What Couples Say about Their Recovery of Sexual Intimacy after Prostatectomy: Toward the Development of a Conceptual Model of Couples' Sexual Recovery after Surgery for Prostate Cancer

IntroductionInterventions designed to help couples recover sexual intimacy after prostatectomy have not been guided by a comprehensive conceptual model.AimWe examined a proposed biopsychosocial conceptual model of couples' sexual recovery that included functional, psychological, and relational aspects of sexuality, surgery‐related sexual losses, and grief and mourning as recovery process.MethodsWe interviewed 20 couples preoperatively and 3 months postoperatively. between 2010 and 2012. Interviews were analyzed with Analytic Induction qualitative methodology, using NVivo software. Paired t‐tests described functional assessment data. Study findings led to a revised conceptual model.Main Outcome MeasuresCouples' experiences were assessed through semi‐structured interviews; male participants' sexual function was assessed with the Expanded Prostate Cancer Index Composite and female participants' sexual function with the Female Sexual Function Index.ResultsPreoperatively, 30% of men had erectile dysfunction (ED) and 84% of partners were postmenopausal. All valued sexual recovery, but worried about cancer spread and surgery side effects. Faith in themselves and their surgeons led 90% of couples to overestimate erectile recovery. Postoperatively, most men had ED and lost confidence. Couples' sexual activity decreased. Couples reported feeling loss and grief: cancer diagnosis was the first loss, followed by surgery‐related sexual losses. Couples' engagement in intentional sex, patients' acceptance of erectile aids, and partners' interest in sex aided the recovery of couples' sexual intimacy recovery. Unselfconscious sex, not returning to erectile function baseline, was seen as the end point. Survey findings documented participants' sexual function losses, confirming qualitative findings.ConclusionsCouples' sexual recovery requires addressing sexual function, feelings about losses, and relationship simultaneously. Perioperative education should emphasize the roles of nerve damage in ED and grief and mourning in sexual recovery. Wittmann D, Carolan M, Given B, Skolarus TA, Crossley H, An L, Palapattu G, Clark P, and Montie JE. What couples say about their recovery of sexual intimacy after prostatectomy: Toward the development of a conceptual model of couples' sexual recovery after surgery for prostate cancer. J Sex Med 2015;12:494–504.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110610/1/jsm12732.pd

Developmental plasticity of cardiac anoxia-tolerance in juvenile common snapping turtles ( Chelydra serpentina)

Article describes study which tested the hypothesis that developmental hypoxia alters cardiomyocyte physiology in a manner that protects the heart from hypoxic stress

Clinical faculty associates serving as hybrid teacher educators: Personal and professional impacts

BackgroundUniversity supervisors in teacher education assume a complex and demanding role, which is essential to the development of prospective teachers, but is often underappreciated or ignored.AimThis descriptive study was designed to explore former clinical faculty associates’ (CFAs’) perceptions of the challenges and opportunities inherent in their work as CFAs, and the influence of this experience on their future professional work.Materials and methodsUsing survey research methodology, followed by selected individual interviews, this paper focuses on the experiences of CFAs, highly respected PK-6 teachers employed by the university for 2–3 years to serve as university supervisors.Results and conclusionAlthough participants reported facing several professional and personal challenges as CFAs, they also described opportunities to participate in a wide variety of professional experiences that positively impacted their future work. Furthermore, most reported feeling the CFA experience was professionally renewing and brought opportunities to build strong personal and professional relationships that cross institutional boundaries

Extended Sentinel Monitoring of Helicoverpa zea Resistance to Cry and Vip3Aa Toxins in Bt Sweet Corn: Assessing Changes in Phenotypic and Allele Frequencies of Resistance

Transgenic corn and cotton that produce Cry and Vip3Aa toxins derived from Bacillus thuringiensis (Bt) are widely planted in the United States to control lepidopteran pests. The sustainability of these Bt crops is threatened because the corn earworm/bollworm, Helicoverpa zea (Boddie), is evolving a resistance to these toxins. Using Bt sweet corn as a sentinel plant to monitor the evolution of resistance, collaborators established 146 trials in twenty-five states and five Canadian provinces during 2020–2022. The study evaluated overall changes in the phenotypic frequency of resistance (the ratio of larval densities in Bt ears relative to densities in non-Bt ears) in H. zea populations and the range of resistance allele frequencies for Cry1Ab and Vip3Aa. The results revealed a widespread resistance to Cry1Ab, Cry2Ab2, and Cry1A.105 Cry toxins, with higher numbers of larvae surviving in Bt ears than in non-Bt ears at many trial locations. Depending on assumptions about the inheritance of resistance, allele frequencies for Cry1Ab ranged from 0.465 (dominant resistance) to 0.995 (recessive resistance). Although Vip3Aa provided high control efficacy against H. zea, the results show a notable increase in ear damage and a number of surviving older larvae, particularly at southern locations. Assuming recessive resistance, the estimated resistance allele frequencies for Vip3Aa ranged from 0.115 in the Gulf states to 0.032 at more northern locations. These findings indicate that better resistance management practices are urgently needed to sustain efficacy the of corn and cotton that produce Vip3Aa

Racial differences in breast cancer survival in the Detroit Metropolitan area

African American (AA) women have poorer breast cancer survival compared to Caucasian American (CA) women. The purpose of this analysis was to determine whether socioeconomic status (SES) and treatment differences influence racial differences in breast cancer survival . The study population included 9,321 women (82% CA, 18% AA) diagnosed with local (63%) or regional (37%) stage disease between 1988 and 1992, identified through the Metropolitan Detroit SEER registry. Data on SES were obtained through linkage with the 1990 Census of Population and Housing Summary Tape and cases were geocoded to census block groups. Pathology, treatment and survival data were obtained through SEER. Cox proportional hazards models were used to compare survival for AA versus CA women after adjusting for age, SES, tumor size, number of involved lymph nodes, and treatment. AA␣women were more likely to live in a geographic area classified as working poor than were CA women ( p <0.001). AA women were less likely to have lumpectomy and radiation and more likely to have mastectomy with radiation ( p <0.001). After multivariable adjusted analysis, there were no significant racial differences in survival among women with local stage disease, although AA women with regional stage disease had persistent but attenuated poorer survival compared to CA women. After adjusting for known clinical and SES predictors of survival, AA and CA women who are diagnosed with local disease demonstrate similar overall and breast cancer-specific survival, while race continues to have an independent effect among women presenting at a later stage of disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44238/1/10549_2005_Article_9103.pd

Use of biomarkers and surrogate endpoints in health technology assessment (HTA): efficient decision-making for allocation of pharmacological treatment strategies in subpopulations of metastatic colorectal cancer patients

When evaluating new cancer therapies in clinical trials, it may take significant time toestimate their effectiveness on overall survival (OS), which is typically an outcome of central interest to regulatory decision-makers. To expedite access to new therapies for patients, regulatory agencies often make their decisions based on treatment effectiveness measured on surrogate outcomes, such as progression free survival (PFS) or tumour response (TR). For such decisions to be robust, a surrogate endpoint needs to be a valid predictor of OS. The aim of the thesis was to investigate the impact of a treatment’s mechanism of action and patients’ Kirsten rat sarcoma (KRAS) status on surrogacy patterns in metastatic colorectal cancer (mCRC). Putative surrogate endpoints considered here were PFS as a surrogate endpoint for OS, and TR as a surrogate for PFS and OS. The surrogate relationships were evaluated across all RCTs, by KRAS status, treatment class, and treatment contrast; using a range of bivariate meta-analytic methods for surrogate endpoint evaluation. A case study in mCRC was used to explore the potential benefits that borrowing of information across trials and treatment classes can provide to inform decision-making. PFS appeared to be a good surrogate endpoint for OS. The surrogate relationship for TR with PFS and OS varied from exhibiting moderate evidence to no evidence to support a surrogate relationship depending on the data set. There was some evidence of the impact of the mechanism of action on the strength of the surrogacy patterns in mCRC, but little evidence of the impact of KRAS status on the validity of surrogate endpoints. The use of these methods within a health technology assessment setting can be beneficial for confirming the validity of a surrogate endpoint, making predictions for OS, and ultimately allowing a trial with premature or no OS data to be assessed by decision-making bodies.</p

Relative Importance of T-Cell Subsets in Monocytotropic Ehrlichiosis: a Novel Effector Mechanism Involved in Ehrlichia-Induced Immunopathology in Murine Ehrlichiosis▿

Infection with gram-negative monocytotropic Ehrlichia strains results in a fatal toxic shock-like syndrome characterized by a decreased number of Ehrlichia-specific CD4+ Th1 cells, the expansion of tumor necrosis factor alpha (TNF-α)-producing CD8+ T cells, and the systemic overproduction of interleukin-10 (IL-10) and TNF-α. Here, we investigated the role of CD4+ and CD8+ T cells in immunity to Ehrlichia and the pathogenesis of fatal ehrlichiosis caused by infection with low- and high-dose (103 and 105 bacterial genomes/mouse, respectively) ehrlichial inocula. The CD4+ T-cell-deficient mice showed exacerbated susceptibility to a lethal high- or low-dose infection and harbored higher bacterial numbers than did wild-type (WT) mice. Interestingly, the CD8+ T-cell-deficient mice were resistant to a low dose but succumbed to a high dose of Ehrlichia. The absence of CD8+ T cells abrogated TNF-α and IL-10 production, reduced tissue injury and bacterial burden, restored splenic CD4+ T-cell numbers, and increased the frequency of Ehrlichia-specific CD4+ Th1 cells in comparison to infected WT mice. Although fatal disease is perforin independent, our data suggested that perforin played a critical role in controlling bacterial burden and mediating liver injury. Similar to WT mice, mortality of infected perforin-deficient mice was associated with CD4+ T-cell apoptosis and a high serum concentration of IL-10. Depletion of IL-10 restored the number of CD4+ and CD8+ T cells in infected WT mice. Our data demonstrate a novel mechanism of immunopathology in which CD8+ T cells mediate Ehrlichia-induced toxic shock, which is associated with IL-10 overproduction and CD4+ T-cell apoptosis