Search

Despite the clinical importance of assessing smoking history and advising patients who smoke to quit, patients with lung cancer often experience feelings of blame and stigma during clinical encounters with their oncology care providers (OCPs). Promoting empathic communication during these encounters may help reduce patients' experience of stigma and improve related clinical outcomes. This paper presents the evaluation of OCP- and patient-reported data on the usefulness of an OCP-targeted empathic communication skills (ECS) training to reduce the stigma of lung cancer and improve communication.What is the impact of the ECS intervention on OCPs' communication skills uptake and patient-reported outcomes (lung cancer stigma, satisfaction with communication, and perceived OCP empathy)?Study subjects included 30 multidisciplinary OCPs treating patients with lung cancer who participated in a 2.25 h ECS training. Standardized Patient Assessments were conducted prior to and following training to assess ECS uptake among OCPs. In addition, of a planned 180 patients who currently or formerly smoked (six unique patients per OCP [three pretraining, three posttraining]), 175 patients (89 pretraining, 86 posttraining) completed post-OCP visit surveys eliciting feedback on the quality of their interaction with their OCP.OCPs exhibited an overall increase in use of empathic communication skills [t(28) = -2.37; P .05], stigma-mitigating skills [t(28) = -3.88; P .001], and breadth of communication skill use [t(28) = -2.91; P .01]. Patients reported significantly higher overall satisfaction with communication post-ECS training, compared with pretraining [t(121) = 2.15; P = .034; Cohen d = 0.35]. There were no significant differences from pretraining to posttraining for patient-reported stigma or perceived OCP empathy.Empathy-based, stigma-reducing communication may lead to improved assessments of tobacco use and smoking cessation for patients with smoking-related cancers. These findings support the dissemination and further testing of a new ECS model for training OCPs in best practices for assessment of smoking history and engagement of patients who currently smoke in tobacco treatment delivery.

Objective Empathic communication in clinical consultations is mutually constructed, with patients first presenting empathic opportunities (statements communicating emotions, challenges, or progress) to which clinicians can respond. We hypothesized that lung cancer patients who did not present empathic opportunities during routine consultations would report higher stigma, anxiety, and depressive symptoms than patients who presented at least one. Methods Audio-recorded consultations between lung cancer patients (N = 56) and clinicians were analyzed to identify empathic opportunities. Participants completed questionnaires measuring sociodemographic and psychosocial characteristics. Results Twenty-one consultations (38 %) did not contain empathic opportunities. Unexpectedly, there was a significant interaction between presenting empathic opportunities and patients’ race on disclosure-related stigma (i.e., discomfort discussing one’s cancer; F = 4.49, p = .041) and anxiety (F = 8.03, p = .007). Among racial minority patients (self-identifying as Black/African-American, Asian/Pacific Islander, or other race), those who did not present empathic opportunities reported higher stigma than those who presented at least one (t=-5.47, p = .038), but this difference was not observed among white patients (t = 0.38, p = .789). Additional statistically significant findings emerged for anxiety. Conclusion Disclosure-related stigma and anxiety may explain why some patients present empathic opportunities whereas others do not. Practice implications Clinicians should intentionally elicit empathic opportunities and encourage open communication with patients (particularly from diverse racial backgrounds).

Objective The purpose of this study was to evaluate a Communication Skills Training (CST) module for health care providers (HCPs) applying a shared decision-making approach to a meeting with an older adult with cancer and his/her family. Methods Ninety-nine HCPs from community-based centers, cancer centers, and hospitals in the Northeastern U.S. who worked primarily with older adult patients participated in a CST module entitled Geriatric Shared Decision Making. Participants completed pre- and post-training Standardized Patient Assessments (SPAs) and a survey on their confidence in and intent to utilize skills taught. Results Results indicated high HCP satisfaction with the module, with over 95 % of participants reporting high endorsement to all five evaluation items. HCPs’ self-efficacy in utilizing communication skills related to geriatric shared decision making significantly increased pre- to post-training. In standardized patient assessments among a subset of providers (n = 30), HCPs demonstrated improvements in three shared decision-making skills: declare agenda, invite agenda, and check preference. Conclusion A geriatric shared decision-making CST workshop for HCPs showed feasibility, acceptability, and improvement in self-efficacy as well as skill uptake. Practice implications This Geriatric Shared Decision-Making CST module provides an intervention for improving provider-patient-family member communication in the context of cancer care for older adults.

Background Distress is common among cancer patients and leads to worse postoperative outcomes. Surgeons are often the first physicians to have in-depth conversations with patients about a new colorectal cancer diagnosis; therefore, it is important that these surgeons understand how patients cope with the distress of a diagnosis and how they can help patients manage this distress. Methods Patients with colorectal cancer were recruited from an outpatient surgery clinic. Purposive sampling was used to recruit patients if they were either planning to undergo surgery or had undergone surgery within six months. In-depth, open-ended, individual qualitative interviews were performed. Grounded theory was used to develop themes regarding patients’ coping strategies and beliefs regarding the role of the surgeon in helping them cope. Results Patients described their own internal coping strategies using problem-focused, emotion-focused, and meaning-focused techniques. Patients also reported the importance of their social support network for coping. Patients believed surgeons and their teams should help patients manage the emotional components of their cancer diagnosis and surgical experience, especially if patients were experiencing high levels of distress or had inadequate coping skills. They did not believe surgeons themselves should be primarily responsible for helping them cope. Conclusion In order for surgeons to guide diagnosis and initial management of distress in colorectal cancer patients undergoing surgery, they should screen patients for distress, identify and strengthen patients’ own coping strategies, facilitate a strong social support network, and provide patients with the option to obtain further support from the surgeon's office.

The COVID-19 pandemic has caused a wave of death across the U.S., but not all of these deaths have been equal. Unfortunately, amid the COVID-19 pandemic, U.S. immigrants have faced more brutal deaths than their non-immigrant counterparts. These disparities reflect long-standing disparities in the end-of-life care received among immigrant patients. Immigrants face unique barriers to ensuring they receive high quality care at the end of life, and the pandemic has highlighted these disparities. There is a critical need for public policy to address these systemic inequities and for providers to be made aware of them in order to ensure better patient care among dying immigrants.

Glutamate receptors have a key role in the neurobiology of opioid addiction. Using electron microscopic immunocytochemical methods, this project elucidates how sex and chronic immobilization stress (CIS) impact the redistribution of GluN1 and GluA1 within rat hippocampal CA3 pyramidal cells following oxycodone (Oxy) conditioned place preference (CPP). Four groups of female and male Sprague-Dawley rats subjected to CPP were used: Saline- (Sal) and Oxy-injected (3 mg/kg, I.P.) naïve rats; and Sal- and Oxy-injected CIS rats. GluN1: In both naive and CIS rats, Sal-females compared to Sal-males had elevated cytoplasmic and total dendritic GluN1. Following Oxy CPP, near plasmalemmal, cytoplasmic, and total GluN1 decreased in CA3 dendrites of unstressed females suggesting reduced pools of GluN1 available for ligand binding. Following CIS, Oxy-males (which did not acquire CPP) had increased GluN1 in all compartments of dendrites and spines of CA3 neurons. GluA1: There were no differences in the distribution GluA1 in any cellular compartments of CA3 dendrites in naïve females and males following either Sal or Oxy CPP. CIS alone increased the percent of GluA1 in CA3 dendritic spines in males compared to females. CIS Oxy-males compared to CIS Sal-males had an increase in cytoplasmic and total dendritic GluA1. Thus, in CIS Oxy-males increased pools of GluN1 and GluA1 are available for ligand binding in CA3 neurons. Together with our prior experiments, these changes in GluN1 and GluA1 following CIS in males may contribute to an increased sensitivity of CA3 neurons to glutamate excitation and a reduced capacity to acquire Oxy CPP.

Background Distress is common among cancer and surgical patients and can lead to worse outcomes if untreated. The objective of this study was to explore sources of distress among colorectal cancer patients undergoing surgery. Materials and methods This was a qualitative study using in-depth, semistructured, one-on-one interviews in an academic setting. Patients were recruited if they had a pathologically confirmed diagnosis of colon or rectal cancer. Purposive sampling was used to recruit patients who were about to undergo (preoperative), or had recently undergone (postoperative), curative resection for colorectal cancer. Results All participants (n = 24) reported experiencing distress during treatment. Participants identified sources of distress preoperatively (negative emotional reaction to diagnosis, distress from preconception of cancer diagnosis, and distress interacting with healthcare system). Sources of distress during in-hospital recovery included negative emotional reaction to having a surgery and negative emotions experienced in the hospital. Postoperative sources of distress included mismatch of expectations and experience of recovery, dealing with distressing physical symptoms and complications after surgery, and distress worrying about recurrence. Participants identified other sources of distress that were not time-specific (distress related to social support network, from disruption of life, and worrying about death). Conclusions Our results highlight a potential role for a comprehensive screening program to identify which patients require assistance with addressing sources of distress during the surgical experience. Understanding how sources of distress may vary by time will help us tailor interventions at different time points of the surgical experience.

Policy makers are interested in estimates of the potential economic impacts of oil price shocks, particularly during periods of rapid and large increases that accompany severe supply shocks. Literature estimates of the economic impacts of oil price shocks, summarized by the oil price elasticity of GDP, span a very wide range due to both fundamental economic and methodological factors. This paper presents a quantitative meta-analysis of the oil price elasticity of GDP for net oil importing countries, with a focus on the United States (US). The full range of estimates of the oil price elasticity of GDP for the US in the data is − 0.124 to + 0.017, accounting for different methodologies, data and other factors. We employ a meta-regression model that controls for key determinant factors to estimate the mean and variance of the GDP elasticity across studies. We use a robust estimation technique to deal with heterogeneity of the data and well-known econometric issues that confront meta-analysis. The resulting regression model is used to simulate the oil price elasticity of GDP for the US, with a mean of − 0.020% and 68% confidence interval of − 0.035 to − 0.006, four quarters after a shock.

© 2017 Adversity, such as living in poor socioeconomic conditions during early childhood, can become embedded in children's physiology and deleteriously affect their health later in life. On the other hand, maternal responsivity may have adaptive effects on physiology during early childhood development. The current study tested both the additive and interactive effects of socioeconomic status (SES) and maternal responsivity measured at 1 year of age on resting autonomic nervous system (ANS) function and trajectory during the first 5 years of life. Participants came from a birth cohort comprised of Mexican-origin families living in California. Children's resting ANS functioning (respiratory sinus arrhythmia; RSA; pre-ejection period; PEP; and heart rate; HR) was collected at 1, 3.5, and 5 years of age (N = 336) and modeled across time using Hierarchical Linear Modeling. Consistent with hypotheses, results showed that low SES predicted flatter trajectories of resting HR and PEP over early childhood (i.e., patterns of consistently higher heart rate; shorter PEP), whereas children who experienced positive maternal responsivity had steeper trajectories in RSA and PEP over time (i.e., increasing parasympathetic activation; decreasing sympathetic activation). The interaction between SES and maternal responsivity significantly predicted RSA intercept at age 5, such that among children living in low SES environments, high maternal responsivity mitigated the negative effect of poverty and predicted higher resting RSA at 5 years of age. Results are consistent with the early life programming theory that suggests that environmental influences become biologically embedded in the physiology of children living in socially disadvantaged contexts, and identify increased maternal responsivity as a developmental mechanism that could offset the deleterious effects of low SES.

The issuance of a Federal Energy Regulatory Commission (FERC) license is an important milestone in the development process of new U.S. hydropower projects. The complexity and uncertain timeline of the licensing process have been often cited as a key deterrent to new hydropower installations in the United States. However, very little attention has been paid to post-licensing timelines and attrition rates. This article explores the challenges faced by developers in bringing their FERC-licensed hydropower projects to the construction stage. Post-licensing activities to be completed before starting construction include obtaining additional permitting from other federal or state agencies, completing the technical design, securing financing, and in most cases, negotiating a power purchase agreement. For the set of projects that obtained a FERC license between 2007 and 2018, we assembled a dataset—combining information from FERC dockets and responses from a questionnaire to developers—to calculate attrition rates and development timelines and to examine the reasons for delays and cancellations.

Previous research has demonstrated that psychopathic personality traits are significantly predictive of blunted cortisol reactivity to a performance-based stressor task (Trier Social Stress Test; TSST) in college students. However, the relationship between cortisol reactivity and psychopathy has not been explored in high risk samples such as incarcerated populations. Further, the role of imprisonment in relation to cortisol stress reactivity has not been previously explored, but could have practical and conceptual consequences in regard to rehabilitation and biological sensitivity to context, respectively. The current study tested the hypotheses that both psychopathic personality traits and amount of time incarcerated are related to cortisol blunting in response to stress among incarcerated young adults. A sample of 49 young adult male offenders was recruited to complete the TSST. Salivary hormone samples were taken just prior to and 20 min post-stressor, and participants were interviewed with the Psychopathy Checklist-Youth Version. Variables quantifying the amount of time at the present facility prior to the date of testing and number of commitments in juvenile facilities were also collected. Correlational analyses indicated that only number of incarcerations was related to blunted cortisol. Hierarchical Linear Modeling revealed that time incarcerated and number of commitments were related to a blunted cortisol response among responders and declining cortisol reactivity among nonresponders, respectively. Controlling for time incarcerated, psychopathic traits were significantly related to cortisol decline in response to the stressor among nonresponders, but were not related to blunted cortisol among responders. Results of this project highlight the potential biological effects of prolonged and repeated incarcerations, and extend our understanding about the relationship between psychopathic traits and cortisol reactivity in an incarcerated sample.

Past research indicates that being religious is associated with prejudice toward racial and value-violating out-groups. However, this past research treated religiosity as a unidimensional construct without taking into account how different components of religiosity—belief in a higher power and the rigidity/flexibility of religious beliefs—are associated with measures of prejudice. Two studies examined the relationship between these two components of religiosity, as measured by the Post-Critical Beliefs Scale, and racial (African Americans, Arabs) and value-violating prejudices (atheists, gay men). As the flexibility of religious beliefs increased (literal vs. symbolic dimension), attitudes toward racial and value-violating out-groups became more positive (Study 1). As belief in God strengthened (exclusion vs. inclusion of transcendence dimension), attitudes toward value-violating out-groups became more negative. Study 2 demonstrated that these two components of religiosity fully mediated the relationship between general religiosity and prejudice toward African Americans, Arabs, and gay men and partially mediated the relationship between religiosity and prejudice toward atheists. Results are discussed in light of reexamining the conclusion that simply being religious is associated with prejudice.

Summary Objective The present study examined whether local administration of the cannabinoid-2 (CB 2 ) receptor agonist GW405833 could modulate joint nociception in control rat knee joints and in an animal model of osteoarthritis (OA). Method OA was induced in male Wistar rats by intra-articular injection of sodium monoiodo-acetate with a recovery period of 14 days. Immunohistochemistry was used to evaluate the expression of CB 2 and transient receptor potential vanilloid channel-1 (TRPV1) receptors in the dorsal root ganglion (DRG) and synovial membrane of sham- and sodium mono-iodoacetate (MIA)-treated animals. Electrophysiological recordings were made from knee joint primary afferents in response to rotation of the joint both before and following close intra-arterial injection of different doses of GW405833. The effect of intra-articular GW405833 on joint pain perception was determined by hindlimb incapacitance. An in vitro neuronal release assay was used to see if GW405833 caused release of an inflammatory neuropeptide (calcitonin gene-related peptide – CGRP). Results CB 2 and TRPV1 receptors were co-localized in DRG neurons and synoviocytes in both sham- and MIA-treated animals. Local application of the GW405833 significantly reduced joint afferent firing rate by up to 31% in control knees. In OA knee joints, however, GW405833 had a pronounced sensitising effect on joint mechanoreceptors. Co-administration of GW405833 with the CB 2 receptor antagonist AM630 or pre-administration of the TRPV1 ion channel antagonist SB366791 attenuated the sensitising effect of GW405833. In the pain studies, intra-articular injection of GW405833 into OA knees augmented hindlimb incapacitance, but had no effect on pain behaviour in saline-injected control joints. GW405833 evoked increased CGRP release via a TRPV1 channel-dependent mechanism. Conclusion These data indicate that GW405833 reduces the mechanosensitivity of afferent nerve fibres in control joints but causes nociceptive responses in OA joints. The observed pro-nociceptive effect of GW405833 appears to involve TRPV1 receptors.

This paper presents the results of a usability study conducted to determine the functionality of a desktop, three-dimensional virtual library designed and supported by the Appalachian State University Distance Learning Library Services team. Formative evaluations were performed with representative students utilizing Morae software. Results influenced the final design of the library.