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This article explores the idea of a drifting house, a house with no fixed coordinates, a concept that is central to an understanding of immigration. It can also describe what Anaïs Nin referred to as a house of incest, which means that under such a roof, all traditional familial boundaries are mobilised, either being crossed or absent to begin with. This is the situation for Jenny and her father in Krys Lee’s short story, “The Believer,” from her debut book Drifting House (2012). After her mother murders a delivery boy and is incarcerated in a high-security psychiatric facility, Jenny and her father become dislocated from their life as immigrants to the United States. Eventually, daughter and father take a road trip to visit Jenny’s mother and then drive on to Las Vegas, where their life as immigrants began and where they will now cross the ultimate boundary. Very few women writers have addressed the emotive theme of incest from the position of a daughter’s willingness to participate or even initiate the sexual encounter. Krys Lee twins immigration with incest to draw significant parallels between the two situations. In doing so, she demonstrates how the European and Korean past remains relevant to post-national literature.

BACKGROUND: Cost can be a major issue in therapeutic decision-making, and in particular for patients with locally advanced non-small cell lung cancer (LA-NSCLC). METHODS: The specific aim of this analysis was to evaluate the costs and outcomes of patients treated on Radiation Therapy Oncology Group (RTOG) 94-10, Medicare Part A and Part B costs from all for patients treated from 1991 to 1996 on RTOG 94-10, a phase III trial showing a survival benefit for concurrent chemoradiation (STD RT) over sequential (RT day 50) chemoradiation in LA-NSCLC with intermediate outcome for concurrent twice daily radiation and chemotherapy (HFX RT). 26-month expected costs for each arm of the trial in 1996 dollars were determined, with Kaplan Meier sampling average estimates of survival probabilities for each month and mean monthly costs. The analysis was performed from a payer’s perspective. Incremental cost-effectiveness ratios were calculated comparing RT on day 50 and HFX RT to the STD RT. RESULTS: Of the 610 patients entered, Medicare cost data and clinical outcomes were available for 92 patients. In this subset, compared to STD RT, RT on day 50 proved less costly but resulted in reduced survival at 1 year. In addition, HFX RT cost slightly more than STD RT but was less effective in this cohort of patients. CONCLUSIONS: In patients with Medicare insurance and with significant toxicity burden, RT on day 50 is the least expensive but also least effective treatment in this subset of patients treated on RTOG 94-10.

This chapter explores the interplay of replacement and rivalry between stepsisters in Jane Alison’s memoir The Sisters Antipodes, in which two seemingly identical families trade spouses. Via the tropes of father-hunger, twinning and the Double, it traces a complicated account of mirroring through the troubling relationship between the ‘metamorphic families’, with a particular focus on Jane and Jenny – stepsisters who correspond in age and colouring – following the ‘split’. Though often continents apart for extended periods of time, the girls become fierce rivals in their struggle to be top daughter to their respective – and each other’s – fathers. As they develop into womanhood, the competition grows increasingly destructive. The chapter draws attention to the wretched human economics of desire and desirability in this tragic tale of familial rearrangement.

Incest is a form of replacement when one family member supplants another to create ‘a strange confusion of kinship’ (Morgan). In Jacques Demy’s Peau d’Âne (1970), for instance, the only female that can possibly replace the dead wife for the grieving king is their daughter, who is a replica of her mother. The Genesis account of Lot and his daughters and the Graeco-Roman myth of Myrrha also consider incest between daughters of marriageable age and their fathers when each replaces her mother via that staple of sexual deception, the bedtrick. This chapter is a comparative study of these daughters, as each comes to represent what Mary Douglas calls ‘matter out of place’ when traditional patterns of filial and paternal relations are transgressed.

Purpose The specific aim of this analysis was to evaluate the feasibility of performing a cost-effectiveness analysis using Medicare data from patients treated on a randomized Phase III clinical trial. Methods and Materials Cost data included Medicare Part A and Part B costs from all providers—inpatient, outpatient, skilled nursing facility, home health, hospice, and physicians—and were obtained from the Centers for Medicare & Medicaid Services for patients eligible for Medicare, treated on Radiation Therapy Oncology Group (RTOG) 9111 between 1992 and 1996. The 47-month expected discounted (annual discount rate of 3%) cost for each arm of the trial was calculated in 1996 dollars, with Kaplan-Meier sampling average estimates of survival probabilities for each month and mean monthly costs. Overall and disease-free survival was also discounted 3%/year. The analysis was performed from a payer's perspective. Incremental cost-effectiveness ratios were calculated comparing the chemotherapy arms to the radiation alone arm. Results Of the 547 patients entered, Medicare cost data and clinical outcomes were available for 66 patients. Reasons for exclusion included no RTOG follow-up, Medicare HMO enrollment, no Medicare claims since trial entry, and trial entry after 1996. Differences existed between groups in tumor characteristics, toxicity, and survival, all which could affect resource utilization. Conclusions Although we were able to test the methodology of economic analysis alongside a clinical trial using Medicare data, the results may be difficult to translate to the entire trial population because of non-random missing data. Methods to improve Medicare data capture and matching to clinical trial samples are required.

This article examines the feasibility and effectiveness of delivering a community-based health education workshop to promote positive health behaviors for breast cancer survivors in a predominately rural 13-county region in North Carolina. Curriculum was based on an existing 20-week center-based exercise and recreation therapy program for breast cancer survivors, and it relied on interagency cooperation for promotion and delivery of the intervention. Evaluation of success was based on attendance, ability of participants to demonstrate appropriate health behaviors, and self-reported changes in health behaviors. Challenges and strategies related to partnering with community agencies and generating attendance are discussed. The authors contend that a community-based workshop supported by multiple agencies can be effective in enhancing health-related knowledge and behaviors for breast cancer survivors.

Purpose: To ( 1 ) measure radiation therapy costs for patients in randomized controlled clinical trials, ( 2 ) compare measured costs to modeling predictions, ( 3 ) examine cost distributions, and ( 4 ) assess feasibility of collecting economic data within a cooperative group. Methods: The Radiation Therapy Oncology Group conducted economic pilot studies for two Phase III studies that compared fractionation patterns. Expected quantities of Current Procedural Terminology (CPT) codes and relative value units (RVU) were modeled. Institutions retrospectively provided procedure codes, quantities, and components, which were converted to RVUs used for Medicare payments. Cases were included if the radiation therapy quality control review judged them to have been treated per protocol or with minor variation. Cases were excluded if economic quality review found incomplete economic data. Results: The median and mean RVUs were within the range predicted by the model for all arms of one study and above the predicted range for the other study. Conclusion: The model predicted resource use well for patients who completed treatment per protocol. Actual economic data can be collected for critical cost items. Some institutions experienced difficulty collecting retrospective data, and prospective collection of data is likely to allow wider participation in future Radiation Therapy Oncology Group economic studies.

This study was performed retrospectively to determine if Medicare claims data could be used to evaluate the cost effectiveness, from a payer perspective, of different radiation treatment schedules evaluated in a national clinical trial.Medicare costs from all providers and all places of service were obtained from the Centers for MedicareMedicaid Services for patients treated in the period 1992-1996 on Radiation Therapy Oncology Group 90-03, and combined with data on outcomes from the trial.Of the 1,113 patients entered, Medicare cost data and clinical outcomes were available for 187 patients. Significant differences in tolerance of treatment and outcome were noted between patients with Medicare data included in the study and patients without Medicare data, and non-Medicare patients excluded from it. Ninety-five percent confidence ellipses on the incremental cost-effectiveness scatterplots crossed both axes, indicating non-significant differences in cost effectiveness between radiation treatment schedules.Claims data permit estimation of cost effectiveness, but Medicare data provide inadequate representation of results applicable to patients from the general population.

To determine the national surgical practice patterns of care for operable lung cancer patients treated with radiation.A nationwide survey of a stratified random sample of institutions was conducted for patients who had non-metastatic lung cancer, Karnofsky Performance Scores (KPS)or =60, and who had received radiation therapy as definitive or adjuvant treatment. Among 541 patients, representing a weighted sample size of 42,335 patients nationwide, 131 (19.8%) underwent surgery as part of their therapy. Pearson chi statistics were used to analyze characteristics of this subset of patients.Of the 131 patients who underwent surgery, 126 patients who had non-small cell lung cancer (NSCLC) were analyzed. Surgical patients were younger, had less weight loss, higher KPS, and higher forced expiratory volume within 1 second (FEV1) values than those treated without surgery. Surgical patients had more stage I/II (53.5% vs 32.2%; p = 0.0004) and less clinical N2/N3 disease (28.8% vs 47.5%; p = 0.002) than nonsurgical patients. Surgery consisted of lobectomy or bilobectomy in 63.2% of patients, pneumonectomy in 23.5%, and wedge resection in 5.9%. Of the patients, 80.4% received radiation in the adjuvant setting and 9.9% in the neoadjuvant setting.Patients with non-metastatic lung cancer who are treated surgically and with radiation have clinically less advanced disease than those treated with radiation alone. Most radiation therapy in this setting is administrated postoperatively and secondary to hilar and/or mediastinal nodal involvement undetected before surgery. Improved preoperative nodal staging and neoadjuvant approaches may alter these practice patterns.

6007 Background: RTOG 9003 compared altered fractionated radiotherapy (AIFX) to standard radiotherapy (SFX). Overall and disease-free survival was improved in the AIFX schedules but with increased toxicity. The specific aim of this study was to compare the cost-effectiveness of AIFX to SFX. Methods: Costs data included Medicare Part A and Part B costs from all providers—inpatient, outpatient, skilled nursing facility, home health, hospice, and physicians and other Part B providers were obtained from the Centers for Medicare & Medicaid Services (CMS) for patients treated on RTOG 9003 from 1992–1996. Claims were restricted to those with a diagnosis of head and neck cancer. We calculated 56-month expected discounted costs for each arm of the trial in 1996 dollars, with Kaplan-Meier sampling average estimates of survival probabilities for each month and mean monthly costs. Costs were discounted back to the time of entry onto the trial, using an annual discount rate of 3% and indexed to 1996 dollars using the Consumer Price Index. The analysis was performed from a payer’s perspective. Incremental cost-effective ratios were calculated comparing AIFX schedules to SFX. Results: Of the 1,130 patients entered, 1,073 patients were analyzable for outcomes and Medicare cost data and clinical outcomes were available for 130 patients. The expected mean 56-month cost and incremental cost-effectiveness ratios (ICER) compared to SFX are presented in the table . Sensitivity analysis and 95% confidence ellipses will be presented. Conclusions: Although more toxic altered fractionated radiotherapy schedules were found to be cost-effective using a willingness to pay of $50,000/life year in patients >65 years old. These results need to be confirmed in a cohort of younger patients. [Table: see text] No significant financial relationships to disclose.

Using a specific model of intellectual behavior, the Special Program Responding to Intellectual Needs of Gifted (SPRING) designed an assessment and intervention process similar to that characteristic of current special education programs. Objectives and enabling activities appropriate to individual students were determined and written on the basis of present level of functioning. The project's 3 years of implementation produced change in excess of chance and maturational projection in 22 of the 26 intellectual abilities treated. Project SPRING demonstrated the feasibility of individualized instruction directed toward the assessed intellectual abilities of gifted and talented children and youth.