What's missing in missing data? Omissions in survey responses among parents of children with advanced cancer

Background: Missing data is a common phenomenon with survey-based research; patterns of missing data may elucidate why participants decline to answer certain questions. Objective: To describe patterns of missing data in the Pediatric Quality of Life and Evaluation of Symptoms Technology (PediQUEST) study, and highlight challenges in asking sensitive research questions. Design: Cross-sectional, survey-based study embedded within a randomized controlled trial. Setting: Three large children's hospitals: Dana-Farber/Boston Children's Cancer and Blood Disorders Center (DF/BCCDC); Children's Hospital of Philadelphia (CHOP); and Seattle Children's Hospital (SCH). Measurements: At the time of their child's enrollment, parents completed the Survey about Caring for Children with Cancer (SCCC), including demographics, perceptions of prognosis, treatment goals, quality of life, and psychological distress. Results: Eighty-six of 104 parents completed surveys (83% response). The proportion of missing data varied by question type. While 14 parents (16%) left demographic fields blank, over half (n=48; 56%) declined to answer at least one question about their child's prognosis, especially life expectancy. The presence of missing data was unrelated to the child's diagnosis, time from progression, time to death, or parent distress (p>0.3 for each). Written explanations in survey margins suggested that addressing a child's life expectancy is particularly challenging for parents. Conclusions and Relevance: Parents of children with cancer commonly refrain from answering questions about their child's prognosis, however, they may be more likely to address general cure likelihood than explicit life expectancy. Understanding acceptability of sensitive questions in survey-based research will foster higher quality palliative care research. © Copyright 2014, Mary Ann Liebert, Inc. 2014.

Performance analysis of three advanced controllers for polymerization batch reactor: an experimental investigation

The performances of three advanced non-linear controllers are analyzed for the optimal set point tracking of styrene free radical polymerization (FRP) in batch reactors. The three controllers are the artificial neural network-based MPC (NN-MPC), the artificial fuzzy logic controller (FLC) as well as the generic model controller (GMC). A recently developed hybrid model (Hosen et al., 2011a. Asia-Pac. J. Chem. Eng. 6(2), 274) is utilized in the control study to design and tune the proposed controllers. The optimal minimum temperature profiles are determined using the Hamiltonian maximum principle. Different types of disturbances are introduced and applied to examine the stability of controller performance. The experimental studies revealed that the performance of the NN-MPC is superior to that of FLC and GMC. © 2013 The Institution of Chemical Engineers.

Uniform elongation and the stress-strain flow curve of steels calculated from hardness using empirical correlations

An empirical relationship between the hardness and uniform elongation of non-Austenitic hypoeutectoid steels has been developed. This new hardness-elongation relationship was combined with previously developed correlations of hardness and strength (yield and ultimate tensile strength) to predict the stressstrain flow curve from a single hardness test. The current study considers both power law hardening behavior and exponential hardening behavior. Reasonable agreement was observed between the experimental and predicted flow curves of a high strength, low alloy steel. Additionally, an empirical correlation of the flow strength at instability with hardness is provided. © ASM International.

Characterization of microstructures and tensile properties of TRIP-aided steels with different matrix microstructure

Three different heat treatment processes have been proposed as a fundamental method to produce three kinds of TRIP-aided steels with polygonal ferritic matrix (F-TRIP), bainitic matrix (B-TRIP) and martensitic matrix (M-TRIP) in a newly designed low alloy carbon steel. By means of dilatometry study and detailed characterization, the relationships among transformation, microstructure and the resulting mechanical behavior were compared and analyzed for the three cases. The work hardening of the samples was evaluated by calculating the instantaneous n value as a function of strain. The M-TRIP sample exhibits the highest strength with the highest work hardening rate at low strains and subsequent rapid descending at high strains. In contrast, the B-TRIP sample has relatively high continuously constant work hardening behavior over strain levels greater than 0.067. The difference in work hardening behavior corresponds directly to the rate of the retained austenite-martensitic transformation during straining, which can be attributed to the carbon content, the morphology of the retained austenite and the matrix microstructure in the respective TRIP-aided samples. © 2014 Elsevier B.V.

Numerical investigation of influence of the Martensite Volume Fraction on dp steels fracture behavior on the basis of digital material representation model

Development of the methodology for creating reliable digital material representation (DMR) models of dual-phase steels and investigation of influence of the martensite volume fraction on fracture behavior under tensile load are the main goals of the paper. First, an approach based on image processing algorithms for creating a DMR is described. Then, obtained digital microstructures are used as input for the numerical model of deformation, which takes into account mechanisms of ductile fracture. Ferrite and martensite material model parameters are evaluated on the basis of micropillar compression tests. Finally, the model is used to investigate the impact of the martensite volume fraction on the DP steel behavior under plastic deformation. Results of calculations are presented and discussed in the paper.

Strain partitioning in dual-phase steels containing tempered martensite

Tempering has been used as a method to develop a range of dual phase steels with the same martensite morphology and volume fraction, but containing phases with different relative strengths. These steels were used to examine the strain partitioning between the two constituent phases experimentally through mechanical testing and numerically through finite element modelling. It was found that increasing the differential in strength between the two phases not only produces regions of high strain, but also regions of low strain. On average, a larger difference in strength between the phases increased the strain carried by the softer phase. There was no discernible preferential strain localisation to the ferrite/martensite interface, with the regions of strain localisation being determined by the morphology of the microstructure. A direct correlation between the average strain in the ferrite, and the measured ductility has been found. © 2014 Elsevier B.V.

Symptoms and distress in children with advanced cancer: prospective patient-reported outcomes from the PediQUEST Study

PURPOSE: Thousands of children are living with advanced cancer; yet patient-reported outcomes (PROs) have rarely been used to describe their experiences. We aimed to describe symptom distress in 104 children age 2 years or older with advanced cancer enrolled onto the Pediatric Quality of Life and Evaluation of Symptoms Technology (PediQUEST) Study (multisite clinical trial evaluating an electronic PRO system).

METHODS: Symptom data were collected using age- and respondent-adapted versions of the PediQUEST Memorial Symptom Assessment Scale (PQ-MSAS) at most once per week. Clinical and treatment data were obtained from medical records. Individual symptom scores were dichotomized into high/low distress. Determinants of PQ-MSAS scores were explored using linear mixed-effects models.

RESULTS: During 9 months of follow-up, PQ-MSAS was administered 920 times: 459 times in teens (99% self-report), 249 times in children ages 7 to 12 years (96% child/parent report), and 212 times in those ages 2 to 6 years (parent reports). Common symptoms included pain (48%), fatigue (46%), drowsiness (39%), and irritability (37%); most scores indicated high distress. Among the 73 PQ-MSAS surveys administered in the last 12 weeks of life, pain was highly prevalent (62%; 58% with high distress). Being female, having a brain tumor, experiencing recent disease progression, and receiving moderate- or high-intensity cancer-directed therapy in the prior 10 days were associated with worse PQ-MSAS scores. In the final 12 weeks of life, receiving mild cancer-directed therapy was associated with improved psychological PQ-MSAS scores.

CONCLUSION: Children with advanced cancer experience high symptom distress. Strategies to promote intensive symptom management are indicated, especially with disease progression or administration of intensive treatments.

Learning transitions-a descriptive study of nurses' experiences during advanced level nursing education

BACKGROUND: Building capacity in a changing health care system is a challenge for advanced nursing education programs. Master-level nursing education is increasingly becoming the required education level for specialist nurses, and additional studies are needed to learn more about students' experiences and learning transitions while undertaking such education. This study aimed to explore nursing students' experience of their learning transitions while undertaking advanced nursing education and to describe how they translated the new knowledge and competence they gained into clinical practice. METHODS: We used a qualitative research design with narrative self-reported reflections. 34 nurses (95 % women) from both urban and rural areas working with children, with adults in outpatient and inpatient endocrinology clinics in hospitals or with adults, including older people, attending primary health care services participated in the study. We collected data at two time points 15 months apart. Time one was the first week of the advanced nursing education, and time two was the completion of the education program. We used Malterud's modification of Giorgi's phenomenological analysis, otherwise known as systematic text condensation, to analyze the data. RESULTS: Two core themes captured the participants' experiences. The first theme was "assessing the situation of people with diabetes from a different perspective", with the subthemes "an expanded perspective of practice and higher level of reflection", "applying critical thinking in practice" and "changing patient-nurse relationships in diabetes care". The second core theme was "a change in participants' perception of their professional position", with the subthemes "a greater knowledge base enhancing professional confidence" and "a more equal position within the professional team". CONCLUSIONS: The study provides in-depth information about transition into advanced nursing education and can inform curriculum developers, nurse educators, policy-makers and nursing managers about how nursing education broadened participants' perspectives of nursing and enhanced their confidence and professional position.