bluuebunny/crossref_metadata_2025 huggingface dataset:
Unequal access to analyst research
Authors: Lepone Andrew , Leung Henry , Li J George
Published: June 2012

This study examines the relationship between equity analysts and information asymmetry, and the extent of leakages in analyst recommendations. Literature suggests that analysts reduce information asymmetry by bringing privately held information to the market, and through superior analysis of publicly available information. However, we find that investor access to analyst reports is far from even, and show evidence consistent with the leakage of analyst recommendations. We find that leakages provide annualised cumulative abnormal returns of approximately 6.30% for upgrades and 12.53% for downgrades over a four-week period, after a generous provision of 1% (round trip) for transaction costs. In our examination of broker/analyst size, we find evidence of greater leakage from the smaller brokers on stock downgrades, but not upgrades. We suggest that smaller brokers are less likely to have an established relationship with company management, are less reliant on them as a source of future information, and are therefore less hesitant to leak downgrades.
Clinical Application of Pharmacogenomics
Authors: Ma Joseph D. , Lee Kelly C. , Kuo Grace M.
Published: June 2012

The purpose of this review is to discuss the clinical application of pharmacogenomics for select drug therapies (eg, proton pump inhibitors [PPIs], codeine, and carbamazepine) and to highlight limitations and challenges that preclude implementation of pharmacogenomics into clinical practice. Genetic polymorphisms of cytochrome P450 (CYP) enzymes and the presence of the human leukocyte antigen ( HLA) -B*1502 allele influence drug disposition and/or response. A portion of PPI pharmacokinetic and pharmacodynamic variability can be explained by CYP2C19 genotype. However, conflicting evidence exists related to Helicobacter pylori cure rates based on CYP2C19 genotype. For codeine, adverse drug reactions in neonates through breast-feeding from CYP2D6 ultra-rapid metabolizers have been reported. However, there is lack of conclusive evidence regarding the overall influence of CYP2D6 polymorphisms on codeine efficacy and toxicity. Although CYP2C19 and CYP2D6 genotyping tests are available, clinical utility remains low. The presence of the HLA-B*1502 allele is associated with carbamazepine-induced Stevens-Johnson syndrome (SJS) and/or toxic epidermal necrolysis (TEN). Pharmacogenomic testing is required prior to initiating carbamazepine in high-risk patients. Lack of sufficient resources, provider knowledge, and ethical, legal, and social issues are several limitations and challenges to implementing pharmacogenomic testing in clinical practice.
The Contribution of Emotional Intelligence to Decisional Styles Among Italian High School Students
Authors: Di Fabio Annamaria , Kenny Maureen E.
Published: June 2012

This study examined the relationship between emotional intelligence (EI) and styles of decision making. Two hundred and six Italian high school students completed two measures of EI, the Bar-On EI Inventory, based on a mixed model of EI, and the Mayer Salovey Caruso EI Test, based on an ability-based model of EI, in addition to the General Decision-Making Style Questionnaire. The findings suggest that both mixed model and ability-based models are related to decision-making style, but that ability-based EI does not predict decision-making style beyond the effects of the mixed model. This study reveals how varied dimensions of EI, especially self-assessment of one’s emotional skills and personal qualities, are related to decision-making style. The assessment of EI may be useful in understanding career decision-making difficulties and in identifying strategies for promoting adaptive career decision making.
Telling Stories of Career Assessment
Authors: McMahon Mary , Watson Mark
Published: June 2012

In the field of career development, there is an acknowledged relationship between career assessment and career counseling. Traditional career assessment and more recent narrative approaches to career counseling are perceived as having an uneasy relationship because of their different philosophical bases. A sustainable future story for the field could be constructed that is guided by the complementarities of both. This article considers this potential complementarity and describes a qualitative Integrative Structured Interview (ISI) Process to construct stories about Holland’s Self-Directed Search (SDS). Narrative career counseling and the story telling approach are the foundation of a qualitative ISI process based on story crafting questions to demonstrate the complementarity of career assessment and story telling.
Children’s Deviant Behavior in Primary Education: Comparing Physical Educator’s Implicit Theory With Diagnostic Criteria
Authors: Efstratopoulou Maria A. , Janssen Rianne , Simons Johan
Published: June 2012

Objective: Physical educators’ implicit theory of children’s deviant behavior in primary education was investigated and compared with diagnostic criteria. Method: A total of 60 physical education (PE) teachers reported deviant behaviors during lessons. Experts sorted these behaviors together with the official diagnostic criteria into categories based on perceived similarity in content. Results: Hierarchical cluster analysis on the derived similarity matrix among the behaviors suggested that PE teachers focus more on attention problems, disobedience, and aggressiveness when internalizing behaviors, such as anxiety and low energy, were less reported. Conclusion: PE teachers may be important and useful informants on children’s behavior in school settings.
Looking ‘the same’: Experiences of women who have had corrective surgery for breast asymmetry
Authors: NiMhurchadha Sinead , Harcourt Diana , Diba Rebecca , Hughes Jennifer , Smith Roger , Nduka Charles
Published: June 2012

Qualitative interviews with ten women found that following corrective surgery for congenital breast asymmetry, women were still concerned with the symmetry of their breasts and expressed high ideals regarding symmetry. Although women found an improvement in body confidence, some felt their confidence and socializing would be further improved with time. Women were secretive about their breast asymmetry and their surgery, being fearful of negative reactions from other people. It is necessary to establish and improve patients’ expectations of the outcome of surgery particularly regarding symmetry, as well as providing psychological and social support to women after surgery.
Quantitative classification of pediatric swallowing through accelerometry
Authors: Celeste Merey , Azadeh Kushki , Sejdić Ervin , Berall Glenn , Chau Tom
Published: June 2012

Background

Dysphagia or swallowing disorder negatively impacts a child’s health and development. The gold standard of dysphagia detection is videofluoroscopy which exposes the child to ionizing radiation, and requires specialized clinical expertise and expensive institutionally-based equipment, precluding day-to-day and repeated assessment of fluctuating swallowing function. Swallowing accelerometry is the non-invasive measurement of cervical vibrations during swallowing and may provide a portable and cost-effective bedside alternative. In particular, dual-axis swallowing accelerometry has demonstrated screening potential in older persons with neurogenic dysphagia, but the technique has not been evaluated in the pediatric population.

Methods

In this study, dual-axis accelerometric signals were collected simultaneous to videofluoroscopic records from 29 pediatric participants (age 6.8 ± 4.8 years; 20 males) previously diagnosed with neurogenic dysphagia. Participants swallowed 3-5 sips of barium-coated boluses of different consistencies (normally, from thick puree to thin liquid) by spoon or bottle. Videofluoroscopic records were reviewed retrospectively by a clinical expert to extract swallow timings and ratings. The dual-axis acceleration signals corresponding to each identified swallow were pre-processed, segmented and trimmed prior to feature extraction from time, frequency, time-frequency and information theoretic domains. Feature space dimensionality was reduced via principal components.

Results

Using 8-fold cross-validation, 16-17 dimensions and a support vector machine classifier with an RBF kernel, an adjusted accuracy of 89.6% ± 0.9 was achieved for the discrimination between swallows with and with out airway entry.

Conclusions

Our results suggest that dual-axis accelerometry has merit in the non-invasive detection of unsafe swallows in children and deserves further consideration as a pediatric medical device.
Overall Survival Benefit With Lapatinib in Combination With Trastuzumab for Patients With Human Epidermal Growth Factor Receptor 2–Positive Metastatic Breast Cancer: Final Results From the EGF104900 Study
Authors: Blackwell Kimberly L. , Burstein Harold J. , Storniolo Anna Maria , Rugo Hope S. , Sledge George , Aktan Gursel , Ellis Catherine , Florance Allison , Vukelja Svetislava , Bischoff Joachim , Baselga José , O'Shaughnessy Joyce
Published: June 2012

Purpose

Phase III EGF104900 data demonstrated that lapatinib plus trastuzumab significantly improved progression-free survival (PFS) and clinical benefit rate versus lapatinib monotherapy, offering a chemotherapy-free option for patients with heavily pretreated human epidermal growth factor receptor 2 (HER2) –positive metastatic breast cancer (MBC). Final planned overall survival (OS) analysis from EGF104900 is reported here.

Patients and Methods

Patients with HER2-positive MBC whose disease progressed during prior trastuzumab-based therapies were randomly assigned to receive lapatinib monotherapy or lapatinib in combination with trastuzumab. OS and updated PFS data are presented using Kaplan-Meier curves and log-rank tests stratified for hormone receptor and visceral disease status. Subgroup analyses were conducted to identify characteristics of patients deriving the greatest clinical benefit.

Results

In this updated final analysis of all patients randomly assigned with strata (n = 291), lapatinib plus trastuzumab continued to show superiority to lapatinib monotherapy in PFS (hazard ratio [HR], 0.74; 95% CI, 0.58 to 0.94; P = .011) and offered significant OS benefit (HR, 0.74; 95% CI, 0.57 to 0.97; P = .026). Improvements in absolute OS rates were 10% at 6 months and 15% at 12 months in the combination arm compared with the monotherapy arm. Multiple baseline factors, including Eastern Cooperative Oncology Group performance status of 0, nonvisceral disease, < three metastatic sites, and less time from initial diagnosis until random assignment, were associated with improved OS. Incidence of adverse events was consistent with previously reported rates.

Conclusion

These data demonstrated a significant 4.5-month median OS advantage with the lapatinib and trastuzumab combination and support dual HER2 blockade in patients with heavily pretreated HER2-positive MBC.
Change in Tumor Size by RECIST Correlates Linearly With Overall Survival in Phase I Oncology Studies
Authors: Jain Rajul K. , Lee J. Jack , Ng Chaan , Hong David , Gong Jing , Naing Aung , Wheler Jennifer , Kurzrock Razelle
Published: June 2012

Purpose

RECIST is used to quantify tumor changes during exposure to anticancer agents. Responses are categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Clinical trials dictate a patient's management options based on the category into which his or her response falls. However, the association between response and survival is not well studied in the early trial setting.

Patients and Methods

To study the correlation between response as quantified by RECIST and overall survival (OS, the gold-standard survival outcome), we analyzed 570 participants of 24 phase I trials conducted between October 2004 and May 2009, of whom 468 had quantifiable changes in tumor size. Analyses of Kaplan-Meier estimates of OS by response and null Martingale residuals of Cox models were the primary outcome measures. All analyses are landmark analyses.

Results

Kaplan-Meier analyses revealed strong associations between change in tumor size by RECIST and survival (P = 4.5 × 10−6 to < 1 × 10−8). The relationship was found to be near-linear (R2 = 0.75 to 0.92) and confirmed by the residual analyses. No clear inflection points were found to exist in the relationship between tumor size changes and survival.

Conclusion

RECIST quantification of response correlates with survival, validating RECIST's use in phase I trials. However, the lack of apparent boundary values in the relationship between change in tumor size and OS demonstrates the arbitrary nature of the CR/PR/SD/PD categories and questions emphasis placed on this categorization scheme. Describing tumor responses as a continuous variable may be more informative than reporting categoric responses when evaluating novel anticancer therapies.
Surveillance Computed Tomography Imaging and Detection of Relapse in Intermediate- and Advanced-Stage Pediatric Hodgkin's Lymphoma: A Report From the Children's Oncology Group
Authors: Voss Stephan D. , Chen Lu , Constine Louis S. , Chauvenet Allen , Fitzgerald Thomas J. , Kaste Sue C. , Slovis Thomas , Schwartz Cindy L.
Published: June 2012

Purpose

Children with Hodgkin's lymphoma (HL) routinely undergo surveillance computed tomography (CT) imaging for up to 5 years after therapy, resulting in cost and radiation exposure, without clear benefit. The objective of this study was to determine the contribution of surveillance CT, as compared with clinical findings, to detection of disease recurrence.

Patients and Methods

Two hundred sixteen patients, age ≤ 21 years old, were treated on the multicenter Pediatric Oncology Group 9425 trial. Data for patients who experienced relapse were retrospectively reviewed to determine whether imaging or clinical events prompted suspicion of disease recurrence. Correlation was made to disease stage, time to recurrence, relapse site, and overall survival (OS).

Results

With a median follow-up time of 7.4 years, 25 (11.6%) of 216 patients had experienced a relapse, of whom 23 experienced local relapse. Median time to relapse was 7.6 months (range, 0.2 to 48.9 months). Nineteen relapses (76%) were detected based on symptoms, laboratory or physical examination findings, and two relapses (8%) were detected by imaging within the first year after therapy. Only four patients (16%) had their recurrence detected exclusively by surveillance imaging after the first year. Six deaths occurred, all in patients who experienced relapse within the first year after therapy. No patient with a recurrence after 1 year off treatment has died, regardless of how the recurrence was detected.

Conclusion

The majority of pediatric HL relapses occurred within the first year after therapy or were detected based on change in clinical status. Detecting late relapse, whether by imaging or clinical change, did not affect OS. These findings indicate that CT is overused for routine surveillance of patients with HL.
The Generalized Tonnetz
Authors: Tymoczko Dmitri
Published: June 2012

This article relates two categories of music-theoretical graphs, in which points represent notes and chords, respectively. It unifies previous work by Brower, Callender, Cohn, Douthett, Gollin, O’Connell, Quinn, Steinbach, and myself, while also introducing new models of voice-leading structure—including a three-note octahedral Tonnetz and tetrahedral models of four-note diatonic and chromatic chords.
Oral history and the radio documentary/feature: Introducing the 'COHRD' form
Authors: McHugh Siobhan
Published: June 2012

In an era when audio is increasingly associated with three-minute digital storytelling, the use of crafted oral history in long-form radio narratives deserves to be recognized as a specific genre: the 'COHRD' (Crafted Oral History Radio Documentary), a blend of oral history, art and
radio journalism. The author, a long-term practitioner of both disciplines, compares the theory and practice of oral history interviewing and the narrative concerns of the radio documentary/feature producer. The article considers how oral history may be enhanced by imaginative treatment and
careful crafting, to yield a hybrid COHRD form. This combines the creative scope of the feature, the editorial gravitas of the documentary and the ground-breaking personal narratives at the heart of oral history. Radio benefits from the in-depth primary research provided by oral history, which
often records the experiences of the marginalized and the overlooked. Oral history benefits through broad dissemination and being made more engaging due to the radio documentary/feature aesthetic. The article suggests that the COHRD found a nascent expression in the pioneering work of producers
such as Corwin (United States 1947), Mitchell (United Kingdom 1950s) and Terkel (United States 1958) and particularly in the Radio Ballads of MacColl, Parker and Seeger (United Kingdom 1958–64). Podcasting has reinvigorated long-form radio narratives, which can now be sourced online
as academic research texts. The COHRD form is exemplified today in programmes such as Hindsight on ABC Radio National (Australia) and Hearing Voices and Radio Diaries on National Public Radio (United States).
Investing for Retirement: The Moderating Effect of Fund Assortment Size on the 1/N Heuristic
Authors: Morrin Maureen , Inman J. Jeffrey , Broniarczyk Susan M. , Nenkov Gergana Y. , Reuter Jonathan
Published: June 2012

Does the number of funds offered in a defined contribution plan affect how many funds consumers choose to invest in or how they spread dollars across the funds they choose? Across three experiments and the analysis of defined contribution plan data, the authors explore these issues by examining investors' tendency to engage in the 1/n heuristic— that is, allocating their dollars evenly across all available investment options. The authors decompose this heuristic into its two underlying behavioral dimensions: the tendency to invest in all available funds (which they label “1/n#”) and the tendency to spread the invested dollars evenly across chosen funds (which they label “1/n$”). The authors argue that choosing from larger fund assortments taxes investors' cognitive resources, which leads to more simplified diversification strategies. They find that increasing the fund assortment size decreases the tendency to invest in all available funds (1/n#) but increases the tendency to spread the invested dollars evenly among the chosen alternatives (1/n$), provided that the number of funds chosen for investment allows for easy equal dollar allocations. The authors integrate their results with prior research regarding asset choice and allocation heuristics.
Integrated Personal Health Record Use: Association With Parent-Reported Care Experiences
Authors: Tom Jeffrey O. , Mangione-Smith Rita , Solomon Cam , Grossman David C.
Published: June 2012

OBJECTIVE:

To examine integrated personal health record (PHR) use patterns among parents of children with chronic disease and compare ratings of care experiences between integrated PHR users and nonusers.

METHODS:

A survey was mailed to 600 randomly selected parents of children with chronic disease ≤5 years old and enrolled at Group Health for ≥1 year. Respondents reported integrated PHR use in the past 12 months, types of services used, or reasons for nonuse. We measured parent ratings of care experiences by using Consumer Assessments of Healthcare Providers and Systems (CAHPS) composite measures: Attention to Growth and Development, Attention to Safety and Health, Getting Care Quickly, Getting Needed Care, Prescription Medications, and Care Coordination. We used multivariate logistic regression to test the association between integrated PHR use and each CAHPS composite measure dichotomized by using the top box score method.

RESULTS:

Of 256 respondents (43% eligible response rate), 166 (65%) were integrated PHR users and 90 (35%) were nonusers. The top integrated PHR services used were viewing immunization records, viewing medical records, secured messaging, and scheduling appointments. The top reasons for not using the integrated PHR were “too busy,” “forgot login/password,” and “my child does not have health care needs.” Adjusted logistic regression did not reveal any significant differences between users and nonusers.

CONCLUSIONS:

Parents of children with chronic disease appear willing to use an integrated PHR to address health care needs for their child. Integrated PHR use was not associated with higher scores on CAHPS composite measures in this health plan.
Cycled Light Exposure Reduces Fussing and Crying in Very Preterm Infants
Authors: Guyer Caroline , Huber Reto , Fontijn Jehudith , Bucher Hans Ulrich , Nicolai Heide , Werner Helene , Molinari Luciano , Latal Beatrice , Jenni Oskar G.
Published: June 2012

OBJECTIVE:

To examine whether cycled lighting (CL) conditions during neonatal care in very preterm infants (<32 weeks’ gestational age [GA]) decrease crying and fussing behavior, improve the consolidation of sleep, and influence activity behavior at 5 and 11 weeks’ postterm corrected age (CA) compared with preterm infants cared for in dim lighting (DL) conditions.

METHODS:

Thirty-seven preterm infants were randomly assigned to CL (7 am–7 pm lights on, 7 pm–7 am lights off [n = 17; mean GA: 30.6 ± 0.95 weeks; 9 girls]) or DL (lights off whenever the child is asleep [n = 20; GA: 29.5 ± 2.1 weeks; 8 girls]) conditions. Sleeping, crying, and activity behavior was recorded by using parental diaries and actigraphy at 5 and 11 weeks’ CA.

RESULTS:

A significant reduction of fussing (59.4 minutes/24 hours [±25.8 minutes]) and crying (31.2 minutes/24 hours [±14.4 minutes]) behavior and a trend to higher motor activity during daytime was found in CL-exposed infants at 5 and 11 weeks’ CA compared with infants cared for in DL conditions. No significant difference between groups was observed for sleep behavior at 5 and 11 weeks’ CA. Infants in CL conditions showed a trend to improved daily weight gain (average: 3.6 g/d) during neonatal care compared with DL conditions.

CONCLUSIONS:

CL conditions in neonatal care have beneficial effects on infant’s fussing and crying behavior and growth in the first weeks of life. This study supports the introduction of CL care in clinical neonatal practice.
Physical Activity and Sedentary Behaviors and Health-Related Quality of Life in Adolescents
Authors: Gopinath Bamini , Hardy Louise L. , Baur Louise A. , Burlutsky George , Mitchell Paul
Published: June 2012

OBJECTIVE:

Our goal was to assess cross-sectional and longitudinal associations between physical activity and sedentary behaviors (television viewing, computer and video-game usage, and reading) with health-related QoL.

METHODS:

Of 2353 children surveyed (median age: 12.7 years), 1216 were resurveyed 5 years later, and 475 were newly recruited into the study (N = 1691). Children completed detailed activity questionnaires. Health-related QoL was assessed by using the Pediatric Quality of Life Inventory (PedsQL).

RESULTS:

Cross-sectionally, after multivariable adjustment, adolescents in the highest versus lowest tertile of time spent in outdoor physical activity and television viewing had a higher (Ptrend = .001) and lower (Ptrend = .0003) total PedsQL score, respectively. Adolescents who remained in the highest tertiles compared with those in the lowest tertiles of total physical activity over the 5 years had significantly higher scores in the following areas: total (Ptrend = .04), physical summary (Ptrend = .0001), and social (Ptrend = .02) domains. Conversely, those in the highest versus lowest tertile of screen-viewing time during follow-up reported significantly lower values in the following areas: total score (6.34-unit difference), physical summary (4.86-unit difference), psychosocial summary (7.09-unit difference), and emotional (8.33-unit difference) and school (9.78-unit difference) domains.

CONCLUSIONS:

Regular physical activity over the long-term was associated with higher perceived health-related QoL among adolescents. Conversely, lower PedsQL scores were observed among those who spent the most time in screen-viewing activities. Improved understanding of these relationships could help in developing interventions to promote general well-being among adolescents.
Outcome Trajectories in Extremely Preterm Infants
Authors: Ambalavanan Namasivayam , Carlo Waldemar A. , Tyson Jon E. , Langer John C. , Walsh Michele C. , Parikh Nehal A. , Das Abhik , Van Meurs Krisa P. , Shankaran Seetha , Stoll Barbara J. , Higgins Rosemary D. ,   for the Generic Database,   Follow-Up Subcommittees of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Published: June 2012

OBJECTIVE:

Methods are required to predict prognosis with changes in clinical course. Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth/admission to the ICU by considering gender, antenatal steroids, multiple birth, birth weight, and gestational age. Predictions may be improved by using additional information available later during the clinical course. Our objective was to develop serial predictions of outcome by using prognostic factors available over the course of NICU hospitalization.

METHODS:

Data on infants with birth weight ≤1.0 kg admitted to 18 large academic tertiary NICUs during 1998–2005 were used to develop multivariable regression models following stepwise variable selection. Models were developed by using all survivors at specific times during hospitalization (in delivery room [n = 8713], 7-day [n = 6996], 28-day [n = 6241], and 36-week postmenstrual age [n = 5118]) to predict death or death/neurodevelopmental impairment at 18 to 22 months.

RESULTS:

Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas the importance of respiratory illness severity increases with advancing postnatal age. The c-statistic in validation models ranged from 0.74 to 0.80 with misclassification rates ranging from 0.28 to 0.30.

CONCLUSIONS:

Dynamic models of the changing probability of individual outcome can improve outcome predictions in preterm infants. Various current and future scenarios can be modeled by input of different clinical possibilities to develop individual “outcome trajectories” and evaluate impact of possible morbidities on outcome.
Maternal Cigarette Smoking and the Development of Necrotizing Enterocolitis
Authors: Downard Cynthia D. , Grant Stephanie N. , Maki Alexandra C. , Krupski Mary C. , Matheson Paul J. , Bendon Robert W. , Fallat Mary E. , Garrison R. Neal
Published: June 2012

BACKGROUND:

The maternal variables that affect fetal development and correlate with necrotizing enterocolitis (NEC), the most common gastrointestinal emergency in premature infants, are not well defined. We hypothesized that maternal risk factors were the primary determinant of future development of NEC.

METHODS:

Patients with NEC were identified from an established NICU database and were control-matched with 2 neonates treated at the same institution. The medical records of each patient during the NICU admission as well as the prenatal and delivery record of the patient’s mother were reviewed. Perinatal data, including maternal smoking, maternal hypertension, maternal BMI, maternal gestational diabetes, conduct of labor and type of delivery, Apgar scores, types of feedings, and placental pathology, were examined, with P < .05 deemed significant.

RESULTS:

A total of 73 neonates diagnosed with NEC and 146 matched controls were identified. Medical records for each subject and their mothers were reviewed (438 records total). Maternal cigarette smoking was significantly associated with the future development of NEC (P = .02). Maternal gestational diabetes, maternal hypertension, formula feeding, and pathologic chorioamnionitis or uteroplacental insufficiency did not correlate with NEC.

CONCLUSIONS:

These data identified maternal cigarette smoking as the only risk factor that is associated with the development of NEC in premature infants. Our data imply that smoking delivers toxins and nicotine to the uterine microenvironment that can affect microvascular development and may predispose the fetus to future NEC.
A Pilot Randomized Controlled Trial of Brief Cognitive-Behavioral Therapy for Anxiety in Patients with Terminal Cancer
Authors: Greer Joseph A. , Traeger Lara , Bemis Heather , Solis Jessica , Hendriksen Ellen S. , Park Elyse R. , Pirl William F. , Temel Jennifer S. , Prigerson Holly G. , Safren Steven A.
Published: June 2012

Learning Objectives

After completing this course, the reader will be able to: Explain the current state of evidence-based treatment for anxiety in patients with cancer and the need for tailored intervention, especially for those with terminal cancer.Discuss and utilize methods for increasing access to psychosocial intervention for patients with cancer who suffer significant physical and psychological morbidity.Describe the effect of a brief cognitive-behavioral therapy intervention tailored to the needs of patients with terminal cancer and comorbid anxiety symptoms.

CME This article is available for continuing medical education credit at CME.TheOncologist.com

Introduction.

Patients with terminal cancer often experience marked anxiety that is associated with poor quality of life. Although cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety disorders, the approach needs to be adapted to address realistic concerns related to having cancer, such as worries about disease progression, disability, and death. In this pilot randomized controlled trial (clinicaltrials.gov identifier NCT00706290), we examined the feasibility and potential efficacy of brief CBT to reduce anxiety in patients with terminal cancer.

Methods.

We adapted CBT by developing treatment modules targeting skills for relaxation, coping with cancer worries, and activity pacing. Adults with incurable malignancies and elevated anxiety based on the Hamilton Anxiety Rating Scale (HAM-A) were randomly assigned to individual CBT or a waitlist control group. Primary outcomes included the number of completed CBT visits and the change in HAM-A scores from baseline to 8-week follow-up per a treatment-blind evaluator. The feasibility criterion was 75% adherence to the intervention.

Results.

We randomized 40 patients with terminal cancers to CBT (n = 20) or waitlist control (n = 20) groups; 70% completed posttreatment assessments. Most patients who received CBT (80%) participated in at least five of the required six therapy sessions. Analysis of covariance models, adjusted for baseline scores, showed that those assigned to CBT had greater improvements in HAM-A scores compared to the control group, with an adjusted mean difference of –5.41 (95% confidence interval: –10.78 to –0.04) and a large effect size for the intervention (Cohen's d = 0.80).

Conclusion.

Providing brief CBT tailored to the concerns of patients with terminal cancer was not only feasible but also led to significant improvements in anxiety.
Thermo-mechanical behaviour of energy piles
Authors: AMATYA B.L. , SOGA K. , BOURNE-WEBB P.J. , AMIS T. , LALOUI L.
Published: June 2012

Energy piles are an effective and economic means of using geothermal energy resources for heating and cooling buildings, contributing to legislative requirements for renewable energy in new construction. While such piles have been used for around 25 years with no apparent detrimental effect, there is limited understanding of their thermo-mechanical behaviour. This paper synthesises the results from three published field studies and illustrates some of the engineering behaviour of such piles during heating and cooling. Simplified load transfer mechanisms for a single pile subjected to pure thermal loadings (i.e. without mechanical load) and combined thermo-mechanical loadings have been developed and are used to interpret the field data with regard to change in axial stress and shaft friction during heating and cooling. The effect of end restraint and ground conditions on the thermo-mechanical response of energy piles is discussed. Values of change in axial stress and mobilised shaft friction due to thermal effects that may be useful in the design of energy piles are presented.
Evolution of stabilised creeping landslides
Authors: PUZRIN A.M. , SCHMID A.
Published: June 2012

A simple analytical model is proposed to quantify evolution of a creeping landslide stabilised by a retaining wall, or by a natural barrier at the bottom of the sliding mass. Development in time of both the landslide displacements and the earth pressure acting on the retaining structure is obtained in the closed form, with the latter given by the classical Terzaghi expression for the average degree of consolidation. Depending on the value of the long-term safety factor, the landslide either eventually slows down, asymptotically approaching final displacements, or the soil behind the retaining wall comes to a passive failure, followed by a post-failure evolution of the landslide. The model is capable of quantifying both scenarios, with some of its features successfully validated against the monitoring and geotechnical data from the two case studies: the Combe Chopin and Ganter landslides in Switzerland. For the Combe Chopin landslide, which came to a standstill, the model has demonstrated its ability to predict final downhill displacements and their development in time. For the Ganter landslide, which failed and achieved steady-state velocity, the model correctly predicted the long-term landslide evolution and the effects of drainage and erosion on the displacement rates.
Dynamic Winkler modulus for axially loaded piles
Authors: ANOYATIS G. , MYLONAKIS G.
Published: June 2012

The problem of axial dynamic pile–soil interaction and its analytical representation using the concept of a dynamic Winkler support are revisited. It is shown that depth- and frequency-dependent Winkler springs and dashpots, obtained by dividing the complex-valued side friction and the corresponding displacements along the pile, may faithfully describe the interaction effect, contrary to the common perception that the Winkler concept is always approximate. An axisymmetric wave solution, based on linear elastodynamic theory, is then derived for the harmonic steady-state response of finite and infinitely long piles in a homogeneous viscoelastic soil stratum, with the former type of pile resting on rigid rock. The pile is modelled as a continuum, without the restrictions associated with strength-of-materials approximations. Closed-form solutions are obtained for: (a) the displacement field in the soil and the pile; (b) the stiffness and damping (‘impedance') coefficients at the pile head; (c) the actual, depth-dependent, dynamic Winkler moduli; and (d) a set of fictitious, depth-independent Winkler moduli to match the dynamic response at the pile head. Results are presented in terms of dimensionless graphs, tables and simple equations that provide insight into the complex physics of the problem. The predictions of the model compare favourably with existing solutions, while new results and simple design-oriented formulae are presented.
The role of infrastructure in improving human settlements
Authors: Parikh Priti , Parikh Himanshu , McRobie Allan
Published: June 2012

This paper considers how the provision of integrated household-level infrastructure – particularly water and environmental sanitation (including water supply, sewerage, roads, storm drainage and solid waste management) – can play a leading role in improving the conditions in slum settlements. Around 700 socio-economic interviews were carried out in India and South Africa to investigate an innovative approach called slum networking, which sees the strong correlation between slum locations and drainage paths as an opportunity for improving the wider urban environment. This recognition allows resources to be mobilised locally, thereby removing the need for external aid funding. The evidence from the 700 families shows that communities perceive water and sanitation inputs to be their top priority and are willing to contribute to the costs. If slum upgrading is led with access to integrated water and environmental sanitation at household level with community contributions to the cost of infrastructure, then slum communities subsequently invest considerably greater sums in improved housing and education, with longer term contributions to poverty alleviation, improvements in health and literacy and an increase in disposable incomes.
Degradation of moving‐image quality in PDPs: Dynamic false contours
Authors: Yamaguchi Takahiro , Masuda Takeo , Kohgami Akihiko , Mikoshiba Shigeo
Published: June 2012

Abstract— When moving images are displayed on matrix displays which reproduce gray levels utilizing pulse‐number/width‐modulation techniques, degradation of the gray levels and colors are often observed. The degradation originates from a temporal non‐uniformity of the light‐emission pattern, which is transformed into a spatial non‐uniformity of the light emission due to an after‐image effect of the eyes, which follow the image motion. The degradation becomes appreciable when the product of the speed of the viewing point on a screen and the light‐emission period of a pixel is greater than the pixel pitch. The degree of degradation is also affected by the pixel arrangement; disturbances for the stripe arrangement are worse than those for the triangle arrangement. The temporal uniformity is degraded when the major light‐emitting blocks of the pulse‐number/width‐modulation change. The uniformity can be improved by dividing the blocks of the major bits. It was analytically verified that the perceived luminance of periodic light emission is proportional to the emission duty factor (which coincides with Talbot‐Plateau's law) and also to the integral of f(t)dt from zero to infinity, independent of decay shape, f(t), of the after‐image.
Electro‐optic excitation/de‐excitation effects in SrS:Ce ACTFEL devices from 15 to 300K
Authors: Plant T. K. , Troppenz U. , Hüttl B. , Velthaus K. O. , Mauch R. H.
Published: June 2012

Abstract— The time‐resolved electroluminescence, EL spectrum, UV‐ and blue‐excited photoluminescence, and transferred charge of high‐efficiency blue SrS:Ce ac‐driven thin‐film electroluminescent (ACTFEL) devices were measured over the temperature range of 15–300K. The purpose of this work was to determine the mechanisms of both optical and electrical excitation/de‐excitation in these structures. We found that two thermally activated processes, a strong one around 100K and a weaker one around 200K, drastically reduce the Ce3+ luminescent efficiency and limit the overall EL performance. Even though the total transferred charge increases with temperature, these two thermal de‐activation processes wipe out any luminescent gains due to increased transferred charge. The fact that a large trailing‐edge emission still exists at 15K indicates that space charge in the form of ionized Ce3+ atoms caused by field‐induced delocalization is still present.
Fabrication of ultra‐high‐resolution three‐color phosphor screens
Authors: Kurinec S. K. , Sluzky E.
Published: June 2012

Abstract— A method for fabricating three‐color phosphor screens with triad pitches of 150 μm and less has been developed. The method combines a modified microlithographic technique with electrophoretic coating of the component phosphors and black‐surround material. Indeed, triad pitches based on 15‐μm color‐line width and 5‐μm spacing between colors have been achieved.
Seed and establishment limitation contribute to long‐term native forb declines in California grasslands
Authors: Brandt Angela J. , Seabloom Eric W.
Published: June 2012

The effects of exotic species invasions on biodiversity vary with spatial scale, and documentation of local‐scale changes in biodiversity following invasion is generally lacking. Coupling long‐term observations of local community dynamics with experiments to determine the role played by exotic species in recruitment limitation of native species would inform both our understanding of exotic impacts on natives at local scales and regional‐scale management efforts to promote native persistence. We used field experimentation to quantify propagule and establishment limitation in a suite of native annual forbs in a California reserve, and compared these findings to species abundance trends within the same sites over the past 48 years. Observations at 11 paired sites (inside and outside the reserve) indicated that exotic annual plants have continued to increase in abundance over the past 48 years. This trend suggests the system has not reached equilibrium >250 years after exotic species began to spread, and 70 years after livestock grazing ceased within the reserve. Long‐term monitoring observations also indicated that six native annual forb species went extinct from more local populations than were colonized. To determine the potential role of exotic species in these native plant declines, we added seed of these species into plots adjacent to monitoring sites where plant litter and live grass competition were removed. Experimental results suggest both propagule and establishment limitation have contributed to local declines observed for these native forbs. Recruitment was highest at sites that had current or historical occurrences of the seeded species, and in plots where litter was removed. Grazing history (i.e., location within or outside the reserve) interacted with exotic competition removal, such that removal of live grass competition increased recruitment in more recently grazed sites. Abundance of forbs was positively related to recruitment, while abundance of exotic forbs was negatively related. Thus, exotic competition is likely only one factor contributing to local declines of native species in invaded ecosystems, with a combination of propagule limitation, site quality, and land use history also playing important and interactive roles in native plant recruitment.
Parasite transmission in complex communities: Predators and alternative hosts alter pathogenic infections in amphibians
Authors: Orlofske Sarah A. , Jadin Robert C. , Preston Daniel L. , Johnson Pieter T. J.
Published: June 2012

While often studied in isolation, host–parasite interactions are typically embedded within complex communities. Other community members, including predators and alternative hosts, can therefore alter parasite transmission (e.g., the dilution effect), yet few studies have experimentally evaluated more than one such mechanism. Here, we used data from natural wetlands to design experiments investigating how alternative hosts and predators of parasites mediate trematode (Ribeiroia ondatrae) infection in a focal amphibian host (Pseudacris regilla). In short‐term predation bioassays involving mollusks, zooplankton, fish, larval insects, or newts, four of seven tested species removed 62–93% of infectious stages. In transmission experiments, damselfly nymphs (predators) and newt larvae (alternative hosts) reduced infection in P. regilla tadpoles by ∼50%, whereas mosquitofish (potential predators and alternative hosts) did not significantly influence transmission. Additional bioassays indicated that predators consumed parasites even in the presence of alternative prey. In natural wetlands, newts had similar infection intensities as P. regilla, suggesting that they commonly function as alternative hosts despite their unpalatability to downstream hosts, whereas mosquitofish had substantially lower infection intensities and are unlikely to function as hosts. These results underscore the importance of studying host–parasite interactions in complex communities and of broadly linking research on predation, biodiversity loss, and infectious diseases.
Integrating Public Health–Oriented E-Learning Into Graduate Medical Education
Authors: Hemans-Henry Calaine , Greene Carolyn M. , Koppaka Ram
Published: June 2012

Objectives. In fall 2008, the New York City Department of Health and Mental Hygiene collaborated with Albert Einstein College of Medicine residency program directors to assess the effectiveness of an e-learning course on accurate death certificate completion among resident physicians.

Methods. We invited postgraduate year 1 and 2 (PGY1 and PGY2) residents (n = 227) to participate and administered a pretest, e-learning module, posttest, and course evaluation to PGY1 residents; PGY2 residents completed a pretest and survey only.

Results. In all, 142 residents (63%) participated. The average pretest scores for PGY2 residents (61%) and PGY1 residents (59%) were not significantly different. The PGY1 residents’ average test score increased significantly after taking the e-learning module (59% vs 72%; P < .01). The participants rated course length, delivery method, and utility highly.

Conclusions. Results suggest that e-learning can effectively integrate public health–oriented training into clinical residency programs.
Are We There Yet? Seizing the Moment to Integrate Medicine and Public Health
Authors: Scutchfield F. Douglas , Michener J. Lloyd , Thacker Stephen B.
Published: June 2012

Multiple promising but unsustainable attempts have been made to maintain programs integrating primary care and public health since the middle of the last century. During the 1960s, social justice movements expanded access to primary care and began to integrate primary care with public health concepts both to meet community needs for medical care and to begin to address the social determinants of health. Two decades later, the managed care movement offered opportunities for integration of primary care and public health as many employers and government payers attempted to control health costs and bring disease prevention strategies in line with payment mechanisms. Today, we again have the opportunity to align primary care with public health to improve the community's health.
Effect on Non-condensable Gas on Solvent-Aided SAGD Processes
Authors: Ardali M. , Barrufet M. , Mamora D. D.
Published: June 2012

Steam Assisted Gravity Drainage (SAGD) is the preferred in-situ technology to recover heavy oil and bitumen from Canadian reservoirs. It is commercially proven, delivers high oil rates and high ultimate recoveries. Given the large energy requirement and the volume of emitted greenhouse gases from SAGD process, there is a strong motivation to develop enhanced oil recovery processes with lower energy and emission intensities. Addition of suitable alkane solvents to steam in processes such as ES-SAGD can reduce the use of energy and green-house emissions in SAGD. Potential hydrocarbon additives provide an additional means to raise oil phase mobility beyond that achieved by heat.

The Athabasca reservoir contains small amounts of initial solution gas which is negligible compared to conventional oil reservoirs, however, even small amounts of solution gas might play an important role in thermal processes driven by gravity drainage. In majority of experimental and simulation study of Solvent-Assisted SAGD processes carried out, initial solution gas is not included.

In this study, extensive simulation study is performed to understand the mechanism of solvent addition to SAGD process when initial solution gas is present. Simulation results show that initial solution gas reduces the oil recovery by SAGD process especially in Athabasca reservoir. A varying thickness non-condensable gas layer impedes heat transfer from the condensing steam to the bitumen zone. Hydrocarbon additives are not very effective in the presence of high initial solution gas ratio. Exsolved solution gas causes early condensation of steam and additives. As a result, hydrocarbon additives have diminished opportunities to contact bitumen and are unable to create a high oil phase mobility zone.

In addition, a number of simulations are conducted to understand the role of operating pressure and pressure imbalance between SAGD well pairs. The difference between the operating pressure of adjacent SAGD well-pairs can be used to remove accumulated solution gas from the steam chamber.