Cancer survivor perspectives on sharing patient-generated health data with central cancer registries.

PURPOSE: Central cancer registries collect data and provide population-level statistics that can be tracked over time; yet registries may not capture the full range of clinically relevant outcomes. Patient-generated health data (PGHD) include health/treatment history, biometrics, and patient-reported outcomes (PROs). Collection of PGHD would broaden registry outcomes to better inform research, policy, and care. However, this is dependent on the willingness of patients to share such data. This study examines cancer survivors' perspectives about sharing PGHD with central cancer registries. METHODS: Three U.S. central registries sampled colorectal, non-Hodgkin lymphoma, and metastatic breast cancer survivors 1-4 years after diagnosis, recruiting them via mail to participate in one of seven focus groups (n = 52). Group discussions were recorded, transcribed, and thematically analyzed. RESULTS: Most survivor-participants were unaware of the existence of registries. After having registries explained, all participants expressed their willingness to share PGHD with them if treated confidentially. Participants were willing to provide information on a variety of topics (e.g., medical history, medications, symptoms, financial difficulties, quality of life, biometrics, nutrition, exercise, and mental health), with a focus on long-term effects of cancer and its treatment. Participants' preferred mode for providing data varied. Participants were also interested in receiving information from registries. CONCLUSIONS: Our results suggest that registry-based collection of PGHD is acceptable to most cancer survivors and could facilitate registry-based efforts to collect PGHD/PROs. Central cancer registry-based collection of PGHD/PROs, especially on long-term effects, could enhance registry support of cancer control efforts including research and population health management.

Effect of canine hyperadrenocorticism on coagulation parameters.

BACKGROUND: Hyperadrenocorticism (HAC) has been associated with thrombotic disease in dogs. HYPOTHESIS: The purpose of this study was to use thromboelastography (TEG) and measurement of thrombin generation (TG) to characterize the hypercoagulable state in dogs with HAC. We hypothesized that dogs with HAC would have a hypercoagulable profile on TEG tracings and an increase in thrombin generation as measured by endogenous thrombin potential (ETP). ANIMALS: Sixteen dogs with HAC. Dogs were compared with a population of normal dogs used to obtain reference intervals. METHODS: TEG tracings on citrated whole blood were obtained from 15 dogs, and TG measurements on frozen-thawed platelet-poor plasma (PPP) were obtained from 15 dogs. RESULTS: For the TEG analysis, when results of individual dogs were compared with the reference interval, 12/15 dogs had at least 1 parameter associated with hypercoagulability. When the population of HAC dogs was compared with a population of healthy dogs, HAC dogs had decreases in R and K and increases in α and MA values. The ETP was increased when the HAC group was compared with a population of normal dogs. However, only 3/15 dogs had an ETP above reference interval, and 1/15 had a decreased lag time. CONCLUSION AND CLINICAL IMPORTANCE: Of 16 dogs with HAC, 12/15 had evidence of hypercoagulability when evaluated by TEG, 4/15 when evaluated by TG, and 2 dogs had increases in ETP and MA.

Hypertrophic osteopathy associated with infective endocarditis in an adult boxer dog.

A 20-month-old, entire male boxer dog was presented with lethargy and intermittent shifting limb lameness. Diagnostic tests revealed aortic valve vegetations suggestive of infective endocarditis causing severe aortic outflow obstruction, and hypertrophic osteopathy of all four limbs. The dog was treated symptomatically and euthanised four days later. The association of infective endocarditis and hypertrophic osteopathy has been poorly documented in the veterinary literature. The pathogenesis of hypertrophic osteopathy is unknown; however, four theories have been put forth to explain this disease: pulmonary shunting, vagal nerve stimulation, humoral substances produced by neoplastic cells and megakaryocyte/platelet clump hypothesis.

Phosphodiesterase type 5 inhibitors' extended duration of response as a variable in the treatment of erectile dysfunction.

The phosphodiesterase type 5 (PDE5) inhibitors, sildenafil, tadalafil and vardenafil, are a class of medications that are safe and effective in treating erectile dysfunction (ED). Yet, resuming sexual activity following a period of abstinence in response to ED may be anxiety-provoking for the man, his partner and their relationship, causing the sexual encounter to become a stressful event. The differences between PDE5 inhibitors in terms of duration of action can be successfully utilized by healthcare professionals to mitigate some of the psychosocial barriers that interfere with treating ED. PDE5 inhibitors with a longer duration of responsiveness provide some men with ED and their partners, a treatment option that may offer greater flexibility and potentially less anxiety surrounding the resumption of sexual activity. Shorter-acting PDE5s may be preferred by men/couples with predictable sexual scripts, excellent communication strategies and concerns regarding the duration of side effects.

Alcohol expectancies of women and men in relation to alcohol use and perceptions of the effects of alcohol on the opposite sex.

The present study was intended to identify specific alcohol expectancies of women and men that could be targeted in expectancy-based interventions to maximize their impact on alcohol use. The Alcohol Expectancy Questionnaire (AEQ) was revised to specifically refer to women, men, or the respondent, and was administered to 433 undergraduates with a measure of alcohol use. When asked about expectancies for themselves, females' and males' drinking correlated most highly with expectations of social facilitation. When asked about expectancies for the opposite sex, however, several other types of expectancies were related to respondents' alcohol use in addition to expectations of enhanced social experiences. Males' drinking corresponded to beliefs that women will be happier, more confident, and will sleep better if they have consumed alcohol. Females' drinking corresponded to beliefs that men will be less sexually inhibited and more romantic after drinking. These findings link past expectancy work with more recent attempts to model the mechanism by which expectancies influence alcohol use and may guide development of maximally effective expectancy-based interventions to reduce drinking.

Consumption-related differences in the organization and activation of marijuana expectancies in memory.

Using a methodology that has advanced the study of alcohol expectancies, the authors modeled a semantic network of marijuana expectancies stored in memory. They used individual-differences scaling, a form of multidimensional scaling, to map expectancies into memory network format and preference mapping to model likely paths of expectancy activation. Organization and activation of marijuana expectancies were found to vary with consumption level. Heavy marijuana consumers emphasized a relaxed-agitated dimension and were most likely to activate positive expectancies of relaxation, cognitive enhancement, and social facilitation. Nonconsumers, however, emphasized a detached-aware dimension and were more likely to activate negative expectancies of cognitive impairment and social impediment. Future efforts to alter likely activation patterns may be successful in changing use patterns.

Moderators of stress in parents of children with autism.

Parents of children with autism experience more stress and are more susceptible to negative outcomes than parents of children with other disabilities. The present work examines the relationship between stressors, social support, locus of control, coping styles, and negative outcomes (depression, social isolation, and spousal relationship problems) among parents of children with autism. Fifty-eight parents completed surveys. Results indicated that several coping styles corresponded to negative outcomes. Furthermore, the relationship between stressors and negative outcomes was moderated by social support and coping style. Results are discussed in relation to applications for clinical practice.

Activation of alcohol expectancies in memory in relation to limb of the blood alcohol curve.

Attempts to understand the mechanism by which alcohol expectancies might influence drinking have related activation of expectancies in memory to alcohol use. Limb of the blood alcohol curve, however, has not been considered. In the present study, 527 undergraduates completed the Anticipated Biphasic Alcohol Effects Scale and a drinking measure. Multidimensional scaling was used to map expectancies into memory network format, and likely activation of expectancies was empirically modeled. Heavier drinkers were most likely to activate positive and arousing expectancies associated with the ascending limb, whereas lighter drinkers were most likely to activate negative and sedating expectancies associated with the descending limb. These findings add to the literature suggesting that activation of expectancies in memory may be an important determinant of drinking behavior and a promising target for intervention strategies.

Validation of multidimensional scaling-based modeling of alcohol expectancies in memory: age and drinking-related differences in expectancies of children assessed as first associates.

BACKGROUND: As evidence has accumulated that alcohol expectancies mediate the effects of other drinking antecedents, attempts to understand the mechanism by which expectancies influence behavior have focused on modeling memory processes. Previous expectancy work, however, has used relatively indirect approaches to retrieve and model information stored in memory. By using the method most recommended by memory researchers for directly obtaining uncontaminated memory contents, we assessed children's expectancies and related findings to empirically modeled organization and activation of expectancies in memory based on scaled instruments. METHODS: Individual interviews were conducted with 462 children in 2nd through 5th grades, and surveys were completed by 1,003 children in 3rd, 6th, 9th, and 12th grades. Interviews and surveys consisted of a measure designed to retrieve participants' first expectancy associate to an alcohol prompt and several drinking quantity/frequency questions. RESULTS: Older and higher drinking children were more likely to report positive expectancies as their first associate to an alcohol prompt. Age and drinking-based findings were consistent with organizational structure, dimension emphasis shift, and paths of association identified by prior multidimensional scaling techniques. CONCLUSIONS: Consumption of alcohol among children corresponded to accessibility of positive expectancies in memory. In addition, the use of multidimensional scaling to study the organization and activation of alcohol expectancies in memory was validated.

Changes in activation of alcohol expectancies in memory in relation to changes in alcohol use after participation in an expectancy challenge program.

Memory model-based expectancy studies have shed light on the process by which expectancies may influence drinking but have not related changes in expectancy activation to drinking changes. In the present study, 38 undergraduates completed a drinking measure and factor-based and memory model-based expectancy measures, before and after an expectancy challenge intervention designed to alter expectancies. Expectancies were mapped into memory network format with individual differences scaling and likely paths of activation were modeled with preference mapping. Results indicated that exposure to the expectancy challenge led to a change in likely activation of expectancies for men, but not for women. In the 30 days after the intervention, alcohol use among men decreased significantly but did not change among women. Therefore, changes in likely activation corresponded to changes in drinking. These findings support a memory model conceptualization of expectancy influence on drinking.

Unipolar brush cells develop a set of characteristic features in primary cerebellar cultures.

The unipolar brush cells (UBCs) are a class of excitatory interneurons recently discovered in the cerebellar granular layer. UBCs differ morphologically and biochemically from granule cells, although they share the same mossy fiber and Golgi cell inputs. To elucidate development of the UBCs, we sought to ascertain their presence in primary cerebellar cultures and the class-specific properties they develop in vitro outside of the context of the tissue. By light and electron microscopy, we demonstrate that primary cultures from embryonic and postnatal mouse and rat cerebella contain UBC-like neurons that are highly polarized and can be distinguished from granule cells on several grounds. Granule cells are more numerous in dissociated postnatal cultures than in embryonic cultures; express little, if any, calretinin immunoreactivity; and develop dendritic processes devoid of typical claw-like endings, but provided with small synaptic junctions. By contrast, UBC-like neurons occur more frequently in embryonic cultures than in postnatal cultures, are intensely calretinin-positive, and develop characteristic cell organelles, dendrites, and large synapses. In embryonic cultures, the UBC-like neurons have a clear nucleus and contain a special cytoplasmic array of ringlet subunits, resembling the botrysome. At 12-28 days in vitro, the UBC dendrites contain abundant mitochondria, are provided with clusters of non-synaptic appendages, and engage in glomerular arrays together with large and small axon terminals. The large terminals contain round synaptic vesicles, form extensive, asymmetric synapses with the cell bodies and the dendrites of the UBC-like neurons, and resemble mossy terminals, while the small terminals contain pleomorphic vesicles, form symmetric synaptic junctions, and resemble Golgi terminals. In postnatal cultures grown for 12 days, UBC-like neurons are rare and resemble in most aspects the cells observed in embryonic cultures, although they rarely develop elaborate dendritic brushes.

Experimental demonstration of the influence of alcohol advertising on the activation of alcohol expectancies in memory among fourth- and fifth-grade children.

Previous work has demonstrated that children's organization and activation of alcohol expectancies in memory vary as a function of alcohol use, even among children as young as in the 3rd grade. To advance the understanding of influences on the development of alcohol expectancies in children, 551 4th- and 5th-grade children were exposed to 5 beer commercials or 5 soft drink commercials. After viewing the advertisements, all children reported their 1st associate to an alcohol prompt and completed a memory model-based measure of children's alcohol expectancies. Multidimensional scaling was used to map expectancies into hypothetical memory network format, and preference mapping was used to derive possible paths of activation. Children who viewed beer commercials were more likely to activate positive and arousing alcohol expectancies. In view of previous findings demonstrating that this pattern of activation corresponded to higher drinking among 3rd, 6th, 9th, and 12th graders, the present findings suggested that antecedents to drinking like exposure to advertising may promote heavier drinking among children by influencing the activation of expectancies in memory.

Efficacy of relapse prevention: a meta-analytic review.

Although relapse prevention (RP) has become a widely adopted cognitive-behavioral treatment intervention for alcohol, smoking, and other substance use, outcome studies have yielded an inconsistent picture of the efficacy of this approach or conditions for maximal effectiveness. A meta-analysis was performed to evaluate the overall effectiveness of RP and the extent to which certain variables may relate to treatment outcome. Twenty-six published and unpublished studies with 70 hypothesis tests representing a sample of 9,504 participants were included in the analysis. Results indicated that RP was generally effective, particularly for alcohol problems. Additionally, outcome was moderated by several variables. Specifically, RP was most effective when applied to alcohol or polysubstance use disorders, combined with the adjunctive use of medication, and when evaluated immediately following treatment using uncontrolled pre-post tests.

Presurgical assessment and surgical treatment for epilepsy.

In the last ten years, dramatic advances in surgical treatment options and techniques have allowed surgical intervention for patients who would otherwise not have been considered as surgical candidates. In this article, a multidisciplinary, logical decision algorithm for a rational approach to surgical treatments is outlined. A carefully considered hierarchy is presented that provides for maximized seizure improvement outcomes. Topics presented include temporal lobectomy, detailed discussion of dominant temporal lobectomy and speech-sparing techniques, neocortical resection, the use of subdural electrode array, depth electrodes, and strip electrodes, multiple subpinal transection, vagus nerve stimulation, and corpus callosotomy. The application of these various techniques to maximize surgical outcome are discussed.

Age and drinking-related differences in the memory organization of alcohol expectancies in 3rd-, 6th-, 9th-, and 12th-grade children.

To advance the theoretical modeling of the development of alcohol expectancies as a parallel processing memory network, this study assessed expectancies and alcohol consumption of 2,324 children in Grades 3, 6, 9, and 12 from a large suburban-rural school district. Individual-differences scaling (INDSCAL), a variant of multidimensional scaling, mapped expectancies into a hypothetical memory network format, and preference mapping (PREFMAP) modeled hypothetical paths of association within this network. Throughout this age range, older and higher drinking youth appeared to associate positive and arousing effects with alcohol cues, in contrast to lower drinking children, who appeared to mainly associate undesirable effects. These drinking-related differences in the organization of expectancy information are discernible well before onset of regular drinking habits and may influence the development of drinking in adolescence.

Development and fine structure of murine Purkinje cells in dissociated cerebellar cultures: neuronal polarity.

Cerebellar Purkinje cells (PC) display a highly distinctive form of polarity. We have cultured murine PCs from dissociated E16 cerebellar anlagen for 1 week to investigate the early stages of neuronal compartmentalization and synaptic interactions, features which are important for the establishment of neuronal polarity. To unequivocally identify the PCs we utilized light and electron microscopic immunocytochemistry with an anti-serum to the cell class-specific marker L7/pcp2 gene product. The PCs typically show a single, long axon, numerous short appendages classified as filopodia and protospines, and a small number of protodendrites. The nucleus is positioned asymmetrically in both the horizontal and vertical axes of the soma. The Golgi apparatus, coated and uncoated vesicles, and mitochondria are prominent ultrastructural features, while the endoplasmic reticulum is highly fragmented. The cell body receives rudimentary synapses on its smooth surfaces and appendages and no consistent morphological differences were detected between these elementary contacts. The axon is clearly identifiable; it emanates from either the cell body or a protodendrite, bifurcates at predominantly right angles, forms beaded collaterals, and terminates with relatively large growth cones. The varicosities of the PC axon contain pleomorphic synaptic vesicles and form rudimentary synapses primarily with the dendritic shafts of immunonegative neurons. The protodendrites are short, quickly tapering and sparsely branched; they emit numerous filopodia and immature spines and terminate with small growth cones. Rudimentary synapses are received on the proximal dendritic shafts and filopodia, and more mature synapses occur frequently on protospines. With few exceptions, PCs lie atop an astrocytic bed layer and glial processes are apposed to the various aspects of the PC body left free by the afferent axons. By contrast, PC processes are largely free of glial sheaths. We conclude that the "stellate stage" of PC development in situ is replicated rather faithfully in culture and that PCs have established polarity and have begun to form intercellular contacts by 1 week in vitro. Moreover, the PCs are already morphologically distinct from other cell types in the 1 week cultures, although they have yet to develop the differentiated features that distinguish mature PCs.

Development and fine structure of murine Purkinje cells in dissociated cerebellar cultures: dendritic differentiation, synaptic maturation, and formation of cell-class specific features.

The morphological differentiation of E16 murine Purkinje cells (PCs) in dissociated cerebellar cultures was analyzed by light and electron microscopic immunocytochemistry after 2-5 weeks in vitro (wiv), with particular emphasis on dendritic differentiation, synaptic maturation, and formation of stereotypical fine structural features. This study complements a companion paper on the features of PCs after 1 wiv. After 2 wiv, the PCs have an eccentric nucleus and the cytoplasmic organelles appear immature; the axon has a distinct initial segment and beaded axon collaterals but its boutons still contain sparse synaptic vesicles; dendrites show few bifurcations and tufts of spiny branchlets. After 3 wiv, the PCs display a centered nucleus, an extensive hypolemmal cisternal system, and stacks of up to four cisterns of granular endoplasmic reticulum; there is an increased number of dendritic bifurcations, spiny branchlets, mature spines, and axonal branches; dendritic tips still contain vesicle clusters, suggesting growth, and many synapses and afferent boutons continue to display immature features. After 4 wiv, elaborate perinucleolar coiled body rosettes, subsurface cistern-mitochondrion complexes and large stacks of granular endoplasmic reticulum finally appear within the soma; dendrites show a further increase in the numbers of bifurcations, segments and spines; most spines are synaptic and show mature features; afferent synapses are differentially distributed; PC boutons consistently display mature features and show a considerable degree of target specificity, although naked spines and reduced glial sheaths persist. After 5 wiv, PCs do not show further maturation and some dystrophic features appear. We conclude that under standard conditions and despite the disruption of normal tissue organization, PCs in dissociated cultures differentiate maximally after 4 wiv, at which stage they display many of the light and electron microscopic features that characterize mature PCs in situ. This prolonged developmental time-frame resembles that in the normal cerebellum. In view of the increasing usage of dissociated cerebellar cultures to study aspects of neuronal differentiation, synaptic activation and neuronal-glial interactions, an elucidation of the neurocytology of dissociated cerebellar cultures as presented in this study provides important clues for the interpretation of experimental data.

Central nervous system atypical teratoid tumor/rhabdoid tumor: response to intensive therapy and review of the literature.

Central nervous system atypical teratoid/rhabdoid tumor (ATT/RT) of infancy and childhood is a unique histologic entity with an extremely aggressive natural history. Standard therapy for infant and childhood medulloblastoma, for which this entity is often mistaken, has been ineffective; most children survive less than 12 months after diagnosis. Intensified therapy has been recently used for children with this disease, with promising results [1,2]. We report four cases of ATT/RT in young children; all had subtotal resections and localized disease at diagnosis. One child treated prior to bone marrow transplant availability died of progressive disease 9 months after diagnosis. Another child, treated with high-dose chemotherapy and radiotherapy in preparation for bone marrow transplant, had a recurrence and died 20 months after diagnosis, without undergoing the transplant. Two children received high-dose chemotherapy and autologous bone-marrow transplant and had a good response to treatment; one survived 19 months, the other child is free of disease 46 months from diagnosis. Intensified therapy has altered the natural history of central nervous system ATT/RT.

Body weight, estrogen and cognitive functioning in Alzheimer's disease: an analysis of the Tacrine Study Group data.

We conducted a retrospective analysis of clinically ascertained Alzheimer's disease subjects, hypothesizing that weight, given its positive relationship to endogenous estrogen levels, would correlate with better cognitive performance among women, but not necessarily men, with this disorder. Baseline (pretreatment) data, collected by the Tacrine Study Group were available from 347 women and 316 men. After controlling for age, duration of dementia, height, and education, we found weight to have a significant, positive relationship with two measures of global cognitive functioning among women. For men, this relationship was smaller and did not reach statistical significance. Post hoc analyses among women found the effect of weight to be independent of concurrent use of estrogen replacement medication. The use of estrogen replacement was independently related to better cognitive performance. Results support the contention that higher body weight - putatively as a reflection of higher levels of endogenous estrogens - has a positive effect on cognitive performance among women with Alzheimer's disease.