The Establishment of the GENEQOL Consortium to Investigate the Genetic Disposition of Patient-Reported Quality-of-Life Outcomes

To our knowledge, no comprehensive, interdisciplinary initiatives have been taken to examine the role of genetic variants on patient-reported quality-of-life outcomes. The overall objective of this paper is to describe the establishment of an international and interdisciplinary consortium, the GENEQOL Consortium, which intends to investigate the genetic disposition of patient-reported quality-of-life outcomes. We have identified five primary patient-reported quality-of-life outcomes as initial targets: negative psychological affect, positive psychological affect, self-rated physical health, pain, and fatigue. The first tangible objective of the GENEQOL Consortium is to develop a list of potential biological pathways, genes and genetic variants involved in these quality-of-life outcomes, by reviewing current genetic knowledge. The second objective is to design a research agenda to investigate and validate those genes and genetic variants of patient-reported quality-of-life outcomes, by creating large datasets. During its first meeting, the Consortium has discussed draft summary documents addressing these questions for each patient-reported quality-of-life outcome. A summary of the primary pathways and robust findings of the genetic variants involved is presented here. The research agenda outlines possible research objectives and approaches to examine these and new quality-of-life domains. Intriguing questions arising from this endeavor are discussed. Insight into the genetic versus environmental components of patient-reported quality-of-life outcomes will ultimately allow us to explore new pathways for improving patient care. If we can identify patients who are susceptible to poor quality of life, we will be able to better target specific clinical interventions to enhance their quality of life and treatment outcomes.quality of life, self-rated health, pain, fatigue, genetic disposition, Patient-Reported Quality-of-Life Outcomes

Small-cell lung cancer patients are just ‘a little bit’ tired: response shift and self-presentation in the measurement of fatigue

Background: Response shift has gained increasing attention in the measurement of health-related quality of life (QoL) as it may explain counter-intuitive findings as a result of adaptation to deteriorating health. Objective: To search for response shift type explanations to account for counter-intuitive findings in QoL measurement. Methods: Qualitative investigation of the response behaviour of small-cell lung cancer (SCLC) patients (n = 23) in the measurement of fatigue with The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) question 'were you tired'. Interviews were conducted at four points during 1st line chemotherapy: at the start of chemotherapy, 4 weeks later, at the end of chemotherapy, and 6 weeks later. Patients were asked to 'think aloud' when filling in the questionnaire. Results: Fifteen patients showed discrepancies between their answer to the EORTC question 'were you tired' and their level of fatigue spontaneously reported during the interview. These patients chose the response options 'not at all' or 'a little' and explained their answers in various ways. In patients with and without discrepancies, we found indications of recalibration response shift (e.g. using a different comparison standard over time) and of change in perspective (e.g. change towards a more optimistic perspective). Patients in the discrepancy group reported spontaneously how they dealt with diagnosis and treatment, i.e. by adopting protective and assertive behaviour and by fighting the stigma. They distanced themselves from the image of the stereotypical cancer patient and presented themselves as not suffering and accepting fatigue as consequence of treatment. Conclusion: In addition to response shift, this study suggests that 'self-presentation' might be an important mechanism affecting QoL measurement, particularly during phases when a new equilibrium needs to be found

Listen to their answers! Response behaviour in the measurement of physical and role functioning

Background: Quality of life (QoL) is considered to be an indispensable outcome measure of curative and palliative treatment. However, QoL research often yields findings that raise questions about what QoL measurement instruments actually assess and how the scores should be interpreted. Objective: To investigate how patients interpret and respond to questions on the EORTC-QLQ-C30 over time and to find explanations to account for counterintuitive findings in QoL measurement. Methods: Qualitative investigation was made of the response behaviour of small-cell lung cancer patients (n = 23) in the measurement of QoL with the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). Focus was on physical functioning (PF, items 1 to 5), role functioning (RF, items 6 and 7), global health and QoL rating (GH/QOL, items 29 and 30). Interviews were held at four points: at the start of the chemotherapy, 4 weeks later, at the end, and 6 weeks after the end of chemotherapy. Patients were asked to 'think aloud' when filling in the questionnaire. Results: Patients used various response strategies when answering questions about problems and limitations in functioning, which impacted the accuracy of the scale. Patients had scores suggesting they were less limited than they actually were by taking the wording of questions literally, by guessing their functioning in activities that they did not perform, and by ignoring or excluding certain activities that they could not perform. Conclusion: Terminally ill patients evaluate their functioning in terms of what they perceive to be normal under the circumstances. Their answers can be interpreted in terms of change in the appraisal process (Rapkin and Schwartz 2004; Health and Quality of Life Outcomes, 2, 14). More care should be taken in assessing the quality of a set of questions about physical and role functioning. © 2008 The Author(s)

On the Computation of the Trace Form of Some Galois Extensions

AbstractWe investigate the trace form trL/K:L→K:x↦trL/Kx2of a finite Galois extensionL/K. In particular, we study 2-extensions of degree ≤16. Using some reduction theorems, these results yield a classification of nearly all trace forms of Galois extensions of degree ≤31. Finally, we study the trace form of a cyclotomic extension and of its maximal real subfield

Efektifitas metode bervariasi terhadap hasil belajar siswa pada bidang studi PAI Di SMP Zainuddin Waru Sidoarjo

Dalam skripsi ini penulis membahas tentang Efektifitas penggunaan Metode Bervariasi Terhadap Hasil Belajar Siswa Pada Bidang Studi PAI Di SMP Zainuddin Waru Sidoarjo dengan tiga rumusan masalah sebagai berikut : 1. Bagaimana penggunaan metode bervariasi di SMP Zainuddin Waru Sidoarjo ? 2. Bagaimana hasil belajar siswa SMP Zainuddin Waru Sidoarjo ? 3. Sejauh mana efektifitas penggunaan metode bervariasi terhadap basil belajar siswa pada bidang studi PAI di SMP Zainuddin Waru Sidoarjo ? Penelitian ini merupakan penelitian kuantitatif dengan populasi berjumlah 108 siswa, yaitu siswa kelas VIII. Dalam hal ini penulis mengambil sampel 30% dari seluruh populasi yang berjumlah 108 siswa sehingga menjadi 30 siswa. Dalam menjawab permasalahan di atas, penulis menggunakan metode pengumpulan data berupa metode observasi, dokumentasi, wawancara atau interview, dan metode angket atau quesioner. Sedangkan untuk analisa data penulis menggunakan analisa data statistik product moment. Berdasarkan hasil penelitian kemudian dapat disimpulkan bahwa penggunaan metode bervariasi di SMP Zainuddin Waru Sidoarjo terbilang baik. Dan hasil belajar siswa pada bidang studi Pendidikan Agama Islam di SMP Zainuddin Waru Sidoarjo terbilang sangat baik. Kemudian dari hasil akhir statistik menunjukkan bahwa ada pengaruh yang terbilang kuat atau tinggi antara efektifitas metode bervariasi terhadaP. basil belajar siswa pada bidang studi Pendidikan Agama Islam di SMP Zainuddin Waru Sidoarjo dengan hasil 0,836

The Impact of Goal Disturbance after Cancer on Cortisol Levels over Time and the Moderating Role of COMT

Due to physical hindrance and time spent in hospital, a cancer diagnosis can lead to disturbance of personally important goals. Goal disturbance in cancer patients has been related to poorer psychological well-being. However, the relation with physiological measures is yet unknown. The purpose of the current study is to examine the impact of goal disturbance on cortisol as a measure of response to stress over time, and a possibly moderating role of a DNA genotype associated with HPA-axis functioning, Catechol-O-Methyl transferase (COMT). We examined the predictive value of goal disturbance on Cortisol Awakening Response (CAR) and Diurnal Cortisol Slope (DCS) over two periods: 1-7 and 7-18 months post-diagnosis, and the moderating role of COMT during these periods. Hierarchical regression analyses showed that goal disturbance 7 months post-diagnosis significantly predicted a steeper CAR a year later. During that period, the slow COMT variant moderated the relation, in that patients reporting high goal disturbance and had the Met/Met variant, had a more flattened CAR. No other significant effects were found. As steeper CARs have been related to adverse health outcomes, and COMT genotype may modify this risk, these results indicate that goal disturbance and genotype may be important factors to consider in maintaining better psychological and physical health in the already vulnerable population of cancer patients