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PURPOSE: To compare 5-year biochemical control, toxicity, and patient-reported quality of life (QOL) outcomes for African American and White patients treated with proton therapy (PT) for prostate cancer. MATERIALS AND METHODS: We reviewed the medical records of 1,066 men with clinically localized prostate cancer. Patients were treated with definitive PT between 2006 and 2010. Patients received a median radiation dose of 78 Gy (RBE) with conventional fractionation (1.8- 2 Gy [RBE] per fraction). Sixty-eight (6.4%) men self-identified as African American and 998 (93.6%) self-identified as White. Five-year rates of biochemical control, grade 3 genitourinary and gastrointestinal toxicity, and patient-reported QOL are reported and compared between African American and White patients. RESULTS: Median biochemical follow-up was 5.0 years for both African American and White patients. Median follow-up for toxicity was 5.0 and 5.2 years, respectively. On multivariate analysis, race was not a significant predictor for 5-year freedom from biochemical failure (HR 0.8, p=0.55). No significant association was found between race and grade 3 genitourinary toxicity on multivariate analysis at 5 years (HR 2.5, p=0.10). Patient-reported QOL using median EPIC bowel, urinary incontinence, and irritative summaries scores were not significantly different between the groups. African Americans had higher median sexual summary scores at 2 years than White patients (75 vs. 54, p=0.01) but by 5+ years, the sexual summary scores were no longer significantly different (63 vs. 53, p=0.35). CONCLUSION: With a median follow-up of 5 years, there were no racial disparities in biochemical control, grade 3 toxicity, or patient-reported QOL after PT for prostate cancer.

PurposeTo report clinical outcomes in patients treated with image guided proton therapy (PT) for localized prostate cancer.Methods and MaterialsThe medical records of 1327 men were reviewed. Each man was enrolled on an outcomes tracking study. Dual enrollment on a prospective clinical trial was allowed. Each patient was treated for localized prostate cancer with PT at our institution between 2006 and 2010. Ninety-eight percent of patients received 78 Gy (radiobiological equivalent [RBE]) or higher; 18% received androgen deprivation therapy (ADT). The 5-year freedom from biochemical progression (FFBP), distant metastasis-free survival, and cause-specific survival rates are reported for each risk group. Data on patient-reported quality of life and high-grade toxicities were prospectively collected and reported. A multivariate analysis was performed to identify clinical predictors of biochemical failure and urologic toxicity.ResultsThe median follow-up time was 5.5 years. The 5-year FFBP rates were 99%, 94%, and 74% in low-risk, intermediate-risk, and high-risk patients, respectively. The actuarial 5-year rates of late grade 3+ Common Terminology Criteria for Adverse Events, version 4.0, gastrointestinal (GI) and genitourinary (GU) toxicity were 0.6% and 2.9%, respectively. Multivariate analysis showed a significant correlation between grade 3+ GU toxicity and pretreatment prostate reductive procedures (P

Purpose We report on quality of life (QOL) and early toxicity among men with prostate cancer who underwent transurethral resection of the prostate (TURP) before proton therapy. Materials and Methods Between 2006 and 2010, 1,289 patients were treated definitively with proton therapy for prostate cancer at our institution and enrolled on a prospective outcomes-tracking protocol. Ninety-six of the men had received a TURP before proton therapy, while 1,193 men had not. Baseline comorbidities, medications, expanded prostate index composite (EPIC) score, international prostate symptom score (IPSS), and CTCAE vs.3 toxicity assessment were collected prospectively. The Kaplan-Meier product limit method was used to estimate freedom from toxicity. Results Men who had TURP before proton therapy had lower baseline EPIC scores for urinary incontinence, bowel summary, and sexual summary compared with the non-TURP group, but no significant difference in urinary obstructive score was observed. After controlling for baseline scores, there was no significant difference in bowel summary or sexual summary scores between the two groups over time. There were, however, differences for urinary irritation/obstruction scores and urinary incontinence scores favoring those patients who did not have a TURP-like procedure. Toxicity assessment showed that the 2-year and 5-year rates of grade 3 genitourinary toxicity in the pretreatment TURP group were 12.3% and 17.2%, respectively. Conclusions Pretreatment TURP was associated with both a high incidence of physician-assessed toxicity and inferior patient-reported QOL scores both before and after proton therapy treatment. Studies investigating QOL and toxicity after specific prostate cancer therapies should stratify patients by pretreatment TURP. Longer follow-up is needed to confirm if these differences ever resolve.

In order to assess the effect of bird feeders on the distribution of ticks on a residential lawn, ticks collected beneath bird feeders were compared to similar control areas on a residential property in Worcester County, MA. Host-seeking ticks were sampled from August 8, 2005 to July 25, 2007 by dragging with white flannel cloth. All ticks were counted and removed from the cloth. Sampling was conducted 38 times. A total of 12 ticks (larvae and nymphs) was collected. Significantly more ticks were collected from under the bird feeders (n = 10) than the control areas (n = 2).

We tested the roles of shelter and prey odor cues on the prestrike movement patterns of the dusky pigmy rattlesnake, Sistrurus miliarius barbouri. In the first experiment, prey odors—mouse, frog, lizard, plus control—were presented in various combinations with and without shelters. The pigmy rattlesnake initially preferred sites with both frog odor and shelter. However, this changed over a 23-h period so that shelter alone became the most preferred feature of the microhabitat choices. The initial 2 h pigmy response was similar to that reported for the western rattlesnake (Crotalus viridis), in that they responded differently to the four choice combinations of shelter and prey odor. This initial pigmy response differed in that only frog odor (but not mouse or lizard odor) affected their initial choices. Our work also indicates that when foraging, novel prey odors (frog) initially attracted their attention, but preference for this odor soon declined. In the second experiment, we examined the preference for prey odors by simultaneously presenting all three prey odors plus control (water). The snakes exhibited no prey odor preference during the first 2-h or during the total 23-h of the trials. In both experiments, the pattern of circadian activity was the same. Circadian activity showed two peaks, one shortly before onset of the nocturnal phase and the second just before midnight; thereafter, activity gradually declined so that most snakes were in, and remained in, a shelter by morning when the diurnal phase began. In these experiments, active movement in pigmy rattlesnakes occurred nocturnally and by day they remain in settled locations. While in such settled positions, the pigmy rattlesnakes coiled into stereotypic ambush postures facing the opening in their shelter where prey would most likely pass.

Objectives: This study examined health care cost outcomes resulting from a health education program (HEP), a social work intervention for spouse caregivers of frail older adults. Method: One-hundred five spouses were recruited and randomly assigned to HEP or usual care (UC). Health care utilization and cost data were collected from the HMO's management information system for both the spouse caregivers and care recipients in quarterly increments for a 30-month period. Results: The results indicate that HEP was cost-effective. Caregivers and care recipients who participated in HEP had significantly lower overall health care costs and significantly lower outpatient costs than those who participated in usual care. Conclusions: By 2 years, total cost savings for caregivers and care recipients who participated in HEP was $309,461.14. HEP is a cost-effective intervention for caregivers and care recipients receiving medical care from a staff-model HMO.

Rattlesnake predatory behavior is defined by a strike and then release of rodent prey. Poststrike, the released envenomated prey dashes off and dies. Therefore, the snake must relocate the prey relying largely upon chemosensory cues emitted by the struck prey. Assessing these poststrike chemosensory cues is important to the snake as these cues may contain significant information about the effectiveness of the preceding strike and hence the likelihood that trailing the odor left by the envenomated prey will allow successful recovery of the prey. One possible cue in this scent trail is concentration of the distinctive odor generated in the prey during envenomation. To test this, we presented snakes with different poststrike choices of low and high prey-odor concentrations. We found that although rattlesnakes could trail each concentration level, they preferred the high odor concentrations. These results imply that rattlesnakes respond to concentration levels, not just to a threshold level of prey odor. This adjustment to different odor concentrations is not accomplished by varying rate of tongue flicks (RTFs). Based on this study and previous work, we propose a behavioral mechanism by which rattlesnakes assess the chemosensory quality of a poststrike prey odor trail.

The organization of the small animal gross anatomy course at Washington State University’s College of Veterinary Medicine was modified in several ways over a two-year period. These modifications were motivated in part by the need to accommodate a larger number of students, but also by our desire to make more efficient use of faculty and student time as well as physical resources and to give our students opportunities to develop non-technical competencies such as communication and teamwork skills. The four major changes were (1) increasing dissection group size, (2) assigning specimens to dissection groups on a rotating basis, (3) reducing the amount of dissection time relative to time spent studying prepared specimens, and (4) introducing ‘‘transition reviews,’’ a limited form of peer teaching meant to emphasize peer interaction and communication skills rather than conveyance of specific and detailed subject matter. This article describes the details of these changes and evaluates their effectiveness based on faculty assessments, results from surveys of participating students, and comparison of examination performance and formal end-of-course student evaluations before and after reorganization of the course. Increasing the dissection group size and reducing per-student dissection time did not adversely affect student performance and were viewed at least neutrally or favorably by most students. Notably, the rotation of specimens and the transition reviews elicited strongly favorable responses from a large majority of students and had several beneficial effects of which students may not have been aware but which were apparent to participating faculty. Overall, the changes were well received by both faculty and students and were, in our view, of sufficient value that this course organization plan would be used regardless of class size.

SUMMARY This article describes the Telephone Support Group Model (TSG), a 12-week group work intervention designed to provide support to caregivers. Telephone support groups provide assistance for hard-to-reach caregivers. Caregivers who are traditionally deterred from face-to-face groups because of social constraints, geographic isolation, or physical limitations, or who are homebound because of the needs of the care recipient, are more able to participate in telephone support. A description of the 12 TSG sessions is provided. Two case examples are provided that illustrate the therapeutic benefits of TSG for caregivers and their families. Adaptations necessary for conducting telephone groups, and the advantages and disadvantages of this type of group work, are discussed. Strategies for evaluating the quality of telephone interventions are also described.

The tentacled snake Erpeton tentaculatum lives its entire life in fresh water where it feeds mostly on fish. Because the tentacled snake strikes underwater, the physical demands differ from those of air, and require modified methods of prey capture compared to terrestrial snakes. To examine this, we scored the feeding behaviours of five snakes and used multiple high-speed films of two snakes striking fishes. In the pre-strike phase, the snake usually assunled a J-shaped posture with its head turned posteriorly at the neck and its body held straight. The snake waited in such a rigid posture for the fish to move into the very narrow 'window' between turned head and body. Tentacles remained erected, and motionless. The strike was extremely rapid, occurring typically from pre-set J-shaped postures, not from sigmoidal body coils. As the head turned and travelled to the fish, the mouth opened and water collected in the ballooning throat. Significant suction feeding was absent. The fish was secured on buccal teeth and quickly swallowed by unilateral displacements of the jaws. Prey capture and swallowing exhibited specialized modifications of the general snake predatory behaviour to address the hydrodynamic demands of such an underwater strike.

Secondary angiosarcoma is a malignant cancer that develops in approximately 1% of patients treated with breast-conserving therapy (BCT) for primary breast cancer. Most treatments for secondary angiosarcoma have been unsuccessful and no consensus has been reached on what is the best therapeutic strategy. We report long-term outcomes of patients with secondary angiosarcoma treated with hyperfractionated and accelerated re-irradiation (HART).We retrospectively reviewed the medical records of, and established direct contact with, 14 consecutive patients with secondary angiosarcoma after BCT with axillary lymph node dissection who were treated at our institution with HART with or without surgery from November 1997 to March 2006. With HART, patients received three radiation therapy treatments each day, with a minimum interfraction interval of four hours, five days a week, at 1 Gy per fraction, to total doses of 45 Gy, 60 Gy, and 75 Gy for areas with a moderate risk for subclinical disease, a high risk for subclinical disease, and gross disease, respectively. The minimum follow-up for these patients was six years.Median survival was 7.0 years (range 0.4-14.7 years), with five- and 10-year overall survival rates of 79% [95% confidence interval (CI), 51-93%] and 63% (95% CI 37-84%), respectively, and five- and 10-year cause-specific survival rates of 79% (95% CI 51-93%) and 71% (95% CI 44-89%), respectively. Toxicity was minimal.Our long-term study provides evidence that patients with secondary angiosarcoma after BCT can frequently be cured. Patients treated with HART have higher overall survival, progression-free survival, and cause-specific survival rates than patients who receive only surgery, conventional radiation therapy, or chemotherapy. HART is well tolerated.

Following the release of envenomated prey, a rattlesnake exhibits a series of poststrike behaviors, involving largely chemosensory cues that lead to recovery and swallowing of the dead prey. Unlike prestrike chemosensory activity that may help the snake place itself generally in the vicinity of prey, this poststrike trailing is more specific and selective. The rattlesnake discriminates the particular poststrike trail of the envenomated mouse from odor trails of other unstruck mice. But an envenomated prey may dash significant distances over complicated terrain. Consequently, poststrike trailing by the rattlesnake may take hours during which it is exposed to its own predators. If the odor trail ages significantly, losing its perceptibility, then poststrike trailing eventually becomes futile. To examine this, each rattlesnake was permitted to strike prey, but allowed to follow the placed scent trails only at six fixed intervals poststrike, t = 0, 2, 4, 6, 12, and 24 hours. Our results indicate that in the absence of an envenomating strike, rattlesnakes did not exhibit successful trailing of prey odors, whether those scent trails were from an unstruck mouse or a mouse struck independently by another snake. However, allowed to strike, snakes maintained an interest in selective trailing up to 24 hours from the time of envenomation, although with decreasing frequency. Therefore, the strike must precede the specific and selective poststrike trailing behavior, characterized by an ability to discriminate and track the scent of the particular mouse envenomated. These results imply that the strike itself is a releaser of selective chemosensory trailing and that snakes can retain for extended periods of time a 'memory′ of the unique chemical cues of the particular mouse struck.

Although respirators and filters are designed to prevent the spread of pathogenic aerosols, a stockpile shortage is anticipated during the next flu pandemic. Contact transfer and reaerosolization of collected microbes from used respirators are also a concern. An option to address these potential problems is UV irradiation, which inactivates microbes by dimerizing thymine/uracil in nucleic acids. The objective of this study was to determine the effects of transmission mode and environmental conditions on decontamination efficiency by UV. In this study, filters were contaminated by different transmission pathways (droplet and aerosol) using three spraying media (deionized water [DI], beef extract [BE], and artificial saliva [AS]) under different humidity levels (30% [low relative humidity {LRH}], 60% [MRH], and 90% [HRH]). UV irradiation at constant intensity was applied for two time intervals at each relative humidity condition. The highest inactivation efficiency (IE), around 5.8 logs, was seen for DI aerosols containing MS2 on filters at LRH after applying a UV intensity of 1.0 mW/cm 2 for 30 min. The IE of droplets containing MS2 was lower than that of aerosols containing MS2. Absorption of UV by high water content and shielding of viruses near the center of the aggregate are considered responsible for this trend. Across the different media, IEs in AS and in BE were much lower than in DI for both aerosol and droplet transmission, indicating that solids present in AS and BE exhibited a protective effect. For particles sprayed in a protective medium, RH is not a significant parameter.

The purpose of this chapter is to describe effective methods for conducting ­evaluation research about caregiver education and support programs. We considered a different focus, reviewing, and evaluating the existing literature. However, a large and growing body of literature already exists about the effectiveness of caregiver education and support programs and it seemed to us that another review would be redundant. The literature is summarized in numerous excellent reviews that have highlighted what is known about the effectiveness of caregiver education and support programs and what remains to be accomplished. In fact, so many review studies have been completed since the first review by Toseland and Rossiter (1989) two decades ago, here we list only some of the reviews since 2000 (see, for example, Acton & Kang, 2001; Brodaty, Green, & Koschera, 2003; Cooke, McNally, Mulligan, Harrison, & Newman, 2001; Coon, Gallagher-Thompson, & Thompson, 2003; Farran, 2001; Gallagher-Thompson & Coon, 2007; Gallagher-Thompson et al., 2000; Harding & Higginson, 2003; Kennet, Burgio, & Schulz, 2000; Pinquart & Sorensen, 2006; Pusey & Richards, 2001; Schulz, 2000; Schulz et al., 2002; Selwood, Johnston, Katona, Lyketsos, & Livingston, 2007; Sorensen, Pinquart, & Duberstein, 2002; Thompson et al., 2007; Thompson, 2000; Toseland, Smith, & McCallion, 2001; Toseland, 2004; Yin, Zhou, & Bashford, 2002).

Many biomass materials can be converted into ethanol, with the conversion process varying based on the biological and structural complexity of the material. This process provides multiple opportunities to highlight important principles in biological engineering, with topical, compelling, and relevant exercises for science, technology, engineering and math (STEM) education. In 2009 we piloted a four-day workshop designed to provide hands-on lab experiences with ethanol production from biomass. The workshop was offered as part of a summer camp for high school girls, sponsored by the Penn State Women in the Sciences and Engineering (WISE) Institute. The participants were divided into three groups, each group performing their own experiments with five different materials - sugarcane, paper, corn stover, poplar, and switchgrass. Workshop participants performed the following procedures: (1) hot water pretreatment to alter biomass structure and increase enzyme accessibility, (2) enzymatic hydrolysis to release sugars from cellulose, (3) fermentation to convert sugars to ethanol, and (4) distillation to recover ethanol from the fermentation broth. Ethanol concentrations in the fermentation broth ranged from 8 to 24 g/L, according to sugarcane > switchgrass > paper = stover > poplar. Although the workshop was performed in a laboratory with specialized instruments dedicated to bioenergy research, the workshop could also be conducted in a typical chemistry laboratory with access to an autoclave and distillation column. A workbook was created to document the experimental procedures and to record data and perform calculations related to feedstock supply and ethanol yields. The workshop built on this technical foundation to include analysis of social, ethical, and ecological issues including environmental impacts, food security, and rural development.

Rattlesnakes in the wild usually strike, envenomate, and release rodents immediately (Klauber, 1956) avoiding potential injury from retaliation, but this may allow the struck rodent to scamper some distance from the site of initial envenomation while the cocktail of venom components immobilizes and eventually kills the rodent. Because the envenomated rodent often breaks visual contact, relocation of the dispatched prey may rely upon chemosensory cues emitted by the struck prey. On theoretical and on experimental grounds, these chemosensory cues may be carried in the blood. Theoretically, the strike includes deep penetration of the fangs (Kardong and Bels, 1998), which may carry away distinctive chemical cues used next to relocate the envenomated prey. Experimental trials with blood suggest that it prompts elevated interest in colubrid snakes (Chiszar et al., 1992a) and prompts high-rates of tongue flicking in rattlesnakes (Chiszar et al., 1993b). Consequently, the purpose of our experiments was to see if blood alone carried chemical cues used during poststrike trailing by the rattlesnake to relocate its envenomated prey.

To evaluate the Advanced Illness Coordinated Care Program (AICCP), delivered by allied health personnel to improve care for patients coping with advanced illness and in need of preparation for end-of-life (EOL) care.Clinical trial involving 275 patients and 143 surrogates in 6 settings who were randomly assigned to the AICCP or usual care (UC).The AICCP participants met with a care coordinator for assistance with provider communication, care coordination, and support. The AICCP was evaluated for effects on satisfaction with care, advance planning, consistency of care with patient preferences, and healthcare costs.The AICCP increased patient satisfaction with care and communication (P = .03), and AICCP surrogates reported fewer problems with provider support (P = .03). More AICCP than UC participants completed an advance directive (AD) (69.4% vs 48.4%; P = .006), and the AICCP group completed more ADs per participant (P = .01). Median time to AD documentation was 46 days for AICCP and 238 days for UC (P = .02). There was no difference in survival (AICCP 43% vs UC 42%). Six-month costs were lower with AICCP than with UC (12,123 US dollars vs 16,295 US dollars); however, the difference did not reach statistical significance.The AICCP improved satisfaction with care and helped patients develop and revise more ADs, sooner, without affecting mortality. This program may be delivered in a range of managed care, fee-for-service, and group-model settings.

3.4%) and incontinence (nZ 1; 0.5%; 7-years actuarial risk of 1.8%). Late grade 2 or higher GU toxicity was associated with a higher bladder volume receiving 70 Gy or higher dose (p Z .02), there was no association with any of other parameters examined. Conclusions: The volume of bladder neck exposed to higher doses may possibly be related to the radiation cystitis, most common late GU toxicity in our cohort with localized prostate cancer treated to 78 grays IMRT. Author Disclosure: H. Inokuchi: None. T. Mizowaki: None. I. Ikeda: None. K. Takayama: None. Y. Norihisa: None. M. Hiraoka: None.

The short-term effectiveness of a Health Education Group (HEP) intervention program for spouses of frail older adults was compared to the usual care (UC) offered to the spouses of frail older persons in a staff model health maintenance organization. HEP is a multicomponent group program offered in eight weekly, two-hour group sessions, and ten monthly, two-hour follow-up group sessions. It includes emotion-focused and problem-focused coping strategies, education, and support. One-hundred and five spouses were recruited and randomly assigned to HEP (n = 58) or UC (n = 47). Spouse caregivers and care recipients were assessed within two weeks of intervention and within two weeks after the completion of the eight weekly group meetings. The results indicate that, for caregivers, HEP was more effective than UC in reducing depression, maintaining social integration, increasing effectiveness in solving pressing problems, increasing knowledge of community services and how to access them, changing caregivers' feelings of competence, and the way they respond to the care giving situation. No significant differences, however, were found between care recipients in the two arms of the study on any of the outcome measures.

220 Background: We report on quality of life (QOL) and early toxicity following proton therapy (PT) among men with prostate cancer who underwent transurethral resection of the prostate (TURP) prior to treatment. Methods: Between 2006 and 2010, 1,540 patients were treated definitively with PT for prostate cancer at UFPTI and enrolled on a prospective IRB-approved outcomes protocol. One hundred of the men had received a TURP before PT. Baseline comorbidities, medications, expanded prostate index composite (EPIC) score, international prostate symptom score (IPSS), and CTCAE vs.3 toxicity assessment were collected prospectively. The Kaplan-Meier product limit method was used to estimate freedom from toxicity. Results: Men who had TURP prior to PT had lower EPIC scores at baseline and at all followup points for urinary function, urinary incontinence, and urinary summary (Table). The TURP group also had lower EPIC bowel bother, bowel function, and bowel summary at baseline, 6-month, and 1-year followup. EPIC urinary bother, urinary irritation/obstruction, and subscales did not show a statistically significant difference at baseline, but they did show lower scores for the TURP group at variable follow-up time points. The IPSS scores among the TURP group did not show a statistical difference from the non-TURP group, except at the 6-month follow-up time point. Toxicity assessment showed that the 2-year and 3-year cumulative incidence of grade 3 GU toxicity rate in the pretreatment TURP group were 14% and 18%, respectively. Conclusions: Pretreatment TURP was associated with both a high incidence of physician-assessed toxicity and inferior patient-reported QOL scores both before and after PT treatment. Studies investigating QOL and toxicity after specific prostate cancer therapies should stratify patients by pretreatment TURP. Longer follow-up and further evaluation of risk factors for grade 3 GU toxicity among this cohort are needed. [Table: see text]

Squamate prey capture evolved in two general directions; one toward an emphasis upon lingual prehension and the other toward an emphasis upon jaw prehension. In basal squamates (Iguania) lingual prehension characterizes prey capture. All other squamates (Scleroglossa) tend to use their jaws for prey prehension and the role of the tongue as a prehensile organ is reduced. However, within some scleroglossan lizards, lingual and jaw modes of prehension are present Selection of a distinct prehension mode during a feeding bout in these lizards has been hypothesized to be related to prey size. To test for the presence of lingual prehension and correlation with prey size, we examined feeding behavior in the blue-tongued skink, Tiliqua scincoides using two prey types (mealworm and cricket). We confirmed that this skink uses both lingual and jaw modes of prehension with accompanying characteristic jaw kinematic profiles. With crickets, only jaw prehension was exhibited, but both modes were used when feeding on equivalently sized prey, mealworms. Consequently, prehension mode is not exclusively elicited by prey size. We, therefore, hypoth- esize that selection of prehension modes, lingual or jaws, in these basal scleroglossans also includes prox- imate factors related to prey behavior.