The association between a patient-centered quality of care index and self-efficacy among cancer survivors.

PURPOSE: The number of cancer survivors in the US surpassed 18.1 million in 2022 and this number continues to grow. Patient self-efficacy, a patient's confidence in his or her ability to self-manage symptoms and healthcare concerns, has been linked to improved health outcomes. We thus set out to examine the association between a patient-centered care quality index and self-efficacy among cancer survivors. METHODS: Data from 777 survivors of breast, prostate, and colorectal cancers at 32 cancer centers nationwide were collected 6 months after an initial survivorship visit. Patients completed surveys assessing patient-centered care (36 items under seven factors) and individual self-efficacy (eight items). Multiple linear regression was used to examine the association between patient-centered care and patient self-efficacy, adjusting for demographics, cancer-related characteristics, and organizational characteristics of high-quality patient-centered survivorship care. RESULTS: In descriptive analyses, there were no statistically significant differences in demographic or cancer-related characteristics between cancer survivors by quality of patient-centered care. In regression models, a one-unit increase in patient-centered care was associated with a 0.23 (95% CI 0.14-0.32) increase in mean self-efficacy compared to low quality of patient-centered care when adjusting for demographics, cancer-related characteristics, and indicators of high-quality survivorship care. Individually, four of the seven factors of quality patient-centered care were statistically significantly associated with greater self-efficacy. Having a medical home was associated with the greatest increase in self-efficacy among survivors. CONCLUSION: Our findings indicate that higher quality patient-centered care is associated with greater cancer survivor self-efficacy. Given that self-efficacy is correlated with improved health outcomes and quality of life, this finding further supports the importance of high-quality patient-centered survivorship care. IMPLICATIONS OF CANCER SURVIVORS: High-quality patient-centered survivorship care was associated with higher patient self-efficacy. This association should further be explored among cancer survivors with diverse characteristics.

Healthcare utilization in cancer survivors: six-month longitudinal cohort data.

PURPOSE: To describe healthcare utilization and reasons for delaying medical care and to identify factors that influence high healthcare utilization and care delay among cancer survivors. METHODS: Baseline (n = 991) and 6 month follow-up data (n = 777) were collected among breast, prostate, and colorectal cancer survivors from 32 US cancer centers. Participants completed surveys on healthcare utilization (e.g., number of visits to specific providers) and delay of medical care. We categorized participants as high or low users based on median number of visits. We used logistic regression models to examine factors that predicted high healthcare utilization or delay. RESULTS: Survivors reported a median of 10.5 visits to healthcare providers and 28% reported ever delaying medical care over 6 months. Compared to prostate cancer survivors, breast and colorectal survivors were 2.4 times more likely (CI = 1.2-4.8) and 4 times more likely (CI = 2.2-7.3) to be high healthcare users, respectively. A higher quality of life score predicted high healthcare utilization (OR = 2.4, CI = 2.0-2.8) and delay of medical care (OR = 1.8, CI = 1.5-2.2). Black survivors were 1.5 times more likely than White survivors to be high healthcare users (CI = 1.1-2.0) and respondents reporting a race category other than White or Black were 1.8 times more likely to delay care (CI = 1.3-2.5). Lower levels of self-efficacy predicted greater healthcare use (OR = 0.7, CI = 0.6-0.8) and delay (OR = 0.6, CI = 0.5-0.7). CONCLUSION: Our findings suggest that race, education, marital status, cancer type, time since diagnosis, quality of life, and self-efficacy are associated with both high healthcare utilization and delay among cancer survivors.

Defining a patient-centered approach to cancer survivorship care: development of the patient centered survivorship care index (PC-SCI).

PURPOSE: This study presents the validation of an index that defines and measures a patient-centered approach to quality survivorship care. METHODS: We conducted a national survey of 1,278 survivors of breast, prostate, and colorectal cancers to identify their priorities for cancer survivorship care. We identified 42 items that were "very important or absolutely essential" to study participants. We then conducted exploratory and confirmatory factor analyses (EFA/CFA) to develop and validate the Patient-Centered Survivorship Care Index (PC-SCI). RESULTS: A seven-factor structure was identified based on EFA on a randomly split half sample and then validated by CFA based on the other half sample. The seven factors include: (1) information and support in survivorship (7 items), (2) having a medical home (10 items) (3) patient engagement in care (3 items), (4) care coordination (5 items), (5) insurance navigation (3 items), (6) care transitions from oncologist to primary care (3 items), and (7) prevention and wellness services (5 items). All factors have excellent composite reliabilities (Cronbach's alpha 0.84-0.94, Coefficient of Omega: 0.81-0.94). CONCLUSIONS: Providing quality post-treatment care is critical for the long-term health and well-being of survivors. The PC-SCI defines a patient-centered approach to survivorship care to complement clinical practice guidelines. The PC-SCI has acceptable composite reliability, providing the field with a valid instrument of patient-centered survivorship care. The PC-SCI provides cancer centers with a means to guide, measure and monitor the development of their survivorship care to align with patient priorities of care. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02362750 , 13 February 2015.

Identifying patients' priorities for quality survivorship: conceptualizing a patient-centered approach to survivorship care.

PURPOSE: This study explored cancer survivors' experiences with and priorities for cancer survivorship care to describe a patient-centered approach to quality survivorship care. METHODS: We conducted 22 focus groups with 170 adult survivors of breast, prostate, and colorectal cancer from six cities across the country and online. We used thematic analysis to identify participants' principles and priorities for quality survivorship care. RESULTS: Based on our analysis of a limited group of cancer survivors, we identified two core principles that underlie participants' expectations for survivorship care and 11 practice priorities that reflect opportunities to improve patient-centeredness at the individual, interpersonal, and organizational levels. The principles reflect participants' desire to be better prepared for and equipped to accept and manage their chronic care needs post-cancer treatment. The priorities reflect practices that patients, providers, and cancer centers can engage in to ensure survivors' goals for post-treatment care are met. CONCLUSIONS: Results from the study suggest the need to expand conceptualization of high-quality survivorship care. The survivor principles and practice priorities identified in this study challenge the field to organize a more patient-centered survivorship care system that empowers and respects patients and provides a holistic approach to survivors' chronic and long-term needs. IMPLICATIONS FOR CANCER SURVIVORS: Quality cancer survivorship care must reflect patients' priorities. The findings from this study can be used to develop a patient-centered framework for survivorship care that can be used in conjunction with quality guidelines to ensure survivorship care is organized to achieve both clinical and patient-centered outcomes.

Efficacy of influenza vaccine (Fluvax) in cancer patients on treatment: a prospective single arm, open-label study.

PURPOSE: Influenza virus infection has significant morbidity and mortality in patients with medical co-morbidities who are also immunosuppressed. The efficacy of the seasonal influenza vaccine has not been well studied in patients receiving chemotherapy. We assessed the efficacy of seasonal influenza vaccine in patients with non-haematological malignancy on active treatment (chemotherapy and targeted therapy). METHODS: A prospective single arm, open label study with 53 patients with non-haematological cancers recruited during the 2011 and 2012 influenza seasons. Participants had one dose of 2011/2012 trivalent vaccine containing strains A/California/7/2009(H1N1), A/Perth/16/2009 (H3N2) and B/Brisbane/60/2008 (Fluvax) prior to or in-between treatment cycles. Haemagglutination inhibition antibody (HIA) titres in serum were measured at baseline 3, 6 and 24 weeks. Primary endpoint: seroconversion rate (SCR) at 3 weeks. Secondary endpoints: late SCR at 6 weeks. rate of sustained sero-protection titres (SPR) at 24 weeks. Seroconversion was defined as postvaccination ≥ 4-fold increase in HIA titre and sero-protection defined as a HIA ≥ 1:40. RESULTS: The SCR at 3 weeks were 35%, 30% and 22.5% to the H1N1, H3N2 and B/Bris strains, respectively. There were no new cases of late SC at 6 weeks or 24 weeks. The SPR at 3 weeks were 72.5%, 65% and 40%, respectively, to H1N1, H3N2 and B/Bris. The SPR at 24 weeks to H1N1, H3N2 and B/Bris were 40%, 52.5% and 17.5%, respectively. CONCLUSIONS: Patients on various solid tumour treatments achieve sero-protection rate congruent with the general population. The sero-protection HIA titres were not sustained at 24 weeks postvaccination.

Development of the chemical exposure monitor with indoor positioning (CEMWIP) for workplace VOC surveys.

The purpose of this article was to research and develop a direct-reading exposure assessment method that combined a real-time location system with a wireless direct-reading personal chemical sensor. The personal chemical sensor was a photoionization device for detecting volatile organic compounds. The combined system was calibrated and tested against the same four standard gas concentrations and calibrated at one standard location and tested at four locations that included the standard locations. Data were wirelessly collected from the chemical sensor every 1.4 sec, for volatile organic compounds concentration, location, temperature, humidity, and time. Regression analysis of the photo-ionization device voltage response against calibration gases showed the chemical sensor had a limit of detection of 0.2 ppm. The real-time location system was accurate to 13 cm ± 6 cm (standard deviation) in an open area and to 57 cm ± 31 cm in a closed room where the radio frequency has to penetrate drywall-finished walls. The streaming data were collected and graphically displayed as a three-dimensional hazard map for assessment of peak exposure with location. A real-time personal exposure assessment device with indoor positioning was practical and provided new knowledge on direct reading exposure assessment methods.

Assessment of Health-Care Worker Exposure to Pandemic Flu in Hospital Rooms.

This study examines the effectiveness of a current Airborne Infection Isolation Room (AIIR) in protecting health-care workers (HCWs) from airborne-infection (AI) exposure, and compares HCW AI exposures within an AIIR and a traditional patient room. We numerically simulated the air-flow patterns in the rooms, using room geometries and layout (room dimensions, bathroom dimensions and details, placement of vents and furniture), ventilation parameters (flow rates at the inlet and outlet vents, diffuser design, thermal sources, etc.), and pressurization corresponding to those measured at a local hospital. A patient-cough was introduced into each simulation, and the AI dispersal was tracked in time using a multi-phase flow simulation approach. The measured data showed that ventilation rates for both rooms exceeded 12 air-changes per hour (ACH), and the AIIR was at almost 16 ACH. Thus, the AIIR met the recommended design criteria for ventilation rate and pressurization. However, the computed results revealed incomplete air mixing, and not all of the room air was changed 12 (or 16) times per hour. In fact, in some regions of the room, the air merely circulated, and did not refresh. With the main exhaust flow rate exceeding the main supply, mass flow rate conservation required a part of the deficit to be accounted for by air migration from the corridor through the gaps around the main door. Hence, the AIIR was effective in containing the "infectious aerosol" within the room. However, it showed increased exposure of the HCW to the AI pathogens, as the flow from the ceiling-mounted supply louver first encountered the patient and then the HCW almost directly on its way to the main exhaust, also located on the ceiling. The traditional patient room exhibited a similar flow path. In addition, for the traditional patient room, some cough-generated aerosol is observed very close to the gaps around the door to the corridor, indicating that the aerosol may escape to the corridor, and spread the infection beyond the room. The computational results suggest that ventilation arrangement can have an important role in better protecting the HCW from exposure to airborne infectious pathogens.

Stomatopod antennule design: the asymmetry, sampling efficiency and ontogeny of olfactory flicking.

Many crustaceans detect odors from distant sources using chemosensory sensilla (aesthetascs) on their antennules. The greater the flow of water through arrays of aesthetascs, the faster the access of odorant to receptors inside the aesthetascs. Stomatopods facilitate odorant access by flicking their antennules, thus increasing the relative velocity of the water reaching their aesthetascs. We used dynamically scaled physical models to investigate how aesthetasc size and spacing and antennule flicking velocity affect flow penetration into the simple aesthetasc arrays of the stomatopod Gonodactylaceus mutatus. Particle image velocimetry of flow fields near models of juvenile and adult antennules revealed that velocity gradients around the aesthetascs are steeper during the outward part of the flick than during the return stroke and that the velocity gradients are steeper at the aesthetasc tips than at their bases. More fluid per unit time flows between aesthetasc rows during the outward stroke than during the return stroke, ensuring that odor sampling is pulsatile. During flicking, velocity gradients are steeper near adult aesthetascs than near juvenile aesthetascs, and adults process more fluid per unit time than juveniles. The resulting differences in odorant access can be related to size- and age-dependent changes in stomatopod ecology.

Urine calcium and urine sodium concentrations are not related, after adjustment for urine magnesium.

BACKGROUND AND OBJECTIVES: Urine calcium correlates with urine sodium. The aims of this study were to investigate whether the urine sodium-calcium relationship persists into old age and whether it holds after adjustment for urine magnesium. DESIGN: Cross-sectional descriptive analysis. PATIENTS: Residents of two aged care institutions (median age 84 years) who were not taking diuretics, calcium or vitamin D supplements. MEASUREMENTS: Early morning urine calcium, sodium and magnesium, plasma creatinine and serum 25-hydroxyvitamin D and parathyroid hormone. RESULTS: Urine calcium correlated with urine sodium (r = 0.29, P < 0.01) and with urine magnesium (r = 0.56, P < 0.001). After adjustment for urine magnesium, the relationship between urine sodium and urine calcium was no longer significant. Forty-five percent of the interindividual variation in urine calcium was explained by a linear model on the basis of urine magnesium and plasma creatinine. CONCLUSION: The data indicate that a correlation between urine sodium and calcium persists in very old age. However, this correlation no longer holds after adjustment for urine magnesium. Further studies examining urine calcium excretion should also consider urine magnesium.

Factory performance evaluations of engineering controls for asphalt paving equipment.

This article describes a unique analytical tool to assist the development and implementation of engineering controls for the asphalt paving industry. Through an agreement with the U.S. Department of Transportation, the National Asphalt Pavement Association (NAPA) requested that the National Institute for Occupational Safety and Health (NIOSH) assist U.S. manufacturers of asphalt paving equipment with the development and evaluation of engineering controls. The intended function of the controls was to capture and remove asphalt emissions generated during the paving process. NIOSH engineers developed a protocol to evaluate prototype engineering controls using qualitative smoke and quantitative tracer gas methods. Video recordings documented each prototype's ability to capture theatrical smoke under "managed" indoor conditions. Sulfur hexafluoride (SF6), released as a tracer gas, enabled quantification of the capture efficiency and exhaust flow rate for each prototype. During indoor evaluations, individual prototypes' capture efficiencies averaged from 7 percent to 100 percent. Outdoor evaluations resulted in average capture efficiencies ranging from 81 percent down to 1 percent as wind gusts disrupted the ability of the controls to capture the SF6. The tracer gas testing protocol successfully revealed deficiencies in prototype designs which otherwise may have gone undetected. It also showed that the combination of a good enclosure and higher exhaust ventilation rate provided the highest capture efficiency. Some manufacturers used the stationary evaluation results to compare performances among multiple hood designs. All the manufacturers identified areas where their prototype designs were susceptible to cross-draft interferences. These stationary performance evaluations proved to be a valuable method to identify strengths and weaknesses in individual designs and subsequently optimize those designs prior to expensive analytical field studies.

Evaluation of leakage from a metal machining center using tracer gas methods: a case study.

To evaluate the efficacy of engineering controls in reducing worker exposure to metalworking fluids, an evaluation of an enclosure for a machining center during face milling was performed. The enclosure was built around a vertical metal machining center with an attached ventilation system consisting of a 25-cm diameter duct, a fan, and an air-cleaning filter. The evaluation method included using sulfur hexafluoride (SF6) tracer gas to determine the ventilation system's flow rate and capture efficiency, a respirable aerosol monitor (RAM) to identify aerosol leak locations around the enclosure, and smoke tubes and a velometer to evaluate air movement around the outside of the enclosure. Results of the tracer gas evaluation indicated that the control system was approximately 98% efficient at capturing tracer gas released near the spindle of the machining center. This result was not significantly different from 100% efficiency (p = 0.2). The measured SF6 concentration when released directly into the duct had a relative standard deviation of 2.2%; whereas, when releasing SF6 at the spindle, the concentration had a significantly higher relative standard deviation of 7.8% (p = 0.016). This increased variability could be due to a cyclic leakage at a small gap between the upper and lower portion of the enclosure or due to cyclic stagnation. Leakage also was observed with smoke tubes, a velometer, and an aerosol photometer. The tool and fluid motion combined to induce a periodic airflow in and out of the enclosure. These results suggest that tracer gas methods could be used to evaluate enclosure efficiency. However, smoke tubes and aerosol instrumentation such as optical particle counters or aerosol photometers also need to be used to locate leakage from enclosures.

Transport of a novel complex in the cytoplasmic matrix of Chlamydomonas flagella.

Proteins necessary for maintenance and function of eukaryotic flagella are synthesized in the cell body. Transport of the inner dynein arm subunit p28(IDA4) in Chlamydomonas flagella requires the activity of the kinesin KHP1(FLA10), a protein inactive at restrictive temperature in fla10, a temperature-dependent mutant of flagellar assembly. To identify other molecules involved in active transport of inner dynein arms within flagella we searched for polypeptides of the cytoplasmic matrix of flagella that fulfill two conditions: they bind to p28 and require the activity of KHP1 to be present in flagella. We found that the cytoplasmic matrix of flagella contains a previously unidentified "17S" complex of at least 13 polypeptides that in part is associated with p28. The 17S complex is present at permissive but not at restrictive temperature in fla10 flagella. It also turns over in the cytoplasmic matrix more frequently than dynein arms within the axoneme. This evidence suggests that the 17S complex transports precursors of inner dynein arms within flagella.

Inner dynein arms but not outer dynein arms require the activity of kinesin homologue protein KHP1(FLA10) to reach the distal part of flagella in Chlamydomonas.

Inner dynein arms, but not outer dynein arms, require the activity of KHP1(FLA10) to reach the distal part of axonemes before binding to outer doublet microtubules. We have analyzed the rescue of inner or outer dynein arms in quadriflagellate dikaryons by immunofluorescence microscopy of p28(IDA4), an inner dynein arm light chain, or IC69(ODA6), an outer dynein arm intermediate chain. In dikaryons two strains with different genetic backgrounds share the cytoplasm. As a consequence, wild-type axonemal precursors are transported to and assembled in mutant axonemes to complement the defects. The rescue of inner dynein arms containing p28 in ida4-wild-type dikaryons progressively occurred from the distal part of the axonemes and with time was extended towards the proximal part. In contrast, the rescue of outer dynein arms in oda2-wild-type dikaryons progressively occurred along the entire length of the axoneme. Rescue of inner dynein arms containing p28 in ida4fla10-fla10 dikaryons was similar to the rescue observed in ida4-wild-type dikaryons at 21 degrees C, whereas it was inhibited at 32 degrees C, a nonpermissive temperature for KHP1(FLA10). In contrast, rescue of outer dynein arms in oda2fla10-fla10 dikaryons was similar to the rescue observed in oda2-wild-type dikaryons at both 21 degrees and 32 degrees C and was not inhibited at 32 degrees C. Positioning of substructures in the internal part of the axonemal shaft requires the activity of kinesin homologue protein 1.

Beakers versus breakers: how fertilisation in the laboratory differs from fertilisation in nature.

The fertilisation of free-spawning invertebrates, mainly sea urchins, has been studied extensively during the last hundred years. However, results obtained from in vitro experiments do not always reflect what happens in the real world. Organisms in their natural habitats have a complex set of challenges, cues and behaviours to contend with during fertilisation and early development, factors that are normally not considered in the laboratory setting. This review examines recent work on fertilisation ecology and discusses the relevance of these results to the findings gleaned from laboratory research. Emphasis is placed on stresses associated with fertilisation in situ, and how responses to environmental stresses (such as from turbulence, oxidative stress, ultraviolet radiation and pathogens) might affect the fertilisation process.

The effects of hydrodynamic shear stress on fertilization and early development of the purple sea urchin Strongylocentrotus purpuratus.

Life in the highly turbulent surf zone poses a severe challenge to reproduction in free-spawning animals. Not only can breaking waves quickly dilute the gametes shed by spawning organisms, but turbulence-induced shear stresses may limit fertilization and interfere with normal development. A Couette cell was used to re-create some of the effects of turbulent water motion to study effects of environmentally relevant shear stresses on fertilization in the purple sea urchin (Strongylocentrotus purpuratus). Although low shear stresses improved fertilization success (presumably by increasing mixing), exposure to high shear stresses (of the magnitude found in the surf zone) substantially decreased fertilization success, probably by interfering with contact between egg and sperm. Furthermore, eggs fertilized at high shear stresses often showed abnormal development and low survival of eggs through the blastula stage.