Theory of uncertainty in illness in patients with cancer of unknown primary origin: Structure providers as antecedents of uncertainty in a population of cancer patients with an unknown primary diagnosis

Uncertainty has been found to be a major component of the cancer experience and can dramatically affect psychosocial adaptation and outcomes of a patient's disease state (McCormick, 2002). Patients with a diagnosis of Carcinoma of Unknown Primary (CUP) may experience higher levels of uncertainty due to the unpredictability of current and future symptoms, limited treatment options and an undetermined life expectancy. To date, only one study has touched upon uncertainty and its' effects on those with CUP but no information exists concerning the effects of uncertainty regarding diagnosis and treatment on the distress level and psychosocial adjustment of this population (Parker & Lenzi, 2003). ^ Mishel's Uncertainty in Illness Theory (1984) proposes that uncertainty is preceded by three variables, one of which being Structure Providers. Structure Providers include credible authority, the degree of trust and confidence the patient has with their doctor, education and social support. It was the goal of this study to examine the relationship between uncertainty and Structure Providers to support the following hypotheses: (1) There will be a negative association between credible authority and uncertainty, (2) There will be a negative association between education level and uncertainty, and (3) There will be a negative association between social support and uncertainty. ^ This cross-sectional analysis utilized data from 219 patients following their initial consultation with their oncologist. Data included the Mishel Uncertainty in Illness Scale (MUIS) which was used to determine patients' uncertainty levels, the Medical Outcomes Study-Social Support Scale (MOSS-SSS) to assess patients, levels of social support, the Patient Satisfaction Questionnaire (PSQ-18) and the Cancer Diagnostic Interview Scale (CDIS) to measure credible authority and general demographic information to assess age, education, marital status and ethnicity. ^ In this study we found that uncertainty levels were generally higher in this sample as compared to other types of cancer populations. And while our results seemed to support most of our hypothesis, we were only able to show significant associations between two. The analyses indicated that credible authority measured by both the CDIS and the PSQ was a significant predictor of uncertainty as was social support measured by the MOSS-SS. Education has shown to have an inconsistent pattern of effect in relation to uncertainty and in the current study there was not enough data to significantly support our hypothesis. ^ The results of this study generally support Mishel's Theory of Uncertainty in Illness and highlight the importance of taking into consideration patients, psychosocial factors as well as employing proper communication practices between physicians and their patients.^

Social cognitive theory and factors associated with Mexican-American parents' beliefs, attitudes and practices regarding communication with their adolescent children about sex

Latinos have the highest teen birth rate nationally. Cameron County, Texas is primarily Latino (Mexican-American). This mixed-method study (n=43) examines Mexican-American parents of adolescents' beliefs, attitudes and practices regarding communication with their adolescent children about sex. Social Cognitive Theory (SCT) constructs self-efficacy, behavioral determinism, environment, outcome expectations and reciprocal determinism can be influences on frequency and quality of parent-adolescent sex communication.^ This study describes Mexican-American parents' of adolescents recollections of their own experiences associated with learning about sexuality. It also examines the attitudes and practices regarding communication about sex and the self-efficacy and behavioral capability of participants to teach their adolescent children about sex and sexually transmitted infections. ^ Negative childhood experiences (shame, lies and trauma) of the parents in this study played a key role in terms of their desire to communicate more comprehensively about sexuality with their own children than did their parents. While participants' reported low self-efficacy and behavioral capability to communicate with their adolescent children about sex, they reported relatively high frequency and quality of communication, with 75% of participants receiving a high quality score and over 44% reporting frequent communication with their adolescent children about sex. A Chi square analysis and Fisher's Exact Score revealed no association between acculturation status, gender or having a child who has mothered/fathered a baby and the frequency or quality of communication about sex with adolescent children. Study participants also gave specific recommendations for method, content and setting of sex education for their children and themselves. Promotora delivery of information and education in a comfortable, culturally appropriate neighborhood setting, as well as parent –child learning sessions were identified as possible approaches to address improve self-efficacy and behavioral capability of parents communicating with their adolescent children about sex.^ The results of this analysis provide public health practitioners and interested community entities data to identify and develop interventions that use a theoretical, evidence-based framework for culturally appropriate interventions to encourage and equip Mexican-American parents to effectively communicate with their adolescent children about sexuality, and ultimately to address the high rates of teen pregnancy in this U.S.-Mexico border community. ^

Sexual initiation of U.S. Latino and Colombian high school students: Toward a new theory of adolescent sexuality and implications for sexual health prevention and promotion

The general research question for this dissertation was: do the data on adolescent sexual experiences and sexual initiation support the explicit or implicit adolescent sexuality theories informing the sexual health interventions currently designed for youth? To respond to this inquiry, three different studies were conducted. The first study included a conceptual and historical analysis of the notion of adolescence introduced by Stanley Hall, the development of an alternative model based on a positive view of adolescent sexuality, and the rationale for introducing to adolescent sexual health prevention programs the new definitions of sexual health and the social determinants of health approach. The second one was a quantitative study aimed at surveying not only adolescents' risky sexual behaviors but also sexual experiences associated with desire/pleasure which have been systematically neglected when investigating the sexual and reproductive health of the youth. This study was conducted with a representative sample of the adolescents attending public high schools in the State of Caldas in the Republic of Colombia. The third study was a qualitative analysis of 22 interviews conducted with male and female U.S. Latino adolescents on the reasons for having had or having not had vaginal sex. The more relevant results were: most current adolescent sexual health prevention programs are still framed in a negative approach to adolescent sexuality developed a century ago by Stanley Hall and Sigmund Freud which do not accept the adolescent sexual experience and propose its sublimation. In contrast, the Colombian study indicates that, although there are gender differences, adolescence is for males and females a normal period of sexual initiation not limited to coital activity, in which sexual desire/pleasure is strongly associated with sexual behavior. By the same token, the study about the reasons for having had or not had initiated heterosexual intercourse indicated that curiosity, sexual desire/pleasure, and love are basic motivations for deciding to have vaginal sexual intercourse for the first time and that during adolescence, young women and men reach the cognitive development necessary for taking conscious decisions about their sexual acts. The findings underline the importance of asking pertinent questions about desire/pleasure when studying adolescent sexuality and adopting an evidence-based approach to sexual health interventions.^

The theory of runs with application to drought predictions

The primary interest was in predicting the distribution runs in a sequence of Bernoulli trials. Difference equation techniques were used to express the number of runs of a given length k in n trials under three assumptions (1) no runs of length greater than k, (2) no runs of length less than k, (3) no other assumptions about the length of runs. Generating functions were utilized to obtain the distributions of the future number of runs, future number of minimum run lengths and future number of the maximum run lengths unconditional on the number of successes and failures in the Bernoulli sequence. When applying the model to Texas hydrology data, the model provided an adequate fit for the data in eight of the ten regions. Suggested health applications of this approach to run theory are provided. ^

Prospective run theory for multinomial outcomes

The focus of this study was to generalize the theory of runs to multinomial outcomes using the generating function approach. Detailed discussion is provided for determining the probability distributions for all runs of length i in a sequence of n trials for the binomial and trinomial cases. The generalization to multinomial case is also presented. Application to data for patients from a long term disability care facility is presented to illustrate the use of Run Theory in determining the probability of a dominant state of treatment associated with a patient during his/her hospitalization. ^

Validity of using item response theory to analyze data from the Work Limitations Questionnaire

The Work Limitations Questionnaire (WLQ) is used to determine the amount of work loss and productivity which stem from certain health conditions, including rheumatoid arthritis and cancer. The questionnaire is currently scored using methodology from Classical Test Theory. Item Response Theory, on the other hand, is a theory based on analyzing item responses. This study wanted to determine the validity of using Item Response Theory (IRT), to analyze data from the WLQ. Item responses from 572 employed adults with dysthymia, major depressive disorder (MDD), double depressive disorder (both dysthymia and MDD), rheumatoid arthritis and healthy individuals were used to determine the validity of IRT (Adler et al., 2006).^ PARSCALE, which is IRT software from Scientific Software International, Inc., was used to calculate estimates of the work limitations based on item responses from the WLQ. These estimates, also known as ability estimates, were then correlated with the raw score estimates calculated from the sum of all the items responses. Concurrent validity, which claims a measurement is valid if the correlation between the new measurement and the valid measurement is greater or equal to .90, was used to determine the validity of IRT methodology for the WLQ. Ability estimates from IRT were found to be somewhat highly correlated with the raw scores from the WLQ (above .80). However, the only subscale which had a high enough correlation for IRT to be considered valid was the time management subscale (r = .90). All other subscales, mental/interpersonal, physical, and output, did not produce valid IRT ability estimates.^ An explanation for these lower than expected correlations can be explained by the outliers found in the sample. Also, acquiescent responding (AR) bias, which is caused by the tendency for people to respond the same way to every question on a questionnaire, and the multidimensionality of the questionnaire (the WLQ is composed of four dimensions and thus four different latent variables) probably had a major impact on the IRT estimates. Furthermore, it is possible that the mental/interpersonal dimension violated the monotonocity assumption of IRT causing PARSCALE to fail to run for these estimates. The monotonicity assumption needs to be checked for the mental/interpersonal dimension. Furthermore, the use of multidimensional IRT methods would most likely remove the AR bias and increase the validity of using IRT to analyze data from the WLQ.^

Learning kinds for students of technical high school : An analysis from the David Ausubel's theory

This article presents the findings of a field research, not experimental, observational, correlating, basic, of mixed data, micro sociologic, leading to a study of surveys.The object of study is to find learning kinds, and the unit of analysis were 529 high school students between 16 and 21 years old. Its purpose is to understand the impact of learning by rote, guided, self learned and meaningful learning and its achievement degree besides the learning outcomes of differentiated curriculum based on David Ausubel's thoughts, associated with different economic specialties (MINEDUC, 1998) where the population of the study is trained. To collect data, the test TADA - DO2 was used, this test has a reliability index of 0.911 according to Cronbach. From the hits it can be stated from the null hypothesis that there is a significant association (a = 0,05) between the learning kinds and the learning expected of differentiated training plan for both, male and female. It is complex to state that the training of the middle-level technicians leads to a successful employment.

Learning kinds for students of technical high school : An analysis from the David Ausubel's theory

This article presents the findings of a field research, not experimental, observational, correlating, basic, of mixed data, micro sociologic, leading to a study of surveys.The object of study is to find learning kinds, and the unit of analysis were 529 high school students between 16 and 21 years old. Its purpose is to understand the impact of learning by rote, guided, self learned and meaningful learning and its achievement degree besides the learning outcomes of differentiated curriculum based on David Ausubel's thoughts, associated with different economic specialties (MINEDUC, 1998) where the population of the study is trained. To collect data, the test TADA - DO2 was used, this test has a reliability index of 0.911 according to Cronbach. From the hits it can be stated from the null hypothesis that there is a significant association (a = 0,05) between the learning kinds and the learning expected of differentiated training plan for both, male and female. It is complex to state that the training of the middle-level technicians leads to a successful employment.

Learning kinds for students of technical high school : An analysis from the David Ausubel's theory

This article presents the findings of a field research, not experimental, observational, correlating, basic, of mixed data, micro sociologic, leading to a study of surveys.The object of study is to find learning kinds, and the unit of analysis were 529 high school students between 16 and 21 years old. Its purpose is to understand the impact of learning by rote, guided, self learned and meaningful learning and its achievement degree besides the learning outcomes of differentiated curriculum based on David Ausubel's thoughts, associated with different economic specialties (MINEDUC, 1998) where the population of the study is trained. To collect data, the test TADA - DO2 was used, this test has a reliability index of 0.911 according to Cronbach. From the hits it can be stated from the null hypothesis that there is a significant association (a = 0,05) between the learning kinds and the learning expected of differentiated training plan for both, male and female. It is complex to state that the training of the middle-level technicians leads to a successful employment.

Distributed www programming using (Ciao-) prolog and the pillow library

We discuss from a practical point of view a number of ssues involved in writing distributed Internet and WWW applications using LP/CLP systems. We describe PiLLoW, a publicdomain Internet and WWW programming library for LP/CLP systems that we have designed in order to simplify the process of writing such applications. PiLLoW provides facilities for accessing documents and code on the WWW; parsing, manipulating and generating HTML and XML structured documents and data; producing HTML forms; writing form handlers and CGI-scripts; and processing HTML/XML templates. An important contribution of PÍ'LLOW is to model HTML/XML code (and, thus, the content of WWW pages) as terms. The PÍ'LLOW library has been developed in the context of the Ciao Prolog system, but it has been adapted to a number of popular LP/CLP systems, supporting most of its functionality. We also describe the use of concurrency and a highlevel model of client-server interaction, Ciao Prolog's active modules, in the context of WWW programming. We propose a solution for client-side downloading and execution of Prolog code, using generic browsers. Finally, we also provide an overview of related work on the topic.

Educating a New Cadre of Experts Specializing in Digital Collections and Digital Curation: Experiential Learning in Digital Library Curriculum

Integration of experiential learning into the library and information science (LIS) courses has been a theme in LIS education, but the topic deserves renewed attention with an increasing demand for professionals in the digital library field and in light of the new initiative announced by the Library of Congress (LC) and the Institution of Museum and Library Services (IMLS) for national residency program in digital curation. The balance between theory and practice in digital library curricula, the challenges of incorporating practical projects into LIS coursework, and the current practice of teaching with hands on activities represent the primary areas of this panel discussion.

The theory of the gene, by Thomas Hunt Morgan ...

2d ed