Information needs of patients with cancer: results from a large study in UK cancer centres

As part of a multi-centred study evaluating a communication skills training model for clinicians, we collected information preferences using an adaptation of Cassileth's Information Needs questionnaire from a heterogeneous sample of 2331 patients. Results showed that 87% (2027) wanted all possible information, both good and bad news and 98% (2203) preferred to know whether or not their illness was cancer. Cross tabulation of responses revealed no significant differences in information preferences for tumour site or treatment aims but did show an effect of age and sex. The few 58/440 (13.2%) patients who stated that in general they preferred to leave disclosure of details up to the doctor, tended to be older patients more than 70 years of age (chi square = 26.01, df = 2, P< 0.0001), although paradoxically they still wanted to know certain specific details. In comparison to men women preferred to know the specific name of the illness (chi square = 4.9, df = 1, P< 0.02) and what were all the possible treatments (chi square = 8.26, df = 1, P< 0.004). The results from this very large sample provide conclusive evidence that the vast majority of patients with cancer want a great deal of specific information concerning their illness and treatment. Failure to disclose such information on the grounds that significant numbers of patients prefer not to know is untenable. © 2001 Cancer Research Campaign http://www.bjcancer.co

Equivalence of Electronic and Paper-and-Pencil Administration of Patient-Reported Outcome Measures: A Meta-Analytic Review

AbstractObjectivesPatient-reported outcomes (PROs; self-report assessments) are increasingly important in evaluating medical care and treatment efficacy. Electronic administration of PROs via computer is becoming widespread. This article reviews the literature addressing whether computer-administered tests are equivalent to their paper-and-pencil forms.MethodsMeta-analysis was used to synthesize 65 studies that directly assessed the equivalence of computer versus paper versions of PROs used in clinical trials. A total of 46 unique studies, evaluating 278 scales, provided sufficient detail to allow quantitative analysis.ResultsAmong 233 direct comparisons, the average mean difference between modes averaged 0.2% of the scale range (e.g., 0.02 points on a 10-point scale), and 93% were within ±5% of the scale range. Among 207 correlation coefficients between paper and computer instruments (typically intraclass correlation coefficients), the average weighted correlation was 0.90; 94% of correlations were at least 0.75. Because the cross-mode correlation (paper vs. computer) is also a test–retest correlation, with potential variation because of retest, we compared it to the within-mode (paper vs. paper) test–retest correlation. In four comparisons that evaluated both, the average cross-mode paper-to-computer correlation was almost identical to the within-mode correlation for readministration of a paper measure (0.88 vs. 0.91).ConclusionsExtensive evidence indicates that paper- and computer-administered PROs are equivalent

Farmer Adoption; Ten Years of Productive Pasture Systems in Southern Australia

n Southern Australian sheep and beef farmers have been slow to adopt technology related to grazing management and pasture utilisation despite clear evidence of a strong link between utilisation (stock per ha) and profitability. Between 1971-95, the average stocking rate on farms was 10-12 dry sheep equivalent per hectare (dse/ha) (Anon 2004). Results from the Hamilton Long-term Phosphate Experiment (Cayley et al., 2002) show higher pasture production, herbage digestibility, stocking rates and profitability as phosphorus fertiliser applications increase. In 1993, the Grassland Productivity Program (GPP) started in the winter rainfall areas of southern Australia (Trompf & Sale 2000), initiated by the Grassland Society of Southern Australia, funded by the wool industry. In brief, groups of 4-6 farmers were assisted by experienced advisors to compare current management practice in one paddock with productive pasture technology (PPT) in an adjacent paddock. PPT consisted of appropriate fertiliser application; pasture manipulation to balance grass and legume content and higher stocking rates to ensure utilisation of the herbage grown. Over 300 farmers participated in GPP between 1993-2003. This paper reports the impact on the grazing industry 10 years after PPT was introduced

Finite-Size Scaling of the Domain Wall Entropy Distributions for the 2D ±J\pm J Ising Spin Glass

The statistics of domain walls for ground states of the 2D Ising spin glass with +1 and -1 bonds are studied for $L \times L$ square lattices with $L \le 48$, and $p$ = 0.5, where $p$ is the fraction of negative bonds, using periodic and/or antiperiodic boundary conditions. When $L$ is even, almost all domain walls have energy $E_{dw}$ = 0 or 4. When $L$ is odd, most domain walls have $E_{dw}$ = 2. The probability distribution of the entropy, $S_{dw}$, is found to depend strongly on $E_{dw}$. When $E_{dw} = 0$, the probability distribution of $|S_{dw}|$ is approximately exponential. The variance of this distribution is proportional to $L$, in agreement with the results of Saul and Kardar. For $E_{dw} = k > 0$ the distribution of $S_{dw}$ is not symmetric about zero. In these cases the variance still appears to be linear in $L$, but the average of $S_{dw}$ grows faster than $\sqrt{L}$. This suggests a one-parameter scaling form for the $L$-dependence of the distributions of $S_{dw}$ for $k > 0$.Comment: 13 page

Peripheral and central mechanisms involved in hormonal control of male and female reproduction

Reproduction involves the integration of hormonal signals acting across multiple systems togenerate a synchronized physiological output. A critical component of reproduction is the luteinizinghormone (LH) surge, which is mediated by estradiol (E2) and neuroprogesterone interacting tostimulate kisspeptin release in the rostral periventricular nucleus of the third ventricle in rats. Recentevidence has shown that both classical and membrane E2 and progesterone signaling is involved inthis pathway. A metabolite of gonadotropin-releasing hormone (GnRH), GnRH-(1-5), has been shownto stimulate GnRH expression, secretion, and has a role in the regulation of lordosis. Additionally,gonadotropin-inhibitory hormone (GnIH) projects to and influences the activity of GnRH neurons inbirds. Stress-induced changes in GnIH have been shown to alter breeding behaviors in birds,demonstrating another molecular control of reproduction. Peripherally, paracrine and autocrineactions within the gonad have been suggested as therapeutic targets for infertility in both males andfemales. Dysfunction of testicular prostaglandin synthesis is a possible cause of idiopathic maleinfertility. Indeed, local production of melatonin and corticotropin-releasing hormone (CRH) couldinfluence spermatogenesis via immune pathways in the gonad. In females, vascular endothelialgrowth factor A (VEGF-A) has been implicated in an angiogenic process that mediates developmentof the corpus luteum and thus fertility via the Notch signaling pathway. Age-induced decreases infertility involve ovarian kisspeptin and its regulation of ovarian sympathetic innervation. Finally,morphological changes in the arcuate nucleus of the hypothalamus influence female sexualreceptivity in rats. The processes mediating these morphological changes have been shown toinvolve rapid effects of E2 controlling synaptogenesis in this hypothalamic nucleus. Together, thisreview highlights new research in these areas, focusing on recent findings in the molecularmechanisms of central and peripheral hormonal control of reproduction.Fil: Rudolph, L. M.. University of California at Los Angeles; Estados UnidosFil: Bentley, G. E.. University of California Berkeley; Estados UnidosFil: Calandra, Ricardo Saul. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Paredes, A. H.. Universidad de Chile; ChileFil: Tesone, Marta. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Wu, T. J.. Uniformed Services University; Estados UnidosFil: Micevych, P. E.. University of California at Los Angeles; Estados Unido

Endotoxin leads to rapid subcellular re-localization of hepatic RXRα: A novel mechanism for reduced hepatic gene expression in inflammation

BACKGROUND: Lipopolysaccharide (LPS) treatment of animals down-regulates the expression of hepatic genes involved in a broad variety of physiological processes, collectively known as the negative hepatic acute phase response (APR). Retinoid X receptor α (RXRα), the most highly expressed RXR isoform in liver, plays a central role in regulating bile acid, cholesterol, fatty acid, steroid and xenobiotic metabolism and homeostasis. Many of the genes regulated by RXRα are repressed during the negative hepatic APR, although the underlying mechanism is not known. We hypothesized that inflammation-induced alteration of the subcellular location of RXRα was a common mechanism underlying the negative hepatic APR. RESULTS: Nuclear RXRα protein levels were significantly reduced (~50%) within 1–2 hours after low-dose LPS treatment and remained so for at least 16 hours. RXRα was never detected in cytosolic extracts from saline-treated mice, yet was rapidly and profoundly detectable in the cytosol from 1 hour, to at least 4 hours, after LPS administration. These effects were specific, since the subcellular localization of the RXRα partner, the retinoic acid receptor (RARα), was unaffected by LPS. A potential cell-signaling modulator of RXRα activity, c-Jun-N-terminal kinase (JNK) was maximally activated at 1–2 hours, coincident with maximal levels of cytoplasmic RXRα. RNA levels of RXRα were unchanged, while expression of 6 sentinel hepatic genes regulated by RXRα were all markedly repressed after LPS treatment. This is likely due to reduced nuclear binding activities of regulatory RXRα-containing heterodimer pairs. CONCLUSION: The subcellular localization of native RXRα rapidly changes in response to LPS administration, correlating with induction of cell signaling pathways. This provides a novel and broad-ranging molecular mechanism for the suppression of RXRα-regulated genes in inflammation

Finite-Size Scaling in the Energy-Entropy Plane for the 2D +- J Ising Spin Glass

For $L \times L$ square lattices with $L \le 20$ the 2D Ising spin glass with +1 and -1 bonds is found to have a strong correlation between the energy and the entropy of its ground states. A fit to the data gives the result that each additional broken bond in the ground state of a particular sample of random bonds increases the ground state degeneracy by approximately a factor of 10/3. For $x = 0.5$ (where $x$ is the fraction of negative bonds), over this range of $L$, the characteristic entropy defined by the energy-entropy correlation scales with size as $L^{1.78(2)}$. Anomalous scaling is not found for the characteristic energy, which essentially scales as $L^2$. When $x= 0.25$, a crossover to $L^2$ scaling of the entropy is seen near $L = 12$. The results found here suggest a natural mechanism for the unusual behavior of the low temperature specific heat of this model, and illustrate the dangers of extrapolating from small $L$.Comment: 9 pages, two-column format; to appear in J. Statistical Physic

Conductance and its universal fluctuations in the directed network model at the crossover to the quasi-one-dimensional regime

The directed network model describing chiral edge states on the surface of a cylindrical 3D quantum Hall system is known to map to a one-dimensional quantum ferromagnetic spin chain. Using the spin wave expansion for this chain, we determine the universal functions for the crossovers between the 2D chiral metallic and 1D metallic regimes in the mean and variance of the conductance along the cylinder, to first nontrivial order.Comment: 10 pages, REVTeX, uses epsf, 2 .eps figures included. Newly written Introduction and small changes to other section

Glucose sensor O-GlcNAcylation coordinates with phosphorylation to regulate circadian clock.

Posttranslational modifications play central roles in&nbsp;myriad biological pathways including circadian regulation. We employed a circadian proteomic approach to demonstrate that circadian timing of phosphorylation is a critical factor in regulating complex GSK3β-dependent pathways and identified O-GlcNAc transferase (OGT) as a substrate of GSK3β. Interestingly, OGT activity is regulated by GSK3β; hence, OGT and GSK3β exhibit reciprocal regulation. Modulating O-GlcNAcylation levels alter circadian period length in both mice and Drosophila; conversely, protein O-GlcNAcylation is circadianly regulated. Central clock proteins, Clock and Period, are reversibly modified by O-GlcNAcylation to regulate their transcriptional activities. In addition, O-GlcNAcylation of a region in PER2 known to regulate human sleep phase (S662-S674) competes with phosphorylation of this region, and this interplay is at least partly mediated by glucose levels. Together, these results indicate that O-GlcNAcylation serves as a metabolic sensor for clock regulation and works coordinately with phosphorylation to fine-tune circadian clock