Feasibility of conducting a palliative care randomized controlled trial in children with advanced cancer: assessment of the PediQUEST study

Pediatric palliative care randomized controlled trials (PPC-RCTs) are uncommon.

Differences in parent-provider concordance regarding prognosis and goals of care among children with advanced cancer

Purpose Concordance between parents of children with advanced cancer and health care providers has not been described. We aimed to describe parent-provider concordance regarding prognosis and goals of care, including differences by cancer type.

Economic impact of advanced pediatric cancer on families

Despite emerging evidence of substantial financial distress in families of children with complex illness, little is known about economic hardship in families of children with advanced cancer.

Improving the care of children with advanced cancer by using an electronic patient-reported feedback intervention : results from the PediQUEST randomized controlled trial.

This study aimed to determine whether feeding back patient-reported outcomes (PROs) to providers and families of children with advanced cancer improves symptom distress and health-related quality of life (HRQoL).

What's missing in missing data? Omissions in survey responses among parents of children with advanced cancer

Background: Missing data is a common phenomenon with survey-based research; patterns of missing data may elucidate why participants decline to answer certain questions. Objective: To describe patterns of missing data in the Pediatric Quality of Life and Evaluation of Symptoms Technology (PediQUEST) study, and highlight challenges in asking sensitive research questions. Design: Cross-sectional, survey-based study embedded within a randomized controlled trial. Setting: Three large children's hospitals: Dana-Farber/Boston Children's Cancer and Blood Disorders Center (DF/BCCDC); Children's Hospital of Philadelphia (CHOP); and Seattle Children's Hospital (SCH). Measurements: At the time of their child's enrollment, parents completed the Survey about Caring for Children with Cancer (SCCC), including demographics, perceptions of prognosis, treatment goals, quality of life, and psychological distress. Results: Eighty-six of 104 parents completed surveys (83% response). The proportion of missing data varied by question type. While 14 parents (16%) left demographic fields blank, over half (n=48; 56%) declined to answer at least one question about their child's prognosis, especially life expectancy. The presence of missing data was unrelated to the child's diagnosis, time from progression, time to death, or parent distress (p>0.3 for each). Written explanations in survey margins suggested that addressing a child's life expectancy is particularly challenging for parents. Conclusions and Relevance: Parents of children with cancer commonly refrain from answering questions about their child's prognosis, however, they may be more likely to address general cure likelihood than explicit life expectancy. Understanding acceptability of sensitive questions in survey-based research will foster higher quality palliative care research. © Copyright 2014, Mary Ann Liebert, Inc. 2014.

Smoothened activates breast cancer stem-like cell and promotes tumorigenesis and metastasis of breast cancer

Smoothened (Smo) is a G protein-coupled receptor protein encoded by the Smo gene of the hedgehog signalling pathway, which is thought to play an important role in maintaining organ patterning, cell differentiation and self-renewal. The possible role of Smo in the process of tumorigenesis and metastasis of breast cancer still remains unclear. The present experiments were to investigate the effect of Smo on activating breast cancer stem-like CD44(+)CD24(-) cells and the tumorigenesis and metastasis of breast cancer. By injected CD44(+)CD24(-) cells (1×10(4)) into the cleared fat pad of NOD/SCID mice, it was observed that CD44(+)CD24(-) cells possess higher tumor-initiating capacity and metastasis properties than equal numbers of non-CD44(+)CD24(-) cells. The mRNA and protein expressions of Smo in CD44(+)CD24(-) cells were higher than those in non-CD44(+)CD24(-) cells, indicating that Smo may play a role in maintaining breast cancer stem cell features. qRT-PCR results revealed that expressions of STAT3, Bcl-2 and cyclinD1 mRNA in MCF-7 cells were decreased after transfected by Smo siRNA. In addition, the expressions of MMP-2 and MMP-9 were downregulated in MCF-7 cells after Smo expression was inhibited. Smo inhibition may be a possible therapeutic target that potentially suppresses breast tumor formation and development.

Symptoms and distress in children with advanced cancer: prospective patient-reported outcomes from the PediQUEST Study

PURPOSE: Thousands of children are living with advanced cancer; yet patient-reported outcomes (PROs) have rarely been used to describe their experiences. We aimed to describe symptom distress in 104 children age 2 years or older with advanced cancer enrolled onto the Pediatric Quality of Life and Evaluation of Symptoms Technology (PediQUEST) Study (multisite clinical trial evaluating an electronic PRO system).

METHODS: Symptom data were collected using age- and respondent-adapted versions of the PediQUEST Memorial Symptom Assessment Scale (PQ-MSAS) at most once per week. Clinical and treatment data were obtained from medical records. Individual symptom scores were dichotomized into high/low distress. Determinants of PQ-MSAS scores were explored using linear mixed-effects models.

RESULTS: During 9 months of follow-up, PQ-MSAS was administered 920 times: 459 times in teens (99% self-report), 249 times in children ages 7 to 12 years (96% child/parent report), and 212 times in those ages 2 to 6 years (parent reports). Common symptoms included pain (48%), fatigue (46%), drowsiness (39%), and irritability (37%); most scores indicated high distress. Among the 73 PQ-MSAS surveys administered in the last 12 weeks of life, pain was highly prevalent (62%; 58% with high distress). Being female, having a brain tumor, experiencing recent disease progression, and receiving moderate- or high-intensity cancer-directed therapy in the prior 10 days were associated with worse PQ-MSAS scores. In the final 12 weeks of life, receiving mild cancer-directed therapy was associated with improved psychological PQ-MSAS scores.

CONCLUSION: Children with advanced cancer experience high symptom distress. Strategies to promote intensive symptom management are indicated, especially with disease progression or administration of intensive treatments.

Electrochemical and DFT studies of quinoline derivatives on corrosion inhibition of AA5052 aluminium alloy in NaCl solution

Two quinoline derivatives, 8-aminoquinoline (8-AQ) and 8-nitroquinoline (8-NQ), have been used as inhibitors to examine their corrosion protection effect on AA5052 aluminium alloy in 3% NaCl solution. The weight-loss and electrochemical measurement have indicated that 8-AQ and 8-NQ play as anodic inhibitor to retard the anodic electrochemical process. SEM/EDS analysis clearly shows that 8-AQ and 8-NQ form a protective film on the AA5052 alloy surface. Density functional theory (DFT) calculation confirmed the formation of strong hybridization between the p-orbital of reactive sites in the inhibitor molecules and the sp-orbital of the Al atom. 8-aminoquinoline and 8-nitroquinoline may be useful as effective corrosion inhibitors for aluminium alloys.

HPV.edu study protocol: a cluster randomised controlled evaluation of education, decisional support and logistical strategies in school-based human papillomavirus (HPV) vaccination of adolescents

BACKGROUND: The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The HPV.edu study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake.

METHODS/DESIGN: HPV.edu is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes.

DISCUSSION: This study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-efficacy, and to reduce fear and anxiety. The study also aims to improve school vaccination program logistics including reduction in time spent vaccinating adolescents and increased number of consent forms returned (regardless of decision). Less anxiety in adolescents will likely promote more efficient vaccination, which will be more acceptable to teachers, nurses and parents. Through these interventions, it is hoped that vaccination uptake will be increased.

Predictive data mining for converged internet of things: a mobile health perspective

Mobile Health (mHealth) is now emerging with Internet of Things (IoT), Cloud and big data along with the prevalence of smart wearable devices and sensors. There is also the emergence of smart environments such as smart homes, cars, highways, cities, factories and grids. Presently, it is difficult to quickly forecast or prevent urgent health situations in real-time as health data are analyzed offline by a physician. Sensors are expected to be overloaded by demands of providing health data from IoT networks and smart environments. This paper proposes to resolve the problems by introducing an inference system so that life-threatening situations can be prevented in advance based on a short and long term health status prediction. This prediction is inferred from personal health information that is built by big data in Cloud. The inference system can also resolve the problem of data overload in sensor nodes by reducing data volume and frequency to reduce workload in sensor nodes. This paper presents a novel idea of tracking down and predicting a personal health status as well as intelligent functionality of inference in sensor nodes to interface IoT networks

A review of security protocols in mHealth Wireless Body Area Networks (WBAN)

The popularity of smartphones has led to an increasing demand for health apps. As a result, the healthcare industry is embracing mobile technology and the security of mHealth is essential in protecting patient’s user data and WBAN in a clinical setting. Breaches of security can potentially be life-threatening as someone with malicious intentions could misuse mHealth devices and user information. In this article, threats to security for mHealth networks are discussed in a layered approach addressing gaps in this emerging field of research. Suite B and Suite E, which are utilized in many security systems, including in mHealth applications, are also discussed. In this paper, the support for mHealth security will follow two approaches; protecting patient-centric systems and associated link technologies. Therefore this article is focused on the security provisioning of the communication path between the patient terminal (PT; e.g., sensors) and the monitoring devices (e.g., smartphone, data-collector).

Inference of personal sensors in the internet of things

Smartphone technology has become more popular and innovative over the last few years, and technology companies are now introducing wearable devices into the market. By emerging and converging with technologies such as Cloud, Internet of Things (IoT) and Virtualization, requirements to personal sensor devices are immense and essential to support existing networks, e.g. mobile health (mHealth) as well as IoT users. Traditional physiological and biological medical sensors in mHealth provide health data either periodically or on-demand. Both of these situations can cause rapid battery consumption, consume significant bandwidth, and raise privacy issues, because these sensors do not consider or understand sensor status when converged together. The aim of this research is to provide a novel approach and solution to managing and controlling personal sensors that can be used in various areas such as the health, military, aged care, IoT and sport. This paper presents an inference system to transfer health data collected by personal sensors efficiently and effectively to other networks in a secure and effective manner without burdening workload on sensor devices.