Here Today, Gone Tomorrow: Understanding Freshman Attrition Using Person-Environment Fit Theory

Person-Environment (PE) fit theory was used to explore the relationship between student involvement and freshman retention. Incoming freshmen (N=382) were followed longitudinally in a twowave panel study, the summer before beginning college, and again during the spring of their freshman year. Involvement levels, a variety of summer and spring preferences (Ps), and spring perceptions (Es) regarding specific aspects of their college environment were assessed. Twelve PE fit indicators were derived and compared with respect to their relationship with student involvement and retention. Results indicated that involvement was linked to some PE fit indicators. Traditional parametric statistical analyses were compared with a new, nonparametric technique, Classification Tree Analysis (CTA), to identify the most accurate classification model for use in designing potential attrition interventions. Discriminant analysis was 14% more accurate than CTA in classifying returners (97% vs. 85%), but CTA was 962% more accurate classifying dropouts (8% vs. 84%). CTA identified nine clusters— five of returners and four of dropouts, revealing that different subgroups of freshmen chose to return (and stay) for different reasons. Students’ end-of-the-year preferences appear to be more important than anticipated preferences, college perceptions, or PE fit level

The Chemical Evolution of the Galactic Bulge

This science white paper addresses the issue of discovering the chemical evolution of the Galactic bulge, from which we may learn the initial mass function at the time of the formation of the bulge, the timescale for the initial burst of star formation, any evidence supporting an extended era of star formation, evidence of very early mergers of massive subcomponents, and the fraction of its mass that was contributed by late mergers. A further immediate problem concerns the composition of dwarfs measured from microlensing events versus the abundance scale measured from giants. A companion White Paper (Clarkson & Rich) addresses a set of bulge science questions that require observations at very high angular resolution

Patient prioritization of comorbid chronic conditions in the Veteran population: Implications for patient-centered care

OBJECTIVE: Patients with comorbid chronic conditions may prioritize some conditions over others; however, our understanding of factors influencing those prioritizations is limited. In this study, we sought to identify and elaborate a range of factors that influence how and why patients with comorbid chronic conditions prioritize their conditions. METHODS: We conducted semi-structured, one-on-one interviews with 33 patients with comorbidities recruited from a single Veterans Health Administration Medical Center. FINDINGS: The diverse factors influencing condition prioritization reflected three overarching themes: (1) the perceived role of a condition in the body, (2) self-management tasks, and (3) pain. In addition to these themes, participants described the rankings that they believed their healthcare providers would assign to their conditions as an influencing factor, although few reported having shared their priorities or explicitly talking with providers about the importance of their conditions. CONCLUSION: Studies that advance understanding of how and why patients prioritize their various conditions are essential to providing care that is patient-centered, reflecting what matters most to the individual while improving their health. This analysis informs guideline development efforts for the care of patients with comorbid chronic conditions as well as the creation of tools to promote patient-provider communication regarding the importance placed on different conditions

Multicomponent frailty assessment tools for older people with psychiatric disorders: a systematic review

Objective: To review evidence evaluating the use of multi-component frailty assessment tools in assessing frailty in older adults with psychiatric disorders. Methods: A systematic literature review was conducted to identify all multi-component frailty assessment tools (i.e. a tool that assesses ≥2 indicators of frailty). The items of each frailty assessment tool were compared to DSM-5 diagnostic criteria for psychiatric disorders to assess construct overlap. Studies conducted in community, inpatient and outpatient clinical settings were considered for inclusion. Participants: Adults aged ≥60 years old. Results: 5,639 studies in total were identified following the removal of duplicates; 97 of which were included for review. Of the 48 multi-component frailty assessment tools identified, no tool had been developed for, or validated in, older adult populations with psychiatric disorder. 24/48 frailty assessment tools contained a psychological assessment domain, with 18/48 tools using presence of depressed mood and/or anxiety as a frailty indicator. Common areas of construct overlap in frailty assessment tools and DSM-5 diagnostic criteria included weight loss (29/48) and fatigue (21/48). Conclusions: Significant construct overlap exists between the indicators of frailty as conceptualised in existing frailty assessment tools and DSM-5 diagnostic criteria for common psychiatric disorders, including Major Depressive Episode and Generalised Anxiety Disorder, which has the potential to confound frailty assessment results. Further research is necessary to establish a reliable and valid tool to assess frailty in this population

SPIRITS 15c and SPIRITS 14buu: Two Obscured Supernovae in the Nearby Star-Forming Galaxy IC 2163

SPIRITS---SPitzer InfraRed Intensive Transients Survey---is an ongoing survey of nearby galaxies searching for infrared (IR) transients with Spitzer/IRAC. We present the discovery and follow-up observations of one of our most luminous ($M_{[4.5]} = -17.1\pm0.4$ mag, Vega) and red ($[3.6] - [4.5] = 3.0 \pm 0.2$ mag) transients, SPIRITS 15c. The transient was detected in a dusty spiral arm of IC 2163 ($D\approx35.5$ Mpc). Pre-discovery ground-based imaging revealed an associated, shorter-duration transient in the optical and near-IR (NIR). NIR spectroscopy showed a broad ($\approx 8400$ km s$^{-1}$), double-peaked emission line of He I at $1.083 \mu$m, indicating an explosive origin. The NIR spectrum of SPIRITS 15c is similar to that of the Type IIb SN 2011dh at a phase of $\approx 200$ days. Assuming $A_V = 2.2$ mag of extinction in SPIRITS 15c provides a good match between their optical light curves. The IR light curves and the extreme $[3.6]-[4.5]$ color cannot be explained using only a standard extinction law. Another luminous ($M_{4.5} = -16.1\pm0.4$ mag) event, SPIRITS 14buu, was serendipitously discovered in the same galaxy. The source displays an optical plateau lasting $\gtrsim 80$ days, and we suggest a scenario similar to the low-luminosity Type IIP SN 2005cs obscured by $A_V \approx 1.5$ mag. Other classes of IR-luminous transients can likely be ruled out in both cases. If both events are indeed SNe, this may suggest $\gtrsim 18\%$ of nearby core-collapse SNe are missed by currently operating optical surveys.Comment: 19 pages, 7 Figures, 4 Table

Chemical Composition of Faint (I~21 mag) Microlensed Bulge Dwarf OGLE-2007-BLG-514S

We present a high-resolution spectrum of a microlensed G dwarf in the Galactic bulge with spectroscopic temperature T_eff = 5600 +/- 180 K. This I~21 mag star was magnified by a factor ranging from 1160 to 1300 at the time of observation. Its high metallicity ([Fe/H] = 0.33 +/- 0.15) places this star at the upper end of the bulge giant metallicity distribution. Using a K-S test, we find a 1.6% probability that the published microlensed bulge dwarfs share an underlying distribution with bulge giants, properly accounting for a radial bulge metallicity gradient. We obtain abundance measurements for 15 elements and perform a rigorous error analysis that includes covariances between parameters. This star, like bulge giants with the same metallicity, shows no alpha enhancement. It confirms the chemical abundance trends observed in previously analyzed bulge dwarfs. At supersolar metallicities, we observe a discrepancy between bulge giant and bulge dwarf Na abundances.Comment: 13 pages, 8 figures, 5 tables, submitted to Ap

Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation

Stakeholder engagement has become widely accepted as a necessary component of guideline development and implementation. While frameworks for developing guidelines express the need for those potentially affected by guideline recommendations to be involved in their development, there is a lack of consensus on how this should be done in practice. Further, there is a lack of guidance on how to equitably and meaningfully engage multiple stakeholders. We aim to develop guidance for the meaningful and equitable engagement of multiple stakeholders in guideline development and implementation. METHODS: This will be a multi-stage project. The first stage is to conduct a series of four systematic reviews. These will (1) describe existing guidance and methods for stakeholder engagement in guideline development and implementation, (2) characterize barriers and facilitators to stakeholder engagement in guideline development and implementation, (3) explore the impact of stakeholder engagement on guideline development and implementation, and (4) identify issues related to conflicts of interest when engaging multiple stakeholders in guideline development and implementation. DISCUSSION: We will collaborate with our multiple and diverse stakeholders to develop guidance for multi-stakeholder engagement in guideline development and implementation. We will use the results of the systematic reviews to develop a candidate list of draft guidance recommendations and will seek broad feedback on the draft guidance via an online survey of guideline developers and external stakeholders. An invited group of representatives from all stakeholder groups will discuss the results of the survey at a consensus meeting which will inform the development of the final guidance papers. Our overall goal is to improve the development of guidelines through meaningful and equitable multi-stakeholder engagement, and subsequently to improve health outcomes and reduce inequities in health

Phase I Safety, Pharmacokinetics, and Clinical Activity Study of Lapatinib (GW572016), a Reversible Dual Inhibitor of Epidermal Growth Factor Receptor Tyrosine Kinases, in Heavily Pretreated Patients With Metastatic Carcinomas

PURPOSE: This study (EGF10004) assessed the safety/tolerability, pharmacokinetics, and clinical activity of daily oral dosing with lapatinib (GW572016) in patients with ErbB1-expressing and/or ErbB2-overexpressing advanced-stage refractory solid tumors. PATIENTS AND METHODS: Heavily pretreated patients with ErbB1-expressing and/or ErbB2-overexpressing metastatic cancers were randomly assigned to one of five dose cohorts of lapatinib administered once daily. Pharmacokinetic samples were obtained on days 1 and 20. Clinical response was assessed every 8 weeks. RESULTS: Sixty-seven patients with metastatic solid tumors were treated with lapatinib. The most frequently reported drug-related adverse events were diarrhea (42%) and rash (31%). No grade 4 drug-related adverse events were reported. Five grade 3 drug-related toxicities (gastrointestinal events and rash) were experienced by four patients. Drug-related interstitial pneumonitis or cardiac dysfunction associated with other ErbB-targeted therapies was not reported. Four patients with trastuzumab-resistant metastatic breast cancer-two of whom were classified as having inflammatory breast cancer-had partial responses (PRs). Twenty-four patients with various other carcinomas experienced stable disease, of whom 10 received lapatinib for > or = 6 months. The relationships between lapatinib dose or serum concentration and clinical response could not be adequately characterized due to the limited response data. The incidence of diarrhea increased with increasing dose, whereas the incidence of rash was not related to dose. CONCLUSION: Lapatinib was well tolerated at doses ranging from 500 to 1,600 mg once daily. Clinical activity was observed in heavily pretreated patients with ErbB1-expressing and/or ErbB2-overexpressing metastatic cancers, including four PRs in patients with trastuzumab-resistant breast cancers and prolonged stable disease in 10 patients