Barriers and facilitators to dental care among culturally and linguistically diverse carers: A mixed-methods systematic review

OBJECTIVES

Culturally and linguistically diverse (CALD) communities experience widespread inequalities in dental care utilization. While, several studies have reported factors contributing to such inequalities, a synthesis of evidence is lacking for CALD carers. This review examined the barriers and facilitators to dental care utilization among CALD carers.

METHODS

Medline, CINAHL, ProQuest, Scopus and Web of Science were searched for dental utilization and related factors, without geographic limitations. An integrated mixed-method design was adopted, where both qualitative and quantitative findings were combined into a single synthesis. Critical appraisal was conducted using JBI tools, and a Universal Health Coverage (UHC) framework guided the synthesis approach. Reliability and researcher triangulation occurred throughout the conduct of this review.

RESULTS

A total of 20 papers were included: qualitative (n = 8), quantitative (n = 8) and mixed method (n = 4). Studies were from Australia, Canada, South Korea, Trinidad and Tobago, United Kingdom and the United States. Three studies insufficiently reported confounding variables and nine qualitative papers lacked philosophical perspectives. Affordability was the foremost barrier at the system level, followed by psychosocial negative provider experiences and language/communication issues at the provider level. Cultural, knowledge, attitudes and beliefs were individual-family level factors. Utilizing a UHC framework, the barriers and facilitators were aggregated at three levels; financial-system, provider and individual-family levels and illustrated in the rainbow model of CALD oral health.

CONCLUSION

The review strengthens evidence for multilayered, system-related policies and culturally sensitive provision of services for reducing oral healthcare inequalities in CALD carers.

P11.64.A Long-term follow up and translational data from the ReoGlio phase Ib trial of GM-CSF and intravenous pelareorep (Reovirus) alongside standard of care in GBM

BACKGROUND

We previously reported safety data from a phase Ib, open-label study of intravenous oncolytic virus pelareorep with GM-CSF alongside standard chemoradiotherapy in newly diagnosed glioblastoma confirming that the combination is well tolerated. We now report on long-term follow up and analysis of translational samples from tumour and blood in a subset of patients.

METHODS

15 patients with newly diagnosed GBM were treated with GM-CSF 50μg subcutaneously on days 1-3 and intravenous pelareorep on days 4-5 in weeks 1 and 4 of chemoradiotherapy, and subsequently in week 1 of each adjuvant temozolomide course: 7 patients received 1x1010TCID50 (dose level 1); 8 received 3x1010TCID50 (dose level 2). The primary objective was to determine the maximum tolerated dose of pelareorep and GM-CSF with standard chemoradiotherapy. Following a protocol amendment we also collected survival data in all patients up to August 2021. Serial blood samples were taken from three patients, at baseline, during chemoradiotherapy and in the first adjuvant cycle. Peripheral blood mononuclear cells were analysed for immune checkpoint expression by flow cytometry, RNAseq gene expression and T-cell receptor clonality, whilst plasma cytokines were quantified by Luminex.

RESULTS

This combination was well tolerated with 87% of patients completing treatment as planned. Survival data analysis showed that median OS was 12.6 months in dose level 1 and 16.1 months in dose level 2, median OS for all patients was 13.1 months. The 24-month survival estimate for all patients was 25.0%, 16.7% for dose level 1 and 33.3% for dose level 2. One patient in dose level 1 remains alive at 43 months post registration without further treatment. Laboratory data showed that pelareorep infusion resulted in inflammatory cytokine and chemokine secretion, immune checkpoint modulation, and upregulation of inflammatory pathways. There was also increased peripheral clonal tumour-specific T-cell proliferation following pelareorep infusion.

CONCLUSION

Although based on small numbers, these long-term follow up data suggest this may be an active combination in a subset of GBM patients. Translational data confirm that pelareorep potentially activates tumour-targeting immune pathways in GBM, with consequential immune checkpoint modulation. These data support a combination clinical trial of pelareorep, radiotherapy and immune checkpoint blockade in GBM.

Cultural and linguistic disparities in dental utilisation in New South Wales, Australia

OBJECTIVE

To examine the patterns and predictors of dental utilisation in culturally and linguistically diverse (CALD) and non-CALD groups in New South Wales.

DESIGN

Secondary analysis of the 2013 and 2015 NSW Adult Population Health Survey (n=24,707).

MAIN OUTCOME

Dental utilisation, defined as a dental visit within the last 12 months. CALD groups were defined using country of birth and language. Andersen's theoretical model was used. Chi-square test and multivariate logistic regression analysis adjusted for potential confounding. Sample weights adjusted for sampling design.

RESULTS

Most (69%) of the population were Australian born; 20% spoke a language other than English at home. Dental utilisation was 58.9% and 63.9% for CALD and non-CALD groups respectively. The foreign-born non-English speaking group had the highest level of education (60%) but lower levels of dental utilisation (OR:0.81, CI 0.69-0.94) than all groups. Australian born non-English speakers had similar levels of dental utilisation to the reference group (OR:1.27, CI 0.99-1.63).

CONCLUSION

There are significant disparities in dental care utilisation among CALD populations. Foreign born, non-English speaking CALD migrants, and people experiencing socioeconomic disadvantage, are at greatest risk of inadequate dental utilisation. Furthermore, the combination of predisposing factors, language and cultural barriers compound disparities in oral health care utilisation. This data highlights the need for oral healthcare services that are sensitive to population needs, to reduce disparities among CALD communities residing in NSW.

Improving the quality of long-term care services in workforce dimension: expert views from Australia and South Korea

Background

The long-term care workforce is an essential factor in the provision of qualified long-term care services. Identifying workforce issues can help developing countries in East Asia and the Pacific prepare for the increase in the older population. Their experiences can be used as lessons for other countries. This study aimed to identify the workforce issues that should be addressed in order to provide high-quality long-term care services for older adults.

Methods

In-depth interviews and content analysis were conducted with a purposive sample of long-term care experts. There were eight participants from Australia and 14 from South Korea. The participants were questioned on important workforce issues to improve the quality of long-term care services. These were open-ended questions that comprised ideas derived from the literature. Major themes were systematically and comprehensively classified and coded to examine recurring comments and themes.

Results

The issues in the two countries were very similar: labor shortages, inadequate working conditions, insufficient career and staff training, and the need of counselors or consultants for finding proper services. There were also differences in terms of competency of the service operators and their corresponding multicultural competency.

Conclusions

Providing high-quality long-term care service requires multipronged approaches to workforce capacity and work environment. An adequate and competent workforce should be established to match the service needs of the older population. To improve quality, better working conditions and improved motivation to work in care for older people should be considered. Concurrently, each country would need a workforce strategy tailored to different conditions and environments. This should include policies to induce an influx into the workforce.

P11.02 Long-term impact of primary brain tumour diagnosis on health-related quality of life: a systematic review

BACKGROUND

A primary brain tumour (PrBT) diagnosis can be devastating, and results in a wide range of symptoms. Relatively little is known about the long-term challenges these symptoms pose on HRQOL. The aim of this review is to identify the long-term HRQOL issues reported at least two years following diagnosis of a PrBT.

MATERIAL AND METHODS

Systematic literature searches were carried out using Medline, EMBASE, CINAHL, PsycINFO and Web of Science Core Collection. Searches were designed to identify a range of reported HRQOL aspects defined as physical, mental or social issues, in adult WHO grade II or III patients. To capture the full extent of patients’ experience, studies of any design reporting on primary data where patients had at least two years follow-up from diagnosis were included. WHO grade I and grade IV tumours were excluded due to their different prognoses and the expected nature of their disease trajectories. Quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). Narrative synthesis was used to collate findings.

RESULTS

The search returned 8438 articles. 477 titles remained after title and abstract screening, with eighteen full text articles included in the final analysis. The majority of studies used quantitative methods, with only two articles reporting qualitative or mixed methodology. Articles were predominantly cross-sectional studies (n = 10), along with cohort studies (n = 3), clinical trials (n = 3) and pilot studies (n = 2). Results indicated that patients reported a variety of issues influencing their HRQOL, with emotional/psychological/cognitive changes being the most commonly reported. Physical complaints included problems with fatigue, seizures and maintaining daily activity. Social challenges included strained social relationships and issues managing finances. Patient coping strategies were found to significantly influence wellbeing and subsequent HRQOL.

CONCLUSION

PrBT patients’ long-term HRQOL and daily functioning can be impacted by their physical, mental and social wellbeing. Findings from this review lay the groundwork for efforts to improve patient HRQOL in long-term survivorship.

Barriers and facilitators to oral health care utilization in culturally and linguistically diverse mothers: a mixed methods systematic review protocol

OBJECTIVE

The objective of the review is to synthesize existing literature examining the barriers and facilitators to preventive oral health care utilization experienced by culturally and linguistically diverse mothers.

INTRODUCTION

Preventive oral health care in the absence of pain is underutilized in culturally and linguistically diverse groups. Culturally and linguistically diverse mothers experience oral health care utilization barriers compared to their host country counterparts. Much of the current evidence is focused on oral health care knowledge, attitudes, and beliefs of culturally and linguistically diverse groups. To date, it remains unclear as to which barriers or facilitators impact preventive oral health care utilization in culturally and linguistically diverse mothers.

INCLUSION CRITERIA

This review will consider studies that explore oral health care utilization in culturally and linguistically diverse mothers (with children younger than 18 years) who are either born in a different country or who have one parent born in a country that differs culturally and/or linguistically to the host population. Papers that explore barriers and facilitators to oral health care utilization will be included. Quantitative and qualitative studies will be included.

METHODS

A three-step search strategy will be conducted within the following databases: MEDLINE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, ProQuest Central, and Scopus. The search will be supplemented with gray literature and reference searching from collected articles. No date limitation will be applied. Two reviewers will assess papers against the inclusion criteria. A convergent integrated approach using the JBI mixed methods methodology will be followed for critical appraisal, data extraction, and data synthesis and integration.

The Future Health Workforce: Integrated Solutions and Models of Care

The health workforce is a vital aspect of health systems, both essential in improving patient and population health outcomes and in addressing contemporary challenges such as universal health coverage (UHC) and sustainable development goals (SDGs) [...].

Towards more effective health workforce governance: The case of overseas-trained doctors

OBJECTIVE

The over-reliance on overseas-trained doctors remains a pressing problem in a handful of countries. This study aimed to explore the experience of rural and remote overseas-trained doctors as regards to their migration, recruitment and ongoing support in Australia as the basis for more effective health workforce governance.

DESIGN

Qualitative interviews were undertaken with overseas-trained doctors in rural and remote Australia. Interview questions focused on the experiences of overseas-trained doctors.

SETTING

Migrant doctors working in general practice in rural and remote Australia.

PARTICIPANTS

Overseas-trained doctors who met inclusion criteria participated in interviews (n=14), which were digitally recorded and transcribed. Thematic coding and analysis were conducted with input from the study's Expert Policy Stakeholder Group.

RESULTS

Overseas-trained doctors enjoyed the relative autonomy of working in rural or remote general practice and were grateful to be in Australia. Specialised rural and remote skills such as cultural competence in matters of Indigenous health and specialised emergency rural skills was a key finding as was the deskilling or lack of career development opportunities. Our analysis pointed to the mismatch in expectations and experiences between overseas-trained doctors, policy-makers and employers, as some doctors experienced obstacles with registration, or the location was not ideal, or there was a lack of awareness of Indigenous-related health and cultural challenges.

CONCLUSIONS

In the context of Australia's continuing reliance on overseas-trained doctors, this study revealed the need for improved communication and coordination between overseas-trained doctors, policy-makers (education, health, employment and immigration) and employers, as a basis for more effective health workforce governance.

The International Classification of Health Interventions: an 'epistemic hub' for use in public health

The current lack of a common basis for collecting data on population-level prevention and health promotion interventions causes public health to be relatively invisible within broader health systems, making it vulnerable to funding cuts when there is pressure to reduce spending. Further, the inconsistent use of terms for describing interventions hinders knowledge translation and building an evidence base for public health practice and policy. The International Classification of Health Interventions (ICHI), being developed by the World Health Organization, is a standard statistical classification for interventions across the full scope of health systems. ICHI has potential to meet the need for a common language and structure for describing and capturing information about prevention and health promotion interventions. We report on a developmental appraisal conducted to examine the strengths and limitations of ICHI for coding interventions delivered for public health purposes. Our findings highlight classification challenges in relation to: consistently identifying separate components within multi-component interventions; operationalizing the ICHI concept of intervention target when there are intermediary targets as well as an ultimate target; coding an intervention component that involves more than one ICHI target or action; and standardising what is being counted. We propose that, alongside its purpose as a statistical classification, ICHI can play a valuable role as an 'epistemic hub', to be used flexibly by public health actors to meet a range of information needs, and as a basis for improved communication and exchange.

An Indigenous cultural competence model for dentistry education

Reorientation of education for health professionals is necessary to support future health workforce in meeting population needs. Dental graduates must be competent to effectively communicate with patients, their families and other health professionals involved in their care, regardless of social or cultural background. Indigenous people in Australia experience significant oral health disparities compared to non-Indigenous Australians. Cultural competence has evolved as the leading model to equip future clinicians to deliver culturally safe care. A case study conducted at the University of Sydney School of Dentistry examined the integration of Indigenous cultural competence into dental curricula using four data sources: a systematic review identifying intervention strategies to improve cultural competence; an online survey to provide a baseline analysis of Indigenous curricula practices; and two in-depth interview studies with academics and students to determine barriers and enablers to increasing Indigenous cultural competence among dental students. As a result, an Indigenous cultural model was developed for dentistry education, recognising three major constituents being critical to achieving cultural competence among dental students. Indigenous cultural competence in dentistry education requires stringent governance, adequate faculty resources and effective educational strategies, in order to increase students' knowledge, understanding and skills to achieve a minimum cultural competence standard upon graduation.

Building a statistical classification: A new tool for classification development and testing

Statistical classifications are essential for collecting consistent data that can be compared over space and time. However, a publicly-documented body of practice concerning how to undertake the development and testing of a statistical classification is currently lacking. What aspects of the classification should be tested during the development process? How do we judge whether the classification is fit-for-purpose? How should problems and shortcomings be identified so that they can be remedied? To fill this gap, we drew on existing, authoritative sources to develop an analytic structure for use in the development and testing of statistical classifications. It consists of two components: (1) a statistical classification development and testing framework reflecting the required features of a statistical classification; and (2) a 4-tier model representing the main elements that make up a statistical classification, to use as a heuristic structure within which to locate issues identified and consider how they can be addressed. In this paper, we outline the development of the framework and model, and reflect on their application in testing a draft classification of health interventions. We propose this analytic structure as a new tool to support those engaged in the development of statistical classifications.

Proposing a re-conceptualisation of competency framework terminology for health: a scoping review

BACKGROUND

Competency frameworks are being taken up by a growing number of sectors and for a broad range of applications. However, the topic of competency frameworks is characterised by conceptual ambiguity, misunderstanding and debate. Lack of consistency in the conceptualisation and use of key terminology creates a barrier to research and development, consensus, communication and collaboration, limiting the potential that competency frameworks have to deal with real workforce challenges. This paper aims to advance the field by conducting a detailed review of the literature to understand the underlying causes of conceptual differences and divergent views and proposing a re-conceptualisation of competency framework terminology for use by the health sector.

METHODS

A broad scoping review of literature was conducted to identify publications relating to the conceptualisation of competency frameworks and key terms, examine how they are conceptualised and determine how this evolved. In addition, a purposive sample of health-related competency frameworks was chosen to illustrate how the terms and concepts are currently being applied in the health context.

RESULTS

Of the 4 155 records identified, 623 underwent text searches and broad quantitative analysis, and 70 were included for qualitative analysis. Quantitative analysis identified 26 key terms, which were coded under six thematic headings. Qualitative analysis using the thematic areas revealed two distinct conceptualisations of competency frameworks and their terminology emerging concurrently in the education and employment sectors, with different underpinnings and purposes. As competency frameworks have developed, these two conceptualisations intertwined, resulting in the same terms being used to convey different concepts. Examination of health-related frameworks showed that this merging of concepts is prominent, with lack of consistency in definitions and use of key terms even within a single organisation.

DISCUSSION AND CONCLUSIONS

Building on previous efforts to address the lack of conceptual clarity surrounding competency frameworks, this paper proposes a re-conceptualisation of the terminology that encompasses two distinct competency framework interpretations, using a glossary of mutually exclusive terms to differentiate concepts. The re-conceptualisation holds relevance for multiple competency framework applications within health, enabling harmonisation, clear communication, consensus-building and effective implementation of competency frameworks.

OS9.5 Evidence that adult glioblastoma adapts to standard therapy though chromatin remodeling

BACKGROUND

Glioblastoma (GBM) tumours recur following standard treatment in almost all cases. We use ‘omics technologies to simultaneously profile pairs of primary and matched recurrent GBM to specifically identify and characterise the cells that resisted treatment, with the aim of determining how to more effectively kill them.

MATERIAL AND METHODS

We have analysed high coverage RNAseq data from pairs of GBM tumours: primary de novo tumour and matched local recurrence from patients that underwent standard therapy. Our original cohort constituted 23 pairs and our validation cohort was an additional 22 pairs. We also cultured two plates of spheroids directly from a patient’s GBM, treating one with radiation and temozolomide. We monitored growth and captured and sequenced RNA from single cells at two time-points: one week post-treatment when the deviation between untreated and treated spheroid growth curves was most pronounced; and three weeks post-treatment when the growth rate of treated spheroids had recovered. We investigated differential gene expression between primary and recurrent pairs, and single cells pre- and post-treatment, and performed a bespoke per patient gene set enrichment analysis.

RESULTS

Differential gene expression analysis in 23 tumour pairs indicated a treatment-induced shift in cell states linked to normal neurogenesis and prompted us to develop a novel gene set enrichment analysis approach to identify gene regulatory factors that may orchestrate such a shift. This revealed the significant and universal dysregulation of genes, through therapy, that are targeted by a specific chromatin remodeling machinery. This finding was validated in an independent cohort of 22 further GBM pairs. To understand the therapeutic potential of this finding we must determine whether genes are dysregulated through therapy owing to a) their fixed expression in inherently treatment resistance cells in the primary tumour which get selected during therapy to increase the signal of that profile, or b) changes in expression during the process of cells acquiring treatment resistance. To inspect this, we analysed single cell gene expression data from GBM spheroids pre- and post-treatment. We found that there was significant dysregulation of the genes associated with the chromatin remodeling complex but only at the three-week post-treatment time-point.

CONCLUSION

Our results indicate that GBM cells are being transcriptionally reprogrammed in response to treatment; the mechanism of which may represent a therapeutic opportunity.

PL3.6 Targeting GSK-3 activity promotes mitotic catastrophe via centrosome destabilisation and enhances the effect of radiotherapy in glioma models

BACKGROUND

Targeting kinases as regulators of cellular processes that drive cancer progression is a promising approach to improve patient outcome in GBM management. The glycogen synthase kinase 3 (GSK-3) plays a role in cancer progression and is known for its pro-proliferative activity in gliomas. The anti-proliferative and cytotoxic effects of the GSK-3 inhibitor AZD2858 were assessed in relevant in vitro and in vivo glioma models to confirm GSK-3 as a suitable target for improved single agent or combination treatments.

MATERIAL AND METHODS

The immortalised cell line U251 and the patient derived cell lines GBM1 and GBM4 were used in in vitro studies including MTT, clonogenic survival, live cell imaging, immunofluorescence microscopy and flow cytometry to assess the cytotoxic and anti-proliferative effects of AZD2858. Observed anti-proliferative effects were investigated by microarray technology for the identification of target genes with known roles in cell proliferation. Clinical relevance of targeting GSK-3 with the inhibitor either for single agent or combination treatment strategies was determined by subcutaneous and orthotopic in vivo modelling. Whole mount mass spectroscopy was used to confirm drug penetration in orthotopic tumour models.

RESULTS

AZD2858 was cytotoxic at low micromolar concentrations and at sub-micromolar concentrations (0.01 - 1.0 μM) induced mitotic defects in all cell lines examined. Prolonged mitosis, centrosome disruption/duplication and cytokinetic failure leading to cell death featured prominently among the cell lines concomitant with an observed S-phase arrest. No cytotoxic or anti-proliferative effect was observed in normal human astrocytes. Analysis of the RNA microarray screen of AZD2858 treated glioma cells revealed the dysregulation of mitosis-associated genes including ASPM and PRC1, encoding proteins with known roles in cytokinesis. The anti-proliferative and cytotoxic effect of AZD2858 was also confirmed in both subcutaneous and orthotopic in vivo models. In addition, combination treatment with AZD2858 enhanced clinically relevant radiation doses leading to reduced tumour volume and improved survival in orthotopic in vivo models.

CONCLUSION

GSK-3 inhibition with the small molecule inhibitor AZD2858 led to cell death in glioma stem cells preventing normal centrosome function and promoting mitotic failure. Normal human astrocytes were not affected by treatment with the inhibitor at submicromolar concentrations. Drug penetration was observed alongside an enhanced effect of clinical radiotherapy doses in vivo. The reported aberrant centrosomal duplication may be a direct consequence of failed cytokinesis suggesting a role of GSK-3 in regulation of mitosis in glioma. GSK-3 is a promising target for combination treatment with radiation in GBM management and plays a role in mitosis-associated events in glioma biology.

P11.13 Radiotherapy combined with a multimodal imaging approach in a glioblastoma preclinical model

BACKGROUND

Glioblastoma multiforme (GBM) carries a poor prognosis, partly due to biological and anatomical heterogeneity. Although radiotherapy (RT) is effective, high doses damage surrounding healthy tissues. Multimodal imaging with Magnetic Resonance (MRI) and Positron Emission Tomography (PET) may represent a useful approach for identifying GBM heterogeneity and visualising metabolic tumour properties. PET radiotracer [18F]-fluciclovine is preferentially accumulated in gliomas compared to healthy brain tissue via the cellular transport systems, LAT1 and ASCT2. In this study the effect of fractionated RT using multimodal imaging including [18F]-fluciclovine uptake and immunohistochemistry (IHC) in a GBM preclinical model will be validated.

MATERIAL AND METHODS

Two C57BL/6J mice cohorts were injected intracranially (i.c.) with murine CT2A-luc cells and subsequently submitted to multiparametric MRI and [18F]-fluciclovine PET imaging during hemi-brain RT (3Gy on 2 days/each week) for maximum 25 days after i.c. injection. Brains were collected for IHC characterization including LAT1 and ASCT2 staining.

RESULTS

Preliminary data showed that both MRI and PET were effective modalities to track tumour growth in this model. PET data revealed up to greater than 3-fold increase in SUVmax from regions of interest around the tumour site compared to healthy brain tissue. Time activity curves showed a steady increase in tumour uptake over 90 minutes. MRI showed a 25% increase in T2 values in tumours relative to unaffected contralateral regions. Confirmation of treatment response through matched imaging and IHC are ongoing, from which changes in glioma cell biology as well as amino acid transporter protein levels will be analysed.

CONCLUSION

These preliminary results show that multimodal imaging presents novel data in the assessment of treatment response in this model and will permit parallel IHC analyses to better define GBM tumour heterogeneity aligned with imaging changes. These data will also inform an on-going clinical study using the same imaging modalities.

Work at authors’ labs are supported by an Investigator initiated project from Blue Earth Diagnostics (AS, SCS) and a University of Leeds Biswas studentship (SCS, DS). Daniela Salvatore is also supported by a Scholarship provided by Molecular and Translational Medicine Doctorate School of University of Milan (Italy).

Strengthening Indigenous cultural competence in dentistry and oral health education: Academic perspectives

INTRODUCTION

Indigenous Australians continue to experience significant oral health disparities, despite numerous closing-the-gap initiatives. Higher education institutions and accrediting bodies recognise the need to incorporate Indigenous culture more widely into dentistry curricula to address these inequalities. This study aimed to define and explore current Indigenous cultural competence curricula, identify enablers and barriers for integration of Indigenous cultural competence curricula and ascertain innovative strategies to aid students in becoming culturally competent upon graduation, from academics' perspectives.

METHODS

Academics from the Doctor of Dental Medicine (DMD) and Bachelor of Oral Health (BOH) programmes at the University of Sydney, School of Dentistry participated in semi-structured interviews to define and explore current and future curricula practices to enable students to become competent in Indigenous culture. Thematic analysis was conducted to synthesise academics' responses.

RESULTS

Thirteen School of Dentistry academics participated in interviews. Following analysis of the data, six key themes emerged: Theme One: Transfer of Indigenous cultural knowledge, Theme Two: Barriers to developing Indigenous cultural curriculum. Theme Three: Importance of cultural immersion, Theme Four: Resources required for Indigenous cultural education, Theme Five: Proposed Indigenous cultural content, Theme Six: Strategies to incorporate Indigenous culture into curricula.

CONCLUSION

Improving Indigenous cultural competence amongst dentistry academics and students requires an educational and philosophical shift, incorporating the social determinants of health whilst maintaining the strengths of the biomedical foundations of dental care. It requires the inclusion of an informed history of Indigenous Australians, immersion within Indigenous communities and reflection upon these experiences, to facilitate culturally appropriate ways to improve the provision of dentistry and oral health for Indigenous peoples.

Indigenous cultural competence: A dental faculty curriculum review

BACKGROUND

Indigenous Australians have more than double the rate of poor oral health than their non-Indigenous counterparts. Cultural competence of dental and oral health practitioners is fundamental to health care and quality of life in addressing health disparities in minority cultural groups in Australia. Higher education curricula reviews have identified the need for institutions to incorporate Indigenous culture and knowledge more widely into the curricula to improve educational outcomes for Indigenous Australians and to increase cultural competence for all students.

AIM

The aim of this research was to provide a baseline analysis of Indigenous cultural competence curricula practices to ascertain changes required within Faculty of Dentistry programmes at the University of Sydney to enable students to become more culturally competent upon graduation.

METHODS

Staff and students of the Doctor of Dental Medicine and Bachelor of Oral Health programmes at the Faculty of Dentistry, University of Sydney participated in an online survey. Quantitative analysis of the survey data was conducted using integrated research electronic data capture survey tools, with open-ended questions being coded to common responses for those questions.

RESULTS

A total of 69 staff (71%) and 191 students (51%) participated in the online survey. The majority of participants perceived there was limited Indigenous content in the curriculum. Most participants reported that Indigenous curriculum was integrated into several units of study. The main pedagogical method for curriculum delivery was lectures, followed by case studies and group discussions.

CONCLUSION

Although some Indigenous content exists in dental faculty curriculum, in-depth investigation is required to develop a comprehensive, evidenced-based Indigenous cultural competence teaching framework, for integration into Doctor of Dental Medicine and Bachelor of Oral Health curricula.

Simultaneous 68Ga DOTATATE Positron Emission Tomography/Magnetic Resonance Imaging in Meningioma Target Contouring: Feasibility and Impact Upon Interobserver Variability Versus Positron Emission Tomography/Computed Tomography and Computed Tomography/Magnetic Resonance Imaging

AIMS

The increasing use of highly conformal radiation techniques to treat meningioma confers a greater need for accurate targeting. Several groups have shown that positron emission tomography/computed tomography (PET/CT) information alters meningioma targets contoured by single observers, but whether this translates into improved accuracy has not been defined. As magnetic resonance imaging (MRI) is the cornerstone of meningioma target contouring, simultaneous PET/MRI may be superior to PET/CT. We assessed whether ⁶⁸Ga DOTATATE PET imaging (from PET/CT and PET/MRI) reduced interobserver variability (IOV) in meningioma target volume contouring.

MATERIALS AND METHODS

Ten patients with meningioma underwent simultaneous ⁶⁸Ga DOTATATE PET/MRI followed by PET/CT. They were selected as it was anticipated that target volume definition in their cases would be particularly challenging. Three radiation oncologists contoured target volumes according to an agreed protocol: gross tumour volume (GTV) and clinical target volume (CTV) on CT/MRI alone, CT/MRI+PET(CT) and CT/MRI+PET(MRI). GTV/CTV Kouwenhoven conformity levels (KCL), regions of contour variation and qualitative differences between PET(CT) and PET(MRI) were evaluated.

RESULTS

There was substantial IOV in contouring. GTV mean KCL: CT/MRI 0.34, CT/MRI+PET(CT) 0.38, CT/MRI+PET(MRI) 0.39 (P = 0.06). CTV mean KCL: CT/MRI 0.31, CT/MRI+PET(CT) 0.35, CT/MRI+PET(MRI) 0.35 (P = 0.04 for all groups; P > 0.05 for individual pairs). One observer consistently contoured largest and one smallest. Observers rarely decreased volumes in relation to PET. Most IOV occurred in bone followed by dural tail, postoperative bed and venous sinuses. Tumour edges were qualitatively clearer on PET(MRI) versus PET(CT), but this did not affect contouring.

CONCLUSION

IOV in contouring challenging meningioma cases was large and only slightly improved with the addition of ⁶⁸Ga DOTATATE PET. Simultaneous PET/MRI for meningioma contouring is feasible, but did not improve IOV versus PET/CT. Whether volumes can be safely reduced according to PET requires evaluation.

Combined Analysis of Neutrino and Antineutrino Oscillations at T2K

T2K reports its first results in the search for CP violation in neutrino oscillations using appearance and disappearance channels for neutrino- and antineutrino-mode beams. The data include all runs from January 2010 to May 2016 and comprise 7.482×10^{20} protons on target in neutrino mode, which yielded in the far detector 32 e-like and 135  μ-like events, and 7.471×10^{20} protons on target in antineutrino mode, which yielded 4 e-like and 66  μ-like events. Reactor measurements of sin^{2}2θ_{13} have been used as an additional constraint. The one-dimensional confidence interval at 90% for the phase δ_{CP} spans the range (-3.13, -0.39) for normal mass ordering. The CP conservation hypothesis (δ_{CP}=0, π) is excluded at 90% C.L.

Measurement of Coherent π^{+} Production in Low Energy Neutrino-Carbon Scattering

We report the first measurement of the flux-averaged cross section for charged current coherent π^{+} production on carbon for neutrino energies less than 1.5 GeV, and with a restriction on the final state phase space volume in the T2K near detector, ND280. Comparisons are made with predictions from the Rein-Sehgal coherent production model and the model by Alvarez-Ruso et al., the latter representing the first implementation of an instance of the new class of microscopic coherent models in a neutrino interaction Monte Carlo event generator. We observe a clear event excess above background, disagreeing with the null results reported by K2K and SciBooNE in a similar neutrino energy region. The measured flux-averaged cross sections are below those predicted by both the Rein-Sehgal and Alvarez-Ruso et al.

Health Workforce Migration in the Asia Pacific: implications for the achievement of sustainable development goals

The maldistribution of health workers globally and within the Asia Pacific region remains problematic. While globalisation, and the increasing mobility of capital and labour, helps to reduce inequalities between countries, it increases inequality within countries. This study examines health workforce data and densities in the Asia Pacific region through a health workforce migration lens. The main implication relevant to achievement of sustainable development goals is the need for countries to work in a co-ordinated way in this region to increase substantially health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing states, most notably the Maldives, Timor- Leste, Kiribati, Samoa, Solomon Islands, Tuvalu and Vanuatu. Abbreviations: OECD – Organisation of Economic Co-operation and Development; SDG – Sustainable Development Goals; SIDS – Small Island Development States.

Foreign-born aged care workers in Australia: A growing trend

AIM

To address Australian aged care workforce challenges, a deeper understanding of the current care workforce is needed especially given estimated increases in demand. We provide a national picture of the aged care workforce in Australia focusing on country of birth.

METHODS

Data from the 2006 and 2011 Australian censuses.

RESULTS

The majority of care workers are Australia-born followed by those born in the United Kingdom, South-East Asia and South Asia. While the number of carers from all regions has grown, the increase from 2006 to 2011 has been highest for carers from South Asia (333% increase) and sub-Saharan Africa (145%). The state with the largest decrease in the proportion of Australian-born care workers is Western Australia where Australian-born workers dropped from 62% in 2006 to 49% in 2011.

CONCLUSIONS

Understanding the migration patterns of the aged care workforce in Australia is critical to health workforce planning given increasing demand.

Measurement of Muon Antineutrino Oscillations with an Accelerator-Produced Off-Axis Beam

T2K reports its first measurements of the parameters governing the disappearance of ν[over ¯]_{μ} in an off-axis beam due to flavor change induced by neutrino oscillations. The quasimonochromatic ν[over ¯]_{μ} beam, produced with a peak energy of 0.6 GeV at J-PARC, is observed at the far detector Super-Kamiokande, 295 km away, where the ν[over ¯]_{μ} survival probability is expected to be minimal. Using a data set corresponding to 4.01×10^{20} protons on target, 34 fully contained μ-like events were observed. The best-fit oscillation parameters are sin^{2}(θ[over ¯]_{23})=0.45 and |Δm[over ¯]_{32}^{2}|=2.51×10^{-3}  eV^{2} with 68% confidence intervals of 0.38-0.64 and 2.26-2.80×10^{-3}  eV^{2}, respectively. These results are in agreement with existing antineutrino parameter measurements and also with the ν_{μ} disappearance parameters measured by T2K.

Cell migration in paediatric glioma; characterisation and potential therapeutic targeting

BACKGROUND

Paediatric high grade glioma (pHGG) and diffuse intrinsic pontine glioma (DIPG) are highly aggressive brain tumours. Their invasive phenotype contributes to their limited therapeutic response, and novel treatments that block brain tumour invasion are needed.

METHODS

Here, we examine the migratory characteristics and treatment effect of small molecule glycogen synthase kinase-3 inhibitors, lithium chloride (LiCl) and the indirubin derivative 6-bromoindirubin-oxime (BIO), previously shown to inhibit the migration of adult glioma cells, on two pHGG cell lines (SF188 and KNS42) and one patient-derived DIPG line (HSJD-DIPG-007) using 2D (transwell membrane, immunofluorescence, live cell imaging) and 3D (migration on nanofibre plates and spheroid invasion in collagen) assays.

RESULTS

All lines were migratory, but there were differences in morphology and migration rates. Both LiCl and BIO reduced migration and instigated cytoskeletal rearrangement of stress fibres and focal adhesions when viewed by immunofluorescence. In the presence of drugs, loss of polarity and differences in cellular movement were observed by live cell imaging.

CONCLUSIONS

Ours is the first study to demonstrate that it is possible to pharmacologically target migration of paediatric glioma in vitro using LiCl and BIO, and we conclude that these agents and their derivatives warrant further preclinical investigation as potential anti-migratory therapeutics for these devastating tumours.

Measurement of the inclusive electron neutrino charged current cross section on carbon with the T2K near detector

The T2K off-axis near detector ND280 is used to make the first differential cross-section measurements of electron neutrino charged current interactions at energies ∼1  GeV as a function of electron momentum, electron scattering angle, and four-momentum transfer of the interaction. The total flux-averaged ν(e) charged current cross section on carbon is measured to be ⟨σ⟩(ϕ)=1.11±0.10(stat)±0.18(syst)×10⁻³⁸ cm²/nucleon. The differential and total cross-section measurements agree with the predictions of two leading neutrino interaction generators, NEUT and GENIE. The NEUT prediction is 1.23×10⁻³⁸ cm²/nucleon and the GENIE prediction is 1.08×10⁻³⁸ cm²/nucleon. The total ν(e) charged current cross-section result is also in agreement with data from the Gargamelle experiment.