Constructive thinking and coping with stress.

Thesis (M.S.

Past and current emotions and attitudes : how survivors of cancer and heart disease adjusted to their illness.

The purpose of this study was to test the hypothesis that survivors of cancer and especially those who survived beyond medical expectations are more likely to have had a cancer-prone personality before diagnosis that changed in a positive direction some time after diagnosis than heart disease survivors. Three groups of survivors: (1) heart-disease survivors (N = 31), (2) cancer survivors with non-exceptional recoveries (N = 35), and (3) cancer survivors who survived despite less than a 25% expectancy that they would (N = 19) were compared. As hypothesized, both cancer groups exhibited significantly more cancer-prone characteristics before diagnosis than the heart disease group. They converged to a similar point at the present time. There was a tendency for the exceptional survivor group to exhibit more of the cancer-prone characteristics before diagnosis than the other cancer group. When a subsample of exceptional survivors who survived despite a less than 1% expectancy of survival was examined, they exhibited a significantly greater change in personality from before diagnosis to the present time than the remaining cancer groups and the heart disease group. Similar patterns were found on the two subscales of Depression and Anger, suggesting their importance in the Cancer-prone Personality. Demographics and gender were partialled out of the analyses. A path analysis implicating parental relationships in predicting cancer-prone personality and cancer-prone personality in predicting cancer was discussed

What motivates social workers to become field instructors: Perspectives from Canada

The field education component of social work education is critical to the overall development of social work students’ readiness for practice. Field instructors assume great responsibility for the emotional, theoretical, administrative, and clinical development of students who enter field education at either the undergraduate or graduate levels of their social work education. This role is generally subsumed on a voluntary basis concurrent with their occupational responsibilities. The purpose of this study was to explore the factors that motivate social workers to take on the field instructor role. Canadian Field Instructors completed an online survey which included a qualitative question to elicit their perspectives on their motivation for becoming a field instructor. Responses (N=58) were grouped into four themes: mentor social work students, give back to the profession, memories of field instruction, and personal and organizational accountability. Implications for field education and social work education are offered.

Male Reading Teachers: Effects on Inner-city Boys

Eighteen inner-city first and second grade boys participated in a pilot study on the effect of sex of reading teacher on boys’ attitudes toward and performance in reading. Each boy participated with either a male or a female research assistant in a 22-week Paired Reading intervention using texts shown to be of high interest to boys. Findings suggest that these contexts yield significant increases in boys’ reading performance, sense of physiological well-being while reading, and their sense of reading progress regardless of the sex of their reading teacher

Encouraging physician appropriate prescribing of non-steroidal anti-inflammatory therapies: protocol of a randomized controlled trial [ISRCTN43532635]

BACKGROUND: Traditional non-steroidal anti-inflammatory drugs (NSAIDs) are a widely used class of therapy in the treatment of chronic pain and inflammation. The drugs are effective and can be relatively inexpensive thanks to available generic versions. Unfortunately the traditional NSAIDs are associated with gastrointestinal complications in a small proportion of patients, requiring costly co-therapy with gastro-protective agents. Recently, a new class of non-steroidal anti-inflammatory agents known as coxibs has become available, fashioned to be safer than the traditional NSAIDs but priced considerably higher than the traditional generics. To help physicians choose appropriately and cost-effectively from the expanded number of anti-inflammatory therapies, scientific bodies have issued clinical practice guidelines and third party payers have published restricted reimbursement policies. The objective of this study is to determine whether an educational intervention can prompt physicians to adjust their prescribing in accordance with these expert recommendations. METHODS: This is an ongoing, randomized controlled trial. All primary care physicians in Manitoba, Canada have been randomly assigned to a control group or an intervention study group. The educational intervention being evaluated consists of an audit and feedback mechanism combined with optional participation in a Continuing Medical Education interactive workshop. The primary outcome of the study is the change, from pre-to post-intervention, in physicians' appropriate prescribing of non-steroidal anti-inflammatory therapies for patients requiring chronic treatment. Three classes of non-steroidal anti-inflammatory therapies have been identified: coxib therapy, traditional NSAID monotherapy, and traditional NSAID therapy combined with gastro-protective agents. Appropriate prescribing is defined based on international clinical practice guidelines and the provincial drug reimbursement policy in Manitoba

Factors affecting inner-city boys' reading: Are male teachers the answer?

Eighteen inner-city first and second grade boys participated in a pilot study on the effect of sex of reading teacher on boys' attitudes toward and performance in reading. Each boy participated with either male or female research assistants in a 22-week Paired Reading intervention using texts shown to be of high interest to boys. Findings suggest that these contexts yield significant increases in boys' reading performance, sense of physiological well-being while reading, and their sense of reading progress regardless of the sex of their reading teacher. | Dix-huit gar9ons du centre-ville en premiere et deuxieme annee ont participe dans une etude pilote sur les effets du sexe du professeur de lecture sur les attitudes envers et la performance dans la lecture. Chaque gar^on a participe avec ou bien des assistants de recherche male ou femelle dans une intervention de "Paired Reading" de 22 semaines en utilisant des textes prouves d'etre fortement interessant aux gar9ons. La recherche suggere que ces contextes donnent des augmentations signifiantes dans la performance du gar9on dans sa lecture, le sens de bien-etre physiologique pendant la lecture, et un sens de progres dans la lecture peu importe le sexe de l'instmcteur de lecture.http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=1844295

Evolutionary Dynamics of Vibrio cholerae O1 following a Single-Source Introduction to Haiti

ABSTRACT Prior to the epidemic that emerged in Haiti in October of 2010, cholera had not been documented in this country. After its introduction, a strain of Vibrio cholerae O1 spread rapidly throughout Haiti, where it caused over 600,000 cases of disease and >7,500 deaths in the first two years of the epidemic. We applied whole-genome sequencing to a temporal series of V. cholerae isolates from Haiti to gain insight into the mode and tempo of evolution in this isolated population of V. cholerae O1. Phylogenetic and Bayesian analyses supported the hypothesis that all isolates in the sample set diverged from a common ancestor within a time frame that is consistent with epidemiological observations. A pangenome analysis showed nearly homogeneous genomic content, with no evidence of gene acquisition among Haiti isolates. Nine nearly closed genomes assembled from continuous-long-read data showed evidence of genome rearrangements and supported the observation of no gene acquisition among isolates. Thus, intrinsic mutational processes can account for virtually all of the observed genetic polymorphism, with no demonstrable contribution from horizontal gene transfer (HGT). Consistent with this, the 12 Haiti isolates tested by laboratory HGT assays were severely impaired for transformation, although unlike previously characterized noncompetent V. cholerae isolates, each expressed hapR and possessed a functional quorum-sensing system. Continued monitoring of V. cholerae in Haiti will illuminate the processes influencing the origin and fate of genome variants, which will facilitate interpretation of genetic variation in future epidemics

Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients

Limitations in methods for the rapid diagnosis of hospital-acquired infections often delay initiation of effective antimicrobial therapy. New diagnostic approaches offer potential clinical and cost-related improvements in the management of these infections. We developed a decision modeling framework to assess the potential cost-effectiveness of a rapid biomarker assay to identify hospital-acquired infection in high-risk patients earlier than standard diagnostic testing. The framework includes parameters representing rates of infection, rates of delayed appropriate therapy, and impact of delayed therapy on mortality, along with assumptions about diagnostic test characteristics and their impact on delayed therapy and length of stay. Parameter estimates were based on contemporary, published studies and supplemented with data from a four-site, observational, clinical study. Extensive sensitivity analyses were performed. The base-case analysis assumed 17.6% of ventilated patients and 11.2% of nonventilated patients develop hospital-acquired infection and that 28.7% of patients with hospital-acquired infection experience delays in appropriate antibiotic therapy with standard care. We assumed this percentage decreased by 50% (to 14.4%) among patients with true-positive results and increased by 50% (to 43.1%) among patients with false-negative results using a hypothetical biomarker assay. Cost of testing was set at $110/d. In the base-case analysis, among ventilated patients, daily diagnostic testing starting on admission reduced inpatient mortality from 12.3 to 11.9$1,640 per patient, resulting in an incremental cost-effectiveness ratio of $21,389 per life-year saved. Among nonventilated patients, inpatient mortality decreased from 7.3 to 7.1$1,381 with diagnostic testing. The resulting incremental cost-effectiveness ratio was $42,325 per life-year saved. Threshold analyses revealed the probabilities of developing hospital-acquired infection in ventilated and nonventilated patients could be as low as 8.4 and 9.8$50,000 per life-year saved. Development and use of serial diagnostic testing that reduces the proportion of patients with delays in appropriate antibiotic therapy for hospital-acquired infections could reduce inpatient mortality. The model presented here offers a cost-effectiveness framework for future test development

Implications of the Nucleocapsid and the Microenvironment in Retroviral Reverse Transcription

This mini-review summarizes the process of reverse-transcription, an obligatory step in retrovirus replication during which the retroviral RNA/DNA-dependent DNA polymerase (RT) copies the single-stranded genomic RNA to generate the double-stranded viral DNA while degrading the genomic RNA via its associated RNase H activity. The hybridization of complementary viral sequences by the nucleocapsid protein (NC) receives a special focus, since it acts to chaperone the strand transfers obligatory for synthesis of the complete viral DNA and flanking long terminal repeats (LTR). Since the physiological microenvironment can impact on reverse-transcription, this mini-review also focuses on factors present in the intra-cellular or extra-cellular milieu that can drastically influence both the timing and the activity of reverse-transcription and hence virus infectivity