective by CAM users. Healthcare professionals need to improve knowledge, communication, reporting and awareness of concurrent CAM in radiotherapy practice.

Complementary and alternative medicine use and disclosure amongst Australian radiotherapy patients.

PURPOSE: Information on complementary and alternative medicine (CAM) use in Australian radiotherapy patients is sparse. This study investigated the type and prevalence of CAM amongst an Australian regional radiotherapy patient cohort and the disclosure of information to the consultant radiation oncologist. METHODS: A single hardcopy questionnaire survey was provided to patients regarding the use of CAM and discussion with the treating medical practitioner. The National Centre for Complementary and Alternative Medicine (NCCAM) classification was used to group responses. The study was open for a period of 4 months, and all patients on treatment during this period were approached. RESULTS: A total of 170 questionnaires were distributed to eligible patients, and 152 patients returned a completed questionnaire (89.4 % response rate). Sixty-nine of the 152 patients (45.4 %) reported active CAM use. Of the 69 patients who used CAM, mind-body medicine (n = 54, 78.3 %) and biological-based therapies (n = 54, 78.3 %) were the commonest NCCAM group, whilst manipulative/body-based therapies (n = 44, 63.8 %), whole medical systems (n = 7, 10.1 %) and energy therapies (n = 5, 7.2 %) were the least common. The most common therapies were vitamins and mineral supplementation (n = 33, 47.8 %) and massage therapy (n = 18, 26.1 %). Of note, only 29 participants stated that they had discussed CAM therapies with their radiation oncologist. CONCLUSIONS: CAM use was prevalent amongst cancer patients undergoing radiotherapy, but frequently not discussed with the treating radiation oncologist. Considering the high prevalence of CAM, further resources could be justifiably directed at providing this service for cancer patients to foster a more holistic approach to their care.

Validation testing of a language translation device for suitability in assisting Australian radiation therapists to communicate with Mandarin-speaking patients.

Introduction: Clear, timely communication between practitioners and patients is key in ensuring equitable access to health services and optimal care. Australia's linguistically diverse population adds complexity to healthcare provision. This paper describes a validation study to assess clinical suitability of a language translation device, intended for use with Mandarin speaking patients undergoing radiotherapy (RT). Materials and methods: After a comprehensive device selection process, common phrases used in RT practice were curated within one clinical center and translated by interpreters. Phrases were categorized by conversation type and readability (according to Flesch-Kincaid and FORCAST scores). Validation of device performance was undertaken by purposely selected radiation therapists (RTTs) who tested and evaluated the device using a survey with 5-point Likert scale responses. Statistical analysis was undertaken on Excel using Pearson's chi-square, z-test, interrater reliability/agreement and linear regression analyses. Results: Six RTTs and two interpreters volunteered to participate in this study. 188 common phrases were spoken verbatim into the device and scored on a 5-point Likert scale, yielding an overall output accuracy of 66%. A z-test confirmed significance against prior comparative research and Linear regression analysis observed improved output between consecutive participants. 62.7% of interpreter scores were identical; a further 29.1% constituted a single point scoring variation. Poorer outcomes were observed with colloquial English and lower readability. Conclusions: This study found the device produced suitable translation accuracy and identified language styles that should be avoided with use. Further research could consider clinical application, expanded languages and/or health disciplines, and development of a national RTT phrase list.

Increased genetic marker density reveals high levels of admixture between red deer and introduced Japanese sika in Kintyre, Scotland.

Hybridization is a natural process at species range boundaries, but increasing numbers of species are hybridizing due to direct or indirect human activities. In such cases of anthropogenic hybridization, subsequent introgression can threaten the survival of native species. To date, many such systems have been studied with too few genetic markers to assess the level of threat resulting from advanced backcrossing. Here, we use 44,999 single nucleotide polymorphisms (SNPs) and the ADMIXTURE program to study two areas of Scotland where a panel of 22 diagnostic microsatellites previously identified introgression between native red deer (Cervus elaphus) and introduced Japanese sika (Cervus nippon). In Kintyre, we reclassify 26% of deer from the pure species categories to the hybrid category whereas in the NW Highlands we only reclassify 2%. As expected, the reclassified individuals are mostly advanced backcrosses. We also investigate the ability of marker panels selected on different posterior allele frequency criteria to find hybrids assigned by the full marker set and show that in our data, ancestry informative markers (i.e. those that are highly differentiated between the species, but not fixed) are better than diagnostic markers (those markers that are fixed between the species) because they are more evenly distributed in the genome. Diagnostic loci are concentrated on the X chromosome to the detriment of autosomal coverage.

Employing positive psychology to improve radiation therapy workplace culture.

The Australian radiotherapy profession is challenged by job dissatisfaction, stress, burnout and unfavourable attrition. This paper will use psychological models to discuss the confluence of job demands, resources and personal characteristics that contribute to these challenges. Factors contributing to burnout and attrition amongst Australian Radiation Therapists will be explored, and a number of leadership strategies will be introduced to improve workplace culture. These strategies - aligned with positive psychology - seek to address staff engagement, emotional needs, and job stressors.

Cost-containment in hypofractionated radiation therapy: a literature review.

Recent technological advances in radiation therapy have allowed for greater accuracy in planning and treatment delivery. The development of hypofractionated radiation treatment regimens is an example, and has the potential to decrease the cost per episode of care, relative to conventional treatments. Our aim was to analyse published literature on the cost-effectiveness and budgetary implications of hypofractionated radiation therapy. As such, this article will quantify the projected health care cost savings and address the optimal means of treatment delivery, associated patient outcomes, and implications arising from an increased use of hypofractionated regimens.

Quantification and decomposition of environment-selection relationships.

In nature, selection varies across time in most environments, but we lack an understanding of how specific ecological changes drive this variation. Ecological factors can alter phenotypic selection coefficients through changes in trait distributions or individual mean fitness, even when the trait-absolute fitness relationship remains constant. We apply and extend a regression-based approach in a population of Soay sheep (Ovis aries) and suggest metrics of environment-selection relationships that can be compared across studies. We then introduce a novel method that constructs an environmentally structured fitness function. This allows calculation of full (as in existing approaches) and partial (acting separately through the absolute fitness function slope, mean fitness, and phenotype distribution) sensitivities of selection to an ecological variable. Both approaches show positive overall effects of density on viability selection of lamb mass. However, the second approach demonstrates that this relationship is largely driven by effects of density on mean fitness, rather than on the trait-fitness relationship slope. If such mechanisms of environmental dependence of selection are common, this could have important implications regarding the frequency of fluctuating selection, and how previous selection inferences relate to longer term evolutionary dynamics.