Tempo-spatial patterns of PM2.5 measured using a portable particulate monitor around a mine complex in Canada's Arctic

Mining activities in Canada's pristine Arctic (e.g., driving on unpacked roads, blasts, rock grinding, diesel combustion, and garbage incineration) could add local sources of airborne fine particulate matter with a diameter of < 2.5 μm (PM_2.5) to their surrounding area. The increase in PM_2.5 above the background level around a mine represents a potential disturbance to caribou. To quantify the spatial distribution of the elevated PM_2.5, we investigated three different sampling schemes to measure PM_2.5 concentration using a portable monitor. We found that the best sampling scheme was to use the regional background PM_2.5 as the reference and analyze the anomaly of PM_2.5 measured at sites around the mine complex from the background level. The regional background PM_2.5 values were measured at the Daring Lake Tundra Research Station during 2018 and 2019. Our results indicated that the background PM_2.5 was not a low and constant value but varied with rain events, wind direction, and the impacts of forest fire smoke. After excluding periods affected by forest fires smokes, we found the background PM_2.5 was close to 0 μg m^-3 for the first few hours after rain, and then increased logistically with the time after rain (t_ar) to the maximum of 5 (or 10) μg m^-3 when the wind came from the north (or south) of the NW-SE axis. The NW-SE axis in western Canada divides the tundra north with few anthropogenic PM_2.5 sources from the forested south with many PM_2.5 sources from forest fire smokes and human activities. Analyses of PM_2.5 anomaly from the background (i.e., PM_2.5 measured at a site around the mining complex-the background level at the corresponding t_ar and wind direction) revealed that the zone of elevated PM_2.5 around the mine (Z_epm) expanded with t_ar. In the first few hours after rain, PM_2.5 was close to 0 everywhere except within meters of a source (e.g., a truck exhaust) in the downwind direction. During t_ar = 6 to 96 h, Z_epm expanded to 6.3 km in the downwind direction when the wind came from south of the NW-SE axis. A similar result was found in the downwind direction when the wind came from north of the NW-SE axis, with Z_epm = 4.4 km. In the upwind direction, the value of Z_epm was much smaller, being 0.7 km (or 1.0 km) when the wind came from the north (or south) of the NW-SE axis. For the period of t_ar between 96 and 192 hours, Z_epm further expanded to 21.2 km when the wind from the south of the NW-SE axis. The results from this study indicated that this reference paradigm that uses the regional background PM_2.5 as the reference in combination with a portable PM_2.5 monitor worked well for quantifying the tempo-spatial patterns of PM_2.5 at locations in remote and mostly pristine Arctic. However, their effectiveness for other regions needs further investigation.

Strategies to facilitate shared decision-making about pediatric oncology clinical trial enrollment: A systematic review

OBJECTIVE

We conducted a systematic review to identify the strategies that have been recommended in the literature to facilitate shared decision-making regarding enrolment in pediatric oncology clinical trials.

METHODS

We searched seven databases for peer-reviewed literature, published 1990-2017. Of 924 articles identified, 17 studies were eligible for the review. We assessed study quality using the 'Mixed-Methods Appraisal Tool'. We coded the results and discussions of papers line-by-line using nVivo software. We categorized strategies thematically.

RESULTS

Five main themes emerged: 1) decision-making as a process, 2) individuality of the process; 3) information provision, 4) the role of communication, or 5) decision and psychosocial support. Families should have adequate time to make a decision. HCPs should elicit parents' and patients' preferences for level of information and decision involvement. Information should be clear and provided in multiple modalities. Articles also recommended providing training for healthcare professionals and access to psychosocial support for families.

CONCLUSION

High quality, individually-tailored information, open communication and psychosocial support appear vital in supporting decision-making regarding enrollment in clinical trials. These data will usefully inform future decision-making interventions/tools to support families making clinical trial decisions.

PRACTICE IMPLICATIONS

A solid evidence-base for effective strategies which facilitate shared decision-making is needed.

2015 President's Plenary International Psycho-oncology Society: psychosocial care as a human rights issue-challenges and opportunities

The International Psycho-Oncology Society (IPOS) Human Rights Task Force has been working since 2008 to raise awareness and support, for the relevance of psychosocial cancer care as a human rights issue. In 2014 the "Lisbon Declaration: Psychosocial Cancer Care as a Universal Human Right" was fully endorsed by IPOS. Subsequently, the IPOS Standard on Quality Cancer Care, endorsed by 75 cancer organizations worldwide, has been updated and now includes 3 core principles: Psychosocial cancer care should be recognised as a universal human right; Quality cancer care must integrate the psychosocial domain into routine care; Distress should be measured as the 6th vital sign. The President's plenary held at the 2015 World Congress of Psycho-Oncology in Washington DC was devoted to discussing psychosocial care as a human rights issue. Many challenges and opportunities are illustrated in different continents and contexts: from Africa where resources for basic cancer treatment are scarce and children and their parents face significant difficulties with hospital detention practices; to Europe where for many countries psychosocial care is still seen as a luxury; and the Middle East where Muslim women face stigma and a culture of silence over cancer. We further discuss how to move the Lisbon Declaration forward towards its implementation into clinical practice globally, using the successful example of the World Health Assembly resolution supporting palliative care as a human right which has achieved widespread approval, and identifying the vital role the IPOS Federation of National Psychoncology Societies plays worldwide to move this agenda forward.

Burnout among psychosocial oncologists: an application and extension of the effort-reward imbalance model

OBJECTIVES

Burnout is a significant problem among healthcare professionals working within the oncology setting. This study aimed to investigate predictors of emotional exhaustion (EE) and depersonalisation (DP) in psychosocial oncologists, through the application of the effort-reward imbalance (ERI) model with an additional focus on the role of meaningful work in the burnout process.

METHODS

Psychosocial oncology clinicians (n = 417) in direct patient contact who were proficient in English were recruited from 10 international psychosocial oncology societies. Participants completed an online questionnaire, which included measures of demographic and work characteristics, EE and DP subscales of the Maslach Burnout Inventory-Human Services Survey, the Short Version ERI Questionnaire and the Work and Meaning Inventory.

RESULTS

Higher effort and lower reward were both significantly associated with greater EE, although not DP. The interaction of higher effort and lower reward did not predict greater EE or DP. Overcommitment predicted both EE and DP but did not moderate the impact of effort and reward on burnout. Overall, the ERI model accounted for 33% of the variance in EE. Meaningful work significantly predicted both EE and DP but accounted for only 2% more of the variance in EE above and beyond the ERI model.

CONCLUSIONS

The ERI was only partially supported as a useful framework for investigating burnout in psychosocial oncology professionals. Meaningful work may be a viable extension of the ERI model. Burnout among health professionals may be reduced by interventions aimed at increasing self-efficacy and changes to the supportive work environment.

Children's Oncology Group's 2013 blueprint for research: behavioral science

Behavioral science has long played a central role in pediatric oncology clinical service and research. Early work focused on symptom relief related to side effects of chemotherapy and pain management related to invasive medical procedures. As survival rates improved, the focused has shifted to examination of the psychosocial impact, during and after treatment, of pediatric cancer and its treatment on children and their families. The success of the clinical trials networks related to survivorship highlights an even more critical role in numerous domains of psychosocial research and care. Within the cooperative group setting, the field of behavioral science includes psychologists, social workers, physicians, nurses, and parent advisors. The research agenda of this group of experts needs to focus on utilization of psychometrically robust measures to evaluate the impact of treatment on children with cancer and their families during and after treatment ends. Over the next 5 years, the field of behavioral science will need to develop and implement initiatives to expand use of standardized neurocognitive and behavior batteries; increase assessment of neurocognition using technology; early identification of at-risk children/families; establish standards for evidence-based psychosocial care; and leverage linkages with the broader behavioral health pediatric oncology community to translate empirically supported research clinical trials care to practice.

Li-Fraumeni syndrome: report of a clinical research workshop and creation of a research consortium

Li-Fraumeni syndrome (LFS) is a rare dominantly inherited cancer predisposition syndrome that was first described in 1969. In most families, it is caused by germline mutations in the TP53 gene and is characterized by early onset of multiple specific cancers and very high lifetime cumulative cancer risk. Despite significant progress in understanding the molecular biology of TP53, the optimal clinical management of this syndrome is poorly defined. We convened a workshop on November 2, 2010, at the National Institutes of Health in Bethesda, Maryland, bringing together clinicians and scientists, as well as individuals from families with LFS, to review the state of the science, address clinical management issues, stimulate collaborative research, and engage the LFS family community. This workshop also led to the creation of the Li-Fraumeni Exploration (LiFE) Research Consortium.

Parental decisions and outcomes regarding disclosing maternal BRCA1 and 2 test results to children

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Background: BRCA1/2 testing is key to hereditary cancer risk management. Though testing is discouraged in children, prior work suggests they are informed of their tested mothers' mutation status; decisions and outcomes of parental disclosure to children remain largely unknown. Methods: We examined predictors of parental disclosure decisions to children ages 8–21 and related outcomes in a large clinical sample (221 tested mothers, 124 untested co-parents). Parents were interviewed prior to mothers' receipt of BRCA1/2 results and 1 and 6 months later. Descriptive analyses were conducted, and bivariate analyses identified candidate predictor variables (demographic, medical, psychosocial) for inclusion in multivariate logistic regression models. Results: 63% of mothers disclosed their results to their children within 1 month of receipt (44% of co-parents also disclosed to children); this increased to 68% by 6 months (55% among co-parents). Within parenting dyads, mothers were significantly more likely than co-parents to disclose to children in the short-term (X2=18.6, p<.0001). Predictors of maternal disclosure to children included not being a BRCA1/2 mutation carrier, older child age, stronger intentions to disclose, more favorable attitudes toward pediatric BRCA1/2 testing, a more open parent-child communication history, and a decisional balance favoring disclosure (all p's<.05). When examined simultaneously, mothers who were not mutation carriers (OR=4.02, 95% CI=1.35, 11.94), mothers of older children (OR=1.30, 95% CI=1.13, 1.49), and those with stronger intentions to disclose (OR=1.39, 95% CI=1.10, 1.76) were more likely to communicate. Other outcomes of maternal disclosure included greater satisfaction with the decision to disclose and more open parent-child communication following disclosure (all p's<.05). Conclusions: This is the largest and most well-characterized study on this topic to date. Short-term rates of parental disclosure to children were high, increasing over time. Parental disclosure decisions are determined by a complex array of both child and parent factors, with some benefits identified with disclosure. Findings indicate a need for additional work, including decision support interventions for communication with children.

No significant financial relationships to disclose.

Emerging roles of thioredoxin cycle enzymes in the central nervous system

The thioredoxins (Trxs) constitute a family of enzymes which catalyze the reduction of protein disulfide bonds. Recent animal studies have revealed the importance of the Trx superfamily in various experimental systems. For example, the homozygous disruption of the genes encoding cytoplasmic (TRX1) or mitochondrial Trx (TRX2) in mice generates lethal embryonic phenotypes. In contrast, transgenic mice overexpressing TRX1 show an extended life span and are relatively resistant to ischemia- mediated brain damage. In addition to their capacity to detoxify peroxides in concert with peroxiredoxins and Trx reductases, Trx isozymes perform multiple redox signaling functions mediated by their specific interaction with various proteins, including redox-regulated kinases and transcription factors. Recent studies indicate that specific isoforms of Trx cycle enzymes, targeted to different cell compartments, are key regulators of fundamental processes, such as gene expression, cell growth and apoptosis. The present review is primarily focused on the emerging neuroprotective role of these proteins in the central nervous system.