PARTAKE survey of public knowledge and perceptions of clinical research in India.

BACKGROUND: A public that is an informed partner in clinical research is important for ethical, methodological, and operational reasons. There are indications that the public is unaware or misinformed, and not sufficiently engaged in clinical research but studies on the topic are lacking. PARTAKE - Public Awareness of Research for Therapeutic Advancements through Knowledge and Empowerment is a program aimed at increasing public awareness and partnership in clinical research. The PARTAKE Survey is a component of the program. OBJECTIVE: To study public knowledge and perceptions of clinical research. METHODS: A 40-item questionnaire combining multiple-choice and open-ended questions was administered to 175 English- or Hindi-speaking individuals in 8 public locations representing various socioeconomic strata in New Delhi, India. RESULTS: Interviewees were 18-84 old (mean: 39.6, SD ± 16.6), 23.6% female, 68.6% employed, 7.3% illiterate, 26.3% had heard of research, 2.9% had participated and 58.9% expressed willingness to participate in clinical research. The following perceptions were reported (% true/% false/% not aware): 'research benefits society' (94.1%/3.5%/2.3%), 'the government protects against unethical clinical research' (56.7%/26.3%/16.9%), 'research hospitals provide better care' (67.2%/8.7%/23.9%), 'confidentiality is adequately protected' (54.1%/12.3%/33.5%), 'participation in research is voluntary' (85.3%/5.8%/8.7%); 'participants treated like 'guinea pigs'' (20.7%/53.2%/26.0%), and 'compensation for participation is adequate' (24.7%/12.9%/62.3%). CONCLUSIONS: Results suggest the Indian public is aware of some key features of clinical research (e.g., purpose, value, voluntary nature of participation), and supports clinical research in general but is unaware of other key features (e.g., compensation, confidentiality, protection of human participants) and exhibits some distrust in the conduct and reporting of clinical trials. Larger, cross-cultural surveys are required to inform educational programs addressing these issues.

Can Genetics Predict Response to Complex Behavioral Interventions? Evidence from a Genetic Analysis of the Fast Track Randomized Control Trial.

Early interventions are a preferred method for addressing behavioral problems in high-risk children, but often have only modest effects. Identifying sources of variation in intervention effects can suggest means to improve efficiency. One potential source of such variation is the genome. We conducted a genetic analysis of the Fast Track randomized control trial, a 10-year-long intervention to prevent high-risk kindergarteners from developing adult externalizing problems including substance abuse and antisocial behavior. We tested whether variants of the glucocorticoid receptor gene NR3C1 were associated with differences in response to the Fast Track intervention. We found that in European-American children, a variant of NR3C1 identified by the single-nucleotide polymorphism rs10482672 was associated with increased risk for externalizing psychopathology in control group children and decreased risk for externalizing psychopathology in intervention group children. Variation in NR3C1 measured in this study was not associated with differential intervention response in African-American children. We discuss implications for efforts to prevent externalizing problems in high-risk children and for public policy in the genomic era.

Caring for Alaska Native prostate cancer survivors in primary care: a survey of Alaska Tribal Health System providers.

BACKGROUND: Little is known about the constraints of optimizing health care for prostate cancer survivors in Alaska primary care. OBJECTIVE: To describe the experiences and attitudes of primary care providers within the Alaska Tribal Health System (ATHS) regarding the care of prostate cancer survivors. DESIGN: In late October 2011, we emailed a 22-item electronic survey to 268 ATHS primary care providers regarding the frequency of Prostate Specific Antigen (PSA) monitoring for a hypothetical prostate cancer survivor; who should be responsible for the patient's life-long prostate cancer surveillance; who should support the patient's emotional and medical needs as a survivor; and providers' level of comfort addressing recurrence monitoring, erectile dysfunction, urinary incontinence, androgen deprivation therapy, and emotional needs. We used simple logistic regression to examine the association between provider characteristics and their responses to the survivorship survey items. RESULTS: Of 221 individuals who were successfully contacted, a total of 114 responded (52% response rate). Most ATHS providers indicated they would order a PSA test every 12 months (69%) and believed that, ideally, the hypothetical patient's primary care provider should be responsible for his life-long prostate cancer surveillance (60%). Most providers reported feeling either "moderately" or "very" comfortable addressing topics such as prostate cancer recurrence (59%), erectile dysfunction (64%), urinary incontinence (63%), and emotional needs (61%) with prostate cancer survivors. These results varied somewhat by provider characteristics including female sex, years in practice, and the number of prostate cancer survivors seen in their practice. CONCLUSIONS: These data suggest that most primary care providers in Alaska are poised to assume the care of prostate cancer survivors locally. However, we also found that large minorities of providers do not feel confident in their ability to manage common issues in prostate cancer survivorship, implying that continued access to specialists with more expert knowledge would be beneficial.

THE PIANO MUSIC OF ROBERT SCHUMANN (1810-1856) AND JOHANNES BRAHMS (1833- 1897): A SURVEY OF CONCERTI, VARIATIONS, AND CHARACTER PIECES

Robert Schumann (1810-1856) and Johannes Brahms (1833-1897), in some ways Robert Schumann's artistic descendant, are the most important and representative German piano composers during the Romantic period. Schumann was already a mature and established musician in 1853 when he first met the young Brahms and recognized his talents, an encounter that had a long-lasting affect on the lives and careers of both men. After Schumann’s mental breakdown and death, Brahms maintained his admiration of Schumann’s music and preserved an intimate relationship with Clara Schumann. In spite of the personal and musical closeness of the two men, Schumann’s music is stylistically distinct from that of Brahms. Brahms followed traditions from Baroque and Classical music, and avoided using images and expressive titles in his music. Brahms extraordinarily intermingled earlier musical forms with multicolored tones of German Romanticism. In contrast, Schumann saw himself as a radical composer devoted to personal emotionalism and spontaneity. He favored programmatic titles for his character pieces and extra-musical references in his music. While developing their own musical styles as German Romantic composers, Schumann and Brahms both utilized the piano as a resourceful tool for self-realization and compositional development. To investigate and compare the main characteristics of Schumann and Brahms’s piano music, I looked at three genres. First, in the category of the piano concerto, I chose two major Romantic works, Schumann’s A minor concerto and Brahms’s B-flat major concerto. Second, for the category of piano variations I included two sets by Brahms because the variation framework was such an important vehicle for him to express his musical thoughts. Schumann’s unique motivic approach to variation is displayed vividly in his character-piece cycle Carnaval. Third, the category of the character piece, perhaps the favorite medium of Romantic expression at the piano, is shown by Schumann’s Papillons and Brahms’s sets of pieces Op.118 and Op.119. This performance dissertation consists of three recitals performed in the Gildenhorn Recital Hall at the University of Maryland, College Park. These recitals are documented on compact disc recordings that are housed within the University of Maryland Library System.

Do debit cards increase household spending? Evidence from a semiparametric causal analysis of a survey

© Institute of Mathematical Statistics, 2014.Motivated by recent findings in the field of consumer science, this paper evaluates the causal effect of debit cards on household consumption using population-based data from the Italy Survey on Household Income and Wealth (SHIW). Within the Rubin Causal Model, we focus on the estimand of population average treatment effect for the treated (PATT). We consider three existing estimators, based on regression, mixed matching and regression, propensity score weighting, and propose a new doubly-robust estimator. Semiparametric specification based on power series for the potential outcomes and the propensity score is adopted. Cross-validation is used to select the order of the power series. We conduct a simulation study to compare the performance of the estimators. The key assumptions, overlap and unconfoundedness, are systematically assessed and validated in the application. Our empirical results suggest statistically significant positive effects of debit cards on the monthly household spending in Italy.

Using Behavioral Insights For a Better Understanding of Economic Decisions (Regarding Savings, Inequality and Dishonesty)

This dissertation consists of three essays on behavioral economics, with a general aim of enriching our understanding of economic decisions using behavioral insights and experimental methodology. Each essay takes on one particular topic with this general aim.

The first chapter studies savings behavior of the poor. In this project, partnering with a savings product provider in Kenya, we tested the extent to which behavioral interventions and financial incentives can increase the saving rate of individuals with low and irregular income. Our experiment lasted for six months and included a total of twelve conditions. The control condition received weekly reminders and balance reporting via text messages. The treatment conditions received in addition one of the following interventions: (1) reminder text messages framed as if they came from the participant’s kid (2) a golden colored coin with numbers for each week of the trial, on which participants were asked to keep track of their weekly deposits (3) a match of weekly savings: The match was either 10% or 20% up to a certain amount per week. The match was either deposited at the end of each week or the highest possible match was deposited at the start of each week and was adjusted at the end. Among these interventions, by far the most effective was the coin: Those in the coin condition saved on average the highest amount and more than twice as those in the control condition. We hypothesize that being a tangible track-keeping object; the coin made subjects remember to save more often. Our results support the line of literature suggesting that saving decisions involve psychological aspects and that policy makers and product designers should take these influences into account.

The second chapter is related to views towards inequality. In this project, we investigate how the perceived fairness of income distributions depends on the beliefs about the process that generated the inequality. Specifically, we examine how two crucial features of this process affect fairness views: (1) Procedural justice - equal treatment of all, (2) Agency - one's ability to determine his/her income. We do this in a lab experiment by varying the equality of opportunity (procedural justice), and one's ability to make choices, which consequently influence subjects’ ability to influence their income (agency). We then elicit ex-post redistribution decisions of the earnings as a function of these two elements. Our results suggest both agency and procedural justice matter for fairness. Our main findings can be summarized as follows: (1) Highlighting the importance of agency, we find that inequality resulting from risk is considered to be fair only when risk is chosen freely; (2) Highlighting the importance of procedural justice, we find that introducing inequality of opportunity significantly increases redistribution, however the share of subjects redistributing none remain close to the share of subjects redistributing fully revealing an underlying heterogeneity in the population about how fairness views should account for inequality of opportunity.

The third chapter is on morality. In this project, we study whether religious rituals act as an internal reminder for basic moral principles and thus affect moral judgments. To this end, we conducted two survey experiments in Turkey and Israel to specifically test the effect of Ramadan and Yom Kippur. The results from the Turkish sample how that Ramadan has a significant effect on moral judgments to some extent for those who report to believe in God. Those who believe in God judged the moral acceptability of ten out of sixty one actions significantly differently in Ramadan, whereas those who reported not to believe in God significantly changed their judgments only for one action in Ramadan. Our results extends the hypothesis established by lab experiments that religious reminders have a significant effect on morality, by testing it in the field in the natural environment of religious rituals.

This thesis is part of a broader collaborative research agenda with both colleagues and advisors. The programming, analyses, and writing, as well as any errors in this work, are my own.

VARIATION FORMS: A SURVEY THROUGH FOUR CENTURIES OF VIOLIN REPERTOIRE

Variation, or the re-working of existing musical material, has consistently attracted the attention of composers and performers throughout the history of Western music. In three recorded recitals at the University of Maryland School of Music, this dissertation project explores a diverse range of expressive possibilities for violin in seven types of variation form in Austro-German works for violin from the 17th through the 20th centuries. The first program, consisting of Baroque Period works, performed on period instrument, includes the divisions on “John come kiss me now” from The Division Violin by Thomas Baltzar (1631 – 1663), constant bass variations in Sonate Unarum Fidium by Johann Heinrich von Schmelzer (1623 – 1680), arbitrary variation in Sonata for Violin and Continuo in E Major, Op. 1, No. 12 “Roger” by George Friedrich Händel (1685 – 1759), and French Double style, melodic-outline variation in Partita for Unaccompanied Violin in B Minor by Johan Sebastian Bach (1685 – 1750). Theme and Variations, a popular Classical Period format, is represented by the Sonata for Piano and Violin in G Major K. 379 by Wolfgang Amadeus Mozart (1756 – 1791) and Sonata for Violin and Piano in A Major, Op. 47 No. 9 the “Kreutzer” by Ludwig van Beethoven (1770 – 1827). Fantasy for Piano and Violin in C Major D. 934 by Franz Schubert (1797 – 1828) represents the 19th century fantasia variation. In these pieces, the piano and violin parts are densely interwoven, having equal importance. Many 20th century composers incorporated diverse types of variations in their works and are represented in the third recital program comprising: serial variation in the Phantasy for Violin and Piano Op.47 of Arnold Schoenberg (1874 – 1951); a strict form of melodic-outline variation in Sonate für Violine allein, Op. 31, No. 2 of Paul Hindemith (1895 – 1963); ostinato variation in Johan Halvorsen’s (1864 – 1935) Passacaglia for Violin and Viola, after G. F. Handel’s Passacaglia from the Harpsichord Suite No. 7 in G Minor. Pianist Audrey Andrist, harpsichordist Sooyoung Jung, and violist Dong-Wook Kim assisted in these performances.

IMPROVISATION AND THE CONCERT SAXOPHONIST: A SURVEY OF COMPOSITIONAL AND PERFORMANCE TECHNIQUES

Much of the contemporary concert (i.e. “classical”) saxophone literature has connections to compositional styles found in other genres like jazz, rock, or pop. Although improvisation exists as a dominant compositional device in jazz, improvisation as a performance technique is not confined to a single genre. This study looks at twelve concert saxophone pieces that are grouped into three primary categories of compositional techniques: 1) those containing unmeasured phrases, 2) those containing limited relation to improvisation but a close relationship to jazz styles, and 3) those containing jazz improvisation. In concert saxophone music, specific crossover pieces use the compositional technique of jazz improvisation. Four examples of such jazz works were composed by Dexter Morrill, Phil Woods, Bill Dobbins, and Ramon Ricker, all of which provide a foundation for this study. In addition, pieces containing varying degrees of unmeasured phrases are highlighted. As this dissertation project is based in performance, the twelve pieces were divided into three recitals that summarize a pedagogical sequence. Any concert saxophonist interested in developing jazz improvisational skills can use the pieces in this study as a method to progress toward the performance of pieces that merge jazz improvisation with the concert format. The three compositional techniques examined here will provide the performer with the necessary material to develop this individualized approach to improvisation. Specific compositional and performance techniques vary depending on the stylistic content: this study examines improvisation in the context of concert saxophone repertoire.

New insights into Hoogsteen base pairs in DNA duplexes from a structure-based survey.

Hoogsteen (HG) base pairs (bps) provide an alternative pairing geometry to Watson-Crick (WC) bps and can play unique functional roles in duplex DNA. Here, we use structural features unique to HG bps (syn purine base, HG hydrogen bonds and constricted C1'-C1' distance across the bp) to search for HG bps in X-ray structures of DNA duplexes in the Protein Data Bank. The survey identifies 106 A•T and 34 G•C HG bps in DNA duplexes, many of which are undocumented in the literature. It also uncovers HG-like bps with syn purines lacking HG hydrogen bonds or constricted C1'-C1' distances that are analogous to conformations that have been proposed to populate the WC-to-HG transition pathway. The survey reveals HG preferences similar to those observed for transient HG bps in solution by nuclear magnetic resonance, including stronger preferences for A•T versus G•C bps, TA versus GG steps, and also suggests enrichment at terminal ends with a preference for 5'-purine. HG bps induce small local perturbations in neighboring bps and, surprisingly, a small but significant degree of DNA bending (∼14°) directed toward the major groove. The survey provides insights into the preferences and structural consequences of HG bps in duplex DNA.

Differences in onset and abuse/dependence episodes between prescription opioids and heroin: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVES: To examine patterns of onset and abuse/dependence episodes of prescription opioid (PO) and heroin use disorders in a national sample of adults, and to explore differences by gender and substance abuse treatment status. METHODS: Analyses of data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). RESULTS: Of all respondents, 5% (n = 1815) reported a history of nonmedical PO use (NMPOU) and 0.3% (n = 150) a history of heroin use. Abuse was more prevalent than dependence among NMPOUs (PO abuse, 29%; dependence, 7%) and heroin users (heroin abuse, 63%; dependence, 28%). Heroin users reported a short mean interval from first use to onset of abuse (1.5 years) or dependence (2.0 years), and a lengthy mean duration for the longest episode of abuse (66 months) or dependence (59 months); the corresponding mean estimates for PO abuse and dependence among NMPOUs were 2.6 and 2.9 years, respectively, and 31 and 49 months, respectively. The mean number of years from first use to remission from the most recent episode was 6.9 years for PO abuse and 8.1 years for dependence; the mean number of years from first heroin use to remission from the most recent episode was 8.5 years for heroin abuse and 9.7 years for dependence. Most individuals with PO or heroin use disorders were remitted from the most recent episode. Treated individuals, whether their problem was heroin or POs, tended to have a longer mean duration of an episode than untreated individuals. CONCLUSION: Periodic remissions from opioid or heroin abuse or dependence episodes occur commonly but take a long time. Timely and effective use of treatment services are needed to mitigate the many adverse consequences from opioid/heroin abuse and dependence.

A SURVEY OF FRENCH KEYBOARD MUSIC FROM 1880 TO 1950

French music flourished from the last quarter of the nineteenth century into the early twentieth century, especially in the genres of opera and orchestral music. Although French keyboard music enjoyed less popularity, being overshadowed by these predominant genres, prominent impressionist figures Claude Debussy (1862-1918) and Maurice Ravel (1875-1937) . . brought its revival to the French music. Scholars consider Debussy to be a frontrunner of Impressionism, and his influence had a major impact on subsequent composers. As a result of his popularity, other significant works by French composers seem to be overlooked by pianists and audiences and are not as often performed. Because keyboard works by Debussy and Ravel are a popular performance choice among pianists, I was eager to examine music by other French composers. Through my resea,rch, I found many great works that warranted further study and deserve a place in the keyboard repertoire. This recording project contains works by lesser-known French composers written between the years of 1880 and 1950, namely Emmanuel Chabrier (1841-1894), Gabriel-Urbain Faure (1845-1924), Charles Koechlin (1867-1950), Albert Roussel (1869-1937), Erik Satie (1866-1925), Francis Poulenc (1899-1963), Darius Milhaud (1892-1974), Robert Casadesus (1899-1972) and Henri Dutilleux (b.1916). Since piano repertoire is abundant, it is sometimes difficult to create a performance program. Therefore, it frequently becomes the default to choosing familiar repertoire rather than using the opportunity to expand the repertoire. As a pianist, I feel responsible to search for hidden musical treasures with which pianists and audiences alike are not so well acquainted. This recording project explores nine lesser-known French compositions written between 1880 and 1950. I expect this to be an opportunity to introduce both pianists and audiences to outstanding but unfamiliar works by French composers. This dissertation was recorded on two compact discs in Dekelboum Concert Hall at Clarice Smith Performing Arts Center of the University of Maryland. The recordings are archived in the University of Maryland Library.

Hemostatic assessment, treatment strategies, and hematology consultation in massive postpartum hemorrhage: results of a quantitative survey of obstetrician-gynecologists.

OBJECTIVE: To assess potential diagnostic and practice barriers to successful management of massive postpartum hemorrhage (PPH), emphasizing recognition and management of contributing coagulation disorders. STUDY DESIGN: A quantitative survey was conducted to assess practice patterns of US obstetrician-gynecologists in managing massive PPH, including assessment of coagulation. RESULTS: Nearly all (98%) of the 50 obstetrician-gynecologists participating in the survey reported having encountered at least one patient with "massive" PPH in the past 5 years. Approximately half (52%) reported having previously discovered an underlying bleeding disorder in a patient with PPH, with disseminated intravascular coagulation (88%, n=23/26) being identified more often than von Willebrand disease (73%, n=19/26). All reported having used methylergonovine and packed red blood cells in managing massive PPH, while 90% reported performing a hysterectomy. A drop in blood pressure and ongoing visible bleeding were the most commonly accepted indications for rechecking a "stat" complete blood count and coagulation studies, respectively, in patients with PPH; however, 4% of respondents reported that they would not routinely order coagulation studies. Forty-two percent reported having never consulted a hematologist for massive PPH. CONCLUSION: The survey findings highlight potential areas for improved practice in managing massive PPH, including earlier and more consistent assessment, monitoring of coagulation studies, and consultation with a hematologist.

Empirical measurement of illicit tobacco trade in the Philippines.

Cigarette smuggling reduces the price of cigarettes, thwarts youth access restrictions, reduces government revenue, and undercuts the ability of taxes to reduce consumption. The tobacco industry often opposes increases to tobacco taxes on the claim that greater taxes induce more smuggling. To date, little is known about the magnitude of smuggling in the Philippines. his information is necessary to effectively address illicit trade and to measure the impacts of tax changes and the introduction of secure tax markings on illicit trade. This study employs two gap discrepancy methods to estimate the magnitude of illicit trade in cigarettes for the Philippines between 1994 and 2009. First, domestic consumption is compared with tax-paid sales to measure the consumption of illicit cigarettes. Second, imports recorded by the Philippines are compared with exports to the Philippines by trade partners to measure smuggling. Domestic consumption fell short of tax-paid sales for all survey years. The magnitude of these differences and a comparison with a prevalence survey for 2009 suggest a high level of survey under-reporting of smoking. In the late 1990s and the mid 2000s, the Philippines experienced two sharp declines in trade discrepancies, from a high of $750 million in 1995 to a low of $133.7 million in 2008. Discrepancies composed more than one-third of the domestic market in 1995, but only 10 percent in 2009. Hong Kong, Singapore, and China together account for more than 80 percent of the cumulative discrepancies over the period and 74 percent of the discrepancy in 2009. The presence of large discrepancies supports the need to implement an effective tax marking and tobacco track and trace system to reduce illicit trade and support tax collection. The absence of a relation between tax changes and smuggling suggests that potential increases in the excise tax should not be discouraged by illicit trade. Finally, the identification of specific trade partners as primary sources for illicit trade may facilitate targeted efforts in cooperation with these governments to reduce illicit trade.

Selection of Postacute Stroke Rehabilitation Facilities: A Survey of Discharge Planners From the Northeast Cerebrovascular Consortium (NECC) Region.

The process of determining the level of care and specific postacute care facility for stroke patients has not been adequately studied. The objective of this study was to better understand the factors that influence postacute care decisions by surveying stroke discharge planners. Requests were sent to discharge planners at 471 hospitals in the Northeast United States to complete an online survey regarding the factors impacting the selection of postacute care. Seventy-seven (16%) discharge planners completed the online survey. Respondents were mainly nurses and social workers and 73% reported ≥20 years healthcare experience. Patients and families were found to be significantly more influential than physicians (P < 0.001) and other clinicians (P = 0.04) in influencing postdischarge care. Other clinicians were significantly more influential than physicians (P < 0.001). Insurance and quality of postacute care were the factors likely to most affect the selection of postacute care facility. Insurance was also identified as the greatest barrier in the selection of level of postacute care (70%; P < 0.001) and specific postacute care facility (46%; P = 0.02). More than half reported that pressure to discharge patients quickly impacts a patients' final destination. Nonclinical factors are perceived by discharge planners to have a major influence on postacute stroke care decision making.

Diversity and Inclusion at UMD Libraries Survey Results

The survey was made available online to library faculty, staff, and student workers. Participation in the survey was completely voluntary, and each individual question was entirely optional. In accordance with UMD policy, responses were treated as confidential. Fewer than five responses in a particular category were considered identifiable by the U.S. Department of Education and were not included in this report. Those who participated in the survey represent a significant portion of the Libraries’ community.