Evaluating minimal important differences for the FACT-Melanoma quality of life questionnaire

Objectives. Minimal Important Differences (MIDs) establish benchmarks for interpreting mean differences in clinical trials involving quality of life outcomes and inform discussions of clinically meaningful change in patient status. As such, the purpose of this study was to assess MIDs for the Functional Assessment of Cancer Therapy–Melanoma (FACT-M). ^ Methods. A prospective validation study of the FACT-M was performed with 273 patients with stage I to IV melanoma. FACT-M, Karnofsky Performance Status (KPS), and Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores were obtained at baseline and 3 months following enrollment. Anchor- and distribution-based methods were used to assess MIDs, and the correspondence between MID ranges derived from each method was evaluated. ^ Results. This study indicates that an approximate range for MIDs of the FACT-M subscales is between 5 to 8 points for the Trial Outcome Index, 4 to 5 points for the Melanoma Combined Subscale, 2 to 4 points for the Melanoma Subscale, and 1 to 2 points for the Melanoma Surgery Subscale. Each method produced similar but not identical ranges of MIDs. ^ Conclusions. The properties of the anchor instrument employed to derive MIDs directly affect resulting MID ranges and point values. When MIDs are offered as supportive evidence of a clinically meaningful change, the anchor instrument used to derive thresholds should be clearly stated along with evidence supporting the choice of anchor instrument as the most appropriate for the domain of interest. In this analysis, the KPS was a more appropriate measure than the ECOG-PS for assessing MIDs. ^

ETIOLOGIC AND CLINICAL FACTORS WHICH DIFFERENTIATE PATIENTS WITH CHROMOSOMAL ABNORMALITIES FROM DIPLOID PATIENTS IN ACUTE NONLYMPHOCYTIC LEUKEMIA

Tumor-specific chromosomal abnormalities have been demonstrated in bone marrow of approximately 50% of newly diagnosed acute nonlymphocytic (ANLL) patients. This study examined two hypotheses: (1) Aneuploid (AA) patients are diagnosed later in the course of their disease than diploid (NN) patients; and (2) AA patients are more likely to have been exposed to environmental agents. Of 324 patients eligible for study, environmental exposure data were obtained for 236 (73%) of them. No evidence was found to suggest that AA patients had more advanced disease than NN patients. Aneuploid patients were more likely than NN patients to: (a) report treatment with cytotoxic drugs for a prior medical condition (odds ratio, adjusted for age, sex and other exposures (OR) = 4.25, 95% confidence intervals, 1.38 to 13.17); (b) smoke cigarettes, OR = 1.82 (1.02, 3.26) and (c) drink alcoholic beverages, OR = 1.91 (1.05, 3.48). No statistically significant associations between aneuploidy and occupational exposures were present, OR = 3.59 (0.76, 17.13). Problems in interpreting these ORs are discussed. ^

The illness experiences of African Americans residing in an inner city community, Houston, Texas

This dissertation documents health and illness in the context of daily life circumstances and structural conditions faced by African American families living in Clover Heights (pseudonym), an inner city public housing project in the Third Ward, Houston, Texas. Drawing from Kleinman's (1980) model of culturally defined health care systems and using the holistic-content approach to narrative analysis (Lieblich, Tuval- Mashiach, & Zilber, 1998) the purpose of this research was to explore the ways in which social and health policy, economic mobility, the inner city environment, and cultural beliefs intertwined with African American families' health related ideas, behaviors, and practices. I recruited six families using a convenience sampling method (Schensul, Schensul, & LeCompte, 1999) and followed them for fourteen months (2010–2011). Family was defined as a household unit, or those living in the same residence, short or long-term. Single, African American women ranging in age from 29–80 years headed all families. All but one family included children or grandchildren 18 years of age and younger, or children or other relative 18 years of age and older. I also recruited six residents with who I became acquainted over the course of the project. I collected data using traditional ethnographic methods including participant-observation, archive review, field notes, mapping, free-listing, in-depth interviews, and life history interviews. ^ Doing ethnography afforded the families who participated in this project the freedom to construct their own experiences of health and illness. My role centered on listening to, learning from, and interpreting participants' narratives, exploring similarities and differences within and across families' experiences. As the research progressed, a pattern concerning diagnosis and pharmacotherapy for children's behavioral and emotional problems, particularly attention-deficit hyperactivity disorder (ADHD) and pediatric bipolar disorder (PBD), emerged from my formal interactions with participants and my informal interactions with residents. The findings presented in this dissertation document this pattern, focusing on how mothers and families interpreted, organized, and ascribed meaning to their experiences of ADHD and PBD. ^ In the first manuscript presented here, I documented three mothers' narrative constructions of a child's diagnosis with and pharmacotherapy for ADHD or PBD. Using Gergen's (1997) relational perspective I argued that mothers' knowledge and experiences of ADHD and PBD were not individually constructed, but were linguistically and discursively constituted through various social interactions and relationships, including family, spirituality and faith, community norms, and expert systems of knowledge. Mothers' narratives revealed the complexity of children's behavioral and emotional problems, the daily trials of living through these problems, how they coped with adversity and developed survival strategies, and how they interacted with various institutional authorities involved in evaluating, diagnosing, and encouraging pharmaceutical intervention for children's behavior. The findings highlight the ways in which mothers' social interactions and relationships introduced a scientific language and discourse for explaining children's behavior as mental illness, the discordances between expert systems of knowledge and mothers' understandings, and how discordances reflected mothers' ‘microsources of power’ for producing their own stories and experiences. ^ In the second manuscript presented here, I documented the ways in which structural factors, including gender, race/ethnicity, and socioeconomic status, coupled with a unique cultural and social standpoint (Collins, 1990/2009) influenced the strategies this group of African American mothers employed to understand and respond to ADHD or PBD. The most salient themes related to mother-child relationships coalesced around mothers' beliefs about the etiology of ADHD and PBD, ‘conceptualizing responsibility,’ and ‘protection-survival.’ The findings suggest that even though mothers' strategies varied, they were in pursuit of a common goal. Mothers' challenged the status quo, addressing children's behavioral and emotional problems in the ways that made the most sense to them, specifically protecting their children from further marginalization in society more so than believing these were the best options for their children.^

A comparative state policy analysis of the adoption of birth defects surveillance legislation

Birth defects are the leading cause of infant mortality in the United States and are a major cause of lifetime disability. However, efforts to understand their causes have been hampered by a lack of population-specific data. During 1990–2004, 22 state legislatures responded to this need by proposing birth defects surveillance legislation (BDSL). The contrast between these states and those that did not pass BDSL provides an opportunity to better understand conditions associated with US public health policy diffusion. ^ This study identifies key state-specific determinants that predict: (1) the introduction of birth defects surveillance legislation (BDSL) onto states' formal legislative agenda, and (2) the successful adoption of these laws. Secondary aims were to interpret these findings in a theoretically sound framework and to incorporate evidence from three analytical approaches. ^ The study begins with a comparative case study of Texas and Oregon (states with divergent BDSL outcomes), including a review of historical documentation and content analysis of key informant interviews. After selecting and operationalizing explanatory variables suggested by the case study, Qualitative Comparative Analysis (QCA) was applied to publically available data to describe important patterns of variation among 37 states. Results from logistic regression were compared to determine whether the two methods produced consistent findings. ^ Themes emerging from the comparative case study included differing budgetary conditions and the significance of relationships within policy issue networks. However, the QCA and statistical analysis pointed to the importance of political parties and contrasting societal contexts. Notably, state policies that allow greater access to citizen-driven ballot initiatives were consistently associated with lower likelihood of introducing BDSL. ^ Methodologically, these results indicate that a case study approach, while important for eliciting valuable context-specific detail, may fail to detect the influence of overarching, systemic variables, such as party competition. However, QCA and statistical analyses were limited by a lack of existing data to operationalize policy issue networks, and thus may have downplayed the impact of personal interactions. ^ This study contributes to the field of health policy studies in three ways. First, it emphasizes the importance of collegial and consistent relationships among policy issue network members. Second, it calls attention to political party systems in predicting policy outcomes. Finally, a novel approach to interpreting state data in a theoretically significant manner (QCA) has been demonstrated.^

Robust effect sizes and their confidence intervals for group difference between trajectories in hierarchical linear growth model

Hierarchical linear growth model (HLGM), as a flexible and powerful analytic method, has played an increased important role in psychology, public health and medical sciences in recent decades. Mostly, researchers who conduct HLGM are interested in the treatment effect on individual trajectories, which can be indicated by the cross-level interaction effects. However, the statistical hypothesis test for the effect of cross-level interaction in HLGM only show us whether there is a significant group difference in the average rate of change, rate of acceleration or higher polynomial effect; it fails to convey information about the magnitude of the difference between the group trajectories at specific time point. Thus, reporting and interpreting effect sizes have been increased emphases in HLGM in recent years, due to the limitations and increased criticisms for statistical hypothesis testing. However, most researchers fail to report these model-implied effect sizes for group trajectories comparison and their corresponding confidence intervals in HLGM analysis, since lack of appropriate and standard functions to estimate effect sizes associated with the model-implied difference between grouping trajectories in HLGM, and also lack of computing packages in the popular statistical software to automatically calculate them. ^ The present project is the first to establish the appropriate computing functions to assess the standard difference between grouping trajectories in HLGM. We proposed the two functions to estimate effect sizes on model-based grouping trajectories difference at specific time, we also suggested the robust effect sizes to reduce the bias of estimated effect sizes. Then, we applied the proposed functions to estimate the population effect sizes (d ) and robust effect sizes (du) on the cross-level interaction in HLGM by using the three simulated datasets, and also we compared the three methods of constructing confidence intervals around d and du recommended the best one for application. At the end, we constructed 95% confidence intervals with the suitable method for the effect sizes what we obtained with the three simulated datasets. ^ The effect sizes between grouping trajectories for the three simulated longitudinal datasets indicated that even though the statistical hypothesis test shows no significant difference between grouping trajectories, effect sizes between these grouping trajectories can still be large at some time points. Therefore, effect sizes between grouping trajectories in HLGM analysis provide us additional and meaningful information to assess group effect on individual trajectories. In addition, we also compared the three methods to construct 95% confident intervals around corresponding effect sizes in this project, which handled with the uncertainty of effect sizes to population parameter. We suggested the noncentral t-distribution based method when the assumptions held, and the bootstrap bias-corrected and accelerated method when the assumptions are not met.^

(Table 1) Species richness and diversity of tundra plants in herbivore exclosure and control plots near Barrow, Alaska

To determine the role lemmings play in structuring plant communities and their contribution to the 'greening of the Arctic', we measured plant cover and biomass in 50 + year old lemming exclosures and control plots in the coastal tundra near Barrow, Alaska. The response of plant functional types to herbivore exclusion varied among land cover types. In general, the abundance of lichens and bryophytes increased with the exclusion of lemmings, whereas graminoids decreased, although the magnitude of these responses varied among land cover types. These results suggest that sustained lemming activity promotes a higher biomass of vascular plant functional types than would be expected without their presence and highlights the importance of considering herbivory when interpreting patterns of greening in the Arctic. In light of the rapid environmental change ongoing in the Arctic and the potential regional to global implications of this change, further exploration regarding the long-term influence of arvicoline rodents on ecosystem function (e.g. carbon and energy balance) should be considered a research priority.

Geochemistry of Cenozoic sediments from the central Artic Ocean

Integrated Ocean Drilling Program (IODP) Expedition 302 (Arctic Coring Expedition, ACEX) recovered a unique sediment record from the central Arctic Ocean, revealing that this region underwent major environmental fluctuations since the Late Cretaceous. Major and trace element composition of 1,300 samples were determined using X-ray fluorescence (XRF). The results show significant compositional variability of the sediments with depth that can be attributed to changes in (a) provenance and pathways of detrital material, (b) paleoenvironmental conditions and depositional processes, and (c) diagenetic overprint of the primary record. In addition to existing lithological units, we introduce new geochemical units for a more process-related approach interpreting the ACEX record. In detail, via the geochemical signature of Siberian flood basalts we are able to reconstruct the discontinuous rifting and deepening of the central Lomonosov Ridge during the Paleogene, accompanied by changing current regimes and the onset of sea ice. Eocene biosiliceous sedimentation took place in a relatively shallow setting under predominantly anoxic bottom water conditions, causing a positive anoxia-productivity feedback, although water column stratification was repeatedly interrupted by ventilation events. Anoxic to sulfidic conditions were even more extreme after biosilica production ceased, and significant amounts of pyrite were deposited on the Lomonosov Ridge. Especially in organic matter-rich Paleogene deposits, diagenetic processes obscured the paleoenvironmental signals. Fundamental environmental changes occurred in the Middle Eocene, but geochemical and micropaleontological proxies point not to the identical sediment depth. After approximately 26 Ma of non-deposition or erosion, the Middle Miocene record shows the transition to dominantly oxic bottom water conditions, although suboxic diagenesis seemingly affected these deposits.

Espacio, presencia, acontecimiento: configuración semántica de la existencia ficcional en un modelo teatral históricamente hegemónico

¿Qué implica para un personaje o para cualquier entidad habitante de un universo de ficción existir ficcionalmente? ¿Cuáles son los procedimientos que construyen esa existencia y cuáles sus consecuencias en el plano semántico? Mi contribución pretende responder esos interrogantes a partir de la demostración de la siguientes hipótesis: existe en el teatro un modelo tradicionalmente dominante de construcción de la existencia ficcional; los habitantes de un mundo ficcional adquieren su existencia, en ese modelo teatral hegemónico, mediante dos tipos de procedimientos semióticos: cualquier presencia inscripta en el espacio escénico y la autoridad legitimadora de existencia que tienen ciertos par-lamentos; la configuración semántica de la existencia ficcional no resulta sólo de los principios constructivos semióticos sino también de presuposiciones que pone en marcha el espectador a partir de sus hábitos interpretativos; la interacción entre procedimientos semióticos y operaciones activadas por el espectador genera, para esta clase de mundos ficcionales, una configuración semántica particular de la categoría de existencia.

El ver sensible en Tomás de Aquino : replanteamiento de una objeción

La conocida tesis de Tomás de Aquino de que el ver «es el más elevado de todos [los sentidos]» (De anima, c13) está detrás de la metáfora de la vista como expresión del conocer y de la afirmación de que este sentido es el más inmaterial (y más próximo a lo espiritual) de todos los sentidos externos. Esta noción de ‘ver’ (y de ‘sentir’) presentaba dos elementos constitutivos de todo sentido: lo que tenía como inmutación o impresión (contacto con la realidad) y su carácter formal (aprehensor de la forma sensible). Lograr una posición unitaria que integre tanto el elemento impresivo (dador de realidad) como aprehensivo o cognoscitivo ha sido también el intento de posturas filosóficas contemporáneas (como la de Zubiri) respondiendo a posiciones insuficientes que o bien han primado el elemento de inmediatez, o han señalado el sentir como mero dador de contenido a la inteligencia. Así, este autor revisa las formas de interpretar el sentido, señalando la primariedad del sentido del tacto y la fundamentalidad de éste para la comprensión del verdadero estatuto del sentir humano, poniendo de nuevo en actualidad la reflexión del Aquinate sobre el sentir, indicando a su vez la diferencia de planteamientos de ambos autores.

Lightness timescale for terrestrial sediments of China

The Nihewan Beds at Yangyuan reflect apparently continuous, high-resolution deposition of fluvial-lacustrine sediment in the climatically important loess deposit regions of north China. The Hutouliang section forms the upper portion of Nihewan Beds deposited during the Brunhes magnetic polarity chron. Lightness values measured on successive samples display similar variability to the aeolian flux record of oceanic sediment core V21-146 located downwind from this area in the North Pacific. The oxygen isotope timescale of core V21-146 was transferred to the lightness curve to provide a preliminary timescale allowing more detailed age control in the Hutouliang section. This timescale will provide useful assistance in dating boundary ages of the loess-soil sequence in China and interpreting regional climatic data.

Cretaceous and Paleogene calcareous nannofossils from ODP Leg 123

Two of five holes drilled at two separate sites during Leg 123 of the Ocean Drilling Program intersected thick and relatively complete sections of Upper Cretaceous-Paleogene nannofossiliferous sediments. Although dominated by turbidite deposition in the upper part, Hole 765C contains a thick and relatively complete Albian-Oligocene section, including a particularly thick Aptian interval, with abundant and fairly well-preserved nannofossils. Several unconformities are confidently interpreted in this section that span much of the Santonian, late Campanian, Maestrichtian, late Eocene, and early Oligocene. Hole 766A contains a thick and relatively complete Albian-lower Eocene section having generally abundant and well-preserved nannofossils. Several unconformities also have been identified in this section that span much of the Coniacian, early Campanian, Maestrichtian, and late Eocene through early Pliocene. The chronostratigraphic position and length of all these unconformities may have considerable significance for reconstructing the sedimentary history and for interpreting the paleoceanography of this region. A particularly thick section of upper Paleocene-lower Eocene sediments, including a complete record across the Paleocene/Eocene boundary, also was cored in Hole 766A that contains abundant and diverse nannofossil assemblages. Although assemblages from this section were correlated successfully using a standard low-latitude zonation, difficulties were encountered that reduced biostratigraphic resolution. Several lines of evidence suggest a mid-latitude position for Site 766 during this time, including (1) high assemblage diversity characteristic of mid-latitude zones of upwelling and (2) absence of certain ecologically controlled markers found only in low latitudes.

Estrategias para mejorar la comprensión del proceso de replicación del ADN en alumnos de la Escuela Secundaria

Teniendo como hipótesis que la representación gráfica de la replicación del ADN utilizada habitualmente genera una comprensión inadecuada del proceso, y que la utilización de una representación alternativa que sitúa las horquillas en el interior de una o varias burbujas de replicación mejora la comprensión del proceso, se presenta una secuencia de estrategias de enseñanza con el objetivo de contribuir a la mejor comprensión del proceso de replicación del ADN

Metodología de la enseñanza y formación del profesorado : El caso de la Sección Pedagógica y la Facultad de Ciencias de la Educación de la Universidad Nacional de La Plata entre 1906 y 1920

En este trabajo investigamos la Metodología de la enseñanza como asignatura y como habilidad del desempeño profesional en la formación inicial de los profesores en la Sección Pedagógica entre 1906 y 1914, y en la Facultad de Ciencias de la Educación entre 1914 y 1920, ambas en la Universidad Nacional de La Plata. Dicha formación se gestó y desarrolló en el marco de un proyecto fundacional integral para nuestra Universidad. Estudiamos desde una perspectiva curricular la formación inicial de los profesores, es decir, aquella instancia institucional y formal de preparación para el ejercicio de la docencia. Aparecen en un segundo plano de importancia referencias al ejercicio profesional en tanto algunas prescripciones pedagógicas y didácticas resultaban también recomendadas para los docentes ya recibidos. Recurrimos al análisis de documentos. Tomamos como universo de análisis las Revistas Archivos de Pedagogía y Ciencias Afines y Archivos de Ciencias de la Educación que, en tanto órgano de difusión de las instituciones mencionadas, nos aportaron valiosos elementos para la reconstrucción de los trayectos formativos de los profesorados y para conocer ciertas características generales adjudicadas a la Metodología de la enseñanza. También utilizamos escritos de Víctor Mercante y otros de Joaquín V. González, quienes fueron referentes claves en la concreción de la formación de docentes en nuestra Universidad. Visualizamos la presencia de un sustento positivista tiñendo diferentes dimensiones formativas: la secuencia y organización de las asignaturas del curriculum, en las que predominaría una supremacía de la teoría sobre la práctica; la exigencia de complementar las lecciones teóricas con instancias de observación y experimentación; las constantes y dominantes manifestaciones sobre la principalidad de la ciencia. Además, a partir del estudio de los programas de "Metodología general" y "Metodología especial" como asignaturas del curriculum, y de la concepción de Mercante sobre éstas, pudimos inferir una confianza depositada en que un buen uso de la Metodología de la enseñanza facilitaría un desempeño profesional eficaz. En el interjuego permanente entre el marco conceptual-referencial y el material empírico, construimos dos ejes a partir de los cuales analizar esa Metodología de enseñanza. El primero es de carácter curricular e incluye, por un lado, entenderla como asignatura del curriculum de la formación de profesores y, por el otro, como una habilidad profesional conformando parte de las intencionalidades formativas de éste. El segundo eje se arma entendiendo a la Metodología de enseñanza como una habilidad del profesional docente que facilita el desempeño en el aula, y a esta habilidad como un lugar reservado para la normatividad del saber pedagógico. Esta mirada histórica sobre los orígenes de la formación docente en nuestra Casa de Estudios, pretende aportar elementos para la reflexión curricular actual sobre la formación de formadores. A su vez, en un segundo plano, nos interesa destacar la presencia y características de un espacio de normatividad/prescripción propio del saber pedagógico de la época. En los debates didácticos actuales, cobra relevancia la conformación de ese componente normativo/prescriptivo, por lo que consideramos que la perspectiva de estudio aquí propuesta nos aporta elementos para enriquecer la reflexión.

El mundo del trabajo en la Argentina : Estrategias productivistas y resistencia obrera. El caso de la empresa metalúrgica Siam Di Tella [1935-1955]

El objetivo de la tesis es estudiar el mundo del trabajo y la dinámica de las relaciones sociales en las etapas 1935-1945 y 1945-1955, -especialmente en los años del peronismo- en la cual estuvieron involucrados empresarios y trabajadores de la actividad industrial. Se tomó como unidad de análisis la empresa Siam Di Tella; y como problemática principal se escogieron las relaciones/conflictos que el sector obrero estableció con el sector empresarial en aquellos aspectos referidos a las estrategias productivas, políticas e incluso educativas, diseñadas por los diferentes actores sociales participantes en la disputa por el control de la producción en el espacio fabril. Por ello, el eje principal de este trabajo estará centrado en la aplicación (empresarial) y en las resistencias (obreras) de aquellas políticas basadas en el disciplinamiento y control (taylorizacion y fordización) de la producción, así como las iniciativas de formación para los trabajadores en el marco del ámbito fabril, -particularmente en el campo técnico/educativo

Impacto de la devaluación de principios de 2002 en el Cinturón Hortícola Platense. Estrategias tecnológicas adoptadas, sus resultados y consecuencias

La horticultura platense se caracteriza por su sistema de producción bajo invernáculo, altamente dependiente de insumos que en su mayoría son importados y dolarizados. Paralelamente, el producto hortícola fresco obtenido es no transable, debiéndose comercializar en el mercado interno. Debido a esto, la devaluación de principios de 2002 inauguró una etapa crítica para el sector hortícola en general y el platense en particular. Ante este contexto se investigaron las diferentes estrategias adoptadas por los productores y el impacto resultante a nivel mercado, precios y costos, como así también los resultados físicos y económicos de los establecimientos hortícolas. Para ello se apeló a la recolección de información primaria y secundaria, interpretando los resultados obtenidos mediante diferentes metodologías. Se analizó el impacto de la devaluación y su asimilación bajo distintos razonamientos según cada productor. Este contexto y las estrategias elegidas también afectaron al mercado, provocando una determinada evolución del precio y volumen ofertado de productos hortícolas. Las estrategias adoptadas, los costos de los insumos, los precios y los volúmenes de los productos ofrecidos, provocaron cambios en los márgenes brutos de los productores, cuyo ingreso nominal y real resultó afectado.