Development of the Awareness of Cultural Safety Scale: A pilot study with midwifery and nursing academics

BACKGROUND

Rates of academic success of Indigenous students compared to other students continues to be significantly lower in many first world countries. Professional development activities for academics can be used to promote teaching, learning and support approaches that value Indigenous worldviews. However, there are few valid and reliable tools that measure the effect of academic development strategies on awareness of cultural safety.

OBJECTIVES

To develop and validate a self-report tool that aims to measure nursing and midwifery academics' awareness of cultural safety.

METHODS

This study followed a staged model for tool development. This included: generation of items, content validity testing and expert Indigenous cultural review, administration of items to a convenience sample of academics, and psychometric testing. An online survey consisting of demographic questions, Awareness of Cultural Safety Scale (ACSS), and awareness of racism items was completed by academics undertaking a professional development program on cultural safety.

FINDINGS

Ratings by experts revealed good content validity with an index score of 0.86. The 12-item scale demonstrated good internal reliability (Cronbach's alpha of 0.87). An evaluation of construct validity through factor analysis generated three factors with sound internal reliability: Factor 1 (Cultural Application, Cronbach's alpha=.85), Factor 2 (Cultural Support, Cronbach's alpha=.70) and Factor 3 (Cultural Acknowledgement, Cronbach's alpha=.85). The mean total scale score was 46.85 (SD 7.05, range 31-59 out of a possible 60). There was a significant correlation between scores on the Awareness of Cultural Safety Scale and awareness of racism scores (r=.461, p=.002).

CONCLUSION

Awareness of cultural safety is underpinned by principles of respect, relationships, and responsibility. Results indicated the ACSS was valid and reliable. Completion of the scale aimed to foster purposeful consideration by nursing and midwifery academics about their perceptions and approaches to teaching in order to improve Indigenous student success.

Molecular Structures of N,N'-Dimethylbenzimidazoline-2-germylene and -stannylene in Solution and in Solid State by Means of Optical (Raman and UV-vis) Spectroscopy and Quantum Chemistry Methods

X-ray data obtained for germylene 1 evidence its monomeric structure, unlike that of stannylene 2, which had been shown previously to form a coordination dimer. Raman spectra of solid and liquid 1 are identical, whereas the Raman spectra of solid 2 and its solution 2a differ significantly. The spectrum of 2 is complicated and contains the lines corresponding to N → Sn coordination bonds forming a dimer. The spectrum of 2a is simpler and close to that of monomeric 1, thus pointing to the rupture of the dimer in solution. The UV-vis spectrum of solid 2 exhibits a band corresponding to a transition involving the N → Sn coordination bonds. Quantum theory of atoms in molecules data estimate the energy of this bond as ∼19 kcal/mol. The aromaticity of 1 and 2 with their 10 π-electron systems including divalent Ge or Sn atoms is confirmed by negative nucleus-independent chemical shift values.

Integrated systematic review on educational strategies that promote academic success and resilience in undergraduate indigenous students

BACKGROUND

Despite numerous recommendations by governments, researchers, and education policymakers the recruitment, retention and success of undergraduate indigenous students in higher education is not commensurate of the wider student population. There is minimal evidence of valuing indigenous worldviews and perspectives in curricula, and effectiveness of educational strategies to strengthen indigenous student success rates in completing undergraduate studies.

OBJECTIVES

To conduct an integrative systematic review of educational strategies to promote academic success and resilience in undergraduate indigenous students.

METHODS

Major databases of Scopus, ProQuest, Informit and Web of Science were searched. Inclusion criteria were peer reviewed research articles from scholarly journals that referenced indigenous, aboriginal, First Nation or Māori students in undergraduate programs in higher education. The search was limited to English language and studies conducted from 1995 to 2014.

RESULTS

The search yielded 156 research papers which reduced to 16 papers that met the inclusion criteria. The included papers were critiqued from a standpoint theory approach that reflects feminism, cultural respect, and humanism. Much of the literature describes issues, and provides qualitative analyses of experiences, but empirical evaluations of interventions are rare.

CONCLUSIONS

There was a gap in current research evaluating strategies to improve indigenous student success and resilience. Key strategies for indigenous student success are multi-faceted, layered support, underpinned by the principles of respect, relationships, and responsibility. Implications for nursing and midwifery education, research and health care practice are outlined.

Use of screening tests, diagnosis wait times, and wait-related satisfaction in breast and prostate cancer

BACKGROUND

Understanding factors relating to the perception of wait time by patients is key to improving the patient experience.

METHODS

We surveyed 122 breast and 90 prostate cancer patients presenting at clinics or listed on the cancer registry in Newfoundland and Labrador and reviewed their charts. We compared the wait time (first visit to diagnosis) and the wait-related satisfaction for breast and prostate cancer patients who received regular screening tests and whose cancer was screening test-detected ("screen/screen"); who received regular screening tests and whose cancer was symptomatic ("screen/symptomatic"); who did not receive regular screening tests and whose cancer was screen test-detected ("no screen/screen"); and who did not receive regular screening tests and whose cancer was symptomatic ("no screen/symptomatic").

RESULTS

Although there were no group differences with respect to having a long wait (greater than the median of 47.5 days) for breast cancer patients (47.8% screen/screen, 54.7% screen/symptomatic, 50.0% no screen/ screen, 40.0% no screen/symptomatic; p = 0.814), a smaller proportion of the screen/symptomatic patients were satisfied with their wait (72.5% screen/ screen, 56.4% screen/symptomatic, 100% no screen/ screen, 90.9% no screen/symptomatic; p = 0.048). A larger proportion of screen/symptomatic prostate cancer patients had long waits (>104.5 days: 41.3% screen/screen, 92.0% screen/symptomatic, 46.0% no screen/screen, 40.0% no screen/symptomatic; p = 0.011) and a smaller proportion of screen/ symptomatic patients were satisfied with their wait (71.2% screen/screen, 30.8% screen/symptomatic, 76.9% no screen/screen, 90.9% no screen/symptomatic; p = 0.008).

CONCLUSIONS

Diagnosis-related wait times and satisfaction were poorest among patients who received regular screening tests but whose cancer was not detected by those tests.

191 ROBUST GENERATION OF NEURAL STEM CELLS FROM PIG INDUCED PLURIPOTENT STEM CELLS FOR TRANSLATIONAL NEURAL REGENERATIVE MEDICINE

The generation of pig induced pluripotent stem cells (iPSC) opened the possibility to evaluate autologous neural cell therapy as a viable option for human patients. However, it is necessary to demonstrate whether pig iPSC are capable of in vitro neural differentiation similar to human iPSC in order to perform in vitro and in vivo comparative studies. Multiple laboratories have generated pig iPSC that have been characterised using pluripotent markers such as SSEA4 and POU5F1. However, correlations of pluripotent marker expression profiles among iPSC lines and their neural differentiation potential has not been fully explored. Because neural rosettes (NR) are composed of neural stem cells, our goal was to demonstrate that NR from pig iPSC can be generated, isolated, and expanded in vitro from multiple porcine iPSC lines similar to human iPSC and that the level of pluripotency in the starting porcine iPSC population (POUF51 and SSEA4 expression) could influence NRs development. Three lines of pig iPSC L1, L2, and L3 were cultured on matrigel-coated plates in mTeSR1 medium (Stemcell Technologies Inc., Vancouver, BC, Canada) and passaged every 3 to 4 days. For neural induction (NI), pig iPSC were disaggregated using dispase and plated. After 24 h, cells were maintained in N2 media [77% DMEM/F12, 10 ng mL–1 bovine fibroblast growth factor (bFGF), and 1X N2] for 15 days. To evaluate the differentiation potential to neuron and glial cells, NR were isolated, expanded in vitro and cultured for three weeks in AB2 medium (AB2, 1X ANS, and 2 mM L-Glutamine). Immunostaining assays were performed to determine pluripotent (POU5F1 and SSEA4), tight junction (ZO1), neural epithelial (Pax6 and Sox1), neuron (Tuj1), astrocyte (GFAP), and oligodendrocyte (O4) marker expression. Line L2 (POU5F1high and SSEA4low) showed a high potential to form NR (6.3.5%, P < 0.05) in comparison to the other 2 lines L1 (POU5F1low and SSEA4low) and L3 (POU5F1low and SSEA4high) upon NI. The NR immunocytochemistry results from Line L2 showed the presence of Pax6+ and Sox1– NRs cells at day 9 post-neural induction and that ZO1 started to localise at the apical border of NRs. At day 13, NRs cells were Pax6+ and Sox1+, and ZO1 was localised to the lumen of NR. After isolation and culture in vitro, NR cells expressed transcription factors PLAGL1, DACH1, and OTX2 through 2 passages, but were not detected in later passages. However, rosette cytoarchitecture was present up until passage 7 and were still Pax6+/Sox1+. NRs at passage 2 were cryopreserved and upon thaw showed normal NR morphology and were Pax6+/Sox1+. To characterise the plasticity of NRs, cells were differentiated. Tuj1 expression was predominant after differentiation indicating a bias towards a neuron phenotype. These results demonstrate that L2 pig iPSC (POUF51high and SSEA4low) have a high potential to form NR and neural differentiation parallels human iPSC neurulation events. Porcine iPSC should be considered as a large animal model for determining the safety and efficacy of human iPSC neural cell therapies.

Changes in prevalence of depression and anxiety following smoking cessation: results from an international cohort study (ATTEMPT)

BACKGROUND

Smoking cessation improves physical health but it has been suggested that in vulnerable individuals it may worsen mental health. This study aimed to identify the short- and longer-term effects of stopping smoking on depression and anxiety in the general population and in those with a history of these disorders.

METHOD

Sociodemographic and smoking characteristics, and mental and physical health were assessed using established measures in the ATTEMPT cohort, an international longitudinal study of smokers (n = 3645). Smokers who had stopped for at least 3 months or less than 3 months at the 12-month follow-up were compared with current smokers (n = 1640).

RESULTS

At follow-up, 9.7% [95% confidence interval (CI) 8.3-11.2] of smokers had stopped for less than 3 months and 7.5% (95% CI 6.3-8.9) for at least 3 months. Compared with current smokers, prevalence of depression prescriptions obtained in the last 2 weeks was lower for those who had stopped for less than 3 months [odds ratio (OR) 0.37, 95% CI 0.14-0.96] or at least 3 months (OR 0.25, 95% CI 0.06-0.94) after adjusting for baseline prescription levels and confounding variables. Adjusted prevalence of recent depression symptoms was also lower for ex-smokers who had stopped for less than 3 months (OR 0.34, 95% CI 0.15-0.78) or at least 3 months (OR 0.24, 95% CI 0.09-0.67) than among continuing smokers. There was no change in anxiety measures in the general population or any increase in anxiety or depression symptoms in ex-smokers with a past history of these conditions.

CONCLUSIONS

Smoking cessation does not appear to be associated with an increase in anxiety or depression and may lead to a reduced incidence of depression.

The impact of traumatic pelvic fractures on sporting activity and quality of life

BACKGROUND

Pelvic fractures (PFX) reflect high-energy trauma with high mortality and morbidity.

AIM

We attempted to determine: whether there is a decrease in levels of sporting and physical activity in patients with operatively-treated PFX; risk factors for decreased sporting activity; any correlation between sporting activity and quality of life in this group.

METHODS

Retrospective demographics on mechanism of injury, fracture type, associated injury and injury severity score, as well as prospective documentation of the level and frequency of sporting activity, were collected from adult patients treated operatively for a PFX between 2007 and 2010, using a specifically designed questionnaire. Quality of life before and after injury was also recorded using the EuroQol-5D health-outcome tool.

RESULTS

80 patients without pre-existing musculoskeletal disability were enrolled. The mean age was 44.9 years (18-65). The mean follow-up was 30.5 months (12-39). A decrease in level and frequency of sporting activity was observed. It was associated with lower-extremity associated injuries, but not with injury severity score, PFX severity, PFX type, age, or timing of follow-up. Sporting activity before injury predicted higher levels of sporting participation after injury. Decreased sporting activity after injury was associated with decreased EuroQol-SD score.

CONCLUSIONS

Patients should be counselled on the likelihood of a reduction in sporting activities after surgically treated PFX. A larger multi-centre study is needed to further expand on the evidence of the true impact of PFX and its associated injuries on sporting activity.

Abstract P1-02-10: Variation in HER2 positive rates in California by geographic region: Implications for setting pathology laboratory benchmarks

Background: It is unclear how much regional variation there is for HER2 positive rates in breast cancer. By looking at regional variation, we can begin to examine the impact of both demographic variation and pathology laboratory practice on HER2 positive rates so that valid laboratory benchmarks can be established.

Methods: Utilizing data from the California Cancer Registry (CCR), we examined the HER2 positive rates sorted by 58 California counties. Counties were grouped into 10 geographic regions for analysis. Stage at presentation and total numbers of breast cancer cases were studied at as variables. Results: 97,248 breast cancer cases were included in the CCR data. Overall, the HER2 positive rate was 16.5%. HER2 positive rates increased with increasing stage at presentation both overall and by region. Overall they were 12.9% for stage 1, 17.4% for stage 2, 23.2% for stage 3, 25.9% for stage 4 and 25.2% for unstaged cases. There was significant regional variation in overall HER2 positive rates ranging from 13.2-18.9%. 4 regions had overall rates within 0.5% of each other, 3 regions had rates &gt; 0.5% below average and 3 regions had rates &gt;0.5% above average. In the regions with overall rates below the average, one region (region 4, N = 4,636) had lower rates across all stages, and two regions (region 7, N = 8,623 and region 8, N = 14,152) had lower rates only for stages 1-2. Of regions with overall rates higher than the average, one region had increased rates across all stages (region 9, N = 24,279) and two regions had increased rates only in stages 1-3 (region 5, N = 9,176 and region 6, N = 4,888).

Conclusions: In California, there is significant variation in HER2 positive rates by geographic region, even when controlling for stage. The possible influence of differences in regional population characteristics versus differences in laboratory practices to explain this variation should be further examined so that valid regional laboratory benchmarks can be established.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-02-10.

Responses by breast and prostate cancer patients to out-of-pocket costs in Newfoundland and Labrador

PURPOSE

Cancer patients face substantial care-related out-of-pocket (oop) costs that may influence treatment decisions, attitudes, and use of drug- or appointment-related cost-saving strategies. We examined the relationship between oop costs and care-related responses by patients.

METHODS

We surveyed 170 prostate and 131 breast cancer patients presenting at clinics or support groups, or listed on the cancer registry in Newfoundland and Labrador.

RESULTS

In the 3-month period before the survey, 18.8% of prostate and 25.2% of breast cancer patients had oop costs greater than $500. Those oop costs consumed more than 7.5% of quarterly household income for 15.9% of prostate and 19.1% of breast cancer patients. Few patients (8.8% prostate, 15.3% breast) ever adopted any drug- or appointment-related cost-saving strategy. Few patients (7.2% prostate, 9.6% breast) said oop costs influenced treatment decisions, told their physicians about their oop costs (27.0% prostate, 21.1% breast), or were aware of available financial assistance programs (27.3% prostate, 36.9% breast). Compared with patients having low or moderate oop costs (22.9% prostate, 16.7% breast, and 25.7% prostate, 58.3% breast respectively), a larger proportion of prostate (56.0%) and breast (58.3%) cancer patients with high oop costs said that those costs created stress. Among prostate cancer patients, a larger proportion of those having high oop costs (compared with low or moderate costs) used drug-related (22.2% vs. 3.3% and 9.6% respectively) and appointment-related (11.1% vs. 1.1% and 3.8% respectively) cost-saving strategies, said oop costs created an unusual amount of stress (48.0% vs. 18.4% and 10.4%), and had difficulty paying those costs (29.2% vs. 6.2% and 10.4%).

CONCLUSIONS

For a small group of breast and prostate cancer patients, oop costs are high, but rarely lead to the use of care-related cost-saving strategies or influence care decisions.

What is the effect of penicillin dosing interval on outcomes in streptococcal infective endocarditis?

OBJECTIVES

Penicillin is an important treatment option for streptococcal infective endocarditis (IE), but its short half-life requires frequent re-dosing (4- or 6-hourly). There is a variation between the dosing regimens in different guidelines and consequent differences in the dosing interval. The objective of this study was to examine the relationship between the penicillin dosing interval and outcomes in streptococcal IE.

METHODS

A retrospective study of cases of streptococcal IE was undertaken using the Leeds Endocarditis Service database. Cases were included if the first-line therapy had been penicillin and excluded if patients had received less than 72 h of therapy. Details of antimicrobial therapy and outcomes were collated using strict definitions. Various parameters were considered as independent variables in a multivariate logistic regression analysis. Univariate analysis of categorical data was carried out using a χ(2) test, and analysis of continuous data using an unpaired t-test.

RESULTS

Two hundred and twelve cases were included in the final analysis. Of the parameters considered, a 4-hourly dosing interval [unadjusted OR = 2.79 (95% CI 1.43-5.62)] and initial echocardiographic evidence of abscess or severe valve regurgitation [unadjusted OR = 0.30 (95% CI 0.13-0.66)] were the only statistically significant factors associated with the success or failure of penicillin therapy. The odds of a successful outcome were almost three times greater with a 4-hourly regimen than with a 6-hourly regimen. Failure of penicillin therapy had no correlation with the MIC of penicillin or the concurrent administration of gentamicin.

CONCLUSIONS

Penicillin continues to be an effective therapy for IE. This study suggests that a 4-hourly dosing interval may be relevant in predicting the success of initial medical therapy. Further prospective studies are warranted to evaluate relationships in more detail.

Predictive validity of the Motivation To Stop Scale (MTSS): a single-item measure of motivation to stop smoking

BACKGROUND

Many different measures of motivation to stop smoking exist but it would be desirable to have a brief version that is standard for use in population surveys and for evaluations of interventions to promote cessation. The aim of this study was to assess the predictive validity and accuracy of the single-item Motivation To Stop Scale (MTSS).

METHODS

This study is part of the "Smoking Toolkit Study;" a monthly survey of representative samples of the English population. We used data from 2483 respondents to the surveys from November 2008 to January 2011, who were smokers, used the MTSS, and were followed up 6 months later to provide information on quit attempts since baseline. The MTSS consists of one item with seven response categories ranging from 1 (lowest) to level 7 (highest level of motivation to stop smoking).

RESULTS

A total of 692 smokers (27.9% (95% CI=26.1-29.6)) made an attempt to quit smoking between baseline and 6-month follow-up. The odds of quit attempts increased linearly with increasing level of motivation at baseline (p<0.001) and were 6.8 (95% CI=4.7-9.9) times higher for the highest level of motivation compared with the lowest. The accuracy of the MTSS for discriminating between smokers who did and did not attempt to quit was ROC(AUC)=0.67 (95% CI=0.65-0.70).

CONCLUSIONS

The MTSS provides strong and accurate prediction of quit attempts and is a candidate for a standard single-item measure of motivation to stop smoking. Further research should assess the external validity of this measure in different smoking populations.

Abstract PD05-09: Whole-genome progression of breast cancer from early neoplasia to invasive carcinoma

Cancer evolution involves cycles of genomic damage, epigenetic deregulation, and increased cellular proliferation that eventually culminate in the carcinoma phenotype. Early breast neoplasias include usual ductal hyperplasia, columnar cell lesions, and flat epithelial atypia and some are thought to represent precursor stages. To elucidate their role in cancer evolution we performed comparative whole genome sequencing of early neoplasias, matched normal tissue, and carcinomas from six patients. The identified somatic mutations served as lineage markers to build trees that relate the tissue samples. On the basis of the lineage trees we inferred the order, timing, and rates of mutational events. We find that in a subset of cases, the last common ancestor of an early neoplasm and a carcinoma was hypermutated and had several aneuploidies, and that evolution further accelerated in the carcinoma lineage. In contrast to highly advanced tumors that are the focus of much of current cancer genome sequencing, the early neoplasia genomes, and the carcinomas as well, harbor a striking paucity of potentially functional somatic point mutations. The earliest significant events we could detect, those changes that occurred in common ancestors of neoplastic and tumor cells, are aneuploidies. Several aneuploidies are recurrent, suggesting that they are among the earliest genomic events that predispose breast tissue to eventual development of invasive carcinoma.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD05-09.