AN EXTENSION OF THE RISK PERCEPTION ATTITUDE (RPA) FRAMEWORK: EXAMINING THE RELATIONSHIPS BETWEEN THINKING STYLE, LOCUS OF CONTROL, ANXIETY, AND INFORMATION SEEKING

The purpose of this dissertation was to reexamine the effects of psychological determinants, specifically risk perceptions and self-efficacy beliefs as predicted by the Risk Perception Attitude Framework (RPA) (Rimal & Real, 2003) on anxiety, information seeking behavior, and knowledge acquisition. Additional goals of this dissertation were to test anxiety as a mediating variable between RPA group membership and information seeking, as well as between RPA group membership and knowledge acquisition; to begin to understand what types of information each of the RPA groups seek; and to test the RPA framework as a model. Furthermore, this dissertation extended the RPA framework by incorporating the effects of cognitive processing, namely thinking style (Nisbett, Peng, Choi, & Norenzayan, 2001) and locus of control (Rotter, 1954) on anxiety to increase the predictive power of the RPA framework model. After conducting a pilot test, it was determined that the context of the experimental messages would be about human papillomavirus (HPV). The data supported the hypotheses that those in the anxious group (individuals with high risk perceptions and low self efficacy beliefs) experienced higher levels of anxiety than the other groups, that the RPA framework was a viable model for predicting information seeking and knowledge acquisition, and finally, that cognitive processing (i.e. thinking style and locus of control) increased the predictive power of the RPA framework. However, the data indicated that that the relationship between RPA group membership (based on an interaction between perceived risk and self efficacy beliefs) and HPV information seeking, as well as knowledge acquisition was not mediated by anxiety. Participants who engaged in HPV information seeking were predominantly interested in finding out general information regarding the virus, rather than specific to risk or efficacy information. Limitations, implications, practical application and future directions are discussed

Radiotherapy and temozolomide for newly diagnosed glioblastoma and anaplastic astrocytoma: validation of Radiation Therapy Oncology Group-Recursive Partitioning Analysis in the IMRT and temozolomide era

Since the development of the Radiation Therapy Oncology Group-Recursive Partitioning Analysis (RTOG-RPA) risk classes for high-grade glioma, radiation therapy in combination with temozolomide (TMZ) has become standard care. While this combination has improved survival, the prognosis remains poor in the majority of patients. Therefore, strong interest in high-grade gliomas from basic research to clinical trials persists. We sought to evaluate whether the current RTOG-RPA retains prognostic significance in the TMZ era or alternatively, if modifications better prognosticate the optimal selection of patients with similar baseline prognosis for future clinical protocols. The records of 159 patients with newly-diagnosed glioblastoma (GBM, WHO grade IV) or anaplastic astrocytoma (AA, WHO grade III) were reviewed. Patients were treated with intensity-modulated radiation therapy (IMRT) and concurrent followed by adjuvant TMZ (n = 154) or adjuvant TMZ only (n = 5). The primary endpoint was overall survival. Three separate analyses were performed: (1) application of RTOG-RPA to the study cohort and calculation of subsequent survival curves, (2) fit a new tree model with the same predictors in RTOG-RPA, and (3) fit a new tree model with an expanded predictor set. All analyses used a regression tree analysis with a survival outcome fit to formulate new risk classes. Overall median survival was 14.9 months. Using the RTOG-RPA, the six classes retained their relative prognostic significance and overall ordering, with the corresponding survival distributions significantly different from each other (P < 0.01, χ2 statistic = 70). New recursive partitioning limited to the predictors in RTOG-RPA defined four risk groups based on Karnofsky Performance Status (KPS), histology, age, length of neurologic symptoms, and mental status. Analysis across the expanded predictors defined six risk classes, including the same five variables plus tumor location, tobacco use, and hospitalization during radiation therapy. Patients with excellent functional status, AA, and frontal lobe tumors had the best prognosis. For patients with newly-diagnosed high-grade gliomas, RTOG-RPA classes retained prognostic significance in patients treated with TMZ and IMRT. In contrast to RTOG-RPA, in our modified RPA model, KPS rather than age represented the initial split. New recursive partitioning identified potential modifications to RTOG-RPA that should be further explored with a larger data set

Recursive partitioning analysis of prognostic factors in WHO grade III glioma patients treated with radiotherapy or radiotherapy plus chemotherapy

<p>Abstract</p> <p>Background</p> <p>We evaluated the hierarchical risk groups for the estimated survival of WHO grade III glioma patients using recursive partitioning analysis (RPA). To our knowledge, this is the first study to address the results of RPA specifically for WHO grade III gliomas.</p> <p>Methods</p> <p>A total of 133 patients with anaplastic astrocytoma (AA, n = 56), anaplastic oligodendroglioma (AO, n = 67), or anaplastic oligoastrocytoma (AOA, n = 10) were included in the study. These patients were treated with either radiotherapy alone or radiotherapy followed by PCV chemotherapy after surgery. Five prognostic factors, including histological subsets, age, performance status, extent of resection, and treatment modality were incorporated into the RPA. The final nodes of RPA were grouped according to their survival times, and the Kaplan-Meier graphs are presented as the final set of prognostic groups.</p> <p>Results</p> <p>Four risk groups were defined based on the clinical prognostic factors excluding age, and split variables were all incorporated into the RPA. Survival analysis showed significant differences in mean survival between the different groups: 163.4 months (95% CI: 144.9-182.0), 109.5 months (86.7-132.4), 66.6 months (50.8-82.4), and 27.7 months (16.3-39.0), respectively, from the lowest to the highest risk group (p = 0.00).</p> <p>Conclusion</p> <p>The present study shows that RPA grouping with clinical prognostic factors can successfully predict the survival of patients with WHO grade III glioma.</p

Examining Risk Perceptions and Efficacy for Healthy Weight Management among Appalachian College-Aged Students: A Test and Extension of the Risk-Perception-Attitude Framework

Obesity disproportionately affects Appalachia and poses a great risk to young adults who already enact poor health behaviors. Research indicates perceptions of risk and efficacy beliefs related to obesity-preventative behaviors are motivating for positive health-related behavioral change. Moreover, literature reveals that social and emotional risks of obesity may be just as motivating as physical risks. The Risk Perception Attitude (RPA) framework posits that efficacy moderates the effect of perceived risk on associated behavioral outcomes. However, neither the RPA nor other literature addresses the role of stigma in this relationship, though obesity stigma has been linked to a variety of negative consequences. This study utilized the RPA framework to investigate the relationship between perceived obesity risks and health self-efficacy beliefs among a sample of young adults. The study also examined stigma as a potential factor in this framework. An online survey was used to collect data from 498 young adults, 263 of whom self-identified as Appalachian. Data analysis provided support for hypothesized relationships, the influence of stigma, and partial validation for the RPA framework. Implications and recommendations for future research are discussed

Addressing the Global Expertise Gap in Radiation Oncology: The Radiation Planning Assistant

PURPOSE: Automation, including the use of artificial intelligence, has been identified as a possible opportunity to help reduce the gap in access and quality for radiotherapy and other aspects of cancer care. The Radiation Planning Assistant (RPA) project was conceived in 2015 (and funded in 2016) to use automated contouring and treatment planning algorithms to support the efforts of oncologists in low- and middle-income countries, allowing them to scale their efforts and treat more patients safely and efficiently (to increase access). DESIGN: In this review, we discuss the development of the RPA, with a particular focus on clinical acceptability and safety/risk across jurisdictions as these are important indicators for the successful future deployment of the RPA to increase radiotherapy availability and ameliorate global disparities in access to radiation oncology. RESULTS: RPA tools will be offered through a webpage, where users can upload computed tomography data sets and download automatically generated contours and treatment plans. All interfaces have been designed to maximize ease of use and minimize risk. The current version of the RPA includes automated contouring and planning for head and neck cancer, cervical cancer, breast cancer, and metastases to the brain. CONCLUSION: The RPA has been designed to bring high-quality treatment planning to more patients across the world, and it may encourage greater investment in treatment devices and other aspects of cancer treatment

Managing Interdependent Information Security Risks: A Study of Cyberinsurance, Managed Security Service and Risk Pooling

The interdependency of information security risks poses a significant challenge for firms to manage security. Firms may over- or under-invest in security because security investments generate network externalities. In this paper, we explore how firms can use three risk management approaches, third-party cyberinsurance, managed security service (MSS) and risk pooling arrangement (RPA), to address the issue of investment inefficiency. We show that compared with cyberinsurance, MSS is more effective in mitigating the security investment inefficiency because the MSS provider (MSSP) serving multiple firms can endogenize the externalities of security investments. However, the investment externalities may discourage a for-profit MSSP from serving all firms even on a monopoly market. We then show that firms can use RPA as a complement to cyberinsurance to address risk interdependency for all firms. However, the adoption of RPA is incentive-compatible for firms only when the security investments generate negative externalities