Development of a blueprint for sibling psychosocial services: A nationwide study

BACKGROUND

Siblings of youth with cancer have heightened risk for poor long-term psychosocial outcomes. Although sibling psychosocial care is a standard in pediatric oncology, this standard is among those least likely to be met. To address barriers to providing sibling services, a blueprint for systematic psychosocial screening and support of siblings was developed based on feedback from a national sample of psychosocial providers.

PROCEDURE

Semi-structured interviews were conducted with a purposive sample of psychosocial care providers (N = 27) of various disciplines working in US pediatric cancer centers, varied in size, type, and extent of sibling support. Interviews queried providers' suggestions for the future of sibling psychosocial care and impressions of a blueprint for sibling service delivery, which was iteratively refined based on respondents' feedback. Interviews were analyzed using applied thematic analysis.

RESULTS

Based on existing literature and refined according to providers' recommendations, the Sibling Services Blueprint was developed to provide a comprehensive guide for systematizing sibling psychosocial care. The blueprint content includes: (i) a timeline for repeated sibling screening and assessment; (ii) a stepped model of psychosocial support; (iii) strategies for circumventing barriers to sibling care; and (iv) recommendations for how centers with varying resources might accomplish sibling-focused care. The blueprint is available online, allowing providers to easily access and individualize the content. Providers indicated enthusiasm and high potential utility and usability of the blueprint.

CONCLUSIONS

The Sibling Services Blueprint may be a useful tool for systematizing sibling psychosocial care, promoting wider availability of sibling-focused services, and addressing siblings' unmet needs.

Growth of tumor-derived activated T cells for the treatment of advanced cancer

In 1994, we reported on a series of patients treated with T-cell therapy (Study #1). This paper (Study #2) is an update of our experience through 1999 in the production of tumor-derived activated cells (TDAC), also called tumor-infiltrating lymphocytes (TIL), from tumor biopsies. TDAC were successfully grown in medium containing Interleukin-2 from 75% of the 366 tumor biopsies tested. There was no significant difference in success (growth to 1 x 10(9) cells) comparing primary and metastatic tumors. Many of the tumors were shipped to the laboratory by overnight delivery from distant sites. Success rate did decrease with the length of time for tumor transport in excess of 24 hours. Certain additional cytokines were tested when cultures did not grow. Interleukin-4 was beneficial in the development of 1 of 4 TDAC cultures which did not grow with IL-2 alone. In order to produce TDAC to treat patients, cells were grown in gas permeable plastic bags or in artificial capillary bioreactor cultures. Approximately 1 x 10(9) were seeded from an initially successful "feasibility study" to bulk produce cells for treatment. Harvest was carried out after about 3 weeks. Sixty-three patients were treated at least once with a minimum of 1 x 10(10) TDAC given by intravenous infusion. On the average, the number of cells per treatment was 3 x 10(10) with a viability of 87%. TDAC cultures contained T cells with variable ratios of CD4 to CD8 cells. Secreted granulocyte-monocyte colony stimulating factor, interferon gamma and tumor necrosis factor alpha were measured in TDAC conditioned medium. Only 34 patients received the full course of 4 TDAC treatments. The cells were well tolerated with mild fever and dyspnea. Partial responses were observed in 8 patients, including the dramatic regression of scalp nodules in a patient with renal cancer. These results showed that therapeutic amounts of TDAC can be produced in cell culture in a reasonable and cost-effective manner. The cells were well tolerated and responses were seen in renal and melanoma patients resistant to IL-2 with bulky, advanced cancer.

Adaptive Optics Imaging of the CLASS Gravitational Lens System B1359+154 with the Canada-France-Hawaii Telescope

We present adaptive optics imaging of the CLASS gravitational lens system B1359+154 obtained with the Canada-France-Hawaii Telescope (CFHT) in the infrared K band. The observations show at least three brightness peaks within the ring of lensed images, which we identify as emission from multiple lensing galaxies. The results confirm the suspected compound nature of the lens, as deduced from preliminary mass modeling. The detection of several additional nearby galaxies suggests that B1359+154 is lensed by the compact core of a small galaxy group. We attempted to produce an updated lens model based on the CFHT observations and new 5 GHz radio data obtained with the MERLIN array, but there are too few constraints to construct a realistic model at this time. The uncertainties inherent with modeling compound lenses make B1359+154 a challenging target for Hubble constant determination through the measurement of differential time delays. However, time delays will offer additional constraints to help pin down the mass model. This lens system therefore presents a unique opportunity to directly measure the mass distribution of a galaxy group at intermediate redshift.

Caltech Faint Galaxy Redshift Survey. XI. The Merger Rate to Redshift 1 from Kinematic Pairs

The rate of mass accumulation due to galaxy merging depends on the mass, density, and velocity distribution of galaxies in the near neighborhood of a host galaxy. The fractional luminosity in kinematic pairs combines all of these effects in a single estimator that is relatively insensitive to population evolution. Here we use a k-corrected and evolution-compensated volume-limited sample having an R-band absolute magnitude of Mk,eR</=-19.8+5logh mag drawing about 300 redshifts from the Caltech Faint Galaxy Redshift Survey and 3000 from the Canadian Network for Observational Cosmology field galaxy survey to measure the rate and redshift evolution of merging. The combined sample has an approximately constant comoving number and luminosity density from redshift 0.1 to 1.1 (OmegaM=0.2, OmegaLambda=0.8); hence, any merger evolution will be dominated by correlation and velocity evolution, not density evolution. We identify kinematic pairs with projected separations less than either 50 or 100 h-1 kpc and rest-frame velocity differences of less than 1000 km s-1. The fractional luminosity in pairs is modeled as fL&parl0;Deltav,rp,Mk,er&parr0;&parl0;1+z&parr0;mL, where &sqbl0;fL,mL&sqbr0; are &sqbl0;0.14+/-0.07,0+/-1.4&sqbr0; and &sqbl0;0.37+/-0.7,0.1+/-0.5&sqbr0; for rp</=50 and 100 h-1 kpc, respectively (OmegaM=0.2, OmegaLambda=0.8). The value of mL is about 0.6 larger if Lambda=0. To convert these redshift-space statistics to a merger rate, we use the data to derive a conversion factor to a physical space pair density, a merger probability, and a mean in-spiral time. The resulting mass accretion rate per galaxy (M1,M2>/=0.2M*) is 0.02+/-0.01&parl0;1+z&parr0;0.1+/-0.5M* Gyr-1. Present-day high-luminosity galaxies therefore have accreted approximately 0.15M* of their mass over the approximately 7 Gyr to redshift 1. Since merging is likely only weakly dependent on the host mass, the fractional effect, deltaM&solm0;M approximately 0.15M*&solm0;M, is dramatic for lower mass galaxies but is, on the average, effectively perturbative for galaxies above 1M*.

Bacillary hemoglobinuria in a free-ranging elk calf

A dead elk (Cervus elaphus roosevelti) calf was diagnosed with bacillary hemoglobinuria, a toxemia caused by the bacterium Clostridium haemolyticum. The mortality occurred in southwest Washington, USA (46 degrees 13'N, 123 degrees 22'W), in an area in which several previous mortalities, suspected but not conclusively diagnosed to be either bacillary hemoglobinuria, enterotoxemia, or leptospirosis, occurred. This is the first reported incidence of mortality attributable to bacillary hemoglobinuria in free-ranging elk. Similar deaths of young elk in the area suggest that mortality from this disease may be common locally.

Leptospira interrogans exposure in free-ranging elk in Washington

Exposure to one or more serovars of Leptospira interrogans was observed in five of six sampled elk (Cervus elaphus roosevelti) killed in November 1993, from an isolated herd in southwest Washington, USA (46 degrees 45'N, 123 degrees 6'W). In April 1994, exposure to L. interrogans serovars was documented in nine of 11 captured cow elk from the same herd. Leptospires were not isolated from any of the exposed elk, and 10 of the 11 cows were pregnant. The high seroprevalence is evidence that exposure is widespread in the herd. Local productivity of elk was high, however, and the surrounding topography was not conducive for transmission to other elk populations.