Xylan-cellulose thin film platform for assessing xylanase activity.

Enzymatic degradation of plant polysaccharide networks is a complex process that involves disrupting an intimate assembly of cellulose and hemicelluloses in fibrous matrices. To mimic this assembly and to elucidate the efficiency of enzymatic degradation in a rapid way, models with physicochemical equivalence to natural systems are needed. Here, we employ xylan-coated cellulose thin films to monitor the hydrolyzing activity of an endo-1,4-ß-xylanase. In situ surface plasmon resonance spectroscopy (SPRS) revealed a decrease in xylan areal mass ranging from 0.01 ± 0.02 to 0.52 ± 0.04 mg·m-2. The extent of digestion correlates to increasing xylanase concentration. In addition, ex situ determination of released monosaccharides revealed that incubation time was also a significant factor in degradation (P > 0.01). For both experiments, atomic force microscopy confirmed the removal of xylans from the cellulose thin films. We provide a new model platform that offers nanoscale sensitivity for investigating biopolymer interactions and their susceptibility to enzymatic hydrolysis.

What sort of follow-up services would Australian breast cancer survivors prefer if we could no longer offer long-term specialist-based care? A discrete choice experiment.

BACKGROUND: Early diagnosis and improved treatment outcomes have increased breast cancer survival rates that, in turn, have led to increased numbers of women undergoing follow-up after completion of primary treatment. The current workload growth is unsustainable for breast cancer specialists who also provide care for women newly diagnosed or with a recurrence. Appropriate and acceptable follow-up care is important; yet, currently we know little about patient preferences. The aim of this study was to explore the preferences of Australian breast cancer survivors for alternative modes of delivery of follow-up services. METHODS: A self-administered questionnaire (online or paper) was developed. The questionnaire contained a discrete choice experiment (DCE) designed to explore patient preferences with respect to provider, location, frequency and method of delivery of routine follow-up care in years 3, 4 and 5 after diagnosis, as well as the perceived value of 'drop-in' clinics providing additional support. Participants were recruited throughout Australia over a 6-month period from May to October 2012. Preference scores and choice probabilities were used to rank the top 10 most preferred follow-up scenarios for respondents. RESULTS: A total of 836 women participated in the study, of whom 722 (86.4%) completed the DCE. In the absence of specialist follow-up, the 10 most valued surveillance scenarios all included a Breast Physician as the provider of follow-up care. The most preferred scenario is a face-to-face local breast cancer follow-up clinic held every 6 months and led by a Breast Physician, where additional clinics focused on the side effects of treatment are also provided. CONCLUSION: Beyond the first 2 years from diagnosis, in the absence of a specialist led follow-up, women prefer to have their routine breast cancer follow-up by a Breast Physician (or a Breast Cancer Nurse) in a dedicated local breast cancer clinic, rather than with their local General Practitioner. Drop-in clinics for the management of treatment related side effects and to provide advice to both develop and maintain good health are also highly valued by breast cancer survivors.

Prevalence and predictors of complementary and alternative medicine (CAM) use by men in Australian cancer outpatient services.

BACKGROUND: Although studies have shown that complementary and alternative medicine (CAM) use is common in cancer patients, no survey has assessed CAM use in men with a variety of cancers. In Australia, no data exist about male cancer patients' use of CAM. PATIENTS AND METHODS: A self-administered questionnaire was completed by 403 men attending four cancer outpatient services in Metropolitan Adelaide. Data were analyzed using Pearson's χ(2) tests and multivariate logistic regression analysis. RESULTS: CAMs were currently used by 52.9%, or used at some point by 61.5%, of respondents. The most popular CAM treatments were dietary supplements (36.1%), prayer (25.9%), herbs and botanicals (21.4%), and relaxation techniques/meditation (15.2%). CAM use was directed by a cancer specialist in 9.9% of respondents. Independent predictors of CAM use were metastatic cancer (P = 0.022), actively practicing religion (P = 0.008), and tertiary education (P = 0.007). CONCLUSIONS: CAM use in males is equally common across all cancer diagnoses, namely prostate, hematological malignancies, colorectal, lung, and other cancers. Oncologists should be aware that one-third of male patients modify their diet and/or search for spiritual guidance, particularly when diagnosed with metastatic cancer.

Understanding young peoples' experience of chronic illness: a systematic review.

OBJECTIVE: The objective of the review was to summarise the best available evidence that described a young person's experience of chronic illness and make recommendations towards the promotion of mental health and prevention of future mental health difficulties. INCLUSION CRITERIA: The review considered qualitative research that used the voices of young people (under 18 years) to describe their experience of chronic illness and the impact it had on their lives. SEARCH STRATEGY: The search strategy sought to find both published and unpublished research papers (limited to the English language). An extensive search was performed using the following databases: PubMed, CINAHL, Web of Science, PsycInfo, Aust Health, Dissertation Abstract International, Expanded Academic Index, Health Source Nursing, and Academic Search Elite. In addition, the reference lists of identified papers were hand searched, to capture all pertinent material, as well as relevant worldwide websites. METHODOLOGICAL QUALITY: Each paper was assessed by two reviewers for methodological quality prior to inclusion in the review using the critical appraisal instrument [Qualitative Assessment and Review Instrument (QARI)] from software developed by the Johanna Briggs Institute (JBI). RESULTS: A total of 18 qualitative papers were included in the review (nine grounded theory, six phenomenology, one ethnography, one social ecological, and one multiple case study). Forty-four papers were initially identified but 26 were excluded as they did not meet the inclusion criteria. Findings were extracted and meta-synthesised using JBI-QARI. Five syntheses about a young person's experience of chronic illness were derived: () the experience of chronic illness makes young people feel uncomfortable in their body and world; () the experience of chronic illness disrupts 'normal' life; () the experience of chronic illness is not all bad; () ways of getting through the chronic illness experience 'what others can do'; and () ways of getting through the chronic illness experience 'what I can do'. CONCLUSION: A positive perspective needs to be taken to promote mental health in young people with chronic illness; clinicians, families, and interventions need to (a) bolster their sense of self, (b) normalise the experience,

Perceptions of "good palliative care" orders: a discursive study of cancer patients' comments.

Patients' perceptions regarding Good Palliative Care (GPC) orders, a form of advance directives, were sought, and issues inherent in their promotion as policy were identified. Semi-structured interviews with 23 oncology-clinic outpatients, focused on end-of-life decision making, were tape-recorded, transcribed, and analyzed using discursive-analytical techniques. Most patients were unfamiliar with the term GPC orders, preferring the familiar "do-not-resuscitate" orders. GPC orders were negatively perceived as vague, beyond the individual's control, implying dependency on others, and failing to reduce suffering. Positive perceptions of GPC orders saw them as counteracting the impersonality of medical procedure and asserting the value of the whole patient within a social context. Participants' comments on a draft copy of a GPC order form suggest that they view consultation as beneficial, but that a standardized form may be impersonal and inappropriate. The structure and content of the GPC order form constitute it as a quasilegal document that may confuse and disempower patients, and function to protect the interests of the medical profession in the guise of promoting patient autonomy. The potential benefits attributed to GPC orders are achievable without the adoption of a blanket policy that depersonalizes and bureaucratizes the dying process, and may be less than sensitive to individual patients' needs.

Relationship between intracranial pressure and the development of vasospasm after aneurysmal subarachnoid hemorrhage.

The relationship between intracranial pressure (ICP) and the development of vasospasm after subarachnoid hemorrhage caused by the rupture of an intracranial aneurysm was investigated. Eleven patients were divided into high (6 cases) and low (5 cases) ICP groups based on ICP data obtained during the perioperative period by continuous ICP monitoring. Transcranial Doppler ultrasonography was performed every 24 hours for 7 days and the severity, distribution, and duration of vasospasm were assessed. The high ICP group tended to have severe, prolonged, and diffuse vasospasm compared with the low ICP group. However, only duration of vasospasm was statistically different. The relationship between cerebral perfusion pressure (CPP) and the development of vasospasm was also examined. CPP had a less significant effect than ICP although similar tendencies for high ICP and low CPP were observed. High ICP worsens vasospasm and treatment for decreasing ICP with perioperative ICP monitoring has potential for avoiding the development of vasospasm.

Treatment of bacterial cystitis with a single dose of trimethoprim, co-trimoxazole or amoxycillin compared with a course of trimethoprim.

A single dose of trimethoprim, co-trimoxazole or amoxycillin was compared with a five-day course of trimethoprim for the treatment of bacterial cystitis in general practice. The respective cure rates were 80%, 80%, 65% and 86%. These differences were not statistically significant. Side effects were minimal. Single dose therapy is recommended as the treatment of choice for bacterial cystitis in domiciliary practice.

Comparison of trimethoprim alone with co-trimoxazole and sulphamethizole for treatment of urinary tract infections.

This study was undertaken to compare the effectiveness of trimethoprim alone (300 mg daily) with both cotrimoxazole (0.96 g 12-hourly) and sulphamethizole (1 g eight-hourly) for the treatment of uncomplicated urinary tract infections in general practice. Treatment was continued for five days in all patients. Twenty patients were included in each group. The cure rates (sterile urine one week after finishing treatment) for trimethoprim, co-trimoxazole and sulphamethizole were 90, 95 and 90% respectively. Side effects were minimal. It is recommended that trimethoprim alone replace co-trimoxazole for the treatment of uncomplicated urinary tract infections.