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Online delivery of parenting support is steadily increasing, yet the factors that influence program engagement and efficacy are still understudied. This study used an integrated data analysis approach to identify family and program-related factors that influence outcomes. We combined individual data from seven published efficacy trials of the web-based version of the Triple P—Positive Parenting Program. Data were analyzed for 985 families with children aged between 2 and 12 years (M = 4.87; SD = 2.14) using a Latent Change Score approach. At post-intervention, sociodemographic factors were not predictive of changes in child behavior problems, while parents of boys and those with higher education showed greater improvements in dysfunctional parenting. Parents who were initially more confident in their parenting showed more overall gains while parents with more initial adjustment difficulties showed less improvement. Only the effect of baseline child behavior problems on changes in dysfunctional parenting was moderated by treatment condition. At follow-up, program variant and completion were the primary outcome predictors, with completion found to be related to initial parenting confidence, internet usage and program variant. The implications of these findings for reaching and retaining parents in online programs across all phases of the engagement process are discussed.

PURPOSE:Until recently, people with metastatic breast cancer (MBC) had a very poor prognosis. New treatment approaches have prolonged the time that people with MBC live, but their quality of life has received less attention. Consequently, the needs and concerns across financial, vocational, psychological, social, and physical domains in MBC patients are poorly understood-particularly regarding the collateral damage or longer-term, life-altering impacts of MBC and its treatments. This study's aims were to characterize MBC-related collateral damage, identify groups most likely to experience collateral damage, and examine its associations with psychological health, illness management, and health behaviors. METHODS:Participants (N = 515) with MBC were recruited from Dr. Susan Love Research Foundation's Army of Women® and other advocacy organizations. Participants completed questionnaires of MBC-related collateral damage, depressive symptoms, anxiety, self-efficacy for managing oncologic treatments and physical symptoms, sleep, and physical activity. RESULTS:Eight domains of MBC-related collateral damage, as well as MBC-related benefit finding, were reliably characterized. Concerns about mortality/uncertainty were most prominent. Participants also endorsed high levels of benefit finding. Participants younger than 50 years, with limited financial resources, or with children under 18 at home reported the most collateral damage. Collateral damage was associated significantly with compromised psychological health, lower illness management efficacy, and poorer health behaviors, beyond sociodemographic and medical characteristics. CONCLUSIONS:Subgroups of MBC patients report long-term, life-altering consequences of MBC and its treatments, which relate to important health outcomes. Clinical implications and recommendations are discussed.

BackgroundThe human breast comprise several ductal systems, or lobes, which contain a small amount of fluid containing cells, hormones, proteins and metabolites. The complex physiology of these ducts is likely a contributing factor to the development of breast cancer, especially given that the vast majority of breast cancers begin in a single lobular unit.MethodsWe examined the levels of total protein, progesterone, estradiol, estrone sulfate, dehydroepiandrosterone sulfate, and macrophages in ductal fluid samples obtained from 3 ducts each in 78 women, sampled twice over a 6 month period. Samples were processed for both cytological and molecular analysis. Intraclass correlation coefficients and mixed models were utilized to identify significant data.ResultsWe found that the levels of these ductal fluid components were generally uncorrelated among ducts within a single breast and over time, suggesting that each lobe within the breast has a distinct physiology. However, we also found that estradiol was more correlated in women who were nulliparous or produced nipple aspirate fluid.ConclusionsOur results provide evidence that the microenvironment of any given lobular unit is unique to that individual unit, findings that may provide clues about the initiation and development of ductal carcinomas.

BackgroundThe human breast comprise several ductal systems, or lobes, which contain a small amount of fluid containing cells, hormones, proteins and metabolites. The complex physiology of these ducts is likely a contributing factor to the development of breast cancer, especially given that the vast majority of breast cancers begin in a single lobular unit.MethodsWe examined the levels of total protein, progesterone, estradiol, estrone sulfate, dehydroepiandrosterone sulfate, and macrophages in ductal fluid samples obtained from 3 ducts each in 78 women, sampled twice over a 6 month period. Samples were processed for both cytological and molecular analysis. Intraclass correlation coefficients and mixed models were utilized to identify significant data.ResultsWe found that the levels of these ductal fluid components were generally uncorrelated among ducts within a single breast and over time, suggesting that each lobe within the breast has a distinct physiology. However, we also found that estradiol was more correlated in women who were nulliparous or produced nipple aspirate fluid.ConclusionsOur results provide evidence that the microenvironment of any given lobular unit is unique to that individual unit, findings that may provide clues about the initiation and development of ductal carcinomas.

IntroductionDuctal carcinoma in situ (DCIS) is a noninvasive breast cancer wherein malignant cells are confined within a ductal lobular unit. Although less than half the cases of DCIS will progress to invasive disease, most women are treated aggressively with surgery, radiation, and/or hormone therapy due to the inability to clinically evaluate the extent and location of the disease. Intraductal therapy, in which a drug is administered directly into the mammary duct through the nipple, is a promising approach for treating DCIS, but the feasibility of instilling drug into a diseased duct has not been established.Patients and methodsFour to 6 weeks before their scheduled surgery, 13 women diagnosed with DCIS were subjected to cannulation of the affected duct. After both the absence of perforation and presence of dye in the duct were confirmed by ductogram, pegylated liposomal doxorubicin was instilled. Histopathologic assessment was performed after surgery to assess the treatment effects.ResultsOf the 13 women enrolled in the study, 6 had their DCIS duct successfully cannulated without perforation and instilled with the drug. The treatment was well tolerated, and no serious adverse events have been reported. Biomarker studies indicated a general decrease in Ki-67 levels but an increase in annexin-1 and 8-hydroxydeoxyguanosine in the lumen of DCIS-containing ducts, which suggests a local response to pegylated liposomal doxorubicin treatment.ConclusionsIntraductal therapy offers a nonsurgical strategy to treat DCIS at the site of disease, potentially minimizing the adverse effects of systemic treatment while preventing development of invasive cancer.

The intraductal approach is particularly appealing in the setting of ductal carcinoma in situ (DCIS), a preinvasive breast neoplasm that is thought to be entirely intraductal in its extent. Based on an emerging understanding of the anatomy of the ductal system as well as novel techniques to leverage the access accorded by the intraductal approach, researchers are actively exploring how ductal lavage, ductoscopy, and intraductal infusion of therapeutic agents may enhance breast cancer treatment. Both cytologic and molecular diagnostics continue to improve, and work is ongoing to identify the most effective diagnostic biomarkers for DCIS and cancer, although optimal targeting of the diseased duct remains an important consideration. Ductoscopy holds potential in detection of occult intraductal lesions, and ductoscopically guided lumpectomy could increase the likelihood of a more comprehensive surgical excision. Exciting pilot studies are in progress to determine the safety and feasibility of intraductal chemotherapy infusion. These studies are an important starting point for future investigations of intraductal ablative therapy for DCIS, because as our knowledge and techniques evolve, it is likely that DCIS may be the target most amenable to treatment by intraductal therapy. If such studies are successful, these approaches will allow an important and meaningful transformation in treatment options for women diagnosed with DCIS.

The intraductal approach is particularly appealing in the setting of ductal carcinoma in situ (DCIS), a preinvasive breast neoplasm that is thought to be entirely intraductal in its extent. Based on an emerging understanding of the anatomy of the ductal system as well as novel techniques to leverage the access accorded by the intraductal approach, researchers are actively exploring how ductal lavage, ductoscopy, and intraductal infusion of therapeutic agents may enhance breast cancer treatment. Both cytologic and molecular diagnostics continue to improve, and work is ongoing to identify the most effective diagnostic biomarkers for DCIS and cancer, although optimal targeting of the diseased duct remains an important consideration. Ductoscopy holds potential in detection of occult intraductal lesions, and ductoscopically guided lumpectomy could increase the likelihood of a more comprehensive surgical excision. Exciting pilot studies are in progress to determine the safety and feasibility of intraductal chemotherapy infusion. These studies are an important starting point for future investigations of intraductal ablative therapy for DCIS, because as our knowledge and techniques evolve, it is likely that DCIS may be the target most amenable to treatment by intraductal therapy. If such studies are successful, these approaches will allow an important and meaningful transformation in treatment options for women diagnosed with DCIS.

The purpose of this project was to develop a reliable, non-invasive technique to gain access to the lining of the milk ducts. In this contract we have devised a technique to reliably identify all of the ductal orifices and confirmed their anatomy in a normal woman using MRI to correlate the ductal orifices to the ducts. The second accomplishment was to demonstrate that we can reliably retrieve ductal epithelial cells as washings by cannulating a duct with a double lumen catheter. Finally, we confirmed the ability to identify a specific ductal orifice, cannulate it with the double lumen catheter and obtain washings in six women scheduled for surgery. This work has led to two patents and 510k approval of the catheter from the FDA. It is being developed by a venture-backed company, Pro.Duct Health Inc, and is in multicenter clinical trials leading to a commercial product in the spring of 2000. The catheter and procedure of ductal lavage will enable clinicians and researchers to non invasively and repeatedly sample the ductal epithelial cells in high risk women, opening the way for the identification of markers, and also provide the ability to monitor the success of chemoprevention techniques. In addition, the intraductal approach to the breast can be exploited for local application of ablative or gene therapy.

The purpose of this project was to develop a reliable, non invasive technique to gain access to the lining of the milk ducts. In a previous IDEA grant we demonstrated the feasibility of an intraductal approach to breast disease, the ability to obtain ductal cells through washings, and the general anatomy of the nipple duct orifices and ductal systems. In our first contract year, we demonstrated the ability to retrieve cells from women's ducts (pre and post mastectomy) through a newly developed double lumen catheter. After studying the microanatomy of the ductal orifices, we also began work on developing a technique for identifying the breast duct orifices. In this second contract year, we determined that our approach involving the dekeratinization of the nipple and application of a fluorescent keratin antibody to the ductal epithelium was not effective. A second approach was developed based on the random diffusion of a small molecular dye into the lactiferous sinuses of the ductal lumens. This method allows for the constant and reproducible identification of each and every duct. In addition, we have continued to refine the retrieval of duct cells in attached and detached breasts with refinements of the catheter as well as our techniques.

The purpose of this project was to develop a reliable, non invasive technique to gain access to the lining of the milk ducts. In a previous IDEA grant (DAMD17-94-J-4281) we demonstrated the feasibility of an intraductal approach to breast disease, the ability to obtain ductal cells through washings, and the general anatomy of the nipple duct orifices and ductal systems. After studying the microanatomy of the ductal orifices, we proceeded to develop a technique for identifying the breast duct orifices. This involves dekeratinizing the nipple and applying a fluorescing keratin antibody to the ductal epithelium. Once this approach has been demonstrated we will proceed to utilize it to further confirm the ductal orifice anatomy. The second accomplishment has been to demonstrate that we can reliably retrieve cells from a duct cannulated with a double lumen catheter.

Since its national debut in 1987, Fresh Air with Terry Gross has been a highly acclaimed and much adored weekday magazine among public radio listeners. Each week, nearly 4.8 million people turn to Peabody Award-winning host Terry Gross for insightful conversations with the leading voices in contemporary arts and issues. The renowned program reaches a global audience, with over 620 public radio stations broadcasting Fresh Air, and 3 million podcast downloads each week. Fresh Air has broken the mold of 'talk show' by weaving together superior journalism and intimate storytelling from modern-day intellectuals, politicians and artists alike. Through probing questions and careful research, Gross's interviews are lauded for revealing a fresh perspective on cultural icons and trends. Her thorough conversations are often complemented by commentary from well-known contributors. Fresh Air is produced at WHYY-FM in Philadelphia and broadcast nationally by NPR., INT. 1: Professor of Law at the Georgetown University Law Center, PETER EDELMAN. Edelman was Assistant Secretary for Planning and Evaluation with the Department of Health and Human Services, but resigned last September because of his disapproval of President Clinton's welfare-reform bill. Edelman criticizes the bill as not promoting job obtainment and as damaging to the lives of poor children and legal immigrants. INT. 2: DR. SUSAN LOVE, M.D. She is known as the "breast doctor" because of her writings and research on the subject, but her new book (with, Karen Lindsey) "Dr. Susan Love's Hormone Book" (Random House) concerns menopause. In the book she addresses the symptoms, medication, and questions some women face when approaching this life phase. Love is a breast surgeon and an adjunct associate professor of clinical surgery at UCLA and is the director of the Santa Barbara Breast Cancer Institute. (THIS INTERVIEW CONTINUES THRU THE END OF THE SHOW). REV.

One limiting factor all of breast cancer prevention research has been our lack of intermediate markers of breast cancer risk. The main reason we have been unable to identify such markers is that we do not have ready, reproducible, non traumatic access to the lining epithelium. Since most breast cancer starts in the epithelial lining of one of the six-to-nine milk ducts found in each breast, breast duct endoscopy and pathological Icytological analysis is an ideal means of gaining access to the ductal epithelia cells and diagnosing, treating and studying the precancerous state. Using a flexible duct endoscope, the breast ducts of seven of nine patients with ductal carcinomas in situ (DCIS) and/or invasive breast cancer ave been success fully cannulated and studied by cytological and pathological analysis. Contrast dyes including methylene blue, gastrograffin, and barium sulfate injected into the cannulated ducts have also demonstrated a number of important observations with respect to both the normal ductal system as well as DCIS. In addition, we have shown that the ductal system of the breast is a non-anastomosin three dimensional network composed of ducts and acini.

Since its national debut in 1987, Fresh Air with Terry Gross has been a highly acclaimed and much adored weekday magazine among public radio listeners. Each week, nearly 4.8 million people turn to Peabody Award-winning host Terry Gross for insightful conversations with the leading voices in contemporary arts and issues. The renowned program reaches a global audience, with over 620 public radio stations broadcasting Fresh Air, and 3 million podcast downloads each week. Fresh Air has broken the mold of 'talk show' by weaving together superior journalism and intimate storytelling from modern-day intellectuals, politicians and artists alike. Through probing questions and careful research, Gross's interviews are lauded for revealing a fresh perspective on cultural icons and trends. Her thorough conversations are often complemented by commentary from well-known contributors. Fresh Air is produced at WHYY-FM in Philadelphia and broadcast nationally by NPR., INT. 1: Surgeon SUSAN LOVE. She is the founding member of the Breast Cancer Coalition. LOVE is also the founding director of the UCLA Breast Cancer, which is one of the world's leading breast treatment facilities. Her book Dr. Susan Love's Breast Book (Addison Wesley) is said to be one of the most important books in women's health in the last decade. A new updated second edition has just been published. INT. 2: Nature Writer SY MONTGOMERY. A New Jersey reporter turned freelance naturalist, MONTGOMERY developed a fascination for Bengal tigers. Her book Spell of the Tiger (Houghton Mifflin), takes a fascinating and frightening look at these Bengal tigers - and the people who worship them. REV. : World Music Critic, MILO MILES reviews Arab pop album "Sif Safaa: New Music From The Middle East" (Hanan, "Ya Leyl A' ah").

The current study investigated the relationship between principles of social learning theory and binge eating episodes in 31 normal weight bulimic women. Participants were asked to monitor the following: (1) levels of self-efficacy related to resisting the urge to binge and/or purge as well as levels of self-efficacy related to handling stressful events, (2) mood states, (3) enjoyment of daily activities, (4) number of stressful events, and (5) number of binging and purging episodes. Participants were asked to monitor these events four times a day for seven days. Measures of locus of control and enjoyment ratings of binging and purging were also gathered prior to monitoring. Results indicated that components of social learning theory predict number of binging and purging episodes. The best predictors were a combination frequency of binging, lowered levels of self-efficacy to resist the urge to binge, and having a general tendency to not feel in control of one's response-outcomes. However, heterogeneity within the group was apparent in that the predictive models failed to significantly predict binging and purging for all participants. It was also the case that there were differences in predictors of binging and purging on an individual level of analysis. For all individuals, self-efficacy to resist the urge to binge/purge was the only consistent predictor of these episodes. For four individuals, frequency of prior binging was an important predictor. Post-hoc analyses suggest that for the group as a whole self-efficacy expectancies affect current behavior more than current behavior affects future expectancies. Even here, variability exists at the individual level of analysis. For four participants, behaviors were more strongly related to subsequent expectancies than expectancies were related to subsequent behaviors. These findings increase our understanding of the role of social learning theory in predicting episodes of binge eating and purging, often thought to be a