The Family Stress Model as it Applies to Custodial Grandfamilies: A Cross Validation.

There is scant research on how the parenting practices of custodial grandmothers affect the psychological adjustment of grandchildren in their care. Yet, the findings from a handful of prior studies suggest the relevance of the Family Stress Model (FSM) to these caregivers. The present study further tested the FSM with baseline data from 343 custodial grandmothers (Mage= 58.5 years) enrolled in a clinical trial of the efficacy of interventions for improving the well-being of their families. Not only was this "help-seeking" sample atypical of prior FSM studies, but also unique to the present study was our addition of multiple parenting practices, self-reported and clinical ratings of grandmothers' distress, and reports of grandchildren's internalizing and externalizing difficulties from grandchildren and grandmothers. Mplus 7.31 was used to test a model where the effect of grandmother distress on grandchildren's internalizing and externalizing difficulties was hypothesized to be indirect through five distinct parenting practices. The findings regarding both the measurement and structural models fit the observed data well, and invariance was largely found across grandchildren's gender and age (4-7 vs. 8-12). Although grandchildren's self-reported internalizing and externalizing difficulties were unrelated to grandmothers' distress and parenting practices, the grandmothers' reports of these outcomes were generally related to their own distress and parenting practices as hypothesized. However, considerable variation was found across the five parenting practices in terms of their relationships to the other FSM constructs. We conclude that data from multiple informants and measures of assorted parenting practices are essential to future research and practice.

The Utility of the Family Empowerment Scale With Custodial Grandmothers.

The Family Empowerment Scale (FES) was developed specifically to assess empowerment in families with emotional disorders. Its relevance to custodial grandfamilies is reflected in the difficulties in grandchildren's social, emotional, and behavioral functioning, wherein such difficulties may be explained via either reactions to changes in their family structure or in their responses to the newly formed family unit. Utilizing 27 items derived from the 34-item version of the FES, which had represented differential levels of empowerment (family, service system, community) as indexed by one's attitudes, knowledge, and behavior, we explored the factor structure, internal consistency, construct, and convergent validity of the FES with grandparent caregivers. Three-hundred forty-three ( M age = 58.45, SD = 8.22, n Caucasian = 152, n African American = 149, n Hispanic = 38) custodial grandmothers caring for grandchildren between ages 4 and 12 years completed the 27 FES items and various measures of their psychological well-being, grandchild psychological difficulties, emotional support, and parenting practices. Factor analysis revealed three factors that differed slightly from the originally proposed FES subscales: Parental Self-Efficacy/Self-Confidence, Service Activism, and Service Knowledge. Each of the factors was internally consistent, and derived factor scores were moderately interrelated, speaking to the question of convergent validity. The construct validity of these three factors was evidenced by meaningful patterns of statistically significant correlations with grandmothers' psychological well-being, grandchild psychological difficulties, emotional support, and parenting practices. These factor scores were independent of grandmother age, health, and education. These findings suggest the newly identified FES factors to be valuable in understanding empowerment among grandmother caregivers.

Measuring the Parenting Practices of Custodial Grandmothers.

Despite increased interest in parenting among custodial grandmothers (CGM), there is scant research on assessing their parenting practices. With CGMs as informants we examined the factor structure for five self-report scales developed as measures of parental nurturance and discipline with birth parents, and then tested for measurement invariance by grandchildren's age (4 - <7 versus ≥7 - 12). We also examined concurrent validity for these scales according to the Family Stress Model. Data were from 343 CGMs (M = 58.45, SD = 8.22) enrolled in a randomized clinical trial caring for grandchildren (GC) aged 4 to 12 (M = 7.81, SD = 2.56). Discipline was assessed by three scales from the Parental Behavior Inventory (Consistency, Effective, and Punitive). Nurturance was assessed by the Positive Affect Index and the Supportive Engaged Behavior scale of the Parenting Practice Interview. Confirmatory factor analysis (CFA) revealed that these scales were best represented as five distinct yet covarying factors (RMSEA = .055; SRMR = .07). Follow-up CFAs within each GC age group supported this model, with only few changes suggested by the corresponding diagnostic tests. A model with these changes was then examined for measurement invariance by CG age group, with complete measurement invariance found and all items loading onto their respective factors significantly. The five scales also correlated as expected with indices of CGM psychological distress and GC adjustment. We conclude that the scales examined here can be used meaningfully with CGM as respondents.

Contemporary management and classification of hepatic leiomyosarcoma.

BACKGROUND: Hepatic leiomyosarcomas are rare soft-tissue tumours. The majority of lesions previously considered as leiomyosarcomas have been identified as gastrointestinal stromal tumours (GISTs). Consequently, understanding of the role of liver resection for true leiomyosarcoma is limited, a fact that is exacerbated by the increasing recognition of leiomyosarcoma subtypes. This study presents data on the outcomes of liver resection for leiomyosarcoma and suggests an algorithm for its pathological assessment and treatment. METHODS: Patients were identified from a prospectively collected departmental database. All tumours were negative for c-kit expression. Immunohistochemistry was performed to identify the presence of oestrogen or progesterone receptor (OR/PR) expression or Epstein-Barr virus (EBV) and patients were stratified according to this profile. RESULTS: Eight patients (of whom seven were female) underwent a total of 11 liver resections over a 12-year period. One patient had a primary hepatic leiomyosarcoma. Of those with metastatic leiomyosarcomas, the primary tumours were located in the mesentery, gynaecological organs and retroperitoneum in four, two and one patient, respectively. Both leiomyosarcomas of gynaecological origin stained positive for OR/PR expression. One patient had previously undergone renal transplantation; this leiomyosarcoma was associated with EBV expression. Median survival was 56 months (range: 22-132 months) and eight, six and four patients remained alive at 1, 3 and 5 years, respectively. CONCLUSIONS: Hepatic resection for leiomyosarcoma is associated with encouraging rates of 5-year overall and disease-free survival. The worse outcome that had been expected based on data derived from historical cohorts (partly comprising subjects with GIST) was not observed. An algorithm for pathological classification and treatment is suggested.

A response to Harris, Gould, and Fujiura: Beyond scoping reviews: a case for mixed-methods research reviews.

This article serves as a response to the Work article on scoping literature reviews by Harris et al. [1]. Conceptualizing scoping reviews as an exploratory approach to organizing literature and research findings in a content area that is still developing, we propose a mixed-methods approach to systematic reviews that enables researchers to capture the breadth and depth of existing knowledge, thereby facilitating the transfer of research findings into field practice.

Examining the factor structure of the Multiple Sclerosis Impact Scale.

The purpose of this study was to investigate the factor structure of the Multiple Sclerosis Impact Scale (MSIS-29) to assess its suitability for modeling the impact of MS on a nation-wide sample of individuals from the United States. Investigators completed a Confirmatory Factor Analysis (CFA) to examine the two-factor structure proposed by Hobart et al. [17]. Although the original MSIS-29 factor structure did not fit the data exactly, the hypothesized two-factor model was partially supported in the current data. Implications for future instrument development and rehabilitation practice are discussed.

An observational study on the expression levels of MDM2 and MDMX proteins, and associated effects on P53 in a series of human liposarcomas.

BACKGROUND: Inactivation of wild type P53 by its main cellular inhibitors (MDM2 and MDMX) is a well recognised feature of tumour formation in liposarcomas. MDM2 over-expression has been detected in approximately 80% of liposarcomas but only limited information is available about MDMX over-expression. To date, we are not aware of any study that has described the patterns of MDM2 and MDMX co-expression in liposarcomas. Such information has become more pertinent as various novel MDM2 and/or MDMX single and dual affinity antagonist compounds are emerging as an alternative approach for potential targeted therapeutic strategies. METHODS: We analysed a case series of 61 fully characterized liposarcomas of various sub-types by immunohistochemistry, to assess the expression levels of P53, MDM2 and MDMX, simultaneously. P53 sequencing was performed in all cases that expressed P53 protein in 10% or more of cells to rule out mutation-related over-expression. RESULTS: 50 cases over-expressed MDM2 and 42 of these co-expressed MDMX at varying relative levels. The relative expression levels of the two proteins with respect to each other were subtype-dependent. This apparently affected the detected levels of P53 directly in two distinct patterns. Diminished levels of P53 were observed when MDM2 was significantly higher in relation to MDMX, suggesting a dominant role for MDM2 in the degradation of P53. Higher levels of P53 were noted with increasing MDMX levels suggesting an interaction between MDM2 and MDMX that resulted in a reduced efficiency of MDM2 in degrading P53. Of the 26 cases of liposarcoma with elevated P53 expression, 5 were found to have a somatic mutation in the P53 gene. CONCLUSIONS: The results suggest that complex dynamic interactions between MDM2 and MDMX proteins may directly affect the cellular levels of P53. This therefore suggests that careful characterization of both these markers will be necessary in tumours when considering in vivo evaluation of novel blocker compounds for MDM proteins, as a therapeutic strategy to restore wild type P53 function.

An unusual case of a large fibroepithelial stromal polyp presenting as a nipple mass.

BACKGROUND: Fibroepithelial stromal polyps (FESP) are benign lesions that typically occur in the genital area and are known to represent a diagnostic challenge for pathologists. Not only do they have a spectrum of morphological changes that ranges from bland morphology to rather atypical appearances, but they also share morphological features with a number of benign and malignant lesions.This is a report of a rare presentation of a FESP of the breast. CASE PRESENTATION: We describe an unusual case of a large polypoid mass arising from the nipple and connected to it by a long pedicle in a female of 45. The lesion comprised spindle and stellate shaped cells with bizarre stromal giant cells. The morphological and immunohistochemical diagnostic features are provided together with a discussion of possible mimics. CONCLUSION: FESPs may occur in the female breast. It is important to differentiate the lesion from other benign and malignant spindle cell lesions particularly metaplastic carcinoma.

A conceptual overview of Structural Equation Modeling (SEM) in rehabilitation research.

Structural Equation Modeling (SEM) is a collection of statistical techniques used to determine the degree to which a proposed theoretical model is supported by data. SEM has been growing in various disciplines as well as in rehabilitation research. It is the goal of this introduction to provide a conceptual overview of SEM. This statistical technique can facilitate a better understanding of large data sets involving theoretical models that have become more frequent in this discipline.

Familial annular erythema--a rare dermatology diagnosis.

We report the second case of autosomal dominant familial annular erythema since its original description in 1966 by Beare et al. A three and a half-year-old boy presented at five days of age with a widespread annular urticated erythematous rash which has persisted despite treatment with various antihistamines and mast-cell stabilizers. His mother reports an identical eruption with an absence of systemic symptoms.

Using scoping literature reviews as a means of understanding and interpreting existing literature.

OBJECTIVE: This article compares and contrasts scoping literature reviews with other established methods for understanding and interpreting extant research literature. METHODS: Descriptions of the key principles and applications of scoping reviews are illustrated with examples from contemporary publications. CONCLUSIONS: Scoping reviews are presented as an efficient way of identifying themes and trends in high-volume areas of scientific inquiry.

Basal cell carcinoma with a sarcomatous component (carcinosarcoma): a series of 5 cases and a review of the literature.

Cutaneous carcinosarcomas are rare biphasic malignant tumors with a malignant epithelial component together with malignant stroma. Five cases treated in the Yorkshire region of England between 2003 and 2006 are presented. The patients were male with an age range from 58 to 84 years. Four lesions occurred on the face and one on the trunk. Each tumor had an epithelial component resembling a typical nodular basal cell carcinoma. The stromal components demonstrated atypical spindle cells and tumor giant cells, undifferentiated stroma, or osteoid formation. All underwent surgical excision and none showed evidence of recurrence (follow-up 3-17 months, one death from unrelated causes). The recent literature concerning the pathogenesis and prognosis of these unusual tumors is reviewed.

Ultrasound and MRI findings in appendicular and truncal fat necrosis.

OBJECTIVE: The objective was to evaluate ultrasound and MRI in clinical appendicular and truncal fat necrosis. MATERIALS AND METHODS: Thirty-three patients (14 men, 19 women, median age 55, range 29-95) were retrospectively evaluated. Histologically, three groups were seen: Group 1 (n = 18) consisted of patients with subcutaneous masses with septal and extrinsic oedema; in Group 2 (n = 11) necrosis occurred within lipomatous tumours and little oedema; and in Group 3 (n = 4) there were large complex masses consistent with Morel-Lavallée lesions. Two experienced radiologists reviewed MR (n = 30) and ultrasound (n = 32) images with consensus agreement. MRI was performed on a 1.5T system with T1-weighted, T2-weighted fat-suppressed and T1-weighted fat-suppressed post-intravenous gadolinium sequences obtained in two orthogonal planes. Ultrasound (linear 5- to 13.5-MHz probe) was performed in the longitudinal and short axis. Anatomical position, size, shape (oval, linear, ill-defined), internal architecture (lobules, septi or stranding), intrinsic signal characteristics, presence of surrounding pseudocapsule, extrinsic linear stranding and vascularity (gadolinium enhancement or power Doppler) were recorded. RESULTS: Anatomical locations were buttock/thigh (n = 17), leg (n = 6), upper limb (n = 5) and thoracic/abdominal wall (n = 5) with the majority of lesions (30 out of 33) oval/linear in shape. On ultrasound and MRI most lesions showed internal fat lobules, intervening septi and a surrounding pseudocapsule. CONCLUSION: Fat necrosis can usually be identified as containing multiple fat lobules on ultrasound and MRI despite a varying degree of inflammatory change surrounding and within the mass.

Solitary subcutaneous metastatic deposit from hepatocellular carcinoma.

Hepatocellular carcinoma is the most common primary tumour of the liver. Metastasis is frequent in these aggressive tumours and is commonly to the lungs, regional lymph nodes, or bone. Metastasis as a discrete subcutaneous nodule has not been described before. We report a case of hepatocellular carcinoma with a solitary subcutaneous metastatic deposit identified 18 months after the initial hepatic surgery.