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The article focuses on the utilization of scrambler therapy to alleviate symptoms in patients with small fiber neuropathy (SFN), a condition characterized by progressive and debilitating pain. It reports on three cases where patients with SFN experienced varying degrees of pain relief and improvement in symptoms following multiple sessions of scrambler therapy, and it highlights the potential as a treatment option for SFN.

Analyses of morphological disparity can incorporate living and fossil taxa to facilitate the exploration of how phenotypic variation changes through time. However, taphonomic processes introduce non-random patterns of data loss in fossil data and their impact on perceptions of disparity is unclear. To address this, we characterize how measures of disparity change when simulated and empirical data are degraded through random and structured data loss. We demonstrate that both types of data loss can distort the disparity of clades, and that the magnitude and direction of these changes varies between the most commonly employed distance metrics and disparity indices. The inclusion of extant taxa and exceptionally preserved fossils mitigates these distortions and clarifies the full extent of the data lost, most of which would otherwise go uncharacterized. This facilitates the use of ancestral state estimation and evolutionary simulations to further control for the effects of data loss. Where the addition of such reference taxa is not possible, we urge caution in the extrapolation of general patterns in disparity from datasets that characterize subsets of phenotype, which may represent no more than the traits that they sample. [ABSTRACT FROM AUTHOR]

The article discusses the use of transcutaneous electrical nerve stimulation (TENS) and scrambler therapy for relief of chronic and neuropathic pain as of July 2023. Topics covered include the physiology and mechanisms of electroanalgesia, the devices in a TENS unit and their use in patients, the heterogenous results with TENS, and the distinctive Scrambler therapy and its differences with TENS. Also noted is the suggested analgesic benefit of scrambler therapy on patients with chronic pain.

Objective: This study examines whether there are differences among first-generation and continuing-generation community college students in the importance they place on achieving college-related goals and difficulties they face from college- and other life-related challenges. Methods: Data were drawn from the Community College Libraries and Academic Support for Student Success student survey. Results: Results from MANCOVA show that, after adjusting for age, gender identity, U.S. birth status, and race/ethnicity, first-generation college students (FGCSs) place more importance on achieving college-related goals and face greater difficulties from college- and other life-related challenges than continuing-generation college students (CGCSs). Contributions: These findings indicate that community colleges should offer more support to FGCSs pertaining to students' goals and challenges so that all community college students may be successful in their academic pursuits. Future research should explore interaction effects among student demographics and their goals and challenges as well as interventions to support community college students. This is because community colleges enroll the largest number of FGCSs compared to other institutions of higher education, and FGCSs and community college students share challenges when it comes to obtaining a college degree. [ABSTRACT FROM AUTHOR]

This study examined how high school students' attitudes toward advanced physics were predicted by their sense of school belonging, and how gender moderated this relationship. The Trends in International Math and Science (TIMSS) 2015 Advanced data, consisting of responses from 12th grade students enrolled in advanced physics courses among nine countries were used for analysis. Results indicated that students' sense of school belonging significantly predicted the extent that students liked learning advanced physics and their valuing of advanced physics and, among Lebanese students, it was the most important predictor. Additionally, the relationship between students' sense of school belonging and liking advanced physics was stronger for males than for females in Norway and Sweden, while the relationship between the sense of school belonging and valuing advanced physics was stronger for males than females in France and Sweden. [ABSTRACT FROM AUTHOR]

Purpose: People with advanced or metastatic cancer and their caregivers may have different care goals and face unique challenges compared to those with early-stage disease or those nearing the end-of-life. These MASCC-ASCO standards and practice recommendations seek to establish consistent provision of quality survivorship care for people affected by advanced or metastatic cancer. Methods: An expert panel comprising MASCC and ASCO members was formed. Standards and recommendations relevant to the provision of quality survivorship care for people affected by advanced or metastatic cancer were developed through conducting: (1) a systematic review of unmet supportive care needs; (2) a scoping review of cancer survivorship, supportive care, and palliative care frameworks and guidelines; and (3) an international modified Delphi consensus process. Results: A systematic review involving 81 studies and a scoping review of 17 guidelines and frameworks informed the initial standards and recommendations. Subsequently, 77 experts (including 8 people with lived experience) across 33 countries (33% were low-to-middle resource countries) participated in the Delphi study and achieved ≥ 94.8% agreement for seven standards (1. Person-Centred Care; 2. Coordinated and Integrated Care; 3. Evidence-Based and Comprehensive Care; 4. Evaluated and Communicated Care; 5. Accessible and Equitable Care; 6. Sustainable and Resourced Care; 7. Research and Data-Driven Care) and ≥ 84.2% agreement across 45 practice recommendations. Conclusion: Standards of survivorship care for people affected by advanced or metastatic cancer are provided. These MASCC-ASCO standards will support optimization of health outcomes and care experiences by providing guidance to stakeholders in cancer care (healthcare professionals, leaders, and administrators; governments and health ministries; policymakers; advocacy agencies; cancer survivors and caregivers. Practice recommendations may be used to facilitate future research, practice, policy, and advocacy efforts. [ABSTRACT FROM AUTHOR]

This study introduces a coefficient of discrimination for use with nominal and ordinal regression models. Computation of the coefficient is demonstrated with data from the Pew Research Center's 25th Anniversary of the Web Omnibus Survey pertaining to cell/home phone ownership, where the coefficient of discrimination indicates that respondent age and gender increased the probability of a correct versus incorrect classification by 13.9%. Additionally, the coefficient is compared to existing coefficients. [ABSTRACT FROM AUTHOR]

This study examined the roles of gender and STEM major status as predictors of performance in formulating a research question and designing experiment among 70 undergraduate Taiwanese college students participating in inquiry-based learning (IBL). Student participants in this study were involved in discrepant demonstrations of scientific events and hands-on activities to introduce conceptual knowledge with the goal of motivating their learning interest in explaining phenomena scientifically. In addition, historical cases of scientific inquiry were utilised to scaffold and support inquiry procedures. At three time points during the semester, learning sheets were used to assess student performance in scientific inquiry practices (generating research questions and designing experiment). Results revealed that female students showed greater ability to form a research question than males. Additionally, while female science majors showed greater ability to generate a research design than female non-science majors, the opposite was true for males. Finally, the challenges and difficulties encountered by students in formulating research question and designing experiments are addressed. The findings of students' significant and positive progress on formulating research question in the three consecutive assessments reveal the potential benefits of pedagogical approaches used in this study. On the other hand, the variety of students' learning outcomes provide insight into potential ways that specific student subgroups may respond to pedagogies within an inquiry-based context. The initial findings also provide a starting point for instructors to begin debating the most productive ways of planning and delivering scientific inquiry instruction. [ABSTRACT FROM AUTHOR]

Cladistic character matrices are routinely repurposed in analyses of morphological disparity. Unfortunately, the sampling of taxa and characters within such datasets reflects their intended application (to resolve phylogeny, rather than distinguish between phenotypes) resulting in tree shapes that often misrepresent broader taxonomic and morphological diversity. Here we use tree shape as a proxy to explore how sampling can affect perceptions of evolving morphological disparity. Through analyses of simulated and empirical data, we demonstrate that sampling can introduce biases in morphospace occupation between clades that are predicted by differences in tree symmetry and branch length distribution. Symmetrical trees with relatively long internal branches predict more expansive patterns of morphospace occupation. Conversely, asymmetrical trees with relatively short internal branches predict more compact distributions. Additionally, we find that long external branches predict greater phenotypic divergence by peripheral morphotypes. Taken together, our results caution against the uncritical repurposing of cladistic datasets in disparity analyses. However, they also demonstrate that when morphological diversity is proportionately sampled, differences in tree shape between clades can speak to genuine differences in morphospace occupation. While cladistic datasets may serve as a useful starting point, disparity datasets must attempt to achieve uniformity in lineage sampling across time and topology. Only when all potential sources of bias are accounted for can evolutionary phenomena be distinguished from artefactual signals. It must be accepted that the non‐uniformity of the fossil record may preclude representative sampling and, therefore, a faithful characterization of the evolution of morphological disparity. [ABSTRACT FROM AUTHOR]

Animal shelters commonly experience difficulties finding homes for dogs with pre-existing medical or behavioral issues. The purpose of this study was to investigate the various factors that contribute to people's willingness to consider adopting dogs with different behavioral and medical needs and backgrounds. A web-based survey was created using the Qualtrics platform. The sample size for this study was (n = 752). Results from generalized linear mixed models and latent regression models showed that, overall stimulus, dogs described as having behavioral issues were viewed as less adoptable, less appealing, and more demanding of resources than dogs described as having medical issues. However, while women perceived dogs with behavioral issues as less adoptable than dogs with medical issues, men viewed dogs with behavioral issues as more adoptable than dogs with medical issues. Dogs described as friendly were perceived as most adoptable followed by (in order) dogs with an abuse history, dogs with allergies, and dogs that jumped/pulled. Dogs with diabetes or separation anxiety were perceived as least adoptable. Dogs described as having a history of abuse were viewed as more adoptable, more affectively appealing, and less demanding of resources than dogs with either medical or behavioral issues. Participants who currently had a dog or who were raised with a dog as a child tended to view stimulus dogs as more adoptable than their counterparts who didn't currently have a dog or who didn't have a dog as a child. Married persons viewed dogs as more adoptable than unmarried persons, and younger persons viewed dogs as more adoptable than older persons. Understanding the attitudes/beliefs of potential dog adopters toward various medical and behavioral issues provides animal rescue and adoption groups with valuable information on how best to market dogs who have medical or behavioral problems. Shelters can offer potential adopters training classes for dogs with behavioral problems and "how-to" educational classes for those who adopt dogs with medical problems. The purpose of this study was to examine the various factors that contribute to people's willingness to consider adopting dogs with different behavioral and medical attributes and backgrounds. There are few extant research studies related to the perceived adoptability of dogs with pre-existing medical and behavioral problems. [ABSTRACT FROM AUTHOR]

The purpose of this qualitative case study was to explore how youth's engineering identity has changed in the process of productive struggle in Making activities in the Midwestern U.S in a summer program. The researchers conducted focus-group interviews, and also administered an Engineering Identity survey as well as the Draw an Engineer Test to the students at two time points (pre/post). Additionally, the researchers observed the level of youths' interaction by video-recording each session, conducted debriefing sessions, and examined youth artifacts. The findings revealed two themes. The first theme is that the boys and girls who were engaged in the process of productive struggle showed changes in their identity with engineering. The second theme is that the boys and girls who weren't fully engaged in the process of productive struggle (i.e., demonstrated unproductive struggle) showed little or no change in their identity with engineering. This study showed that regardless of whether the students went through the process of productive struggle or not, they developed neutral or positive attitudes toward engineering. This finding also added to the existing literature on that productive struggle in Making activities has potential to enhance these youth' learning of engineering knowledge and engineering tools. [ABSTRACT FROM AUTHOR]

The purpose of this study is to examine the incorporation of Google Earth Virtual Reality (VR) into English Learners' (ELs) expository writing experiences from a Funds of Knowledge perspective utilizing a mixed-methods explanatory sequential design. The participants were 22 ELs from a middle school in a rural Midwestern town. During the quantitative phase, the expository writing artifacts were collected through a multiple before-and-after non-experimental design and analyzed using ANOVA. A text-in-context coding approach was adopted to examine changes in students' writing. The results showed a statistically significant increase in expository writing skills, particularly in description, cause/effect, compare/contrast, and enumeration. A descriptive survey assessing the acceptance of Google Earth VR was distributed as well. During the qualitative phase, a follow-up focus group for the ELs and teacher interviews were conducted. Field notes/memos were used to triangulate the data. The qualitative findings indicated that the ELs were engaged in the virtual-assisted writing environment and showed positive attitudes toward Google Earth VR. Concerns about using Google Earth VR in writing (i.e. time-consuming as well as distracting and posing integration difficulties) were addressed. Future directions inspired from this study are discussed as well. [ABSTRACT FROM AUTHOR]

This paper presents results from a randomized experimental design replicated over four semesters that compared students' performance in understanding landform evolution processes as measured by the pretest to posttest score growth between two treatment methods: an online interactive simulation tool and a paper‐based exercise. While both methods were shown to be effective at enhancing students' learning of the landform concepts and processes, there was no statistically significant difference in score growth between the two instructional methods. However, the attitudinal survey indicated that students consistently favored the simulation approach over the paper‐based exercise. With the simulation method, female students showed greater score growth than males, especially for test items requiring higher level thinking. This indicates that the visually rich interactive simulation tool may be integrated to better support female students' learning in geoscience. Science major students generally outperformed non‐science major students in terms of score growth, which suggests that background knowledge played an important role in realizing the potential of computer modeling in enhancing students' learning. Sufficient scaffolding is necessary to maximize the effect of interactive earth surface modeling in geoscience education. [ABSTRACT FROM AUTHOR]

Complex regional pain syndrome is a chronic debilitating pain disorder that is difficult to manage, in part due to its heterogeneous clinical presentation and lack of clearly defined pathophysiology. Patients usually require a multidisciplinary approach to treatment, which can entail pharmacotherapy, physical therapy, behavioral therapy, and interventional pain procedures, such as sympathetic nerve blocks, spinal cord stimulation, and dorsal root ganglion stimulation. However, many patients continue to experience pain refractory to these multimodal strategies. Scrambler therapy (ST) is a noninvasive method of neuromodulation that is applied through cutaneous electrodes, and can alleviate chronic neuropathic pain by stimulating C-fibers and replacing endogenous pain signals with synthetic non-nociceptive signals. Although the use of ST has been reported for several types of refractory central and peripheral neuropathic pain, there is a paucity of data regarding the use of ST for complex regional pain syndrome. We present two patients with complex regional pain syndrome of the right lower extremity, who each underwent ST and experienced significant pain relief and improvement in function and quality of life. [ABSTRACT FROM AUTHOR]

Objective: Wendler's glottoplasty (WG) is a pitch‐elevating surgery performed by laryngologists providing gender‐affirming care. The surgery creates an anterior glottic web that could theoretically cause airway concerns, either perioperatively or at the time of future procedures; such concerns are not well‐described in the literature. We seek to assess surgeon opinions on airway concerns regarding WG. Method: A survey of laryngologists assessing opinions on airway considerations in glottoplasty. Results: A total of 19 physicians responded, representing approximately 193 surgeries. 52.6% performed glottoplasty and the remainder responded based on experience with anterior glottic webs. Two perioperative airway complications were reported, both mild stridor that did not prevent same‐day discharge. No long‐term sequela was reported. All surveyed laryngologists endorsed an altered general anesthetic approach for future procedures, with 73.7% advocating for use of a smaller endotracheal tube. 72.2% did not have "major concerns" about future intubations, and only 5.3% thought the immediate risk of airway compromise was a "real concern." 91.9% counsel their patients routinely but briefly on airway concerns. Open‐ended comments conveyed themes of concern for post‐operative disruption of the web more than of airway compromise. Conclusion: Because glottoplasty is performed in the anterior glottis and does not significantly impact airway patency, the risk of serious airway complications appears to be minimal. Laryngologists believe future intubations require a modified approach with a smaller tube, partly due to concern for glottic web trauma. Based on this pilot study, the topic deserves greater work to standardize care and anesthetic alterations for patients with WG. Level of Evidence: 5 [ABSTRACT FROM AUTHOR]

The article presents a case study of a 53-year-old Asian woman with brain and bone metastases and large lung mass. The patient experienced a progressive brain metastases after taking erlotinib and osimertinib. Evidence for continuing or stopping tyrosine kinase inhibitors (TKIs) or targeted therapy in patients with progressive lung cancer are discussed.

Nonnormality of data presents unique challenges for researchers who wish to carry out structural equation modeling. The subsequent SPSS syntax program computes bootstrap-adjusted fit indices (comparative fit index, Tucker -- Lewis index, incremental fit index, and root mean square error of approximation) that adjust for nonnormality, along with the Bollen -- Stine bootstrap-adjusted X2 equivalent statistic and associated scaling factor. [ABSTRACT FROM AUTHOR]

The present study examined the association of anxiety and impulsivity with premature muzzle grayness among young dogs. A sample of 400 dogs, ages 1–4 years was obtained at dog parks, shows, veterinary clinics, and other venues. Each dog was photographed and the degree of muzzle grayness was rated on an ordinal scale ranging from “no gray” to “full gray.” White or pale colored dogs were dropped from the study because it was impossible to determine degree of grayness. Each owner filled out a questionnaire assessing the constructs of anxiety and impulsivity, as well as other behaviors and characteristics. To prevent response bias, owners were told that the purpose of the study involved dog lifestyle. Distractor items were added to the survey to prevent the owner from guessing the purpose of the survey. Examples of survey items indicating anxiety included: destruction when left alone; hair loss on vet exam or being in a new place; and cringes/cowers in response to groups of people. Examples of survey items indicating impulsivity included: jumping on people, inability to calm, loss of focus, hyperactivity after exercise. In our sample of young dogs, latent variable regression showed that the extent of muzzle grayness was significantly and positively predicted by anxiety ( p = 0.005) and impulsivity ( p < 0.001). Dog size, spay/neuter status, or medical problems did not predict extent of muzzle grayness. Fear responses to loud noise, unfamiliar animals and people were associated with increased grayness. Ordinal regression analysis showed that muzzle grayness was significantly predicted by fear of loud noises ( p = 0.001), unfamiliar animals ( p = 0.031), and unfamiliar people ( p < 0.001). Premature graying in young dogs may be a possible indicator of anxiety, fear or impulsivity issues in dogs under four years of age. [ABSTRACT FROM AUTHOR]

Selenium species, particularly the oxyanions selenite (SeO3 2-) and selenate (SeO4 2-), are significant pollutants in the environment that leach from rocks and are released by anthropogenic activities. Selenium is also an essential micronutrient for organisms across the tree of life, including microorganisms and human beings, particularly because of its presence in the 21st genetically encoded amino acid, selenocysteine. Environmental microorganisms are known to be capable of a range of transformations of selenium species, including reduction, methylation, oxidation, and demethylation. Assimilatory reduction of selenium species is necessary for the synthesis of selenoproteins. Dissimilatory reduction of selenate is known to support the anaerobic respiration of a number of microorganisms, and the dissimilatory reduction of soluble selenate and selenite to nanoparticulate elemental selenium greatly reduces the toxicity and bioavailability of selenium and has a major role in bioremediation and potentially in the production of selenium nanospheres for technological applications. Also, microbial methylation after reduction of Se oxyanions is another potentially effective detoxification process if limitations with low reaction rates and capture of the volatile methylated selenium species can be overcome. This review discusses microbial transformations of different forms of Se in an environmental context, with special emphasis on bioremediation of Se pollution. [ABSTRACT FROM AUTHOR]

The article presents the revelations of the Partial Oral Treatment of Endocarditis (POET) trial. It discusses the change in initial intravenous antibiotic treatment to two-drug oral antibiotic treatment on patients with infective endocarditis on the left side of the heart, heart problems caused by streptococcus.

The purpose of this qualitative case study was to explore how an after-school program that infused Maker education influenced Midwestern U.S. middle school youths' attitudes toward science. The researchers conducted pre- and post-interviews with six students from non-dominant backgrounds as well as the teacher, and also administered attitudinal surveys to the six students at two time points (pre/post). Additionally, the researchers observed the level of student participation by video-recording each after-school session, observed the level of student anxiety by using skin temperature biofeedback, and examined student artifacts. At the end of the program, the researchers administered a program survey to the six students. The findings revealed three themes (fun elements of science, career choice, trial and error). In this study, the after-school program infused with Maker education showed great potential in sustaining the non-dominant youths' positive attitudes toward science. The findings speak to the need for future studies that investigate pedagogy issues in Making after-school programs and also highlight equity issues in the opportunities for non-dominant youth to participate in these programs. [ABSTRACT FROM AUTHOR]

Recent data suggest that we are not successfully getting the message across about the importance of advance care planning for patients who have a life-ending illness. Half to three-quarters of patients with incurable cancer think that they might be cured by chemotherapy, radiation, or surgery. The source of this denial may lie with them, it may be traceable to their physicians, or it may be a combination of the two. This avoidance has consequences, since those patients with "prognostic awareness" have end-of-life care pathways that involve little use of the hospital, ICU, end-of-life chemo, or "codes" with almost no chance of success, and much more dying at home with hospice care. If we can successfully initiate advance care planning discussions with our patients and families, their end-of-life processes will improve, resulting in better care, less use of the hospital, and more honoring of newly discerned choices. We show how this can be done in regular oncology practice by introducing the Johns Hopkins "Palliative Care Temporary Tattoo" and by providing some ways to discuss car-diopulmonary resuscitation in settings where it will not be helpful. [ABSTRACT FROM AUTHOR]

The article focuses on pain is a common multidimensional symptom that compromises quality of life for many patients with serious illness is understanding the concept of total pain who care for patients facing a life-limiting illness. Topics include the nociception refers to neural encoding of impending tissue damage, the pain refers to the subjective experience of actual or impending harm and the serious illness can fundamentally disrupt previously established expectations for the future.

Purpose: Prognostic awareness, or knowing that one has a life-ending disease, is associated with a better end-of-life experience, including less depression and anxiety. We sought to determine whether reliable sources on the Internet contained helpful prognostic information about advanced cancer. Methods: We played the role of a 62-year-old person with stage IV incurable cancer and accessed four commonly used Web sites for the 10 most common causes of cancer death (American Cancer Society, ASCO, National Cancer Institute, Up To Date), as well as disease-specific Web sites. Results: Approximately half the Web sites (26 of 50; 52%) had some notation of 5-year survival. Only four of 50 (8%) gave any average or median survival. Only 13 of 50 (26%) noted that stage IV cancer was a serious and usually life-ending illness. Nearly all had some information about hospice and palliative care. Conclusion: Information that can help with patient prognostic awareness is not currently found on cancer-related Web sites. Oncologists should be aware that their patients will not find estimates of survival or treatment effect on the Internet. This may contribute to overoptimistic estimates of survival and subsequent aggressive end-of-life care. [ABSTRACT FROM AUTHOR]

Technology provides the means to create useful learning and practice environments for learners. Well-designed cognitive tutor systems, for example, can provide appropriate learning environments that feature cognitive supports (ie, scaffolding) for students to increase their procedural knowledge. The purpose of this study was to conduct a series of usability tests of a dialogue-based design framework for the presentation of domain knowledge and assess how it can be used to actively engage learners in learning about research methods. Three formal usability assessments and an instructor adoption assessment were conducted during the development of the tutoring system. Each usability assessment employed diverse data collection methods to ensure broad and in-depth coverage of findings. The findings revealed that the dialogue metaphor enabled natural and participatory interactions between the system and users. The feedback prompts or hints and support resources provided opportunities for learning during the process of problem solving. Future research to extend the support of usability assessments is also discussed. [ABSTRACT FROM AUTHOR]

PURPOSE: A majority of patients enrolled in hospice have advanced cancer. Most of them are burdened by symptoms related to uncontrolled tumor growth. Although palliative radiation therapy (RT) is highly effective, only 1% of hospice patients are ever referred. Commonly cited concerns include high treatment cost, burden of travel for multiple visits, and a perceived reluctance of radiation oncologists to deliver single-fraction RT. METHODS: A clinic offering affordable RT to patients in hospice was developed to simplify the intake, reduce cost, and minimize travel to a single visit. The goal was to evaluate, simulate and plan treatment, and treat patients with a single fraction of palliative RT within a 4-hour period. RESULTS: The initial 18-month experience is reported in this Health Information Portability and Accountability Act-compliant report that was approved by the Viriginia Commonwealth University Institutional Review Board. Eight referrals were received from local hospice agencies that had not referred any patients in previous years. A telephone screening process avoided unnecessary travel for two patients who were not candidates for RT. Two additional patients who were evaluated with a same-day computed tomography simulation were not good candidates for RT. Ultimately, four patients were successfully treated with single-fraction palliative RT of 8 Gy. None had to disenroll from hospice. CONCLUSION: This novel program increased access to palliative RT for patients in hospice who would otherwise not have been referred. The main challenge identified was a need for ongoing educational activities at hospice agencies where staff turnover may be high and understanding about palliative RT can be limited. [ABSTRACT FROM AUTHOR]

The article presents a case study related to 80-year-old woman with several years of severe diabetic neuropathy manifest as symmetric stocking-glove electric shocks that caused pain with walking or gripping. Topics include the scrambler therapy is a noninvasive neuromodulation that sends nonpain information along the existing nerve pathways to modify central sensitization, and the success in several randomized controlled trials treating as low-back pain, and postherpetic neuropathy.

All health care practitioners face patients and families in desperate situations who say, “We are hoping for a miracle.” Few providers have any formal training in responding to this common, difficult, and challenging situation. We want to do our best to preserve hope, dignity, and faith while presenting the medical issues in a nonconfrontational and helpful way. We present the acronym AMEN (affirm, meet, educate, no matter what) as one useful tool to negotiate these ongoing conversations. [ABSTRACT FROM AUTHOR]

Objective: To assess parents' perspectives of their home environments to establish the validity of scores from the Behavior and Attitudes Questionnaire for Healthy Habits (BAQ-HH).Design: In the present descriptive study, we surveyed a cross-sectional sample of parents of pre-school children. Questionnaire items developed in an iterative process with community-based programming addressed parents' knowledge/awareness, attitudes/concerns and behaviours about healthy foods and physical activity habits with 6-point rating scales. Exploratory and confirmatory factor analyses were used to psychometrically evaluate scores from the scales.Setting: English and Spanish versions of the BAQ-HH were administered at parent-teacher conferences for pre-school children at ten Head Start centres across a five-county agency in autumn 2010.Subjects: From 672 families with pre-school children, 532 parents provided responses to the BAQ-HH (79 % response rate). The majority was female (83 %), Hispanic (66 %) or white (16 %), and ages ranged from 20 to 39 years (85 %).Results: Exploratory and confirmatory analyses revealed a knowledge scale (seven items), an attitude scale (four items) and three behaviour subscales (three items each). Correlations were identified between parents' perceptions of home activities and reports of children's habits. Differences were identified by gender and ethnicity groupings.Conclusions: As a first step in psychometric testing, the dimensionality of each of the three scales (Knowledge, Attitudes and Behaviours) was identified and scale scores were related to other indicators of child behaviours and parents' demographic characteristics. This questionnaire offers a method to measure parents' views to inform planning and monitoring of obesity-prevention education programmes. [ABSTRACT FROM AUTHOR]

ObjectiveTo assess parents’ perspectives of their home environments to establish the validity of scores from the Behavior and Attitudes Questionnaire for Healthy Habits (BAQ-HH).DesignIn the present descriptive study, we surveyed a cross-sectional sample of parents of pre-school children. Questionnaire items developed in an iterative process with community-based programming addressed parents’ knowledge/awareness, attitudes/concerns and behaviours about healthy foods and physical activity habits with 6-point rating scales. Exploratory and confirmatory factor analyses were used to psychometrically evaluate scores from the scales.SettingEnglish and Spanish versions of the BAQ-HH were administered at parent–teacher conferences for pre-school children at ten Head Start centres across a five-county agency in autumn 2010.SubjectsFrom 672 families with pre-school children, 532 parents provided responses to the BAQ-HH (79 % response rate). The majority was female (83 %), Hispanic (66 %) or white (16 %), and ages ranged from 20 to 39 years (85 %).ResultsExploratory and confirmatory analyses revealed a knowledge scale (seven items), an attitude scale (four items) and three behaviour subscales (three items each). Correlations were identified between parents’ perceptions of home activities and reports of children's habits. Differences were identified by gender and ethnicity groupings.ConclusionsAs a first step in psychometric testing, the dimensionality of each of the three scales (Knowledge, Attitudes and Behaviours) was identified and scale scores were related to other indicators of child behaviours and parents’ demographic characteristics. This questionnaire offers a method to measure parents’ views to inform planning and monitoring of obesity-prevention education programmes. [ABSTRACT FROM PUBLISHER]

Background and Objective: In September 2013 the Institute of Medicine (IOM) released a report on the quality of cancer care in the United States. We report here on the recommendations of the IOM report and the implications for the palliative care community. Methods: The IOM report is based on a consensus of literature and expert opinion. The recommendations provide direction for health policy, education, and clinical practice. The report emphasizes the significance of the aging population and implications for cancer care. Results: The recommendations from the report offer many opportunities for palliative care including enhancing the use of advance care planning and integration of palliative care across the cancer trajectory. Conclusions: Quality cancer care depends on the integration of quality palliative care. The palliative care community can use this IOM report to guide their collaboration with oncology and to enhance the quality of care provided to cancer patients and their families. [ABSTRACT FROM AUTHOR]

Palliative care has been one of the most rapidly growing fields of health care in the United States in the past decade. The benefits of palliative care have now been shown in multiple clinical trials, with increased patient and provider satisfaction, equal or better symptom control, more discernment of and honoring choices about place of death, fewer and less intensive hospital admissions in the last month of life, less anxiety and depression, less caregiver distress, and cost savings. The cost savings come from cost avoidance, or movement of a patient from a high cost setting to a lower cost setting. Barriers to expanded use include physician resistance, unrealistic expectations of patients and families, and lack of workforce. The future of palliative care includes more penetration into other fields such as nephrology, neurology, and surgery; further discernment of the most effective and cost-effective models; and establishment of more outpatient services. [ABSTRACT FROM AUTHOR]

The present study examined gender and attitude toward science in fourth- and eighth-grade students in the United States and also assessed to what extent the relationship between science attitude and science achievement differed by gender. Results showed that both fourth- and eighth-grade boys demonstrated more confidence in science than girls, while eighth-grade boys also showed greater liking for science than girls. Additionally, gender moderated the relationship between science achievement and (a) liking science (for fourth-grade students) and (b) confidence in science (eighth-grade students). Results are discussed in terms of addressing gender inequities in science education and career opportunities. [ABSTRACT FROM PUBLISHER]

The purpose of the current study was to assess the gender invariance of an a priori four-factor solution of behavioral consequences of drinking. Results evidenced strong partial measurement invariance, with marginal structural invariance, which signals that the underlying constructs possessed the same theoretical structure for both men and women. [ABSTRACT FROM AUTHOR]

Palliative care has been one of the most rapidly growing fields of health care in the United States in the past decade. The benefits of palliative care have now been shown in multiple clinical trials, with increased patient and provider satisfaction, equal or better symptom control, more discernment of and honoring choices about place of death, fewer and less intensive hospital admissions in the last month of life, less anxiety and depression, less caregiver distress, and cost savings. The cost savings come from cost avoidance, or movement of a patient from a high cost setting to a lower cost setting. Barriers to expanded use include physician resistance, unrealistic expectations of patients and families, and lack of workforce. The future of palliative care includes more penetration into other fields such as nephrology, neurology, and surgery; further discernment of the most effective and cost-effective models; and establishment of more outpatient services. [ABSTRACT FROM AUTHOR]

Abstract: Following the ban in 2003 on the use of tributyl-tin compounds in antifouling coatings, the search for an environmentally-friendly alternative has accelerated. Biocidal TBT alternatives, such as diuron and Irgarol 1051®, 1 [1] Irgarol 1051® — registered trademark no. 2195791, Ciba Specialty Chemicals Corp., US. have proved to be environmentally damaging to marine organisms. The issue regarding the use of biocides is that concerning the half-life of the compounds which allow a perpetuation of the toxic effects into the marine food chain, and initiate changes in the early stages of the organisms' life-cycle. In addition, the break-down of biocides can result in metabolites with greater toxicity and longevity than the parent compound. Functionalized coatings have been designed to repel the settlement and permanent attachment of fouling organisms via modification of either or both surface topography and surface chemistry, or by interfering with the natural mechanisms via which fouling organisms settle upon and adhere to surfaces. A large number of technologies are being developed towards producing new coatings that will be able to resist biofouling over a period of years and thus truly replace biocides as antifouling systems. In addition urgent research is directed towards the exploitation of mechanisms used by living organisms designed to repel the settlement of fouling organisms. These biomimetic strategies include the production of antifouling enzymes and novel surface topography that are incompatible with permanent attachment, for example, by mimicking the microstructure of shark skin. Other research seeks to exploit chemical signals and antimicrobial agents produced by diverse living organisms in the environment to prevent settlement and growth of fouling organisms on vulnerable surfaces. Novel polymer-based technologies may prevent fouling by means of unfavourable surface chemical and physical properties or by concentrating antifouling compounds around surfaces. [Copyright &y& Elsevier]

The author comments on the article "The Lake Wobegon Effect: Are All Cancer Patients Above Average?" by J. H. Wolf and K. S. Wolf, presenting views concerning palliative care, medical decision making, and the ways in which physicians can relate information to their patients. Medical care costs and Hospice care services are mentioned.

The purpose of this qualitative case study was to explore how equity-oriented pedagogy infused with Making activities promoted five non-dominant middle school youths' attitudes toward science in an after-school program in the Midwestern United States. The researchers conducted pre- and post-interviews with five students from non-dominant backgrounds, and also administered attitudinal surveys to the five students at two time points (pre/post). Additionally, the researchers observed the level of student participation by video recording each after-school session, observed the level of student anxiety by using skin temperature biofeedback, and examined student artifacts. The findings revealed three themes. This study found that equity-oriented pedagogy infused with Making activities showed great potential in sustaining non-dominant youths' positive attitudes toward science. [ABSTRACT FROM AUTHOR]

Abstract: Background: Performance status (PS) is a commonly used factor in determining the appropriateness for chemotherapy of patients with non-small cell lung cancer (NSCLC). The prevalence of poor PS and impact of chemotherapy on survival among NSCLC patients has not been studied in community populations. Patients and methods: Insured patients, aged 50+ years, diagnosed with advanced stage NSCLC between 2000 and 2007 were identified via tumor registry (n =292) and linked to electronic medical records, automated medical claims, and Census tract information. A multivariate Cox proportional hazards model was used to determine the factors associated with survival. Results: Of 292 stage IIIB–IV patients, 82 (28%) had PS 3 or 4, and 39% of PS 3–4 patients received first line chemotherapy. Those who received chemotherapy lived 4.8 months compared to 2.4 months for those who did not. Factors associated with a reduced likelihood of death included receipt of chemotherapy (hazard ratio [HR], 0.64), and female gender (HR, 0.71). Modern chemotherapy may be associated with positive effects on survival for poor PS patients, as for good PS patients. Further trials, especially randomized trials, in this neglected subgroup are indicated. [Copyright &y& Elsevier]

Abstract: Background: Lorazepam (Ativan®), diphenhydramine (Benadryl®), haloperidol (Haldol®) (ABH) topical gel is currently widely used for nausea in hospice because of perceived efficacy and low cost and has been suggested for cancer chemotherapy. However, there are no studies of absorption, a prerequisite for effectiveness. We completed this study to establish whether ABH gel drugs are absorbed, as a prerequisite to effectiveness. Intervention: Ten healthy volunteers, aged 25 to 58 years (mean 37 years), two African Americans and eight Caucasian Americans, applied the standard 1.0mL dose (2mg of lorazepam, 25mg of diphenhydramine, and 2mg of haloperidol in a pluronic lecithin organogel), rubbed on the volar surface of the wrists by the subject. Measures: Blood samples were obtained at 0, 30, 60, 90, 120, 180, and 240 minutes. Plasma concentrations were analyzed by liquid chromatography-tandem mass spectrometry using deuterated internal standards for each drug. Outcomes: No lorazepam or haloperidol was detected in any sample from any of the 10 volunteers down to a level of 0.05ng/mL. Diphenhydramine was found in multiple plasma samples at concentrations >0.05ng/mL in three patients, with the highest concentration of 0.30ng/mL in one person at 240 minutes. Overall, five of 10 patients exhibited detectable diphenhydramine in one or more samples, supporting limited absorption. No subject noted any side effects. Conclusions/Lessons Learned: As commonly used, none of the lorazepam, haloperidol, or diphenhydramine in ABH gel is absorbed in sufficient quantities to be effective in the treatment of nausea and vomiting. Diphenhydramine is erratically absorbed at subtherapeutic levels. The efficacy of ABH gel should be confirmed in randomized trials before its use is recommended. [Copyright &y& Elsevier]

Summary: Background: Evidence-based guidelines recommend chemotherapy for medically fit patients with stages II–IV non-small cell lung cancer (NSCLC). Adherence to chemotherapy guidelines has rarely been studied among large populations, mainly because performance status (PS), a key component in assessing chemotherapy appropriateness, is missing from claims-based datasets. Among a large cohort of patients with known PS, we describe first line chemotherapy use relative to guideline recommendations and identify patient factors associated with guideline concordant use. Patients and methods: Insured patients, ages 50+, with stages II–IV NSCLC between 2000 and 2007 were identified via tumor registry (n =406). Chart abstracted PS, automated medical claims, Census tract information, and travel distance were linked to tumor registry data. Chemotherapy was considered appropriate for patients with PS 0–2. Multivariate logit models were fit to evaluate patient characteristics associated with chemotherapy over- and under-use per guideline recommendations. Tests of statistical significance were two sided. Results: Overall compliance with first line chemotherapy guidelines was 71%. Significant (p <0.05) predictors of chemotherapy underuse (19%) included increasing age (odds ratio [OR], 1.09), higher income (OR, 1.02), diagnosed before 2003 (OR, 2.05), and vehicle access (OR, 6.96) in the patient''s neighborhood. Significant predictors of chemotherapy overuse (10%) included decreasing age (OR, 0.92), diagnosed after 2003 (OR, 3.24), and higher income (OR, 1.05) in the patient''s neighborhood. Among NSCLC patients 29% do not receive guideline recommended chemotherapy treatment missing opportunities for cure or beneficial palliation, or receiving chemotherapy with more risk of harm than benefit. Care concordant with guidelines is influenced by age, economic considerations such as income and transportation barriers. [ABSTRACT FROM AUTHOR]

Objective: Donation after cardiac death (DCD) or donation of organs after removal of life support is an accepted means of organ retrieval that usually occurs in the setting of sudden illness but has not been described in people with progressive neurologic illness. We report DCD in two people with progressive amyotrophic lateral sclerosis (ALS). Methods: Case series at an academic medical center of two men with progressive ALS who underwent withdrawal of artificial life support, rapid cardiac death, and subsequent organ donation. The primary outcome was donation of organs in concordance with patient and family wishes. Results: Both patients underwent peaceful withdrawal of life support in the presence of family, and multiple organs were donated. Conclusions: Patients may legally and ethically refuse life-sustaining care. These patients considered their lives to be more burdensome than beneficial near the end of their lives, both carefully planned the time and circumstance of their deaths, and both fulfilled a long-standing desire to donate their organs. This study describes a potential opportunity for patients with progressive neurologic illness. [ABSTRACT FROM AUTHOR]

The article reports on the projected increase in medical expenses of U.S. cancer patients to more than 173 billion U.S. dollars by year 2020. It examines the contribution of treatment duration and prices of anticancer drugs that limit the number of people with access to health benefits. It explores a challenge to oncologists to help reduce the cost of medical expenses through choice of drugs, type of support therapy and limitations of imaging procedures and hospitalizations.

BACKGROUND: Performance status (PS) is a good prognostic factor in lung cancer and is used to assess chemotherapy appropriateness. Researchers studying chemotherapy use are often hindered by the unavailability of PS in automated data sources. To the authors' knowledge, no attempts have been made to estimate PS using claims-based measures. The current study explored the ability to estimate PS using routinely available measures. METHODS: A cohort of insured patients aged ≥50 years who were diagnosed with American Joint Committee on Cancer stage II through IV lung cancer between 2000 and 2007 was identified via a tumor registry (n = 552). PS was abstracted from medical records. Automated medical and pharmaceutical claims from the year preceding diagnosis were linked to tumor registry data. A logistic regression model was fit to estimate good versus poor PS in a random half of the sample. C statistics, sensitivity, specificity, and R² were used to compare the predictive ability of models that included demographic factors, comorbidity measures, and claims-based utilization variables. Model fit was evaluated in the other half of the sample. RESULTS: PS was available in 80% of medical records. The multivariable regression model predicted good PS with high sensitivity (0.88 or 0.94 depending on how good PS was defined), but moderate specificity (0.45 or 0.32) with a 0.50 prediction cutoff, and good sensitivity (0.64 or 0.83) and specificity (0.69 or 0.55) when the cutoff was 0.70. The goodness-of-fit c statistic was 0.76 or 0.78. CONCLUSIONS: PS can be estimated, with some accuracy, using claims-based measures. Emphasis should be placed on documenting PS in medical records and tumor registries. [ABSTRACT FROM AUTHOR]

The study presented here investigated factors that are related to social skills measures of youths with visual impairments. It found that participation in extracurricular activities and paid work experiences, as well as the age of onset of visual impairments, were significantly related to differences in the participants' scores on the Social Skills Rating System. [ABSTRACT FROM AUTHOR]