Testing the Spousal Model of Stress in Healthy Controls, Persons with Multiple Sclerosis and their Spousal Caregivers

The current study examined the Spousal Model of Stress in a sample of healthy, married controls (n=52) and a sample of persons with multiple sclerosis and their spousal caregivers (n=51). The Spousal Model of Stress was created by joining together Ruben Hill’s (1958) ABCX Model of Stress and Karney & Bradbury’s (1995) Vulnerability- Stress-Adaptation Model of Marriage. Factors in the Spousal Model include stress, resources/vulnerabilities, perceptions/adaptive processes, and outcomes (marital satisfaction, marital quality, life satisfaction, and depression). The new model revealed that spousal attributions were an important factor in predicting marital quality and marital satisfaction in a group of healthy spouses. Life satisfaction and depression in this group was predicted by amount of perceived stress. The Model also revealed that social support was an important factor in predicting marital quality, marital satisfaction, and life satisfaction in a group of persons with MS and their spousal caregivers. Limitations and future directions are discussed

Processing and Transmission of Information

Contains reports on two research projects.National Aeronautics and Space Administration (Grant NGL 22-009-013)U. S. Army Research Office - Durham (Contract DAHC04-71-C-0039

Patient–provider communication data: linking process and outcomes in oncology care

Lisa Kennedy Sheldon1,2, Fangxin Hong3,4, Donna Berry4,51University of Massachusetts Boston, Boston, MA, USA; 2St Joseph Hospital, Nashua, NH, USA; 3Dana-Farber Cancer Institute, Department of Biostatistics and Computational Biology, Boston, MA, USA; 4Dana-Farber Cancer Institute, Phyllis F Cantor Center for Research in Nursing and Patient Care Services, Boston, MA, USA; 5Harvard Medical School, Boston, MA, USAOverview: Patient–provider communication is vital to quality patient care in oncology settings and impacts health outcomes. Newer communication datasets contain patient symptom reports, real-time audiofiles of visits, coded communication data, and visit outcomes. The purpose of this paper is to: (1) review the complex communication processes during patient–provider interaction during oncology care; (2) describe methods of gathering and coding communication data; (3) suggest logical approaches to analyses; and (4) describe one new dataset that allows linking of patient symptoms and communication processes with visit outcomes.Challenges: Patient–provider communication research is complex due to numerous issues, including human subjects’ concerns, methods of data collection, numerous coding schemes, and varying analytic techniques.Data collection and coding: Coding of communication data is determined by the research question(s) and variables of interest. Subsequent coding and timestamping the behaviors provides categorical data and determines the interval between and patterns of behaviors.Analytic approaches: Sequential analyses move from descriptive statistics to explanatory analyses to direct analyses and conditional probabilities. In the final stage, explanatory modeling is used to predict outcomes from communication elements. Examples of patient and provider communication in the ambulatory oncology setting are provided from the new Electronic Self Report Assessment-Cancer II dataset.Summary: More complex communication data sets provide opportunities to link elements of patient–provider communication with visit outcomes. Given more complex datasets, a step-wise approach is necessary to analyze and identify predictive variables. Sequential analyses move from descriptive results to predictive models with communication data, creating links between patient symptoms and concerns, real-time audiotaped communication, and visit outcomes. The results of these analyses will be useful in developing evidence-based interventions to enhance communication and improve psychosocial outcomes in oncology settings.Keywords: communication, analysis, distress, cancer, outcome

An Evaluation of the Kansas Bioscience Authority: Economic Impact Measures

In the fall of 2011, the Kansas Bioscience Authority (KBA) requested that the University of Kansas Center for Science, Technology & Economic Policy at the Institute for Policy & Social Research provide a review of KBA’s Direct Outcomes Description and Measurement Policy. This policy informs KBA's collection of economic impact data and frames KBA’s policies more generally in light of technology evaluation. This report responds to KBA's request and addresses the following topics: 1) general challenges of technology evaluation; 2) the scope of KBA’s technology programs; 3) the contributions of KBA’s current measures to overall program evaluation; 4) measures that might be added or enhanced in the future; and 5) a comparison of this review to other efforts to evaluate KBA. This report discusses the inherent difficulty of measuring long‐term scientific investments with short‐term indicators of future economic impact. KBA has several programs designed to increase bioscience research, foster commercial development, and attract new ventures to the state of Kansas. Each of these activities requires different metrics to evaluate its overall impact. We reviewed these metrics and compared them to those being collected by similar state agencies as well as the federal STAR METRICS program. Our review shows that KBA collects more metrics than agencies reviewed in other states. KBA also collects many of the indicators used in the federal STAR METRICS program. We recommend that KBA enhance its measures by including additional STAR METRICS measures such as patent citations, scientific publications, and workforce development indicators including students trained in bioscience on KBA funded projects. Although, KBA has been reviewed on two previous occasions, this report provides new information on the quality of the economic impact data they collect. Overall, we find that KBA collects a comprehensive set of outcome measures that span the scope of KBA’s mission and provide the basis for understanding the economic impact of their scientific investments

Student-Identified Requirements for Persistence in a Limited Residency Ph.D. Program

The attrition rate for students in traditional doctoral programs hovers around 50%, while students in limited-residency and online programs tend to leave programs at rates 10% to 20% higher. Other than a student’s intrinsic motivation, prior research with the population studied in this program has not uncovered factors that may be predictive of attrition. The goal of this study was to better understand this phenomenon from the perspective of this population. Analysis from interviews with graduates of such a program yielded a set of best practices, focused primarily on assisting students as they prepared for their dissertation. The development and application of policies, procedures and tools based on results of this research may help administrators and faculty address the additional 10% to 20% they have historically experienced

A Grounded Theory of Persistence in a Limited-Residency Doctoral Program

Approximately 50% of doctoral students in social science, humanities, and educational doctoral programs fail to earn their Ph.D. This number is 10% to 15% higher for students enrolled in online or limited-residency programs. Using in-depth interviews and qualitative data analysis techniques, this grounded-theory study examined participants’ recollections of their experience as students in a limited-residency doctoral program and their reasons for withdrawal while working on their dissertation. The resultant theory clarified relationships between attrition and support issues (i.e., advisor support, dissertation process support and program office support). The theoretical model helps identify steps faculty and administration may take in order to reduce high levels of attrition

The role of primary oral healthcare clinicians in the detection and diagnosis of oral and oropharyngeal cancer in New Zealand

Background Oral and oropharyngeal cancer (commonly referred to collectively as oral cancer, or OC) is the sixth most common cancer. Cancer Registry records show that the incidence of OC in New Zealand (NZ) has increased over the last 50 years, and distinct incidence patterns persist by gender, age, ethnicity and anatomical site. Despite advances in treatment, a poor prognosis persists for those diagnosed. Improving survival rates will need better rates of early diagnosis. Little is known about the factors leading to delays in OC diagnosis in NZ or whether clinicians’ deficiencies in knowledge contribute to delays in diagnosis. International studies have observed regular dental care to be associated with an earlier stage of OC diagnosis, but whether this holds in NZ is not known. This study explored factors which may contribute to the stage of diagnosis of OC in NZ. It had two main aims: to assess the OC knowledge, beliefs and practices of NZ dentists and clinical dental technicians (CDTs); and to determine whether regular dental care affects the stage of OC diagnosis in the Canterbury region. Methods A self-administered questionnaire was developed and sent to all general dentists and CDTs registered with the Dental Council of NZ. The questionnaire data were compared with those from the NZ Cancer Registry (cases diagnosed with OC from 1 January 2012 until 31 December 2013), to determine whether clinicians have adequate knowledge to enable early detection of suspicious oral lesions. Data from the OC cases from the Canterbury District Health Board (CDHB) were analysed for associations of tumour extent by regular dental attendance. Results Dental clinicians were found to be knowledgeable about many aspects of OC, but differences in knowledge exist among clinicians, suggesting that some are more able to detect early OCs than others. Time from graduation, the type of clinician and the graduation country may influence some beliefs and practices about OC, thereby affecting clinicians’ ability to detect malignant lesions. Most clinicians reported providing OC screening (OCS) examinations for all patients, but one-third identified barriers to doing so. Consequently, it is likely that a proportion of dentists and CDTs do not provide routine OCS examinations. Non-smokers and those of higher socio-economic status were more likely than others to be routine users of dental care. However, there was a lack of data on the dental history of cases, and so, whether differential access to dental care impacts on stage of diagnosis of OC could not be explored in this study. It was noteworthy that general medical practitioners (GMPs) continue to detect most of the OC in NZ, but their knowledge, beliefs and practices in respect of OC have yet to be explored. Conclusion Missed opportunities for early diagnosis of OC may result from identified deficiencies in dental clinicians’ knowledge of OC, their failure to provide an OCS examination for all patients, and high-risk patients not seeking regular dental care. A better understanding of these is required to increase rates for early diagnosis of OC and ultimately improve patient outcomes

Molecular Subtypes and Personalized Therapy in Metastatic Colorectal Cancer

Development of colorectal cancer occurs via a number of key pathways, with the clinicopathological features of specific subgroups being driven by underlying molecular changes. Mutations in key genes within the network of signalling pathways have been identified; however, therapeutic strategies to target these aberrations remain limited. As understanding of the biology of colorectal cancer has improved, this has led to a move toward broader genomic testing, collaborative research and innovative, adaptive clinical trial design. Recent developments in therapy include the routine adoption of wider mutational spectrum testing prior to use of targeted therapies and the first promise of effective immunotherapy for colorectal cancer patients. This review details current biomarkers in colorectal cancer for molecular stratification and for treatment allocation purposes, including open and planned precision medicine trials. Advances in our understanding, therapeutic strategy and technology will also be outlined

Pediatric Anemia in Rural Ghana: A Cross-Sectional Study of Prevalence and Risk Factors

Summary Objective: To assess anemia prevalence and identify associated parameters in children <3 years of age in a rural area of Ghana. Method: Univariate and multivariate logistic regression of cross-sectional survey results from 861 children aged <3 years attending routine immunization services in Berekum district. Results: Anemia prevalence was 73.1%; most were either mildly (31.2%) or moderately (38.7%) affected. Risk factors for anemia (hemoglobin < 11.0 g/dl) in multivariate analysis were malaria parasitemia and male sex; these factors and younger age were associated with anemia severity. A partial defect in glucose-6-phosphate dehydrogenase was associated with decreased severity. Height-for-age, but not weight-for-age, was associated with anemia and its severity. Conclusions: Malaria parasitemia was strongly associated with anemia and its severity, suggesting that malaria control may be the most effective way to reduce the burden of anemia in rural Ghanaian children