A study of the relationship between a child's achievement and adjustment in grades one and three.

Thesis (Ed.M.)--Boston Universit

Breast cancer distant recurrence lead time interval by detection method in an institutional cohort.

BACKGROUND: Lead time, the interval between screen detection and when a disease would have become clinically evident, has been cited to explain longer survival times in mammography detected breast cancer cases (BC). METHODS: An institutional retrospective cohort study of BC outcomes related to detection method (mammography (MamD) vs. patient (PtD)). Cases were first primary invasive stage I-III BC, age 40-74 years (n = 6603), 1999-2016. Survival time was divided into 1) distant disease-free interval (DDFI) and 2) distant disease-specific survival (DDSS) as two separate time interval outcomes. We measured statistical association between detection method and diagnostic, treatment and outcome variables using bivariate comparisons, Cox proportional hazards analyses and mean comparisons. Outcomes were distant recurrence (n = 422), DDFI and DDSS. RESULTS: 39% of cases were PtD (n = 2566) and 61% were MamD (n = 4037). MamD cases had a higher percentage of Stage I tumors [MamD 69% stage I vs. PtD 31%, p \u3c .001]. Rate of distant recurrence was 11% among PtD BC cases (n = 289) vs. 3% of MamD (n = 133) (p \u3c .001). Order of factor entry into the distant recurrence time interval (DDFI) model was 1) TNM stage (p \u3c .001), 2) HR/HER2 status (p \u3c .001), 3) histologic grade (p = .005) and 4) detection method (p \u3c .001). Unadjusted PtD DDFI mean time was 4.34 years and MamD 5.52 years (p \u3c .001), however when stratified by stage, the most significant factor relative to distant recurrence, there was no significant difference between PtD and MamD BC. Distant disease specific survival time did not differ by detection method. CONCLUSION: We observed breast cancer distant disease-free interval to be primarily associated with stage at diagnosis and tumor characteristics with less contribution of detection method to the full model. Patient and mammography detected breast cancer mean lead time to distant recurrence differed significantly by detection method for all stages but not significantly within stage with no difference in time from distant recurrence to death. Lead time difference related to detection method appears to be present but may be less influential than other factors in distant disease-free and disease specific survival

Use of Subsistence-Harvested Whale Carcasses by Polar Bears in the Southern Beaufort Sea

The availability of a food subsidy has the potential to influence the condition, behavior, fitness, and population dynamics of a species. Since the early 2000s, monitoring efforts along the coast of northern Alaska have indicated a higher proportion of polar bears (Ursus maritimus) of the southern Beaufort Sea (SB) subpopulation coming onshore to feed on subsistence-harvested bowhead whale (Balaena mysticetus) carcasses during the fall and early winter seasons. Concurrently, Indigenous communities annually hunt bowhead whale and deposit the unused remains at localized “bone piles,” creating the potential for human-bear interactions. Our objective was to determine the annual number of polar bears feeding at the bone pile near Kaktovik, Alaska. Using a hair snag surrounding the bone pile, we collected hair samples to identify individual bears via microsatellite genotypes during 2011 – 14. We used capture-mark-recapture data in the POPAN open-population model to estimate the number of bears visiting the bone pile. We estimated that as many as 72 (SE = 9) and 76 (SE = 10) male and female polar bears, respectively, used the bone pile located at Kaktovik, Alaska, in 2012, which represents approximately 16% of the SB polar bear subpopulation. It will be important to monitor the number of bears using the bone pile and subsequent human-bear interactions and conflicts along the northern coast of Alaska, if sea ice continues to recede.L’existence de subventions alimentaires a la possibilité d’influencer l’état, le comportement, la condition physique et la dynamique de la population d’une espèce. Depuis le début des années 2000, les efforts de surveillance déployés sur la côte nord de l’Alaska ont laissé entrevoir une plus grande proportion d’ours polaires (Ursus maritimus) de la sous-population du sud de la mer de Beaufort venant sur le littoral pour manger les carcasses des baleines boréales (Balaena mysticetus) pêchées à des fins de subsistance pendant les saisons de l’automne et du début de l’hiver. En même temps, les collectivités autochtones chassent les baleines boréales tous les ans et déposent leurs restes dans des « tas d’ossements », ce qui crée la possibilité d’interactions entre les humains et les ours. Notre objectif consistait à déterminer le nombre annuel d’ours polaires qui s’alimentent au tas d’ossements situé près de Kaktovik, en Alaska. De 2011 à 2014, à l’aide d’un piège à poils placé près du tas d’ossements, nous avons recueilli des échantillons de poils afin d’identifier les ours individuels au moyen de génotypes microsatellites. Nous avons employé les données de capture-marquage-recapture du modèle de population ouverte POPAN pour estimer le nombre d’ours se rendant au tas d’ossements. Nous avons estimé que jusqu’à 72 (ET = 9) et 76 (ET = 10) ours polaires mâles et femelles, respectivement, ont utilisé le tas d’ossements de Kaktovik, en Alaska, en 2012, ce qui représente environ 16 % de la sous-population d’ours polaires du sud de la mer de Beaufort. Il sera important de surveiller le nombre d’ours qui utilisent le tas d’ossements de même que les interactions et les conflits entre les humains et les ours qui s’ensuivront sur la côte nord de l’Alaska si la glace de mer continue de reculer

CHESS Improves Cancer Caregivers\u27 Burden and Mood: Results of an eHealth RCT

OBJECTIVE: Informal caregivers (family and friends) of people with cancer are often unprepared for their caregiving role, leading to increased burden or distress. Comprehensive Health Enhancement Support System (CHESS) is a Web-based lung cancer information, communication, and coaching system for caregivers. This randomized trial reports the impact on caregiver burden, disruptiveness, and mood of providing caregivers access to CHESS versus the Internet with a list of recommended lung cancer websites. METHODS: A total of 285 informal caregivers of patients with advanced nonsmall cell lung cancer were randomly assigned to a comparison group that received Internet or a treatment group that received Internet and CHESS. Caregivers were provided a computer and Internet service if needed. Written surveys were completed at pretest and during the intervention period bimonthly for up to 24 months. Analyses of covariance (ANCOVAs) compared the intervention\u27s effect on caregivers\u27 disruptiveness and burden (CQOLI-C), and negative mood (combined Anxiety, Depression, and Anger scales of the POMS) at 6 months, controlling for blocking variables (site, caregiver\u27s race, and relationship to patient) and the given outcome at pretest. RESULTS: Caregivers randomized to CHESS reported lower burden, t(84) = 2.36, p = .021, d = .39, and negative mood, t(86) = 2.82, p = .006, d = .44, than those in the Internet group. The effect on disruptiveness was not significant. CONCLUSIONS: Although caring for someone with a terminal illness will always exact a toll on caregivers, eHealth interventions like CHESS may improve caregivers\u27 understanding and coping skills and, as a result, ease their burden and mood

An eHealth System Supporting Palliative Care for Patients with Non-Small Cell Lung Cancer: A Randomized Trial

BACKGROUND: In this study, the authors examined the effectiveness of an online support system (Comprehensive Health Enhancement Support System [CHESS]) versus the Internet in relieving physical symptom distress in patients with non-small cell lung cancer (NSCLC). METHODS: In total, 285 informal caregiver-patient dyads were assigned randomly to receive, for up to 25 months, standard care plus training on and access to either use of the Internet and a list of Internet sites about lung cancer (the Internet arm) or CHESS (the CHESS arm). Caregivers agreed to use CHESS or the Internet and to complete bimonthly surveys; for patients, these tasks were optional. The primary endpoint-patient symptom distress-was measured by caregiver reports using a modified Edmonton Symptom Assessment Scale. RESULTS: Caregivers in the CHESS arm consistently reported lower patient physical symptom distress than caregivers in the Internet arm. Significant differences were observed at 4 months (P = .031; Cohen d = .42) and at 6 months (P = .004; d = .61). Similar but marginally significant effects were observed at 2 months (P = .051; d = .39) and at 8 months (P = .061; d = .43). Exploratory analyses indicated that survival curves did not differ significantly between the arms (log-rank P = .172), although a survival difference in an exploratory subgroup analysis suggested an avenue for further study. CONCLUSIONS: The current results indicated that an online support system may reduce patient symptom distress. The effect on survival bears further investigation

Remote sensing for cost-effective blue carbon accounting

Blue carbon ecosystems (BCE) include mangrove forests, tidal marshes, and seagrass meadows, all of which are currently under threat, putting their contribution to mitigating climate change at risk. Although certain challenges and trade-offs exist, remote sensing offers a promising avenue for transparent, replicable, and cost-effective accounting of many BCE at unprecedented temporal and spatial scales. The United Nations Framework Convention on Climate Change (UNFCCC) has issued guidelines for developing blue carbon inventories to incorporate into Nationally Determined Contributions (NDCs). Yet, there is little guidance on remote sensing techniques for monitoring, reporting, and verifying blue carbon assets. This review constructs a unified roadmap for applying remote sensing technologies to develop cost-effective carbon inventories for BCE – from local to global scales. We summarise and discuss (1) current standard guidelines for blue carbon inventories; (2) traditional and cutting-edge remote sensing technologies for mapping blue carbon habitats; (3) methods for translating habitat maps into carbon estimates; and (4) a decision tree to assist users in determining the most suitable approach depending on their areas of interest, budget, and required accuracy of blue carbon assessment. We designed this work to support UNFCCC-approved IPCC guidelines with specific recommendations on remote sensing techniques for GHG inventories. Overall, remote sensing technologies are robust and cost-effective tools for monitoring, reporting, and verifying blue carbon assets and projects. Increased appreciation of these techniques can promote a technological shift towards greater policy and industry uptake, enhancing the scalability of blue carbon as a Natural Climate Solution worldwide

Sustainment of the TeleSleep program for rural veterans

BackgroundIn fiscal year 2021, the Veterans Health Administration (VHA) provided care for sleep disorders to 599,966 Veterans, including 189,932 rural Veterans. To further improve rural access, the VA Office of Rural Health developed the TeleSleep Enterprise-Wide Initiative (EWI). TeleSleep's telemedicine strategies include tests for sleep apnea at the Veteran's home rather than in a sleep lab; Clinical Video Telehealth applications; and other forms of virtual care. In 2017 and 2020, VHA provided 3-year start-up funding to launch new TeleSleep programs at rural-serving VA medical facilities.MethodsIn early 2022, we surveyed leaders of 24 sites that received TeleSleep funding to identify successes, failures, facilitators, and barriers relevant to sustaining TeleSleep implementations upon expiration of startup funding. We tabulated frequencies on the multiple choice questions in the survey, and, using the survey's critical incident framework, summarized the responses to open-ended questions. TeleSleep program leaders discussed the responses and synthesized recommendations for improvement.Results18 sites reported sustainment, while six were “on track.” Sustainment involved medical centers or regional entities incorporating TeleSleep into their budgets. Facilitators included: demonstrating value; aligning with local priorities; and collaborating with spoke sites serving rural Veterans. Barriers included: misalignment with local priorities; and hiring delays. COVID was a facilitator, as it stimulated adoption of telehealth practices; and also a barrier, as it consumed attention and resources. Recommendations included: longer startup funding; dedicated funding for human resources to accelerate hiring; funders communicating with local facility leaders regarding how TeleSleep aligns with organizational priorities; hiring into job classifications aligned with market pay; and obtaining, from finance departments, projections and outcomes for the return on investment in TeleSleep

Expressions 1992

https://openspace.dmacc.edu/expressions/1014/thumbnail.jp