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The effect of varying the film temperature from 15C to 60 C is investigated using high speed video imaging. It is demonstrated that increasing the temperature difference between the droplet and film liquid changes the size and frequency of the secondary droplets. The impact can be split into three regimes. In the crater expansion regime, the crater follows a self-similar behaviour. In the second stage, the crater becomes deeper and wider at higher temperatures possibly due to decrease in the viscosity or surface tension. It is seen that the crater collapse is less dependent on the temperature and occurs at fixed time for a particular Webber number.

Summary: Shovelnose sturgeon Scaphirhynchus platorynchus are a large‐river fish distributed throughout the Mississippi River basin, including the lower 1,533 km of the Mississippi River where riverine habitat has been and continues to be modified for navigation and is a potential site for development of instream hydrokinetic electric power generation. Information about habitat use and preference is essential to future conservation efforts. Shovelnose sturgeon have previously been found to select particular habitat types, and these selected habitats vary seasonally; although these past analyses do not consider the selected habitats in a landscape context. We used ecological niche factor analysis (ENFA) that uses distributions of telemetry locations and environmental variables to model habitat suitability in a landscape context. We recorded 333 locations of shovelnose sturgeon during July–December 2013 that included periods of relatively high and low river stages. The ENFA analysis indicated high‐suitability locations were in or near deep water during both high and low river stages. During high river stages, high‐suitability locations were near island tip habitat, deep water, and steep bottom slope and far from main channel habitat. During low stages, high‐suitability locations were in or near deep water and main channel habitat and far from secondary channel and wing dike habitats. This landscape‐scale analysis supports seasonal shifts in habitat use and provides insights that can be used to inform habitat conservation and management to benefit shovelnose sturgeon in the lower Mississippi River and possibly other large rivers. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of environmental parameters on the probability of capturing endangered pallid sturgeon ( Scaphirhynchus albus) using trotlines in the lower Mississippi River. Pallid sturgeon were sampled by trotlines year round from 2008 to 2011. A logistic regression model indicated water temperature ( T; P < 0.01) and depth ( D; P = 0.03) had significant effects on capture probability ( Y = −1.75 − 0.06 T + 0.10 D). Habitat type, surface current velocity, river stage, stage change and non-sturgeon bycatch were not significant predictors (P = 0.26-0.63). Although pallid sturgeon were caught throughout the year, the model predicted that sampling should focus on times when the water temperature is less than 12°C and in deeper water to maximize capture probability; these water temperature conditions commonly occur during November to March in the lower Mississippi River. Further, the significant effect of water temperature which varies widely over time, as well as water depth indicate that any efforts to use the catch rate to infer population trends will require the consideration of temperature and depth in standardized sampling efforts or adjustment of estimates. [ABSTRACT FROM AUTHOR]

A method to find experimentally the equivalent effective length of the Thermoacoustic (TA) core of a TA Engine (TAE) is proposed. The TAE is first operated with various Feedback Loop (FL) length configurations. For every configuration, the frequencies of sound waves were recorded to determine the wavelengths. These wavelengths are compared with the measured FL lengths and a constant deviation was observed, which gives the effective length of the TA Core as 55 cm. This effective length is used in the calculation of the FL ratio. The peak pressure in the TA cores and the onset Temperature Difference (TD) of the TAE with various FL ratios were compared. A normalized intensity of the sound wave produced by the TAE was also compared for different FL ratios. The optimum FL ratio was found to be 3.37. [ABSTRACT FROM AUTHOR]

Inputs of nutrients, sediments and detritus from catchments can promote selected components of reservoir fish assemblages, while hindering others. However, investigations linking these catchment subsidies to fish assemblages have generally focussed on one or a handful of species. Considering this paucity of community-level awareness, we sought to explore the association between land use and fish assemblage composition in reservoirs. To this end, we compared fish assemblages in reservoirs of two sub-basins of the Tennessee River representing differing intensities of agricultural development, and hypothesised that fish assemblage structure indicated by species percentage composition would differ among reservoirs in the two sub-basins. Using multivariate statistical analysis, we documented inter-basin differences in land use, reservoir productivity and fish assemblages, but no differences in reservoir morphometry or water regime. Basins were separated along a gradient of forested and non-forested catchment land cover, which was directly related to total nitrogen, total phosphorous and chlorophyll-a concentrations. Considering the extensive body of knowledge linking land use to aquatic systems, it is reasonable to postulate a hierarchical model in which productivity has direct links to terrestrial inputs, and fish assemblages have direct links to both land use and productivity. We observed a shift from an invertivore-based fish assemblage in forested catchments to a detritivore-based fish assemblage in agricultural catchments that may be a widespread pattern among reservoirs and other aquatic ecosystems. Inputs of nutrients, sediments and detritus from catchments can promote selected components of reservoir fish assemblages, while hindering others. We compared fish assemblages in reservoirs of two sub-basins of the Tennessee River representing differing intensities of agricultural development, and hypothesised that fish assemblage structure indicated by species percentage composition would differ among reservoirs in the two sub-basins. We observed a shift from an invertivore-based fish assemblage in forested catchments to a detritivore-based fish assemblage in agricultural catchments that may be a widespread pattern among reservoirs and other aquatic ecosystems. [ABSTRACT FROM AUTHOR]

In laser material processing, understanding the laser interaction and the effect of processing parameters on this interaction is fundamental to any process if the system is to be optimized. Expanding this to different materials or other laser systems with different beam characteristics makes this interaction more complex and difficult to resolve. This work presents an innovative way to understand these interactions in terms of mean surface enthalpy values derived from both material parameters and laser parameters. From these fundamental properties the melt depth for any material can be predicted using a simple theory. By considering the mean enthalpy of the surface, the transition from conduction limited melting to keyholing can also be accurately predicted. The theory is compared to experimental results and the predicted and observed data are shown to correspond well for these experimental results as well as for published results for stainless steel and for a range of metals. [ABSTRACT FROM AUTHOR]

Objective: To examine the evidence of an association between hypermobility and musculoskeletal pain in children. Methods: A systematic review of the literature was performed using the databases PubMed, EMBASE, NHS Evidence, and Medline. Inclusion criteria were observational studies investigating hypermobility and musculoskeletal pain in children. Exclusion criteria were studies conducted on specialist groups (i.e. dancers) or hospital referrals. Pooled odds ratios (ORs) were calculated using random effects models and heterogeneity was tested using χ2-tests. Study quality was assessed using the Newcastle-Ottawa Scale for case-control studies. Results: Of the 80 studies identified, 15 met the inclusion criteria and were included in the review. Of these, 13 were included in the statistical analyses. Analysing the data showed that the heterogeneity was too high to allow for interpretation of the meta-analysis (I2 = 72%). Heterogeneity was much lower when the studies were divided into European (I2 = 8%) and Afro-Asian subgroups (I2 = 65%). Sensitivity analysis based on data from studies reporting from European and Afro-Asian regions showed no association in the European studies [OR 1.00, 95% confidence interval (CI) 0.79-1.26] but a marked relationship between hypermobility and joint pain in the Afro-Asian group (OR 2.01, 95% CI 1.45-2.77). Meta-regression showed a highly significant difference between subgroups in both meta-analyses (p < 0.001). Conclusion: There seems to be no association between hypermobility and joint pain in Europeans. There does seem to be an association in Afro-Asians; however, there was a high heterogeneity. It is unclear whether this is due to differences in ethnicity, nourishment, climate or study design. [ABSTRACT FROM AUTHOR]

The relationship between the use of complementary therapy (CT) and satisfaction with medical treatment decision making and with the treating oncologist was evaluated in a sample of 166 women who were undergoing an initial course of chemotherapy for early-stage breast cancer. At the beginning of chemotherapy, 39% indicated already trying CT and an additional 13% reported planning to try CT. These women mentioned a variety of vitamin, nutritional, herbal, physical, mental, and spiritual approaches. Four months later, when most patients had completed chemotherapy, more than half (53%) reported using CT, with another 8% planning to try it. Regression analysis controlling for psychosocial and medical variables revealed that women who were younger and less satisfied with their treatment decision-making experience were significantly more likely to use CT. When predicting use of CT at the conclusion of treatment, baseline utilization was the greatest predictor, but dissatisfaction with the oncologist was also a significant predictor. These findings suggest that patients who are dissatisfied with their medical care may be more likely to use CT during treatment. Further research is needed to elucidate the relationship between satisfaction with medical decision making and the patient-physician relationship to CT use among cancer patients. The findings also highlight the importance of good patient-physician communication about CT use throughout the cancer treatment experience. [ABSTRACT FROM AUTHOR]

Background: Exercise is associated with an improved quality of life among cancer survivors. Previous research has highlighted the utility of the theory of planned behavior in understanding cancer survivors' intention to exercise. The purpose of this study was to extend the research on the theory of planned behavior in relation to exercise intention in breast cancer survivors and to provide preliminary evidence supporting its application with prostate cancer survivors during treatment. METHODS: Participants consisted of 126 breast and 82 prostate cancer survivors receiving active treatment. Participants completed self-administered, mail-in questionnaires that assessed demographic and medical variables, past exercise, and the theory of planned behavior. RESULTS: For breast cancer survivors, the results revealed that attitudes, subjective norm, and perceived behavioral control explained 66% of the variance in exercise intention with the instrumental component of attitude, subjective norm, and perceived behavioral control making significant unique contributions to intention. For prostate cancer survivors, attitudes, subjective norm, and perceived behavioral control explained 57% of the variance in exercise intention, with subjective norm and perceived behavioral control making significant unique contributions to intention. CONCLUSIONS: The results provide further support that the theory of planned behavior is a useful framework for understanding determinants of exercise intention in breast cancer survivors undergoing active treatment and preliminary support for prostate cancer survivors undergoing active treatment. When designing exercise interventions, differences in breast and prostate cancer survivors' exercise intention merit consideration. [ABSTRACT FROM AUTHOR]

It is estimated that as many as 80% of adult cancer patients use at least one form of Complementary and Alternative Medicine (CAM) during or after conventional treatment. Studies of physician-patient communication about the use of CAM have concluded that patients frequently do not tell their oncologists about their use of CAM and physicians consistently underestimate the numbers of their patients using CAM. The purpose of this multi-site study was to assess newly diagnosed cancer patients' and oncologists' communication practices with regard to complementary therapies. Patients (106 breast and 82 prostate) indicated which of 45 complementary therapies they were using while physicians at their institutions indicated which they supported. It is noted that, although we use the popular acronym 'CAM' all patients surveyed were receiving conventional medical treatment. Thus, the survey addressed complementary therapies only. A large majority (84%) indicated they were using at least one therapy with the most popular being exercise, vitamins, prayer, and nutritional supplements. Surprisingly, the oncologists surveyed were generally enthusiastic and supportive of patients' use of complementary therapies. In addition to those therapies popular with patients, at least half the physicians supported massage, journal writing, support groups, acupuncture, biofeedback, and art therapy. However, discussions of CAM are relatively rare and most likely to be initiated by patients. When the topic is discussed, both patients and doctors say it usually enhances their relationship. Implications for CAM program development and oncology professionals' roles in patient education regarding complementary therapies are presented. [ABSTRACT FROM AUTHOR]

Objective:Many cancer survivors use some form of complementary therapy (CT); this is particularly true for women with breast cancer. The majority of reports on CT use in women with breast cancer have focused on CT use during cancer treatment or within a year or two of treatment completion. The purpose of this study was to evaluate longertermbreast cancer survivors' (average, 8.7 years) frequency of CT use and their beliefs about the role of CT in cancer recovery and the prevention of cancer recurrence, as well as the relationship of CT use with current life satisfaction. METHODS: A mail survey was completed by 608 breast cancer survivors a minimum of 2 years after their most recent cancer diagnosis. Participants were contacted through the American Cancer Society Reach to Recovery program in Florida. The self-report questionnaire inquired about the use of various CTs, beliefs about CT, current life satisfaction, demographic characteristics, and cancer treatment history. RESULTS: Most of the respondents were older than 50, were Caucasian, were married, had attended or completed college, and were at least 5 years after breast cancer treatment. The most commonly used CTs included exercise, vitamins, prayer/spiritual practice, support groups, humor, self-help books, and relaxation. These survivors used CT therapies because they wanted to play a more active role in their cancer recovery, to manage stress, and to maintain hope. A majority of them reported that they used CT to reduce the risk of cancer recurrence. Use of CT was not correlated with life satisfaction. CONCLUSIONS: Most of the breast cancer survivors in this study had used some form of CT since the time of their most recent cancer diagnosis and believed that such therapies could be of significant benefit, despite a lack of correlation between CT use and current life satisfaction. Many believed that use of CT may prevent cancer recurrence. It is important, therefore, to investigate the efficacy of variousCTs among longer-termcancer survivors, especially with regard to their potential in preventing cancer recurrence. [ABSTRACT FROM AUTHOR]

The classification of the off-diagonal points within a typical grey level co-occurrence matrix (GLCM) is discussed through the application of an intuitive nearest peak and a boundary rule method. Both approaches are applied to a synthetic image consisting of five regions with varying amounts of added random noise and also to an image containing three Brodatz textures of different standard deviation. The two approaches correctly identify the majority of the internal region pixels. However, the nearest peak method is shown to produce serious misclassifications at the region boundaries in the form of bands of additional regions. The boundary rule method does not show this characteristic. The overall classification accuracy and the k[SUBhat] statistic were used to test the performance of each technique. [ABSTRACT FROM AUTHOR]

Fatigue is one of the most common and debilitating symptoms experienced by cancer patients, yet until recent years it has received little systematic attention, due in part to the lack of adequate instruments to measure fatigue. The primary aim of this report is to further validate a recently developed measure of fatigue for use with cancer patients: the Fatigue Symptom Inventory (FSI). This 13-item self-report measure was designed to measure the intensity and duration of fatigue and its interference with quality of life. The FSI was originally validated in a sample of breast cancer patients and a sample of healthy individuals. In this study, the FSI was evaluated in an outpatient sample that included male and female cancer patients, as well as some older patients, with a variety of cancer diagnoses. A seven-item interference scale was found to have good internal consistency, with alpha coefficients above 0.90. Convergent validity was demonstrated via comparisons with an existing measure of fatigue. Construct validity was demonstrated via comparisons with measure of life satisfaction and depression as well as comparisons among subgroups of patients expected to differ in their experience of fatigue. Overall, the FSI was further established as a valid and reliable measure of fatigue in cancer patients. The potential application of this measure in psychosocial oncology research is discussed. [ABSTRACT FROM AUTHOR]

Information regarding the nature, frequency, correlates and temporal trajectory of concerns of stem cell transplantation (SCT) recipients is critical to the development of interventions to enhance quality of life (QOL) in these individuals. This study examined psychosocial concerns in 110 SCT (87% autologous) recipients drawn from two SCT centers. Participants were a mean of 46 years of age and 17 months post-SCT (range 3–62 months). Information regarding current and past SCT-related concerns, performance status, and demographic characteristics was collected by telephone interview or questionnaire. Recipients reported a wide variety of psychosocial concerns following SCT. Recipients who were younger, female and evidenced a poorer performance status reported a larger number of post-SCT concerns. Examination of the temporal trajectory of concerns suggests that some concerns are salient throughout the course of post-SCT recovery (eg disease recurrence, energy level, ‘returning to normal’), some are salient early in the course of recovery (eg quality of medical care, overprotectiveness by others), and others emerge later in the course of recovery (eg feeling tense or anxious, sexual life, sleep, relationship with spouse/partner, ability to be affectionate). Implications for the development of interventions to enhance post-SCT QOL are identified. [ABSTRACT FROM AUTHOR]

As more women are treated with bone marrow transplantation (BMT) for breast cancer, there is growing interest in quality of life (QOL) following treatment. Although there have been some clinical studies of QOL following BMT, this area has received little systematic attention. In particular, it is unclear how QOL for women treated with BMT for breast cancer differs from that which might be expected for ‘healthy’ women of about the same age. To address this issue, we compared QOL reported by women treated with autologous BMT for breast cancer with that of a group of women of similar age with no history of cancer. In addition, we examined the relationship of demographic factors, medical factors, and self-reported symptom prevalence, severity, and distress to QOL in post-BMT patients. All participants completed the SF-36 Health Survey developed from the Medical Outcomes Study (SF-36). Post-BMT patients also completed the ECOG Performance Status Rating Scale (PSR) and the Memorial Symptom Assessment Scale (MSAS). Results indicated that, compared to the women with no cancer history, post-BMT patients reported significantly impaired physical functioning, physical role functioning, general health, vitality, social functioning, and emotional role functioning. Impaired QOL following BMT was significantly associated with lower income, a longer time to engraftment, longer hospital stay, poor performance status, and greater symptom prevalence, severity, and distress. The problems identified in this study may be important targets for intervention when trying to improve QOL following BMT. [ABSTRACT FROM AUTHOR]

Objective: On the basis of revisions of DSM criteria, questions have been raised concerning the occurrence of posttraumatic stress disorder (PTSD) symptoms among adults who have been diagnosed and treated for life-threatening illnesses. The present study examined the prevalence and correlates of PTSD symptoms among women who had undergone autologous bone marrow transplantation (ABMT) for breast cancer.Methods: Participants were 43 women who had undergone ABMT for breast cancer an average of 19 months previously (range = 2 to 62 months) and had no clinical evidence of disease at their most recent follow-up visit. PTSD symptoms and quality of life were assessed using standardized self-report instruments.Results: Between 12% and 19% of participants were likely to meet DSM-IV criteria for the current diagnosis of PTSD. Women who were less well educated, had more advanced disease at the time of the transplantation and had longer hospital stays for the transplantation reported more symptoms of PTSD. Greater PTSD symptomatology was associated with reports of poorer physical health, mental health, and sleep quality.Conclusion: Comparisons with previous research suggest that rates of PTSD are higher among women who undergo ABMT as opposed to less intensive forms of breast cancer treatment. These findings are consistent with the view that development of PTSD symptoms is associated with the degree of life threat. The clinical significance of PTSD in this patient population is underscored by findings indicating that greater PTSD symptoms are associated with poorer health-related quality of life. [ABSTRACT FROM AUTHOR]

The article reflects on the political and bureaucratic pressures on United Kingdom oil taxation policy. The section examines the development of North Sea oil taxation since 1972-73. It focuses on the "First Report from the Committee of Public Accounts, Session 1972-73," hereafter the PAC Report. It analyzes the impact of the 1975 Oil Taxation Act. It also attempts to summarize the effects of such laws and draws attention to the uncertainties and inefficiencies created by a constantly changing tax regime.

As more individuals undergo autologous bone marrow transplantation (BMT), there is growing interest in the impact of treatment side effects on quality of life. Fatigue is a potentially disruptive treatment side effect that has not been systematically assessed following BMT. The primary aim of this study was to determine whether the severity of fatigue and its impact on quality of life is significantly greater in women who had undergone BMT for breast cancer than in women of similar age with no history of cancer. Another aim was to identify the medical and psychosocial correlates of fatigue in women who had completed BMT. A group of women treated with autologous BMT for breast cancer (n = 43; mean age = 44; mean time since BMT = 20 months) and a group of women of similar age with no history of cancer (n = 43; mean age = 46) participated in this study. Subjects completed measures of fatigue, anxiety, depression, and sleep habits. Medical data were obtained from computerized patient records. Women who had completed BMT for breast cancer reported significantly more frequent and severe fatigue than women with no cancer history. In addition, fatigue had a significantly greater impact on daily functioning and quality of life in BMT recipients than in women with no cancer history. Fatigue following BMT for breast cancer was related to both medical factors (i.e., time since BMT) and psychosocial factors (i.e., anxiety, depressive symptoms and sleep difficulties). Following BMT for breast cancer, women may experience fatigue that is worse than might "normally" be expected and can interfere with daily functioning and quality of life. Future research should focus on identifying the biological correlates of fatigue, psychological and physiological mechanisms by which fatigue is produced, and interventions to alleviate fatigue. [ABSTRACT FROM AUTHOR]

Discusses the abstract of the article "The Preemptive Effect of Pre-incisional Bupivacaine Infiltration Following Lower Abdominal Surgery under Epidural Anesthesia," by Hann D. Li and colleagues submitted at the 27th Congress of The Scandinavian Society of Anesthesiology and Intensive Care Medicine.

Introduction: The involvement of students in the embodiment of university teaching through peer-assisted learning formats is commonly applied. Publications on this topic exclusively focus on strictly defined situations within the curriculum and selected target groups. This study, in contrast, presents and evaluates a large-scale structured and quality-assured peer teaching programme, which offers diverse and targeted courses throughout the preclinical part of the medical curriculum., Methods: The large-scale peer teaching programme consists of subject specific and interdisciplinary tutorials that address all scientific, physiological and anatomic subjects of the preclinical curriculum as well as tutorials with contents exceeding the formal curriculum. In the study year 2013/14 a total of 1,420 lessons were offered as part of the programme. Paper-based evaluations were conducted over the full range of courses. Acceptance and benefit of this peer teaching programme were evaluated in a retrospective study covering the period 2012 to 2014. Usage of tutorials by students who commenced their studies in 2012/13 (n=959) was analysed from 2012 till 2014. Based on the results of 13 first assessments in the preclinical subjects anatomy, biochemistry and physiology, the students were assigned to one of five groups. These groups were compared according to participation in the tutorials. To investigate the benefit of tutorials of the peer teaching programme, the results of biochemistry re-assessments of participants and non-participants of tutorials in the years 2012 till 2014 (n=188, 172 and 204, respectively) were compared using Kolmogorov-Smirnov- and Chi-square tests as well as the effect size Cohen's d., Results: Almost 70 % of the students attended the voluntary additional programme during their preclinical studies. The students participating in the tutorials had achieved different levels of proficiency in first assessments. The acceptance of different kinds of tutorials appears to correlate with their performance in first assessments. 94% of the students participating in tutorials offered in the study year 2013/14 rated the tutorials as "excellent" or "good". An objective benefit has been shown by a significant increase in re-assessment scores with an effect size between the medium and large magnitudes for participants of tutorials compared to non-participants in the years 2012, 2013 and 2014. In addition, significantly higher pass rates of re-assessments could be observed., Conclusion: Acceptance, utilisation and benefit of the assessed peer teaching programme are high. Beyond the support of students, a contribution to the individualisation of studies and teaching is made. Further studies are necessary to investigate possible influences of large-scale peer teaching programmes, for example on the reduction of study length and drop-off rates, as well as additional effects on academic achievements., (Copyright © 2017. Published by Elsevier GmbH.)

Objectives: In a 12-month observational study, we evaluated the effect of opioid use on the outcomes in 1700 adult patients with fibromyalgia., Methods: Data were evaluated using propensity score matching after patients were divided into cohorts based on their baseline medication use: (1) taking an opioid (concurrent use of tramadol was permitted); (2) taking tramadol (but no opioids); and (3) not taking opioids or tramadol. Changes in outcomes were assessed using the Brief Pain Inventory for severity and pain-related interference (BPI-S, BPI-I), Fibromyalgia Impact Questionnaire (FIQ), Patient Health Questionnaire for depression (PHQ-8), Insomnia Severity Index (ISI), Sheehan Disability Scale (SDS), 7-item Generalized Anxiety Disorder Scale (GAD-7), and economic factors. Time-to-opioid or tramadol discontinuation was analyzed using Kaplan-Meier survival analyses., Results: Compared with the opioid cohort, the nonopioid cohort demonstrated significantly greater reductions (P<0.05) in BPI-I, FIQ, PHQ-8, SDS, and ISI; the tramadol cohort compared with the opioid group showed greater reductions on FIQ and ISI. Reductions in BPI-S and GAD-7 did not differ significantly among cohorts. Compared with the opioid cohort, patients in the tramadol cohort had fewer outpatient visits to health care providers. Few significant differences were found between the tramadol and nonopioid cohorts across outcomes., Discussion: Although pain severity was reduced over time in all cohorts, opioid users showed less improvement in pain-related interference with daily living, functioning, depression, and insomnia. Overall, the findings show little support for the long-term use of opioid medications in patients with fibromyalgia given the poorer outcomes across multiple assessment domains associated with this cohort.

Objective: To describe 12-month treatment patterns and outcomes for patients starting a new medication for fibromyalgia in routine clinical practice., Design and Outcome Measures: Data from 1,700 patients were collected at baseline and 1, 3, 6, and 12 months. Repeated measures and Poisson regression models controlling for demographic, clinical, and baseline outcomes were used to assess changes in health outcomes (Brief Pain Inventory severity and interference, Sheehan Disability Scale, Fibromyalgia Impact Questionnaire), satisfaction, and economic factors for patients who initiated on pregabalin (214, 12.6%), duloxetine (264, 15.5%), milnacipran (134, 7.9%), or tricyclic antidepressants (66, 3.9%). Sensitivity analyses were run using propensity-matched cohorts., Results: Patients started on 145 unique drugs for fibromyalgia, and over 75% of patients took two or more medications concurrently for fibromyalgia at each time point assessed. Overall, patients showed improvement on the four health outcomes, with few differences across medication cohorts. At baseline, patients reported annual averages of 20.3 visits for outpatient care, 27.7 missed days of work, and 32.6 days of care by an unpaid caregiver. The duloxetine and milnacipran (vs pregabalin or tricyclic antidepressant) cohorts had fewer outpatient visits during the 12-month study. Patients reported satisfaction with overall treatment and their fibromyalgia medication (46.0% and 42.8%, respectively)., Conclusions: In this real-world setting, patients with fibromyalgia reported modest improvements, high resource, and medication use, and were satisfied with the care they received. Cohort differences were difficult to discern because of the high rates of drug discontinuation and concomitant medication use over the 12-month study period., (Wiley Periodicals, Inc.)

Objective: Painful physical symptoms are common in patients with major depressive disorder (MDD) and can negatively affect patient outcomes. Duloxetine has demonstrated efficacy in treating MDD and other certain painful conditions; this study specifically evaluated patients with both MDD and MDD-associated pain., Methods: This randomized, double-blind clinical trial enrolled adult outpatients with MDD (DSM-IV-TR criteria; Montgomery-Åsberg Depression Rating Scale [MADRS] total score ≥20) and at least moderate pain (Brief Pain Inventory, Short Form [BPI] average pain rating ≥3). Patients received placebo (N = 266) or duloxetine (N = 261) 60 mg once daily (QD) (after starting dose of 30 mg QD for 1 week). This study replicated another study evaluating MDD and MDD-associated pain., Clinical Trial Registration: Clinicaltrials.gov (NCT01070329)., Main Outcome Measures: Co-primary outcomes were the MADRS total score (change from baseline at 8 week endpoint) and BPI average pain rating (overall main effect over 8 weeks of treatment). The Sheehan Disability Scale (SDS) global functional impairment score at week 8 assessed functioning as a secondary outcome. Changes were analyzed using mixed-effects model repeated measures (MMRM), and the MADRS remission rate (total score ≤12 at 8-week endpoint) was analyzed using the Cochran-Mantel-Haenszel test., Results: Both co-primary objectives and the first two gated secondary objectives were achieved: compared with placebo, duloxetine significantly improved the mean MADRS total score, BPI average pain rating, SDS global functional impairment score, and remission of depression at 8-week endpoint (all p < 0.01). The third gated secondary objective, evaluating remission of depression at the last two non-missing visits, was not achieved. The within-group MADRS remission rate was greater for duloxetine-treated patients with ≥50% (versus <50%) improvement in BPI average pain (p < 0.001). Safety outcomes were similar to previous reports. This study did not address the effects of duloxetine on MDD and comorbid pain of a known origin., Conclusions: These results replicated findings supporting the efficacy and tolerability of duloxetine compared to placebo as treatment for depression and pain in patients with MDD and at least moderate pain associated with MDD.

The Satisfaction with Life Domains Scale for Cancer (SLDS-C) is a brief self-report measure of quality of life that uses a familiar and easily understood graphic response format of smiling and frowning faces. This article explores the factor structure and further examines the validity of the SLDS-C compared with another cancer specific quality-of-life measure, the Functional Assessment of Cancer Therapy Scale-General (FACT-G), in a sample of patients with a variety of cancer diagnoses. A self-administered questionnaire containing the SLDS-C and the FACT-G was completed by 352 adult cancer survivors who were at various points post diagnosis. Three SLDS-C factor subscales were derived from analyses of these data: "Life as a Whole," "Daily Activities," and "Social Relationships." Evidence for the concurrent validity of the SLDS-C is presented, including its correlation with the total score of the FACT-G (r = .76) and its correlation with subscale scores of this widely used cancer quality-of-life measure. The SLDS-C has a high level of internal consistency (alpha = .94), and differences in SLDS-C total scores were found for time since diagnosis, number of diagnoses, spread of disease, type of cancer, and treatment status.