External validity and reliability of the Psychosocial Assessment Tool (PAT) among Canadian parents of children newly diagnosed with cancer

BACKGROUND

The Psychosocial Screening Tool (PAT) was developed and validated with a sample of caregivers of children newly diagnosed with cancer in the United States. This study aimed to assess cultural adaptation (Phase 1) and validity and reliability of the revised PAT (PATrev) with a Canadian sample (Phase 2).

PROCEDURE

In Phase 1, a convenience sample of seven parents of children who were treated for cancer and six pediatric oncology healthcare experts participated. In Phase 2, 67 parents of children newly diagnosed with cancer from 4 Canadian pediatric cancer centers participated. To assess reliability and validity of the PATrev, parents completed behavioral (BASC-2) and quality of life (PedsQL) instruments about the child and an anxiety inventory (STAI) about themselves.

RESULTS

The PAT required minor changes to be culturally adapted for the Canadian population. The PATrev had strong inter-rater (0.77) test-retest (0.75), and internal consistency reliability (0.85), as well as moderate to strong validity comparing PATrev child's problems and PedsQL total (-0.49), PedsQL anxiety (-0.47), BASC-2 internalizing (0.64), behavioral (0.63), and adaptive scores (-0.56). PATrev discriminative validity was confirmed with BASC-2 scores (AUR scores of 0.70-0.74). PATrev parental stressors were strongly correlated to STAI scores (0.53). Finally, agreement between PATrev child's problems and parental anxiety scores was moderate (0.47).

CONCLUSION

This study supports the original PAT, demonstrates PATrev is a reliable and valid psychosocial screening tool, and provides unique evidence regarding early psychosocial risk in the family, which have important implications for guiding psychosocial practice.

Developing a strategy for accreditation of clinical services

Accreditation is one method of assuring quality. Accreditation requires the setting of standards and the creation of a robust and reliable process for assessing them. Accreditation offers different advantages to different groups, eg quality assurance to commissioners and the boards of provider organisations, confidence and choice for patients, and a quality improvement pathway for services to follow. This paper is focused on service accreditation and it proposes that service accreditation be professionally led.

Does the use of the revised psychosocial assessment tool (PATrev) result in improved quality of life and reduced psychosocial risk in Canadian families with a child newly diagnosed with cancer?

OBJECTIVES

Early psychosocial screening may guide interventions and ameliorate the adverse psychosocial effects of childhood cancer. The revised psychosocial assessment tool provides risk information - Universal (typical distress), Targeted (additional specific distress), and Clinical (severe distress) - about the child with cancer and his or her family. This pilot study investigated the benefits of providing a summary of family psychosocial risk information to the medical team treating the newly diagnosed child (Experimental Group, EG).

METHOD

We conducted a pilot randomized control trial with a sample of 67 parents, comparing the EG to the control group (CG) on parental perception of family psychosocial difficulties (revised psychosocial assessment tool risk levels), child behavior (behavior assessment scale for children-2), pediatric quality of life (PedsQL), and parental anxiety (state-anxiety scale of the state-trait anxiety inventory ), 2-4 weeks after diagnosis (Time 1) and 6 months later (Time 2).

RESULTS

Compared to the CG, participants in the EG had significantly reduced targeted and clinical risk (p < 0.001), and improved pain related PedsQL at Time 2 (p < 0.05). Scores for PedsQL total and nearly all subscales improved over time in both groups (p < 0.05 to p < 0.001). No changes in behavior scores were noted.

CONCLUSION

Preliminary findings suggest that providing a summary of the Psychosocial Assessment Tool to the treating team shortly after diagnosis may help reduce family wide psychosocial risk 6 months later and improve quality of life related to pain for children who are undergoing treatment for cancer.

Search for doubly charged Higgs boson pair production in pp¯ collisions at √s=1.96 TeV

We present a search for pair production of doubly charged Higgs bosons in the processes qq¯→H(++)H(--) decaying through H(±±)→τ(±)τ(±),μ(±)τ(±),μ(±)μ(±). The search is performed in pp¯ collisions at a center-of-mass energy of √s = 1.96 TeV using an integrated luminosity of up to 7.0 fb(-1) collected by the D0 experiment at the Fermilab Tevatron Collider. The results are used to set 95% C.L. limits on the pair production cross section of doubly charged Higgs bosons and on their mass for different H(±±) branching fractions. Models predicting different H(±±) decays are investigated. Assuming B(H(±±)→τ(±)τ(±))=1 yields an observed (expected) lower limit on the mass of a left-handed H(L)(±±) boson of 128 (116) GeV and assuming B(H(±±)→μ(±)τ(±))=1 the corresponding limits are 144 (149) GeV. In a model with B(H(±±)→τ(±)τ(±))=B(H(±±)→μ(±)τ(±))=B(H(±±)→μ(±)μ(±))=1/3, we obtain M(H(L)(±±))>130 (138) GeV.

Extending the clinical research network approach to all of healthcare

The development of Clinical Research Networks (CRN) has been central to the work conducted by Health Departments and research funders to promote and support clinical research within the NHS in the UK. In England, the National Institute for Health Research has supported the delivery of clinical research within the NHS primarily through CRN. CRN provide the essential infrastructure within the NHS for the set up and delivery of clinical research within a high-quality peer-reviewed portfolio of studies. The success of the National Cancer Research Network is summarized in Chapter 5. In this chapter progress in five other topics, and more recently in primary care and comprehensively across the NHS, is summarized. In each of the 'topic-specific' networks (Dementias and Neurodegenerative Diseases, Diabetes, Medicines for Children, Mental Health, Stroke) there has been a rapid and substantial increase in portfolios and in the recruitment of patients into studies in these portfolios. The processes and the key success factors are described. The CRN have worked to support research supported by pharmaceutical, biotechnology and medical device companies and there has been substantial progress in improving the speed, cost and delivery of these 'industry' studies. In particular, work to support the increased speed of set up and delivery of industry studies, and to embed this firmly in the NHS, was explored in the North West of England in an Exemplar Programme which showed substantial reductions in study set-up times and improved recruitment into studies and showed how healthcare (NHS) organizations can overcome delays in set up times when they actively manage the process. Seven out of 20 international studies reported that the first patient to be entered anywhere in the world was from the UK. In addition, the CRN have supported research management and governance, workforce development and clinical trials unit collaboration and coordination. International peer reviews of all of the CRN have been positive and resulted in the continuation of the system for a further 5 years in all cases.

Central nervous system atypical teratoid rhabdoid tumours: the Canadian Paediatric Brain Tumour Consortium experience

BACKGROUND

Atypical teratoid rhabdoid tumours (ATRT) are aggressive brain tumours mostly occurring in early childhood. Largest published series arise from registries and institutional experiences (1-4). The aim of this report is to provide population-based data to further characterise this rare entity and to delineate prognostic factors.

PATIENTS AND METHODS

A national retrospective study of children ⩽18years diagnosed with a central nervous system (CNS) ATRT between 1995 and 2007 was undertaken. All cases underwent central pathology review.

RESULTS

There were 50 patients (31 males; median age at diagnosis of 16.7months). Twelve patients were >36months. Infratentorial location accounted for 52% of all cases. Nineteen patients (38%) had metastatic disease. Fifteen (30%) underwent gross total resection (GTR). Ten patients (20%) underwent palliation. Among the 40 remaining patients, 22 received conventional chemotherapy and 18 received high dose chemotherapy regimens (HDC); nine received intrathecal chemotherapy and 15 received adjuvant radiation. Thirty of the 40 treated patients relapsed/progressed at a median time of 5.5months (0-32). The median survival time of the entire cohort was 13.5months (1-117.5months). Age, tumour location and metastatic status were not prognostic. Patients with GTR had a better survival (2years overall survival (OS): 60%±12.6 versus 21.7%±8.5, p=0.03). HDC conferred better outcome (2years OS 47.9%±12.1 versus 27.3%±9.5, p=0.036). Upfront radiation did not provide survival benefit. Six of the 12 survivors (50%) did not receive radiation.

CONCLUSION

The outcome of CNS ATRT remains poor. However, the use of HDC provides encouraging results. GTR is a significant prognostic factor. The role of adjuvant radiation remains unclear.

Search for a fermiophobic and standard model Higgs boson in diphoton final states

We present a search for the standard model Higgs boson and a fermiophobic Higgs boson in the diphoton final states based on 8.2  fb(-1) of pp collisions at sqrt[s]=1.96  TeV collected with the D0 detector at the Fermilab Tevatron Collider. No excess of data above background predictions is observed and upper limits at the 95% C.L. on the cross section multiplied by the branching fraction are set which are the most restrictive to date. A fermiophobic Higgs boson with a mass below 112.9 GeV is excluded at the 95% C.L.

Lead: ongoing public and occupational health issues in vulnerable populations: a case study

BACKGROUND

Lead has been recognized increasingly as a public health risk, although with the introduction of wide-ranging occupational and public health measures, levels of blood lead in the general population of the UK and other developed nations have been in decline in recent years. Nonetheless, cases of lead poisoning still occur.

METHODS

We report on a large cluster of exposed lead workers and their families, including several children. The focus of the occupational and public health investigations was to identify the different groups at risk and the pathways by which potential exposures were taking place.

RESULTS

Lead in the workplace was found to account for the raised blood lead levels amongst the workers with exposure occurring as a result of insufficient demarcation between 'clean' and 'dirty' areas, and from contamination of personal belongings with lead. Furthermore, there was evidence of para-occupational exposure of family members.

CONCLUSIONS

The successful control of lead in this case required multidisciplinary working. Efforts included extensive workplace controls, along with the education and care of workers and their families, though complicated by lack of familiarity with the UK health service amongst the affected groups, language barriers, underlying low levels of literacy and high mobility.

Search for neutral minimal supersymmetric standard model Higgs bosons decaying to tau pairs produced in association with b quarks in pp collisions at √s = 1.96 TeV

We report results from a search for neutral Higgs bosons produced in association with b quarks using data recorded by the D0 experiment at the Fermilab Tevatron Collider and corresponding to an integrated luminosity of 7.3 fb(-1). This production mode can be enhanced in several extensions of the standard model (SM) such as in its minimal supersymmetric extension (MSSM) at high tanβ. We search for Higgs bosons decaying to tau pairs with one tau decaying to a muon and neutrinos and the other to hadrons. The data are found to be consistent with SM expectations, and we set upper limits on the cross section times branching ratio in the Higgs boson mass range from 90 to 320 GeV/c(2). We interpret our result in the MSSM parameter space, excluding tanβ values down to 25 for Higgs boson masses below 170 GeV/c(2).

Precision measurement of the ratio B(t→Wb)/B(t→Wq) and extraction of V(tb)

We present a measurement of the ratio of top quark branching fractions R=B(t→Wb)/B(t→Wq), where q can be a d, s, or b quark, in the lepton+jets and dilepton tt final states. The measurement uses data from 5.4 fb(-1) of pp collisions collected with the D0 detector at the Fermilab Tevatron Collider. We measure R=0.90±0.04, and we extract the Cabibbo-Kobayashi-Maskawa (CKM) matrix element |V(tb)| as |V(tb)|=0.95±0.02, assuming unitarity of the 3×3 CKM matrix.

Search for a fourth generation t' Quark in p ̄p collisions at √s = 1.96 TeV

We present a search for pair production of a fourth generation t' quark and its antiparticle, followed by their decays to a W boson and a jet, based on an integrated luminosity of 5.3 fb(-1) of proton-antiproton collisions at √s = 1.96  TeV collected by the D0 Collaboration at the Fermilab Tevatron Collider. We set upper limits on the t' ̄t' production cross section that exclude at the 95% C.L. a t' quark that decays exclusively to W+jet with a mass below 285 GeV. We observe a small excess in the μ+jets channel which reduces the mass range excluded compared to the expected limit of 320 GeV in the absence of a signal.

Precise measurement of the top quark mass in the dilepton channel at D0

We measure the top quark mass (m(t)) in p ̄p collisions at a center of mass energy √s = 1.96 TeV using dilepton t ̄t→W(+)bW(-) ̄b→ℓ(+)ν(ℓ)bℓ(-) ̄ν(ℓ) ̄b events, where ℓ denotes an electron, a muon, or a tau that decays leptonically. The data correspond to an integrated luminosity of 5.4 fb(-1) collected with the D0 detector at the Fermilab Tevatron Collider. We obtain m(t)=174.0±1.8(stat)±2.4(syst) GeV, which is in agreement with the current world average m(t)=173.3±1.1 GeV. This is currently the most precise measurement of m(t) in the dilepton channel.