Integrating Patient-Centred Research in the Canadian Cancer Trials Group

The inclusion of patients as partners in research is a key link in the delivery of patient-centred care in healthcare systems. Despite genuine intentions to engage patients in authentic partnerships, efforts can result in tokenism and benefits of engagement are missed. Understanding how patient engagement provides value along the research to patient-care continuum and how to best engage patients as partners are key. This document describes the method taken by the Canadian Cancer Trials Group (CCTG) to implement meaningful patient centricity and engagement and the benefits realized. Originally, Patient Representatives were recruited and assigned to CCTG Committees. Lacking guidance, the role was one of a passive meeting attendee. A gap analysis identified a need for clarity in expectations, understanding of the linkage to CCTG strategic objectives, and supporting tools and training. A plan was developed and successfully implemented in three phases, each phase building on the previous, the level of patient engagement simultaneously changing from “Inform” to “Involve” to “Collaborate” on the International Association for Public Participation (IAP2) scale. Results include significant contributions to increased patient accrual in CCTG trials, to increased CCTG grant funding, as well as recognition and adoption of these practices within Canada and internationally.

STUDIES ON THE ANOMALOUS VISCOSITY AND FLOW-BIREFRINGENCE OF PROTEIN SOLUTIONS : III. CHANGES IN THESE PROPERTIES OF MYOSIN SOLUTIONS IN RELATION TO ADENOSINETRIPHOSPHATE AND MUSCULAR CONTRACTION

1. An investigation of the physicochemical properties of myosin has been carried out. Prepared under standard conditions, the ratio of flow-birefringence to protein concentration is uniform. The effect of electrolytes, pH, and urea on the flow-birefringence and viscosity (relative and anomalous) of myosin has been examined. 2. Decrease or abolition of flow-birefringence does not necessarily imply far reaching denaturation, since such effects can be reversed by a variety of means. 3. When a myosin solution is treated with adenosinetriphosphate, its flow-birefringence is decreased (average 48 per cent), its anomalous viscosity is retained, and its relative viscosity is decreased (average 14 per cent). The full effect of adenosinetriphosphate is obtained at 0.004 M; a molarity very much less than that of other substances which decrease the flow-birefringence of myosin. 4. The changes in the physicochemical properties of myosin brought about by adenosinetriphosphate are spontaneously reversible, and are connected with the enzymatic action of the protein as adenosinetriphosphatase. 5. Effects similar to those of adenosinetriphosphate on the physicochemical properties of purified myosin have been obtained so far only with inosinetriphosphate. 6. Inorganic phosphate is split off by myosin from inosinetriphosphate as well as from adenosinetriphosphate. Inorganic triphosphate is split by 1 to 2 per cent solution of three times precipitated myosin. 7. Adenosinediphosphate and inorganic triphosphate act as competitive inhibitors with adenosinetriphosphate, blocking the fall of flow-birefringence. 8. The implications of the results, and the conception of active enzymic groups attached to proteins participating in cell structure, whether contractile or non-contractile, are discussed in relation to present views on muscle physiology and other biological problems.

STUDIES ON THE ANOMALOUS VISCOSITY AND FLOW-BIREFRINGENCE OF PROTEIN SOLUTIONS : II. ON DILUTE SOLUTIONS OF PROTEINS FROM EMBRYONIC AND OTHER TISSUES

1. An extensive investigation has been made of protein particle shape using the methods of flow-birefringence and anomalous viscosity measurement in the coaxial cell. 2. As a result of investigations on a number of proteins, it is concluded that they may be divided into four groups. Group A consists of those which show flow-anomaly both in the bulk phase and in the surface film. These also show flow-birefringence in the bulk phase. Examples: tobacco mosaic disease virus nucleoprotein; myosin. Though corpuscular proteins, they have elongated particles before denaturation. Group B consists of those which show flow-anomaly only (in the first instance) in the surface film, and no flow-birefringence in the bulk phase. They are probably close to spherical in shape in solution, but form elongated particles as they denature in the surface film. After this process has been completed, they may show flow-anomaly also in the bulk phase. Some proteins show flow-anomaly in the surface film immediately it forms, others only show it after a certain time has elapsed for the building up of the film. We designate the former as group B₁ and the latter as group B₂. Group B₁, immediate surface film flow-anomaly. Examples: serum euglobulin, amphibian embryo euglobulin b. Group B₂, slowly appearing surface film flow-anomaly. After the film has once been fully formed and then dispersed by shaking, the solution may have the properties of that of a protein in group B₁; i.e., anomalous flow in the film may occur immediately on testing in the viscosimeter. Examples: avian ovalbumin, amphibian embryo pseudoglobulin. Group C consists of those proteins which show flow-anomaly neither in the bulk phase nor in the surface film, under the conditions used by us. They are probably close to spherical in shape. Examples: insulin, methaemoglobin, amphibian embryo euglobulin c, mucoproteins. 3. The theoretical significance of protein fibre molecules, whether native or formed by denaturation in the living cell, is discussed, especially in relation to experimental morphology and cytology.

STUDIES ON THE ANOMALOUS VISCOSITY AND FLOW-BIREFRINGENCE OF PROTEIN SOLUTIONS : I. GENERAL BEHAVIOUR OF PROTEINS SUBJECTED TO SHEAR

1. A coaxial viscosimeter which permits the simultaneous determination of relative and anomalous viscosity and of flow-birefringence is described. Flow-anomaly and flow-birefringence are regarded as characteristic of elongated micelles and molecules. 2. Such methods have been applied to dilute solutions of proteins. The conditions under which the coaxial (Couette) viscosimeter measures the viscosity of the bulk phase and the surface film phase respectively have been investigated and are described. 3. The general behaviour of protein solutions subjected to shear is summarised.

A systematic approach to the investigation and diagnosis of a unilateral pleural effusion

Fluid in the pleural space is a common sequela of a wide range of diseases which may be pulmonary, pleural or extrapulmonary. As the differential diagnosis is wide, a systematic approach to investigation and diagnosis is recommended. This review highlights the important features and recommendations for the investigation of a unilateral pleural effusion, a common condition encountered by the general physician. The aim of this study was to assist with a speedy diagnosis of the underlying pathology, using appropriate investigative techniques, while minimising the use of invasive procedures.

Impairment of germline transmission after blastocyst injection with murine embryonic stem cells cultured with mouse hepatitis virus and mouse minute virus

The aim of this study was to determine the susceptibility of murine embryonic stem (mESCs) to mouse hepatitis virus (MHV-A59) and mouse minute virus (MMVp) and the effect of these viruses on germline transmission (GLT) and the serological status of recipients and pups. When recipients received 10 blastocysts, each injected with 10(0) TCID(50) MHV-A59, three out of five recipients and four out of 14 pups from three litters became seropositive. When blastocysts were injected with 10(-5) TCID(50) MMVp, all four recipients and 14 pups from four litters remained seronegative. The mESCs replicated MHV-A59 but not MMVp, MHV-A59 being cytolytic for mESCs. Exposure of mESCs to the viruses over four to five passages but not for 6 h affected GLT. Recipients were seropositive for MHV-A59 but not for MMVp when mESCs were cultured with the virus over four or five passages. The data show that GLT is affected by virus-contaminated mESCs.

Applications of optical resonance to biological imaging and label-free protein microarrays

We present biological imaging and sensing methods based on optical resonance and interference. In fluorescence microscopy, our nanoscale imaging capability sheds light onto conformational changes of DNA, DNA-protein complexes and polymer coatings on a solid surface. Interference measurements on a layered substrate yield a label-free sensing platform for protein binding in a high-throughput micro-array format.

Mouse antibody production test: can we do without it?

Introduction of microbiologically contaminated materials into mice can cause infections of the recipients and jeopardize experimental protocols. As such, the methods used to screen biological materials should be sensitive, reliable and suitable for routine diagnostic work. In this report, the sensitivity of the viral plaque assay, mouse antibody production test and polymerase chain reaction (PCR) for detection of MHV-A59 and MMVp, two of the most prevalent pathogenic viruses in experimental mouse facilities, was compared. Analysis of serial tenfold dilutions of virus stocks revealed that the sensitivity of the mouse antibody production test on day 28 (10(-10) dilution) was at least 10 times higher than that of the viral plaque assay (10(-9) dilution) and 10(4) times more than that of the RT-PCR (10(-6) dilution) for detection of MHV-A59. For detection of MMVp, the PCR (10(-10) dilution) proved to be 10(6) times more sensitive than the viral plaque assay (10(-4) dilution) and the mouse antibody production test on day 28 (10(-4) dilution) which were equally sensitive. Based on the present study, it was shown that the method for diagnosis of viruses in biological materials should be employed only after the sensitivity has been determined for the viruses of interest implying that the most sensitive method needs to be determined independently for each virus.

Accuracy in workload measurement: a fact or fallacy?

As the drive within a market-led National Health Service is towards cost-efficiency and through-put, nurses are now more than ever having to 'prove their worth'. This has led to various workload measurement systems being used throughout nursing. Before examining the accuracy of these measurement tools this paper attempts to define workload and investigates how measurement is limited by an unclear definition of what 'nursing' actually is. There is little argument as to some of the beneficial effects of monitoring workload where changes in practice, rostering, skill mix and establishments have occurred. It is, however, necessary to examine the accuracy of workload measurement within the current framework of nursing to see if it is the promised panacea. The issues surrounding patient dependency and professional judgement are discussed and the seeming unacceptability of such 'soft data' to non-nursing personnel. Both the 'bottom-up' and 'top-down' approaches of workload measurement are explored within the context of equity, neutrality and bias. The conclusion is drawn that accuracy in nursing workload measurement is not possible in the current economic climate and that a compromise solution that uses patient dependency as an assessment tool is the best that can be hoped for without limiting nursing to inflexible and restrictive practices.

Classical swine fever virus diversity and evolution

By analysing the nucleotide sequence data generated from both the E2 (gp55) and the NS5B genes of classical swine fever virus (CSFV), in addition to previously published data from the 5'NCR, we were able to divide 115 CSFV isolates into two major groups, five subgroups and two disparate isolates. Further discrimination was possible by analysis of sequence data from the E2 region. The three sequencing based methods were compared to monoclonal antibody (MAb) typing and to limited restriction enzyme (RE) mapping. Although both MAb and RE methods confirmed the previous classification the resolution was inferior. We estimated an approximate evolution rate for CSFV from an analysis of the virus variation observed in a single geographical area over a 6 year period. Applying this proposed rate to each of our deduced CSFV subgroups enabled us to calculate the approximate dates of divergence for each subgroup.

Balancing skill mix--future paediatric health care provision

Issues of "cost vs quality" and the needs for "pairs of hands" rather than "pair of eyes" has meant that nursing service managers are having to look closely at the skill mix of the staff they employ. This paper outlines the need to define the role of the nurse and the function of skill mix review. Arguments are discussed surrounding the issues of an all qualified nursing staff in a traditional hospital or the use of a generic "multiskilled" workforce within a "patient-focused" environment. The reasons for developing the role of the National Vocational Qualification (NVQ) Support Worker are examined and how they, and the Project 2000 trained staff nurse compare, against each other when looking for staff to employ. This paper looks at the paediatric field of health care in the light of the recommendations made by the 1991 Clothier Report to increase the number of specialist trained staff within that environment and what the future role of the children's nurse may be

Histochemical identification of 9-O-acyl sialic acids: studies of bovine submandibular and rat sublingual gland and human colon

Formalin-fixed tissue specimens containing glycoproteins with side chain O-acylated sialic acids were used to re-examine, compare and evaluate the usefulness of three methods based on the periodic acid-borohydride reduction-saponification-periodic acid-Schiff sequence (PA-Bh-KOH-PAS) for the histochemical identification of 9-O-acyl sialic acids (9-O-AcSA). Method I, modified from Veh et al. (1979), involved a comparison of the staining intensely obtained when both oxidation steps of the PA-Bh-KOH-PAS sequence were carried out with the selective oxidation technique of Volz et al. (1987) with that obtained when the initial oxidation step was carried out with 0.5 M periodic acid for 4 h at room temperature. Methods II and III, modified from Reid et al. (1978), involved an initial PA-Bh step under oxidation conditions that cleaved all the vicinal diols associated with neutral sugars and side chain unsubstituted and 7-O-acyl sialic acids. The Schiff staining obtained following subsequent re-oxidation with either 0.5M (method II) or 1% periodic acid (method III) for 4 h at room temperature (PA-Bh-PAS procedure) identifies 9-O-AcSa.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of tamoxifen on oestrogen binding, lipid and lipoprotein concentrations and blood clotting parameters in premenopausal women with breast pain

As part of a controlled trial of the use of tamoxifen for the treatment of mastalgia, some of the metabolic and haematological effects of this agent were measured. A panel of haemostatic variables including prothrombin time, kaolin cephalin clotting time, fibrinogen, euglobulin lysis time, factor VII, factor VIII, protein C and anti-thrombin III were determined. In addition, levels of sex hormone-binding globulin and both total and free oestradiol were estimated. No alteration in clotting function was found during the administration of tamoxifen, although hepatic function did alter during this period with an increase in concentration of sex hormone-binding globulin. There was a significant increase in total oestradiol and free oestradiol although the percentage of biologically available free oestradiol fell slightly during the course of tamoxifen treatment. There was a slight reduction in low-density lipoprotein cholesterol with an increase in HDL2, a subclass of high-density lipoprotein (HDL) cholesterol, consistent with an oestrogen-agonist effect. These data suggest that tamoxifen administration does not adversely influence haemostatic mechanisms or lipoprotein metabolism in the short term.

Impaired vessel wall response to venous occlusion in patients with chronic renal failure on maintenance hemodialysis

We have studied vessel wall function in two groups of patients with chronic renal failure - 1) conservative treatment only and 2) maintenance hemodialysis. Three proteins synthesized by vascular endothelium-plasminogen activator (PA), factor VIII related antigen (VIII:RAg) and antithrombin III (ATIII) - were assayed before and after a fifteen minute period of venous occlusion. The release of PA was significantly reduced in patients on maintenance hemodialysis as compared to both undialyzed uremics and controls. Lesser amounts of VIII:RAg were also released by hemodialysis patients than by undialyzed uremics. These defects, which are suggestive of vessel wall dysfunction on maintenance hemodialysis, may contribute to the high incidence of arteriopathy and thrombotic disease observed in this group of patients.

Factor XI deficiency and a platelet defect

A patient with a lifelong bleeding tendency of moderate severity was found to have both factor XI deficiency and a long bleeding time. There was a significant deficiency of platelet factor 3, but other parameters of platelet function were normal. Infusion studies showed that both fresh plasma and platelet concentrate were required for complete correction of the haemostatic abnormalities, suggesting that these two defects were inherited coincidentally.

Records of diseases in ancient China

No abstract recieved.