A strategy to advance the evidence base in palliative medicine: formation of a palliative care research cooperative group.

BACKGROUND: Palliative medicine has made rapid progress in establishing its scientific and clinical legitimacy, yet the evidence base to support clinical practice remains deficient in both the quantity and quality of published studies. Historically, the conduct of research in palliative care populations has been impeded by multiple barriers including health care system fragmentation, small number and size of potential sites for recruitment, vulnerability of the population, perceptions of inappropriateness, ethical concerns, and gate-keeping. METHODS: A group of experienced investigators with backgrounds in palliative care research convened to consider developing a research cooperative group as a mechanism for generating high-quality evidence on prioritized, clinically relevant topics in palliative care. RESULTS: The resulting Palliative Care Research Cooperative (PCRC) agreed on a set of core principles: active, interdisciplinary membership; commitment to shared research purposes; heterogeneity of participating sites; development of research capacity in participating sites; standardization of methodologies, such as consenting and data collection/management; agile response to research requests from government, industry, and investigators; focus on translation; education and training of future palliative care researchers; actionable results that can inform clinical practice and policy. Consensus was achieved on a first collaborative study, a randomized clinical trial of statin discontinuation versus continuation in patients with a prognosis of less than 6 months who are taking statins for primary or secondary prevention. This article describes the formation of the PCRC, highlighting processes and decisions taken to optimize the cooperative group's success.

The lung cancer exercise training study: a randomized trial of aerobic training, resistance training, or both in postsurgical lung cancer patients: rationale and design.

BACKGROUND: The Lung Cancer Exercise Training Study (LUNGEVITY) is a randomized trial to investigate the efficacy of different types of exercise training on cardiorespiratory fitness (VO2peak), patient-reported outcomes, and the organ components that govern VO2peak in post-operative non-small cell lung cancer (NSCLC) patients. METHODS/DESIGN: Using a single-center, randomized design, 160 subjects (40 patients/study arm) with histologically confirmed stage I-IIIA NSCLC following curative-intent complete surgical resection at Duke University Medical Center (DUMC) will be potentially eligible for this trial. Following baseline assessments, eligible participants will be randomly assigned to one of four conditions: (1) aerobic training alone, (2) resistance training alone, (3) the combination of aerobic and resistance training, or (4) attention-control (progressive stretching). The ultimate goal for all exercise training groups will be 3 supervised exercise sessions per week an intensity above 70% of the individually determined VO2peak for aerobic training and an intensity between 60 and 80% of one-repetition maximum for resistance training, for 30-45 minutes/session. Progressive stretching will be matched to the exercise groups in terms of program length (i.e., 16 weeks), social interaction (participants will receive one-on-one instruction), and duration (30-45 mins/session). The primary study endpoint is VO2peak. Secondary endpoints include: patient-reported outcomes (PROs) (e.g., quality of life, fatigue, depression, etc.) and organ components of the oxygen cascade (i.e., pulmonary function, cardiac function, skeletal muscle function). All endpoints will be assessed at baseline and postintervention (16 weeks). Substudies will include genetic studies regarding individual responses to an exercise stimulus, theoretical determinants of exercise adherence, examination of the psychological mediators of the exercise - PRO relationship, and exercise-induced changes in gene expression. DISCUSSION: VO2peak is becoming increasingly recognized as an outcome of major importance in NSCLC. LUNGEVITY will identify the optimal form of exercise training for NSCLC survivors as well as provide insight into the physiological mechanisms underlying this effect. Overall, this study will contribute to the establishment of clinical exercise therapy rehabilitation guidelines for patients across the entire NSCLC continuum. TRIAL REGISTRATION: NCT00018255.

The impact of structured support groups for pregnant South African women recently diagnosed HIV positive.

The authors of this study evaluated a structured 10-session psychosocial support group intervention for newly HIV-diagnosed pregnant South African women. Participants were expected to display increases in HIV disclosure, self-esteem, active coping and positive social support, and decreases in depression, avoidant coping, and negative social support. Three hundred sixty-one pregnant HIV-infected women were recruited from four antenatal clinics in Tshwane townships from April 2005 to September 2006. Using a quasi-experimental design, assessments were conducted at baseline and two and eight months post-intervention. A series of random effects regression analyses were conducted, with the three assessment points treated as a random effect of time. At both follow-ups, the rate of disclosure in the intervention group was significantly higher than that of the comparison group (p<0.001). Compared to the comparison group at the first follow-up, the intervention group displayed higher levels of active coping (t=2.68, p<0.05) and lower levels of avoidant coping (t=-2.02, p<0.05), and those who attended at least half of the intervention sessions exhibited improved self-esteem (t=2.11, p<0.05). Group interventions tailored for newly HIV positive pregnant women, implemented in resource-limited settings, may accelerate the process of adjusting to one's HIV status, but may not have sustainable benefits over time.

Stability in autobiographical memories.

A total of 30 undergraduates recalled the same 20 autobiographical memories at two sessions separated by 2 weeks. At each session they dated their memories and rated them on 18 properties commonly studied in autobiographical memory experiments. Individuals showed moderate stability in their ratings on the 18 scales (r approximately .5), with consistency of dating being much higher (r = .96). There was more stability in the individuals' average rating on each scale (r approximately .8), even when the averages were calculated on different memories in the different sessions. The results are consistent with a constructive view of autobiographical memory, in which stable individual differences in cognitive style are important.

Internal languages of retrieval: the bilingual encoding of memories for the personal past.

In contrast to most research on bilingual memory that focuses on how words in either lexicon are mapped onto memory for objects and concepts, we focus on memory for events in the personal past. Using a word-cue technique in sessions devoted exclusively to one language, we found that older Hispanic immigrants who had come to the United States as adults internally retrieved autobiographical memories in Spanish for events in the country of origin and in English for events in the U.S. These participants were consistently capable of discerning whether a memory had come to them "in words" or not, reflecting the distinction between purely imagistic or conceptual memories and specifically linguistic memories. Via examination of other phenomenological features of these memories (sense of re-living, sensory detail, emotionality, and rehearsal), we conclude that the linguistic/nonlinguistic distinction is fundamental and independent of these other characteristics. Bilinguals encode and retrieve certain autobiographical memories in one or the other language according to the context of encoding, and these linguistic characteristics are stable properties of those memories over time.

The effect of a urinary incontinence self-management program for older women in South Korea: A pilot study

© 2015 Chinese Nursing Association.Background Although self-management approaches have shown strong evidence of positive outcomes for urinary incontinence prevention and management, few programs have been developed for Korean rural communities. Objectives This pilot study aimed to develop, implement, and evaluate a urinary incontinence self-management program for community-dwelling women aged 55 and older with urinary incontinence in rural South Korea. Methods This study used a one-group pre- post-test design to measure the effects of the intervention using standardized urinary incontinence symptom, knowledge, and attitude measures. Seventeen community-dwelling older women completed weekly 90-min group sessions for 5 weeks. Descriptive statistics and paired t-tests and were used to analyze data. Results The mean of the overall interference on daily life from urine leakage (pre-test: M = 5.76 ± 2.68, post-test: M = 2.29 ± 1.93, t = -4.609, p < 0.001) and the sum of International Consultation on Incontinence Questionnaire scores (pre-test: M = 11.59 ± 3.00, post-test: M = 5.29 ± 3.02, t = -5.881, p < 0.001) indicated significant improvement after the intervention. Improvement was also noted on the mean knowledge (pre-test: M = 19.07 ± 3.34, post-test: M = 23.15 ± 2.60, t = 7.550, p < 0.001) and attitude scores (pre-test: M = 2.64 ± 0.19, post-test: M = 3.08 ± 0.41, t = 5.150, p < 0.001). Weekly assignments were completed 82.4% of the time. Participants showed a high satisfaction level (M = 26.82 ± 1.74, range 22-28) with the group program. Conclusions Implementation of a urinary incontinence self-management program was accompanied by improved outcomes for Korean older women living in rural communities who have scarce resources for urinary incontinence management and treatment. Urinary incontinence self-management education approaches have potential for widespread implementation in nursing practice.

THE LESSER-KNOWN PIANO CHAMBER MUSIC OF CAMILLE SAINT-SAENS: A RECORDING PROJECT

Throughout his long and industrious lifetime, Camille Saint-Saens (1835-1921) devoted himself unconditionally to music both as a composer and a performer. Saint-Saens was a self-described traditionalist and musical purist, yet his works are distinctly expressive and imaginative, and they reflect the composer's own unique musical language which incorporates recognizably modem traits such as chromaticism and frequent modulation. As a performer, Saint-Saens preferred to premiere his own works and often included his chamber music in his concert programs. Regarded primarily as a symphonic composer in the present day, however, his extensive and varied collection of chamber music works is sadly neglected. Six varied small-ensemble works with piano from his chamber music repertoire have been selected for study and recording for this project: Piano Trio No. 1 in F Major, Op. 18 (1864); Sonata for Cello and Piano No. 1 inC Minor, Op. 32 (1872); two pieces for two pianos, Le Rouet d'Omphale (The Spinning Wheel ofOmphale), Op. 31 (1871) and Phaeton, Op. 39 (1874); piano duet Konig Harald Haifagar (King Harald Haarfager), Op. 59 (1880); and a wind quartet, Caprice sur des airs Danois et Russes (Caprice on Danish and Russian Airs) for Flute, Oboe, Clarinet and Piano, Op. 79 (1887). Analyses of the forms and harmonic structures of these compositions will be included in this dissertation paper as well as studies from the viewpoint of Saint-Saens' compositional style, ensemble characteristics, and writing for the piano. The recordings for this project were made in four sessions in LeFrak Concert Hall at Queens College, the City University of New York. On September 24, 2003, Op. 31, Op. 39 and Op. 59 were recorded with Professor Morey Ritt, piano. On March 2, 2004, Op. 18 was recorded with Elena Rojas, violin, and Clare Liu, cello, and on March 15, 2004, Op. 32 was recorded, also with Ms. Liu. The Caprice, Op. 79 was recorded on June 27, 2008 with Laura Conwesser, flute; Randall Wolfgang, oboe; and Steve Hartman, clarinet. The recordings may be found on file in the library at the University of Maryland, College Park.

RECORDING PROJECT: THE COMPLETE (PUBLISHED) PIANO WORKS OF ROBERT HELPS

This recording represents the complete solo piano works of Robert Helps (1928-2001). As of this writing (March, 2008), approx.120 minutes of Helps' solo piano music has been published, all of which is included on the Digital Media (CD). This project includes the following works: Trois Hommages, Quartet, Nocturne, Valse Mirage, In Retrospect, Three Etudes, Portrait, Three Etudes for the Left Hand, Starscape, Recollections, Shall We Dance and Image. (His few remaining pieces are officially "pending publication" and are therefore not included in this project.) Robert Helps, American pianist and composer, enjoyed a successful career on both fronts, teaching at such institutions as San Francisco Conservatory, Stanford University, the University of California, Berkeley, the New England Conservatory, the Manhattan School of Music and Princeton University. Helps, never the recipient of a university or conservatory degree, received private instruction from pianist Abby Whiteside and composer Roger Sessions. His recording of the Sessions' Sonatas is considered to be their benchmark performance. As a composer, he received commission and awards from the American Academy of Arts and Letters, the Ford Foundation, the Guggenheim Foundation and the National Endowment for the Arts. Helps' compositions were anachronistic in style: his compositional style ranges from Post-Impressionism, Neo­ Romanticsim and early 20th century Atonalism, although he never engaged in serial practices. Since his death in 2001, the Robert Helps Trust has been established at the University of South Florida. Funds are being used to support the continued publishing of his scores. The Robert Helps International Composition Competition and Festival was established in 2005.

Patient education preferences in ophthalmic care.

BACKGROUND: The learning preferences of ophthalmology patients were examined. METHODS: Results from a voluntary survey of ophthalmology patients were analyzed for education preferences and for correlation with race, age, and ophthalmic topic. RESULTS: To learn about eye disease, patients preferred one-on-one sessions with providers as well as printed materials and websites recommended by providers. Patients currently learning from the provider were older (average age 59 years), and patients learning from the Internet (average age 49 years) and family and friends (average age 51 years) were younger. Patients interested in cataracts, glaucoma, macular degeneration, and dry eye were older; patients interested in double vision and glasses were younger. There were racial differences regarding topic preferences, with Black patients most interested in glaucoma (46%), diabetic retinopathy (31%), and cataracts (28%) and White patients most interested in cataracts (22%), glaucoma (22%), and macular degeneration (19%). CONCLUSION: MOST OPHTHALMOLOGY PATIENTS PREFERRED PERSONALIZED EDUCATION: one-on-one with their provider or a health educator and materials (printed and electronic) recommended by their provider. Age-related topics were more popular with older patients, and diseases with racial risk factors were more popular with high risk racial groups.

MUSICAL IMPROVISATION AND THE CREATIVE PROCESS

Musical improvisation combines technical proficiency and musical intuition. Due to its interactive nature, improvisation provides an avenue of communication among all art forms. This dissertation project explores the collaborative aspects of improvisation involving a musician, visual artist, a small group of dancers, and videographer. Video footage from two separate recording sessions provided hours of visual materials which were studied and edited. The first session was a live performance recorded in front of a studio audience. The second session was a two-day collaboration between musician and dancers in a studio space. The process of editing and compiling images with audio-an important element in this project-presented many unforeseeable challenges and lessons. This recorded dissertation is comprised of seven music videos that demonstrate my ability as an artist in collaboration with visual artist-professor Richard Klank, dancers David Yates, Jamie Garcia, Raha Behnam, Rachel Wolfe and Adrian Galvin, and video artist Nguyen Nguyen. Each video represents an individual creative process involving musical performance, studio lighting, sound recording, and video editing.

Post-1945 Danish Piano Trio Literature: A Recording Dissertation

This recording dissertation surveys post-1945 literature written for piano trio (violin, violoncello and piano) by ten Danish composers. The literature was first considered for inclusion by searching a database provided by the Danish Music Information Center (www.mic.dk). Scores were rented from the publisher Edition Wilhelm Hansen AS, or purchased from the publisher Samfundet til Udgivelse af Dansk Musik. An additional score published by Viking Musikforlag was used as well. The music was then studied and evaluated for selection. During the selection process, the following criteria were considered: 1) quality of the compositions; 2) recognition of the composers at the national or international level; 3) whether the compositions had been previously recorded; and 4) variety of compositional styles. The selected works are written by Niels Viggo Bentzon, Vagn Holmboe, Anders Koppel, Herman D. Koppel, Bent Lorentzen, Anders Nordentoft, Per Norgard, Michael Nyvang, Karl Aage Rasmussen, and Poul Rovsing Olsen. The selected compositions were practiced, rehearsed, and performed under direct supervision of the composers and other expert musicians. In order to better understand the compositional style of each composer, relevant books, articles, and recordings were researched and studied. This recording dissertation is supported by a written document. A subjective preference for program balance was exercised to determine the order of recorded works. The written document is divided into chapters defined by composer, following the order of the recorded document, which include the composers' biographies and notes referring to the recorded compositions. The recording took place at the Manzius Gaarden, Birkerod, Denmark during three sessions: July 31-August 2, 2002, March 2 and 3, 2003, and June 2-4, 2003. The music for this dissertation was recorded by the members of the Jalina Trio; Line Fredens, violin, Janne Fredens, cello and Natsuki Fukasawa, piano. Aksel Trige, a well-respected recording engineer, was engaged for the recording and editing. Additionally, a Hamburg Steinway concert grand piano was rented and a Joseph Guarnerius filius Andreas Cremona violin (1706) was provided by the Augustinus Fonden, Denmark. The cellist used her own instrument, Vuillaume of Paris (c. 1850). The expense of this recording was partially paid by generous grants from the Augustinus Fonden, the Solist Foreningen af 1921, and the Dansk Musikerforbunds Kollective Rettighedsmidler. The compositions selected for this recording dissertation are assumed to be previously unrecorded, with the exception of Poul Rovsing Olsen's Trio II.

Biological and physical interactions on a tropical island coral reef: Transport and retention processes on moorea, French Polynesia

The Moorea Coral Reef Long Term Ecological Research project funded by the US National Science Foundation includes multidisciplinary studies of physical processes driving ecological dynamics across the fringing reef, back reef, and fore reef habitats of Moorea, French Polynesia. A network of oceanographic moorings and a variety of other approaches have been used to investigate the biological and biogeochemical aspects of water transport and retention processes in this system. There is evidence to support the hypothesis that a low-frequency counterclockwise flow around the island is superimposed on the relatively strong alongshore currents on each side of the island. Despite the rapid flow and flushing of the back reef, waters over the reef display chemical and biological characteristics distinct from those offshore. The patterns include higher nutrient and lower dissolved organic carbon concentrations, distinct microbial community compositions among habitats, and reef assemblages of zooplankton that exhibit migration behavior, suggesting multigenerational residence on the reef. Zooplankton consumption by planktivorous fish on the reef reflects both retention of reef-associated taxa and capture by the reef community of resources originating offshore. Coral recruitment and population genetics of reef fishes point to retention of larvae within the system and high recruitment levels from local adult populations. The combined results suggest that a broad suite of physical and biological processes contribute to high retention of externally derived and locally produced organic materials within this island coral reef system. © 2013 by The Oceanography Society. All rights reserved.

Cumulative stress in childhood is associated with blunted reward-related brain activity in adulthood.

Early life stress (ELS) is strongly associated with negative outcomes in adulthood, including reduced motivation and increased negative mood. The mechanisms mediating these relations, however, are poorly understood. We examined the relation between exposure to ELS and reward-related brain activity, which is known to predict motivation and mood, at age 26, in a sample followed since kindergarten with annual assessments. Using functional neuroimaging, we assayed individual differences in the activity of the ventral striatum (VS) during the processing of monetary rewards associated with a simple card-guessing task, in a sample of 72 male participants. We examined associations between a cumulative measure of ELS exposure and VS activity in adulthood. We found that greater levels of cumulative stress during childhood and adolescence predicted lower reward-related VS activity in adulthood. Extending this general developmental pattern, we found that exposure to stress early in development (between kindergarten and grade 3) was significantly associated with variability in adult VS activity. Our results provide an important demonstration that cumulative life stress, especially during this childhood period, is associated with blunted reward-related VS activity in adulthood. These differences suggest neurobiological pathways through which a history of ELS may contribute to reduced motivation and increased negative mood.

Health coaching for glaucoma care: a pilot study using mixed methods.

INTRODUCTION: Adherence to glaucoma medications is essential for successful treatment of the disease but is complex and difficult for many of our patients. Health coaching has been used successfully in the treatment of other chronic diseases. This pilot study explores the use of health coaching for glaucoma care. METHODS: A mixed methods study design was used to assess the health coaching intervention for glaucoma patients. The health coaching intervention consisted of four to six health coaching sessions with a certified health coach via telephone. Quantitative measures included demographic and health information, adherence to glaucoma medications (using the visual analog adherence scale and medication event monitoring system), and an exit survey rating the experience. Qualitative measures included a precoaching health questionnaire, notes made by the coach during the intervention, and an exit interview with the subjects at the end of the study. RESULTS: Four glaucoma patients participated in the study; all derived benefits from the health coaching. Study subjects demonstrated increased glaucoma drop adherence in response to the coaching intervention, in both visual analog scale and medication event monitoring system. Study subjects' qualitative feedback reflected a perceived improvement in both eye and general health self-care. The subjects stated that they would recommend health coaching to friends or family members. CONCLUSION: Health coaching was helpful to the glaucoma patients in this study; it has the potential to improve glaucoma care and overall health.

Effect of Addiction Modeling Reinforcement Schedules on Delay Discounting

Elevated delay discounting, in which delayed rewards quickly lose value as a function of time, is associated with substance use and abuse. Currently, the direction of causation is unclear: while some research indicates that elevated delay discounting leads to future substance use, it is also possible that chronic substance use and specifically the rate of reinforcement associated with drug use, leads to elevated delay discounting. This project aims to examine the latter possibility. 47 participants completed ten 30-minute daily sessions of a visual attention task, and were reinforced at a rate intended to model drug use (fixed ratio 1) or drug abstinence (fixed ratio 10). Baseline and post-training rates of delay discounting were assessed for hypothetical $50 and $1000. Area under the curve of the indifference points as a function of delay was calculated. A greater area under the curve suggests more self-control, whereas a lower value represents more impulsiveness. Results at the monetary value of both $50 and $1000 showed increased impulsivity in relation to the control for both the FR1 and FR10 groups indicating that the two schedules may both model drug use.