Influencia de un programa de ejercicio aeróbico en la calidad de vida de pacientes afectadas por cáncer de mama = Influence of an aerobic exercise program on breast cancer patients’ quality of life

INTRODUCCIÓN Actualmente las supervivientes de cáncer de mama viven durante más tiempo. Sin embargo, los tratamientos utilizados presentan importantes efectos secundarios que afectan y marcan su calidad de vida. Numerosos estudios han mostrado que el ejercicio es una herramienta apta, segura y efectiva reduciendo algunos de estos efectos secundarios y, en suma, mejorando la calidad de vida de estas pacientes, aspecto que presenta al ejercicio físico como una intervención integral para ellas. Por el contrario, se ha observado que las supervivientes de cáncer de mama reducen la cantidad de ejercicio que realizan después de dichos tratamientos. Por ello, el objetivo de este proyecto es examinar los efectos de un programa integral de ejercicio en la calidad de vida y la cantidad de ejercicio físico que realizan las pacientes con cáncer de mama en su tiempo, tras finalizar sus tratamientos. MATERIAL Y MÉTODOS Se diseñó un Ensayo Clínico Aleatorizado. Noventa pacientes diagnosticadas de cáncer de mama en estadios tempranos que habían terminado sus tratamientos de radioterapia y quimioterapia recientemente, fueron reclutadas por la Universidad Politécnica de Madrid, desde enero de 2013 hasta junio de 2014. Las pacientes fueron aleatorizadas tras las mediciones iniciales al grupo control (tratamientos habituales) o grupo intervención, durante tres meses. La intervención consistió en 24 clases de ejercicio combinando práctica aeróbica y de fuerza con el fin de reducir los efectos secundarios de dichos tratamientos. La calidad de vida, la cantidad de ejercicio físico realizado en tiempo de ocio, VO2max, la fuerza, la movilidad articular del hombro, la fatiga, la depresión y la ansiedad fueron medidos al inicio y después de los tres meses en todos los pacientes. RESULTADOS Un total de 89 pacientes con una media de 49.06±8.75 de edad fueron finalmente analizadas. El grupo intervención (n=44) mostraron significativamente mejores resultados en calidad de vida (p=0.0001; d=0.85), cantidad de ejercicio en tiempo de ocio (p=0.0001; d=2.77), en variables de la composición corporal, en variables físicas y en variables psicológicas comparado con el grupo control (n=45). Además, se observó una correlación significativa entre la calidad de vida y el ejercicio realizado en tiempo de ocio en el grupo intervención (r= 0.58; p=0.001), que no fue patente en el grupo control. Se observaron cambios significativos en el grupo de intervención relativos a la composición corporal, con aumento de la masa muscular (p=0.001) y reducción de la masa grasa (p=0.0001). Tanto las variables físicas como psicológicas también mostraron diferencias significativas a favor al grupo de intervención en las comparaciones entre grupos. CONCLUSIONES Según estos resultados, un programa de ejercicio físico específico es una intervención integral que mejora los hábitos y la calidad de vida de las supervivientes de cáncer de mama, lo que reduce determinados efectos secundarios de los tratamientos y aumenta la salud física y psicológica general de estas mujeres. Este tipo de intervenciones pude ser una herramienta barata y efectiva para ofrecer a los pacientes, integrada en los tratamientos habituales. ABSTRACT INTRODUCTION It is well known that breast cancer survivors are living longer. However, breast cancer treatments present serious side effects, which could affect breast cancer survivors’ (BCS) health and quality of life (QoL). Exercise has been presented as a feasible, safe and effective tool in reducing some of these side effects and to improve survivors’ QoL, acting as an integrative treatment for them, although it has been observed that BCS reduce their leisure time exercise (LTE) levels. Therefore, the aim of this study was to examine the effects of an integrative exercise program in QoL and LTE in BCS after the completion of their adjuvant treatment. MATERIAL AND METHODS A randomized controlled trial (RCT) was designed. Ninety patients diagnosed with an early stage of breast cancer and who recently finished chemotherapy and radiotherapy treatments were recruited by the Technical University of Madrid from January 2013 to June 2014. Patients were randomized after baseline assessments to the intervention group (IG) or to the control group (CG) (usual care) for three months. The Intervention consisted in 24 supervised exercise classes, combining aerobic and resistance exercises in order to reduce the most common side effects of the treatments. QoL, LTE, body composition, VO2max, strength, shoulder range of motion, fatigue, depression and self-esteem were measured in all the patients at baseline and after three months. RESULTS A total of 89 patients aged 49.06±8.75 years were finally assessed. IG (n=44) showed significant better results in QoL (p=0.0001; d=0.85), LTE (p=0.0001; d=2.77), in body composition, in the physical variable and in psychological outcomes, compared with the CG (n=45). In addition, a correlation between QoL and LTE (r= 0.58; p=0.001) was found in the IG, while CG did not show this correlation. Significant changes in body composition were observed in the group comparisons, especially in lean mass (p=0.001) and body fat mass (p= 0.0001). Positive changes were also observed in the physical and psychological variables in comparisons between groups. CONCLUSIONS These results suggest that this exercise program may be an integrative intervention, which is able to improve QoL and LTE levels in breast cancer survivors, reducing breast cancer side effects of treatments and improving their physical and psychological general health. Exercise may be an effective and inexpensive strategy to be included in patients integrative care.

Estudio de las dinámicas de pérdida de peso corporal en los programas de ejercicio físico y nutrición = Study of the dynamics of body weight loss in exercise and nutritional programs

Introducción. La obesidad puede definirse como una enfermedad metabólica crónica de origen multifactorial, lo que provoca trastornos o problemas físicos y psicológicos a la persona, con patologías asociadas que limitan la esperanza de vida y deterioran la calidad de la misma, siendo determinante para sus áreas sociales y laborales. Este trastorno metabólico crónico se caracteriza por una acumulación excesiva de energía en el cuerpo en forma de grasa, lo que lleva a un aumento de peso con respecto al valor esperado por sexo, edad y altura. La gestión y el tratamiento de la obesidad tienen objetivos más amplios que la pérdida de peso e incluyen la reducción del riesgo y la mejora de la salud. Estos pueden ser alcanzados por la pérdida modesta de peso (es decir, 10.5% del peso corporal inicial), la mejora del contenido nutricional de la dieta y un modesto incremento en la actividad física y condición física. La dieta es uno de los métodos más populares para perder peso corporal. El ejercicio es otra alternativa para perder peso corporal. El aumento de ejercicio provoca un desequilibrio cuando se mantiene la ingesta calórica. También tiene ventajas, como la mejora del tono muscular, la capacidad cardiovascular, fuerza y flexibilidad, aumenta el metabolismo basal y mejora el sistema inmunológico. Objetivos. El objetivo de esta tesis es contribuir en un estudio de intervención para aclarar la evolución del peso corporal durante una intervención de dieta y ejercicio. Para ello, se evaluaron los efectos de la edad, sexo, índice de masa corporal inicial y el tipo de tratamiento en las tendencias de pérdida de peso. Otro objetivo de la tesis era crear un modelo de regresión lineal múltiple capaz de predecir la pérdida de peso corporal después del periodo de intervención. Y, por último, determinar el efecto sobre la composición corporal (peso corporal, índice de masa corporal, la masa grasa, y la masa libre de grasa) de las diferentes intervenciones basadas en ejercicios (fuerza, resistencia, resistencia combinada con fuerza, y las recomendaciones de actividad física (grupo control)) en combinación con dieta de adultos con sobrepeso y obesidad, después de la intervención, así como los cambios de la composición corporal 3 años más tarde. Diseño de la investigación. Los datos empleados en el análisis de esta tesis son parte del proyecto “Programas de Nutrición y Actividad Física para el tratamiento de la obesidad” (PRONAF). El proyecto PRONAF es un estudio clínico sobre programas de nutrición y actividad física para el sobrepeso y la obesidad, desarrollado en España durante varios años de intervención. Fue diseñado, en parte, para comparar diferentes tipos de intervención, con el objetivo de evaluar su impacto en las dinámicas de pérdida de peso, en personas con sobrepeso y obesidad. Como diseño experimental, el estudio se basó en una restricción calórica, a la que, en algunos casos, se le añadió un protocolo de entrenamiento (fuerza, resistencia, o combinado, en igualdad de volumen e intensidad). Las principales variables para la investigación que comprende esta tesis fueron: el peso corporal y la composición corporal (masa grasa y masa libre de grasa). Conclusiones. En esta tesis, para los programas de pérdida de peso en personas con sobrepeso y obesidad con un 25-30% de la restricción calórica, el peso corporal se redujo significativamente en ambos sexos, sin tener en cuenta la edad y el tipo de tratamiento seguido. Según los resultados del estudio, la pérdida de peso realizada por un individuo (hombre o mujer) durante los seis meses puede ser representada por cualquiera de las cinco funciones (lineal, potencial, exponencial, logarítmica y cuadrática) en ambos sexos, siendo la cuadrática la que tiende a representarlo mejor. Además, se puede concluir que la pérdida de peso corporal se ve afectada por el índice de masa corporal inicial y el sexo, siendo mayor para las personas obesas que para las de sobrepeso, que muestran diferencias entre sexos sólo en la condición de sobrepeso. Además, es posible calcular el peso corporal final de cualquier participante involucrado en una intervención utilizando la metodología del proyecto PRONAF sólo conociendo sus variables iniciales de composición corporal. Además, los cuatro tipos de tratamientos tuvieron resultados similares en cambios en la composición corporal al final del período de intervención, con la única excepción de la masa libre de grasa, siendo los grupos de entrenamiento los que la mantuvieron durante la restricción calórica. Por otro lado, sólo el grupo combinado logra mantener la reducción de la masa grasa (%) 3 años después del final de la intervención. ABSTRACT Introduction. Obesity can be defined as a chronic metabolic disease from a multifactorial origin, which leads to physical and psychological impacts to the person, with associated pathologies that limit the life expectancy and deteriorate the quality of it, being determinant for the social and labor areas of the person. This chronic metabolic disorder is characterized by an excessive accumulation of energy in the body as fat, leading to increased weight relative to the value expected by sex, age and height. The management and treatment of obesity have wider objectives than weight loss alone and include risk reduction and health improvement. These may be achieved by modest weight loss (i.e. 5–10% of initial body weight), improved nutritional content of the diet and modest increases in physical activity and fitness. Weight loss through diet is one of the most popular approaches to lose body weight. Exercise is another alternative to lose body weight. The increase of exercise causes an imbalance when the caloric intake is maintained. It also has advantages such as improved muscle tone, cardiovascular fitness, strength and flexibility, increases the basal metabolism and improves immune system. Objectives. The aim of this thesis is to contribute with an interventional study to clarify the evolution of the body weight during a diet and exercise intervention. For this, the effects of age, sex, initial body mass index and type of treatment on weight loss tendencies were evaluated. Another objective of the thesis was to create a multiple linear regression model able to predict the body weight loss after the intervention period. And, finally, to determine the effect upon body composition (body weight, body mass index, fat mass, and fat-free mass of different exercise-based interventions (strength, endurance, combined endurance and strength, and physical activity recommendations group (control group)) combined with diet in overweight and obese adults, after intervention as well as body composition changes 3 years later. Research Design. The data used in the analysis of this thesis are part of the project "Programs of Nutrition and Physical Activity for the treatment of obesity" (PRONAF). The PRONAF project is a clinical trial program about nutrition and physical activity for overweight and obesity, developed in Spain for several years of intervention. It was designed, in part, to compare different types of intervention, in order to assess their impact on the dynamics of weight loss in overweight and obese people. As experimental design, the study was based on caloric restriction, which, in some cases, added a training protocol (strength, endurance, or combined in equal volume and intensity). The main research variables comprising this thesis were: body weight and body composition outcomes (fat mass and fat-free mass). Conclusions. In this thesis, for weight loss programs in overweight and obese people with 25-30% of caloric restriction, the body weight was significantly decreased in both sexes, regardless the age and type of followed treatment. According to the results of the study, the weight loss performed by an individual (male or female) during six months can be represented by any of the five functions (linear, power law, exponential, logarithmic and quadratic) in both sexes, being the quadratic one which tends to represent it better. In addition, it can be concluded that the body weight loss is affected by the initial body mass index and sex condition, being greater for the obese people than for the overweight one, showing differences between sexes only in the overweight condition. Moreover, it is possible to calculate the final body weight of any participant engaged in an intervention using the PRONAF Project methodology only knowing their initial body composition variables. Furthermore, the four types of treatments had similar results on body composition changes at the end of the intervention period, with the only exception of fat-free mass, being the training groups the ones that maintained it during the caloric restriction. On the other hand, only the combined group achieved to maintain the fat mass (%) reduced 3 years after the end of the intervention.

Neurite, a finite difference large scale parallel program for the simulation of the electrical signal propagation in neurites under mechanical loading

With the growing body of research on traumatic brain injury and spinal cord injury, computational neuroscience has recently focused its modeling efforts on neuronal functional deficits following mechanical loading. However, in most of these efforts, cell damage is generally only characterized by purely mechanistic criteria, function of quantities such as stress, strain or their corresponding rates. The modeling of functional deficits in neurites as a consequence of macroscopic mechanical insults has been rarely explored. In particular, a quantitative mechanically based model of electrophysiological impairment in neuronal cells has only very recently been proposed (Jerusalem et al., 2013). In this paper, we present the implementation details of Neurite: the finite difference parallel program used in this reference. Following the application of a macroscopic strain at a given strain rate produced by a mechanical insult, Neurite is able to simulate the resulting neuronal electrical signal propagation, and thus the corresponding functional deficits. The simulation of the coupled mechanical and electrophysiological behaviors requires computational expensive calculations that increase in complexity as the network of the simulated cells grows. The solvers implemented in Neurite-explicit and implicit-were therefore parallelized using graphics processing units in order to reduce the burden of the simulation costs of large scale scenarios. Cable Theory and Hodgkin-Huxley models were implemented to account for the electrophysiological passive and active regions of a neurite, respectively, whereas a coupled mechanical model accounting for the neurite mechanical behavior within its surrounding medium was adopted as a link between lectrophysiology and mechanics (Jerusalem et al., 2013). This paper provides the details of the parallel implementation of Neurite, along with three different application examples: a long myelinated axon, a segmented dendritic tree, and a damaged axon. The capabilities of the program to deal with large scale scenarios, segmented neuronal structures, and functional deficits under mechanical loading are specifically highlighted.

A repressible female-specific lethal genetic system for making transgenic insect strains suitable for a sterile-release program

We have developed a tetracycline-repressible female-specific lethal genetic system in the vinegar fly Drosophila melanogaster. One component of the system is the tetracycline-controlled transactivator gene under the control of the fat body and female-specific transcription enhancer from the yolk protein 1 gene. The other component consists of the proapoptotic gene hid under the control of a tetracycline-responsive element. Males and females of a strain carrying both components are viable on medium supplemented with tetracycline, but only males survive on normal medium. A strain with such properties would be ideal for a sterile-insect release program, which is most effective when only males are released in the field.

User's manual for the CAL-3D user convenience package. Volume II - program listings. Final technical report.

National Highway Traffic Safety Administration, Washington, D.C.

PROMETHEUS 2 - a user oriented program for human crash dynamics. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Improved air bag restraints for front seat compact car occupants. Vol. II - final program report. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Pedestrian model parametric studies. Interim report, volume II - vehicle design optimization program.

National Highway Traffic Safety Administration, Washington, D.C.

Highly demanding resistive vibration exercise program is tolerated during 56 days of strict bed-rest

Several studies have tried to find countermeasures against musculoskeletal de-conditioning during bed-rest, but none of them yielded decisive results. We hypothesised that resistive vibration exercise (RVE) might be a suitable training modality. We have therefore carried out a bed-rest study to evaluate its feasibility and efficacy during 56 days of bed-rest. Twenty healthy male volunteers aged 24 to 43 years were recruited and, after medical check-ups, randomised to a non-exercising control (Ctrl) group or a group that performed RVE 11 times per week. Strict bed-rest was controlled by video surveillance. The diet was controlled. RVE was performed in supine position, with a static force component of about twice the body weight and a smaller dynamic force component. RVE comprised four different units (squats, heel raises, toe raises, kicks), each of which lasted 60 - 100 seconds. Pre and post exercise levels of lactate were measured once weekly. Body weight was measured daily on a bed scale. Pain questionnaires were obtained in regular intervals during and after the bed-rest. Vibration frequency was set to 19 Hz at the beginning and progressed to 25.9 Hz (SD 1.9) at the end of the study, suggesting that the dynamic force component increased by 90%. The maximum sustainable exercise time for squat exercise increased from 86 s (SD 21) on day 11 of the BR to 176 s (SD 73) on day 53 (p = 0.006). On the same days, post-exercise lactate levels increased from 6.9 mmol/l (SD2.3) to 9.2 mmol/l (SD 3.5, p = 0.01). On average, body weight was unchanged in both groups during bed-rest, but single individuals in both groups depicted significant weight changes ranging from -10% to + d10% (p < 0.001). Lower limb pain was more frequent during bed-rest in the RVE subjects than in Ctrl (p = 0.035). During early recovery, subjects of both groups suffered from muscle pain to a comparable extent, but foot pain was more common in Ctrl than in RVE (p = 0.013 for plantar pain, p = 0.074 for dorsal foot pain). Our results indicate that RVE is feasible twice daily during bed-rest in young healthy males, provided that one afternoon and one entire day per week are free. Exercise progression, mainly by progression of vibration frequency, yielded increases in maximum sustainable exercise time and blood lactate. In conclusion, RVE as performed in this study, appears to be safe.

Clinical outcomes from skin screening clinics within a community-based melanoma screening program

Background : Within a randomized trial of population screening for melanoma, primary care physicians conducted whole-body skin examinations and referred all patients with suspect lesions to their own doctor for further treatment. Objective: Our aim was to describe characteristics of skin screening participants, clinical screening diagnoses, management following referral, and specificity and yield of screening examinations. Methods: Information collected from consent forms, referral forms, and histopathological reports of lesions that had been excised or undergone biopsy was analyzed by means of descriptive statistics. Results: A total of 16,383 whole-body skin examinations resulted in 2302 referrals (14.1% overall; 15.5% men, 18.2% >= 50 years of age) for 4129 suspect lesions (including 222 suspected melanoma, 1101 suspected basal cell carcinomas [BCCs], 265 suspected squamous cell carcinomas [SCCs]). Histopathologic results were available for 94.8% of 1417 lesions excised and confirmed 33 melanomas (23 in men; 24 in participants ? 50 years of age), 259 BCCs, and 97 SCCs. The probability of detecting skin cancer of any type within the program was 2.4%. The estimated specificity of whole-body skin examinations for melanoma was 86.1% (95% confidence interval = 85.6-86.6). The positive predictive value (number of confirmed/number of lesions excised or biopsied x 100) for melanoma was 2.5%, 19.3% for BCC, and 7.2% for SCC (overall positive predictive value for skin cancer, 28.9%). Limitations: Follow-up of participants with a negative screening examination has not been conducted for the present investigation. Conclusions: The rate of skin cancer detected per 100 patients screened was higher than previously reported and men and attendees older than 50 years more frequently received a referral and diagnosis of melanoma. The specificity for detection of melanoma through whole-body skin examination by a primary care physician was comparable to that of other screening tests, including mammography.

Whole body vibration training:analysis and characterization

The aim of this work is to contribute to the analysis and characterization of training with whole body vibration (WBV) and the resultant neuromuscular response. WBV aims to mechanically activate muscle by eliciting stretch reflexes. Generally, surface electromyography is utilized to assess muscular response elicited by vibrations. However, EMG analysis could potentially bring to erroneous conclusions if not accurately filtered. Tiny and lightweight MEMS accelerometers were found helpful in monitoring muscle motion. Displacements were estimated integrating twice the acceleration data after gravity and small postural subject adjustments contribution removal. Results showed the relevant presence of motion artifacts on EMG recordings, the high correlation between muscle motion and EMG activity and how resonance frequencies and dumping factors depended on subject and his positioning onto the vibrating platform. Stimulations at the resonant frequency maximize muscles lengthening and in turn, muscle spindle solicitation , which may produce more muscle activation. Local mechanical stimulus characterization (Le, muscle motion analysis) could be meaningful in discovering proper muscle stimulation and may contribute to suggest appropriate and effective WBV exercise protocols. ©2009 IEEE.

A synthesis of long-term research by the Florida Coastal Everglades LTER Program

This paper synthesizes research conducted during the first 5–6 years of the Florida Coastal Everglades Long-Term Ecological Research Program (FCE LTER). My objectives are to review our research to date, and to present a new central theme and conceptual approach for future research. Our research has focused on understanding how dissolved organic matter (DOM) from upstream oligotrophic marshes interacted with a marine source of the limiting nutrient, phosphorus (P), to control productivity in the oligohaline estuarine ecotone. We have been working along freshwater to marine transects in two drainage basins located in Everglades National Park (ENP). The Shark River Slough transect (SRS) has a direct connection to the Gulf of Mexico, providing this estuarine ecotone with a source of marine P. The oligohaline ecotone along our southern Everglades transect (TS/Ph), however, is separated from this marine P source by the Florida Bay estuary. We originally hypothesized an ecosystem productivity peak in the SRS ecotone, driven by the interaction of marine P and Everglades DOM, but no such productivity peak in the TS/Ph ecotone because of this lack of marine P. Our research to date has tended to show the opposite pattern, however, with many ecosystem components showing enhanced productivity in the TS/Ph ecotone, but not in the SRS ecotone. Water column P concentrations followed a similar pattern, with unexpectedly high P in the TS/Ph ecotone during the dry season. Our organic geochemical research has shown that Everglades DOM is more refractory than originally hypothesized. We have also begun to understand the importance of detrital organic matter production and transport to ecotone dynamics and as the base of aquatic food webs. Our future research will build on this substantial body of knowledge about these oligotrophic estuaries. We will direct our efforts more strongly on biophysical dynamics in the oligohaline ecotone regions. Specifically, we will be focusing on inputs to these regions from four primary water sources: freshwater Everglades runoff, net precipitation, marine inputs, and groundwater. We are hypothesizing that dry season groundwater inputs of P will be particularly important to TS/Ph ecotone dynamics because of longer water residence times in this area. Our organic geochemical, biogeochemical, and ecosystem energetics work will focus more strongly on the importance of detrital organics and will take advantage of a key Everglades Restoration project, scheduled for 2008 or 2009, that will increase freshwater inputs to our SRS transect only. Finally, we will also begin to investigate the human dimensions of restoration, and of a growing population in south Florida that will become increasingly dependent on the Everglades for critical ecosystem services (including fresh water) even as its growth presents challenges to Everglades sustainability.

Timeshare Owner Preferences - An Analysis of Program and Service Relationships during Recessionary Times

Since the 1970s various industry studies have indicated that the vacation ownership industry has enjoyed unprecedented growth in unit sales, resort growth, and the number of owners (American Resort Devleopment Association [ARDA], 2007; ARDA, 2009a; ARDA, 2009b). However, due to the recent economic downturn these growth metrics are no longer obtainable. This external impact has caused developers to retrench and therefore reflect upon their existing product and service offerings, financial metrics, and consumer markets (ARDA, 2010a; ARDA 2010b). The crux of these findings indicates that the industry has shifted to maintaining and enhancing product and service offerings as a reaction to changing economic conditions. The findings reported in the body of this manuscript represent product and service preferences as collected from a random data pull of their existing ownership base. The study also revealed current preferences of timeshare owners with relation to services provided and products/amenities offered. Management implications and limitations of the current study are discussed.

Participation in a positive youth development program and multi -problem alternative high school students' transformative goals: An investigation of the theoretical and methodological utility and validity of the Transformative Goal Attainment (TGAS)

There is a growing body of literature that provides evidence for the efficacy of positive youth development programs in general and preliminary empirical support for the efficacy of the Changing Lives Program (CLP) in particular. This dissertation sought to extend previous efforts to develop and preliminarily examine the Transformative Goal Attainment Scale (TGAS) as a measure of participant empowerment in the promotion of positive development. Consistent with recent advances in the use of qualitative research methods, this dissertation sought to further investigate the utility of Relational Data Analysis (RDA) for providing categorizations of qualitative open-ended response data. In particular, a qualitative index of Transformative Goals, TG, was developed to complement the previously developed quantitative index of Transformative Goal Attainment (TGA), and RDA procedures for calculating reliability and content validity were refined. Second, as a Stage I pilot/feasibility study this study preliminarily examined the potentially mediating role of empowerment, as indexed by the TGAS, in the promotion of positive development. ^ Fifty-seven participants took part in this study, forty CLP intervention participants and seventeen control condition participants. All 57 participants were administered the study's measures just prior to and just following the fall 2003 semester. This study thus used a short-term longitudinal quasi-experimental research design with a comparison control group. ^ RDA procedures were refined and applied to the categorization of open-ended response data regarding participants' transformative goals (TG) and future possible selves (PSQ-QE). These analyses revealed relatively strong, indirect evidence for the construct validity of the categories as well as their theoretically meaningful structural organization, thereby providing sufficient support for the utility of RDA procedures in the categorization of qualitative open-ended response data. ^ In addition, transformative goals (TG) and future possible selves (PSQ-QE), and the quantitative index of perceived goal attainment (TGA) were evaluated as potential mediators of positive development by testing their relationships to other indices of positive intervention outcome within a four-step method involving both analysis of variance (ANOVA and RMANOVAs) and regression analysis. Though more limited in scope than the efforts at the development and refinement of the measures of these mediators, the results were also promising. ^