5 years of teleoncology in North Queensland: a sustainable model

Background: The Townsville Cancer Centre (TCC) has been delivering its medical oncology services closer to home for patients from 19 rural centres via teleoncology since 2007. Patients are satisfied with this model of care. The aim is to describe the services extended to rural patients and the resource improvements enjoyed by rural hospitals as a result of teleoncology over this period. Methods: Data for patients treated via teleoncology from 1st April 2007 to 31st March 2012 was extracted from the oncology information system of TCC. Demographic details and type of services provided are presented descriptively. Results: A total of 170 patients were seen in 800 consultations over 60 months. Median age was 58 years (20–89), males 46% and females 54%. 25 patients were from remote indigenous communities. Most common cancer types were breast (37%), colorectal (21%) and lung (22%). A total of 87 patients received chemotherapy in Mount Isa, supervised remotely from Townsville via video conference with curative intent in 30% and palliative intent in the rest. Examples of chemotherapy regimens included docetaxel, doxorubicin and cyclophosphamide (TAC), bleomycin, etoposide and cisplatin (BEP), methotreaxte and ifosfamide infusion. 15 patients were seen urgently and appropriate treatment initiated within 24 hours in Mount Isa, thus avoiding inter hospital transfer. Six admitted patients were seen on regular ward rounds. Severe toxicities included one death from pneumonia, one stroke and one resuscitated cardiac arrest. By improving the resources in Mount Isa hospital to accommodate these services, numbers of oncology specific medical and allied health practitioners and service capability have improved. Conclusion: Teleoncology model can enhance rural service capabilities and health resources so that comprehensive medical oncology services can be sustainably provided to rural areas by remote supervision

Compression and amplification algorithms in hearing aids impair the selectivity of neural responses to speech

In quiet environments, hearing aids improve the perception of low-intensity sounds. However, for high-intensity sounds in background noise, the aids often fail to provide a benefit to the wearer. Here, using large-scale single-neuron recordings from hearing-impaired gerbils—an established animal model of human hearing—we show that hearing aids restore the sensitivity of neural responses to speech, but not their selectivity. Rather than reflecting a deficit in supra-threshold auditory processing, the low selectivity is a consequence of hearing-aid compression (which decreases the spectral and temporal contrasts of incoming sound) and amplification (which distorts neural responses, regardless of whether hearing is impaired). Processing strategies that avoid the trade-off between neural sensitivity and selectivity should improve the performance of hearing aids

Genome scanning for identification of resistance gene analogs (RGAs) in a highly durable blast resistance rice (Oryza sativa L.) cultivar, Moroberekan

Disease resistance in plants is a desirable economic trait. Many disease resistance genes from various plants have been cloned so far. The gene products of some of these can be distinguished by the presence of an N terminal nucleotide binding site and a C-terminal stretch of leucine-rich repeats. Oligonucleotides already designed from sequence motifs conserved between resistance N genes of tobacco and RPS2 of Arabidopsis thaliana were used as PCR primers (AS1/S2) to scan the rice blast disease resistant moroberekan genomic DNA. The primer pairs RL, CL and tobacco N gene which were used based on leucine-rich repeat regions of genes RPS2 in Arabidopsis, Cf9 of tomato against Cladosporium fulvum and N gene of tobacco confers resistance to the viral pathogen, tobacco mosaic virus respectively. The fragment amplified by the primer AS1/S2 was cloned and sequenced. The PCR products for the other three primers were sequenced directly. Homology search of the resultant nucleotide sequences and deduced amino acid sequences with the reported sequences available in public data bases of NCBI BLASTn and PSI blast indicated the presence of resistance protein-like gene in BRGA-1(blast resistant gene analogue-1), putative retro-elements and putative retro-transposons proteins in BRGA-2, mitochondrial DNA in BRGA-3 and NBS-LRR type resistance protein and NB-ARC domain containing expressed protein of Oryza sativa in BRGA-4.Key words: Disease resistance, Magnaporthe grisea, leucine-rich repeats (LRR), Nucleotide-binding site (NBS), retrotransposon, rice blast disease, Oryza sativa L

Perspectives of Complementary and Alternative Medicine use by cancer patients in a regional hospital in North Queensland, Australia

Objectives: This study aimed to investigate CAMs used, and reasons for and disclosure of this use by cancer patients in a regional hospital in North Queensland, Australia. Methods: Patients attending the Day Oncology Unit of the Townsville University Hospital were invited to participate in a self-completed questionnaire or telephone interview regarding perspectives of their CAM use. Data were analysed using descriptive statistics and chi-squared and independent t-tests were performed to allow comparison between the responses by CAM users and non-users. Results: 102 completed questionnaires were used in the analysis, where 40.2 % of respondents were found to be using some form of CAM. Cannabis, magnesium, and massage were the most prominent therapies used, with cannabis use in cancer, not commonly reported in prior literature. The main reasons given for using CAM were to treat symptoms of cancer, side-effects of treatment or to improve general health. Two-thirds of these respondents disclosed their CAM use to health professionals mostly to obtain a professional opinion or due to concerns of interactions with cancer treatment. CAM users were statistically more likely to have used CAM prior to their cancer diagnosis and have lower emotional wellbeing than non-users. Non-CAM users indicated that a lack of knowledge of CAM or concerns regarding interactions with cancer treatment were the most popular reasons for not adopting these therapies. Conclusion: While lower than the averages of previously published CAM use, our study highlights that there is still a significant group of cancer patients in the North Queensland region using CAMs

Knowledge, attitudes, and practices of Australian oncology health professionals on complementary medicines

Background: Approximately half of people with cancer are using complementary and alternative medicine (CAM), presenting safety concerns due to potential interactions with conventional cancer treatment. Oncology staff have a role to play in ensuring the safe use of CAMs and so, this study examined their knowledge, attitudes, and practices regarding CAMs. Aim: This study aimed to assess the knowledge, attitudes, and practices of Australian doctors, nurses, and pharmacists regarding CAM use in oncology. Method: Members of three national oncology professional associations took part in an online questionnaire, which determined their knowledge, attitudes, and practices regarding CAM. Results: Ninety-nine completed surveys were obtained from nine doctors, 70 nurses, and 20 pharmacists. Most respondents (68.4%) felt that they did not have adequate knowledge of CAMs to respond to patients' questions. Assessment of attitudes found respondents generally believed that CAMs have a complementary role in oncology but indicated their concerns for the safety of patients. Respondents indicated in practice they would discuss CAMs with less than half of patients (40.6%), with a lack of scientific data and guidelines for CAM use presenting significant barriers to these discussions. Conclusion: Our study suggests that oncology health professionals' knowledge of CAMs potentially leads to a lack of confidence in providing advice to patients and concerns for patient safety. This impacts their discussion of CAMs and lack of disclosure from patients about their use of CAMs. Education on CAMs in oncology would assist in increasing professionals' confidence in discussing these therapies, leading to increased patient disclosure of CAMs and safer treatment decision making for people with cancer

Delimitation of lymphatic filariasis transmission risk areas: a geo-environmental approach

BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis (GPELF) depends upon Mass Drug Administration (MDA) to interrupt transmission. Therefore, delimitation of transmission risk areas is an important step, and hence we attempted to define a geo-environmental risk model (GERM) for determining the areas of potential transmission of lymphatic filariasis. METHODS: A range of geo-environmental variables has been selected, and customized on GIS platform to develop GERM for identifying the areas of filariasis transmission in terms of "risk" and "non-risk". The model was validated through a 'ground truth study' following standard procedure using GIS tools for sampling and Immuno-chromotographic Test (ICT) for screening the individuals. RESULTS: A map for filariasis transmission was created and stratified into different spatial entities, "risk' and "non-risk", depending on Filariasis Transmission Risk Index (FTRI). The model estimation corroborated well with the ground (observed) data. CONCLUSION: The geo-environmental risk model developed on GIS platform is useful for spatial delimitation purpose on a macro scale

Putting policy into practice: how three cancer services perform against indigenous health and cancer frameworks

Improving cancer outcomes for Indigenous people by providing culturally safe, patient-centred care is a critical challenge for health services worldwide. This article explores how three Australian cancer services perform when compared to two national best practice guidelines: the National Aboriginal and Torres Strait Islander Cancer Framework (Cancer Framework) and the National Safety and Quality Health Service (NSQHS) User Guide for Aboriginal and Torres Strait Islander Health (User Guide). The services were identified through a nationwide project undertaken to identify cancer services providing treatment to Indigenous cancer patients. A small number of services which were identified as particularly focused on providing culturally safe cancer care participated in case studies. Interviews were conducted with 35 hospital staff (Indigenous and non-Indigenous) and 8 Indigenous people affected by cancer from the three services. The interviews were analysed and scored using a traffic light system according to the seven priorities of the Cancer Framework and the six actions of the NSQHS User Guide. While two services performed well against the User Guide, all three struggled with the upstream elements of the Cancer Framework, suggesting that the treatment-focused Optimal Care Pathway for Aboriginal and Torres Strait Islander People with Cancer (Cancer Pathway) may be a more appropriate framework for tertiary services. This article highlights the importance of a whole-of-organisation approach when addressing and embedding the six actions of the User Guide. Health services which have successfully implemented the User Guide are in a stronger position to implement the Cancer Framework and Cancer Pathway.Emma V. Taylor, Marilyn Lyford, Lorraine Parsons, Michele Holloway, Karla Gough, Sabe Sabesan and Sandra C. Thompso

The application of digital volume correlation (DVC) to evaluate strain predictions generated by finite element models of the osteoarthritic humeral head

Continuum-level finite element models (FEMs) of the humerus offer the ability to evaluate joint replacement designs preclinically; however, experimental validation of these models is critical to ensure accuracy. The objective of the current study was to quantify experimental full-field strain magnitudes within osteoarthritic (OA) humeral heads by combining mechanical loading with volumetric microCT imaging and digital volume correlation (DVC). The experimental data was used to evaluate the accuracy of corresponding FEMs. Six OA humeral head osteotomies were harvested from patients being treated with total shoulder arthroplasty and mechanical testing was performed within a microCT scanner. MicroCT images (33.5 µm isotropic voxels) were obtained in a pre- and post-loaded state and BoneDVC was used to quantify full-field experimental strains (≈ 1 mm nodal spacing, accuracy = 351 µstrain, precision = 518 µstrain). Continuum-level FEMs with two types of boundary conditions (BCs) were simulated: DVC-driven and force-driven. Accuracy of the FEMs was found to be sensitive to the BC simulated with better agreement found with the use of DVC-driven BCs (slope = 0.83, r2 = 0.80) compared to force-driven BCs (slope = 0.22, r2 = 0.12). This study quantified mechanical strain distributions within OA trabecular bone and demonstrated the importance of BCs to ensure the accuracy of predictions generated by corresponding FEMs

Associations of CDH1 germline variant location and cancer phenotype in families with hereditary diffuse gastric cancer (HDGC)

INTRODUCTION: Hereditary diffuse gastric cancer (HDGC) is a cancer syndrome associated with variants in E-cadherin (CDH1), diffuse gastric cancer and lobular breast cancer. There is considerable heterogeneity in its clinical manifestations. This study aimed to determine associations between CDH1 germline variant status and clinical phenotypes of HDGC. METHODS: One hundred and fifty-two HDGC families, including six previously unreported families, were identified. CDH1 gene-specific guidelines released by the Clinical Genome Resource (ClinGen) CDH1 Variant Curation Expert Panel were applied for pathogenicity classification of truncating, missense and splice site CDH1 germline variants. We evaluated ORs between location of truncating variants of CDH1 and incidence of colorectal cancer, breast cancer and cancer at young age (gastric cancer at \u3c40 or breast cancer \u3c50 years of age). RESULTS: Frequency of truncating germline CDH1 variants varied across functional domains of the E-cadherin receptor gene and was highest in linker (0.05785 counts/base pair; p=0.0111) and PRE regions (0.10000; p=0.0059). Families with truncating CDH1 germline variants located in the PRE-PRO region were six times more likely to have family members affected by colorectal cancer (OR 6.20, 95% CI 1.79 to 21.48; p=0.004) compared with germline variants in other regions. Variants in the intracellular E-cadherin region were protective for cancer at young age (OR 0.2, 95% CI 0.06 to 0.64; p=0.0071) and in the linker regions for breast cancer (OR 0.35, 95% CI 0.12 to 0.99; p=0.0493). Different CDH1 genotypes were associated with different intracellular signalling activation levels including different p-ERK, p-mTOR and β-catenin levels in early submucosal T1a lesions of HDGC families with different CDH1 variants. CONCLUSION: Type and location of CDH1 germline variants may help to identify families at increased risk for concomitant cancers that might benefit from individualised surveillance and intervention strategies