Trends in health information seeking among cancer and non-cancer adults between 2003 and 2005: A descriptive analysis of Health Information National Trends Survey (HINTS) data

Cancer is the second leading cause of death in the United States. With the advent of new technologies, changes in health care delivery, and multiplicity of provider types that patients must see, cancer care management has become increasingly complex. The availability of cancer health information has been shown to help cancer patients cope with the management and effects of their cancers. As a result, more cancer patients are using the internet to find resources that can aid in decision-making and recovery. ^ The Health Information National Trends Survey (HINTS) is a nationally representative survey designed to collect information about the experiences of cancer and non-cancer adults with health information sources. The HINTS survey focused on both conventional sources as well as newer technologies, particularly the internet. This study is a descriptive analysis of the HINTS 2003 and HINTS 2005 survey data. The purpose of the research is to explore the general trends in health information seeking and use by US adults, and especially by cancer patients. ^ From 2003 to 2005, internet use for various health-related activities appears to have increased among adults with and without cancer. Differences were found between the groups in the general trust in information media, particularly the internet. Non-cancer respondents tended to have greater trust in information media than cancer respondents. ^ The latter portion of this work examined characteristics of HINTS respondents that were thought to be relevant to how much trust individuals placed in the internet as a source of health information. Trust in health information from the internet was significantly greater among younger adults, higher-earning households, internet users, online seekers of health or cancer information, and those who found online cancer information useful. ^

The relationship between risk perception and ethnicity as an explanation for late stage skin cancer diagnosis in Black and Hispanic populations: An analysis using data from the 2005 Health Information and National Trends Survey

Objective. The purpose of this study was to determine the relationship between ethnicity and skin cancer risk perception while controlling for other risk factors: education, gender, age, access to healthcare, family history of skin cancer, fear, and worry. ^ Methods. This study utilized the Health Information National Trends Survey (HINTS) dataset, a nationally representative sample of 5,586 individuals 18 years of age or older. One third of the respondents were chosen at random and asked questions involving skin cancer. Analysis was based on questions that identified skin cancer risk perception, fear of finding skin cancer, and frequency of worry about skin cancer and a variety of sociodemographic factors. ^ Results. Ethnicity had a significant impact on risk perception scores while controlling for other risk factors. Other risk factors that also had a significant impact on risk perception scores included family history of skin cancer, age, and worry. ^

Physical activity among breast and prostate cancer survivors: Barriers, facilitators and maintenance following the FRESH START trial

Research provides evidence of the positive health effects associated with regular physical activity participation in all populations. Activity may prove to be especially beneficial in those with chronic conditions such as cancer. However, the majority of cancer patients and survivors do not participate in the recommended amount of physical activity. The purpose of this dissertation was to identify factors associated with physical activity participation, describe how these factors change as result of a diet and exercise intervention, and to evaluate correlates of long term physical activity maintenance. ^ For this dissertation, I analyzed data from the FRESH START trial, a randomized, single-blind, phase II clinical trial focused on improving diet and physical activity among recently diagnosed breast and prostate cancer survivors. Analyses included both parametric and non-parametric statistical tests. Three separate studies were conducted, with sample sizes ranging from 400 to 486. ^ Common barriers to exercise, such as “no willpower,” “too busy,” and “I have pain,” were reported among breast and prostate cancer survivors; however, these barriers were not significantly associated with minutes of physical activity. Breast cancer survivors reported a greater number of total barriers to exercise as well as higher proportions reporting individual barriers, compared to prostate cancer survivors. Just less than half of participants reduced their total number of barriers to exercise from baseline to 1-year follow-up, and those who did reduce barriers reported greater increases in minutes of physical activity compared to those who reported no change in barriers to exercise. Participants in both the tailored and standardized intervention groups reported greater minutes of physical activity at 2-year follow-up compared to baseline. Overall, twelve percent of participants reached recommended levels of physical activity at both 1- and 2-year follow-up. Self-efficacy was positively associated with physical activity maintenance, and the number of total barriers to exercise was inversely associated with physical activity maintenance. ^ Results from this dissertation are novel and informative, and will help to guide future physical activity interventions among cancer survivors. Thoughtfully designed interventions may encourage greater participation in physical activity and ultimately improve overall quality of life in this population. ^

Social and economically influenced factors associated with breast cancer treatment among blacks and whites. A qualitative study

Background: Despite the fact breast cancer mortality has declined in recent years, the mortality gap between African-American and white women continues to grow. A part of these disparities may be due to either inadequately following guideline recommended treatment or treatment delays. Although racial/ethnic disparities in breast cancer treatment and mortality have been extensively documented, the mechanisms by which these disparities occur remain largely unknown. Social and economically influenced factors such as choice of providers, distance of treatment facility, transportation, health insurance, and job related factors may also contribute to racial differences in breast cancer treatment; however, these have not been explored sufficiently in previous research. ^ Aim: The purpose of this study was to evaluate the role of social and economically influenced factors that may contribute to racial disparities in the receipt of guideline recommended treatment using the Health Disparities Model. ^ Methods: In this qualitative comparative case study, data from medical records, structured telephone interviews, and in-depth patient interviews explored the relationship between social and economically influenced factors and breast cancer treatment. Transcripts were analyzed using standard iterative process followed by immersion/crystallization approach. Participants were identified through rapid ascertainment from the New Jersey Cancer Registry and this study included 8 African-American and 8 white women aged 20-85 years old diagnosed with early stage breast cancer between 2003-2007, matched on age, race, and physician recommended treatment. ^ Results: We did not identify differences by race in factors that influenced the receipt of breast cancer treatment among the individual matched pairs. Four prominent themes emerged among women from both groups who experienced similar difficulties influenced by socioeconomic factors. Choice of providers, distance of facility, health insurance, and job related factors all contributed to breast cancer treatment experience among these women. Conclusions: We identified common issues influenced by socioeconomic factors and its relation with the receipt of breast cancer treatment, regardless of race. However, more research is needed to study the additional factors conveying racial differences affecting breast cancer treatment. ^

Goal-oriented self-adaptive hp-strategies for finite element analysis of electromagnetic scattering and radiation problems

In this paper, a fully automatic goal-oriented hp-adaptive finite element strategy for open region electromagnetic problems (radiation and scattering) is presented. The methodology leads to exponential rates of convergence in terms of an upper bound of an user-prescribed quantity of interest. Thus, the adaptivity may be guided to provide an optimal error, not globally for the field in the whole finite element domain, but for specific parameters of engineering interest. For instance, the error on the numerical computation of the S-parameters of an antenna array, the field radiated by an antenna, or the Radar Cross Section on given directions, can be minimized. The efficiency of the approach is illustrated with several numerical simulations with two dimensional problem domains. Results include the comparison with the previously developed energy-norm based hp-adaptivity.

Design and Simulation of Deep Nanometer SRAM Cells under Energy, Mismatch, and Radiation Constraints

La fiabilidad está pasando a ser el principal problema de los circuitos integrados según la tecnología desciende por debajo de los 22nm. Pequeñas imperfecciones en la fabricación de los dispositivos dan lugar ahora a importantes diferencias aleatorias en sus características eléctricas, que han de ser tenidas en cuenta durante la fase de diseño. Los nuevos procesos y materiales requeridos para la fabricación de dispositivos de dimensiones tan reducidas están dando lugar a diferentes efectos que resultan finalmente en un incremento del consumo estático, o una mayor vulnerabilidad frente a radiación. Las memorias SRAM son ya la parte más vulnerable de un sistema electrónico, no solo por representar más de la mitad del área de los SoCs y microprocesadores actuales, sino también porque las variaciones de proceso les afectan de forma crítica, donde el fallo de una única célula afecta a la memoria entera. Esta tesis aborda los diferentes retos que presenta el diseño de memorias SRAM en las tecnologías más pequeñas. En un escenario de aumento de la variabilidad, se consideran problemas como el consumo de energía, el diseño teniendo en cuenta efectos de la tecnología a bajo nivel o el endurecimiento frente a radiación. En primer lugar, dado el aumento de la variabilidad de los dispositivos pertenecientes a los nodos tecnológicos más pequeños, así como a la aparición de nuevas fuentes de variabilidad por la inclusión de nuevos dispositivos y la reducción de sus dimensiones, la precisión del modelado de dicha variabilidad es crucial. Se propone en la tesis extender el método de inyectores, que modela la variabilidad a nivel de circuito, abstrayendo sus causas físicas, añadiendo dos nuevas fuentes para modelar la pendiente sub-umbral y el DIBL, de creciente importancia en la tecnología FinFET. Los dos nuevos inyectores propuestos incrementan la exactitud de figuras de mérito a diferentes niveles de abstracción del diseño electrónico: a nivel de transistor, de puerta y de circuito. El error cuadrático medio al simular métricas de estabilidad y prestaciones de células SRAM se reduce un mínimo de 1,5 veces y hasta un máximo de 7,5 a la vez que la estimación de la probabilidad de fallo se mejora en varios ordenes de magnitud. El diseño para bajo consumo es una de las principales aplicaciones actuales dada la creciente importancia de los dispositivos móviles dependientes de baterías. Es igualmente necesario debido a las importantes densidades de potencia en los sistemas actuales, con el fin de reducir su disipación térmica y sus consecuencias en cuanto al envejecimiento. El método tradicional de reducir la tensión de alimentación para reducir el consumo es problemático en el caso de las memorias SRAM dado el creciente impacto de la variabilidad a bajas tensiones. Se propone el diseño de una célula que usa valores negativos en la bit-line para reducir los fallos de escritura según se reduce la tensión de alimentación principal. A pesar de usar una segunda fuente de alimentación para la tensión negativa en la bit-line, el diseño propuesto consigue reducir el consumo hasta en un 20 % comparado con una célula convencional. Una nueva métrica, el hold trip point se ha propuesto para prevenir nuevos tipos de fallo debidos al uso de tensiones negativas, así como un método alternativo para estimar la velocidad de lectura, reduciendo el número de simulaciones necesarias. Según continúa la reducción del tamaño de los dispositivos electrónicos, se incluyen nuevos mecanismos que permiten facilitar el proceso de fabricación, o alcanzar las prestaciones requeridas para cada nueva generación tecnológica. Se puede citar como ejemplo el estrés compresivo o extensivo aplicado a los fins en tecnologías FinFET, que altera la movilidad de los transistores fabricados a partir de dichos fins. Los efectos de estos mecanismos dependen mucho del layout, la posición de unos transistores afecta a los transistores colindantes y pudiendo ser el efecto diferente en diferentes tipos de transistores. Se propone el uso de una célula SRAM complementaria que utiliza dispositivos pMOS en los transistores de paso, así reduciendo la longitud de los fins de los transistores nMOS y alargando los de los pMOS, extendiéndolos a las células vecinas y hasta los límites de la matriz de células. Considerando los efectos del STI y estresores de SiGe, el diseño propuesto mejora los dos tipos de transistores, mejorando las prestaciones de la célula SRAM complementaria en más de un 10% para una misma probabilidad de fallo y un mismo consumo estático, sin que se requiera aumentar el área. Finalmente, la radiación ha sido un problema recurrente en la electrónica para aplicaciones espaciales, pero la reducción de las corrientes y tensiones de los dispositivos actuales los está volviendo vulnerables al ruido generado por radiación, incluso a nivel de suelo. Pese a que tecnologías como SOI o FinFET reducen la cantidad de energía colectada por el circuito durante el impacto de una partícula, las importantes variaciones de proceso en los nodos más pequeños va a afectar su inmunidad frente a la radiación. Se demuestra que los errores inducidos por radiación pueden aumentar hasta en un 40 % en el nodo de 7nm cuando se consideran las variaciones de proceso, comparado con el caso nominal. Este incremento es de una magnitud mayor que la mejora obtenida mediante el diseño de células de memoria específicamente endurecidas frente a radiación, sugiriendo que la reducción de la variabilidad representaría una mayor mejora. ABSTRACT Reliability is becoming the main concern on integrated circuit as the technology goes beyond 22nm. Small imperfections in the device manufacturing result now in important random differences of the devices at electrical level which must be dealt with during the design. New processes and materials, required to allow the fabrication of the extremely short devices, are making new effects appear resulting ultimately on increased static power consumption, or higher vulnerability to radiation SRAMs have become the most vulnerable part of electronic systems, not only they account for more than half of the chip area of nowadays SoCs and microprocessors, but they are critical as soon as different variation sources are regarded, with failures in a single cell making the whole memory fail. This thesis addresses the different challenges that SRAM design has in the smallest technologies. In a common scenario of increasing variability, issues like energy consumption, design aware of the technology and radiation hardening are considered. First, given the increasing magnitude of device variability in the smallest nodes, as well as new sources of variability appearing as a consequence of new devices and shortened lengths, an accurate modeling of the variability is crucial. We propose to extend the injectors method that models variability at circuit level, abstracting its physical sources, to better model sub-threshold slope and drain induced barrier lowering that are gaining importance in FinFET technology. The two new proposed injectors bring an increased accuracy of figures of merit at different abstraction levels of electronic design, at transistor, gate and circuit levels. The mean square error estimating performance and stability metrics of SRAM cells is reduced by at least 1.5 and up to 7.5 while the yield estimation is improved by orders of magnitude. Low power design is a major constraint given the high-growing market of mobile devices that run on battery. It is also relevant because of the increased power densities of nowadays systems, in order to reduce the thermal dissipation and its impact on aging. The traditional approach of reducing the voltage to lower the energy consumption if challenging in the case of SRAMs given the increased impact of process variations at low voltage supplies. We propose a cell design that makes use of negative bit-line write-assist to overcome write failures as the main supply voltage is lowered. Despite using a second power source for the negative bit-line, the design achieves an energy reduction up to 20% compared to a conventional cell. A new metric, the hold trip point has been introduced to deal with new sources of failures to cells using a negative bit-line voltage, as well as an alternative method to estimate cell speed, requiring less simulations. With the continuous reduction of device sizes, new mechanisms need to be included to ease the fabrication process and to meet the performance targets of the successive nodes. As example we can consider the compressive or tensile strains included in FinFET technology, that alter the mobility of the transistors made out of the concerned fins. The effects of these mechanisms are very dependent on the layout, with transistor being affected by their neighbors, and different types of transistors being affected in a different way. We propose to use complementary SRAM cells with pMOS pass-gates in order to reduce the fin length of nMOS devices and achieve long uncut fins for the pMOS devices when the cell is included in its corresponding array. Once Shallow Trench isolation and SiGe stressors are considered the proposed design improves both kinds of transistor, boosting the performance of complementary SRAM cells by more than 10% for a same failure probability and static power consumption, with no area overhead. While radiation has been a traditional concern in space electronics, the small currents and voltages used in the latest nodes are making them more vulnerable to radiation-induced transient noise, even at ground level. Even if SOI or FinFET technologies reduce the amount of energy transferred from the striking particle to the circuit, the important process variation that the smallest nodes will present will affect their radiation hardening capabilities. We demonstrate that process variations can increase the radiation-induced error rate by up to 40% in the 7nm node compared to the nominal case. This increase is higher than the improvement achieved by radiation-hardened cells suggesting that the reduction of process variations would bring a higher improvement.

Transcription and activity of antioxidant enzymes after ionizing irradiation in radiation-resistant and radiation-sensitive mice

The involvement of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase in radiobiological processes has been described at the enzyme activity level. We irradiated radiation-resistant (RR) and radiation-sensitive (RS) mice and studied antioxidant enzymes at the transcriptional and activity level. In addition, aromatic hydroxylation and lipid peroxidation parameters were determined to study radiation resistance at the oxidation level. RS BALB/c/J Him mice and RR C3H He/Him mice were whole-body-irradiated with x-rays at 2, 4, and 6 Gy and killed 5, 15, and 30 min after irradiation. mRNA was isolated from liver and hybridized with probes for antioxidant enzymes and β-actin as a housekeeping gene control. Antioxidant enzyme activities were determined by standard assays. Parameters for aromatic hydroxylation (o-tyrosine) and lipid peroxidation (malondialdehyde) were determined by HPLC methods. Antioxidant transcription was unchanged in contrast to antioxidant activities; SOD and CAT activities were elevated within 15 min in RR animals but not in RS mice, at all doses studied. Glutathione peroxidase activity was not different between RR and RS mice and was only moderately elevated after irradiation. No significant differences were found between RR and RS animals at the oxidation level, although a radiation dose-dependent increase of oxidation products was detected in both groups. We found that ionizing irradiation led to increased antioxidant activity only minutes after irradiation in the absence of increased transcription of these antioxidant enzymes. RR animals show higher antioxidant enzyme activities than do RS mice, but oxidation products are comparable in RS and RR mice. As unchanged transcription of antioxidant enzymes could not have been responsible for the increased antioxidant enzyme activities, preformed antioxidant enzymes should have been released by the irradiation process. This would be in agreement with previous studies of preformed, stored SOD. The finding of higher SOD and CAT activities in RR than in RS animals could point to a role for these antioxidant enzymes for the process of radiation sensitivity.

Vasoactive intestinal peptide inhibits human small-cell lung cancer proliferation in vitro and in vivo

Small-cell lung carcinoma (SCLC) is an aggressive, rapidly growing and metastasizing, and highly fatal neoplasm. We report that vasoactive intestinal peptide inhibits the proliferation of SCLC cells in culture and dramatically suppresses the growth of SCLC tumor-cell implants in athymic nude mice. In both cases, the inhibition was mediated apparently by a cAMP-dependent mechanism, because the inhibition was enhanced by the adenylate cyclase activator forskolin and the phosphodiesterase inhibitor 3-isobutyl-1-methylxanthine in proportion to increases in intracellular cAMP levels, and the inhibition was abolished by selective inhibition of cAMP-dependent protein kinase. If confirmed in clinical trials, this antiproliferative action of vasoactive intestinal peptide may offer a new and promising means of suppressing SCLC in human subjects, without the toxic side effects of chemotherapeutic agents.