A multifactorial analysis of melanoma: prognostic histopathological features comparing Clark's and Breslow's staging methods

A multifactorial analysis was used to identify the dominant prognostic variables affecting survival from a computerized data base of 339 melanoma patients treated at this institution during the past 17 years. Five of the 13 parameters examined simultaneously were found to independently influence five year survival rates: 1) pathological stage (I vs II, p = 0.0014), 2) lesion ulceration (present vs absent, p = 0.006), 3) surgical treatment (wide excision vs wide excision plus lymphadenectomy, p = 0.024), 4) melanoma thickness (p = 0.032), and 5) location (upper extremity vs lower extremity vs trunk vs head and neck, p = 0.038). Additional factors considered that had either indirect or no influence on survival rates were clinical stage of disease, age, sex, level of invasion, pigmentation, lymphocyte infiltration, growth pattern, and regression. Most of these latter variables derived their prognostic value from correlation with melanoma thickness, except sex which correlated with location (extremity lesions were more frequent on females, trunk lesions on males). This statistical analysis enabled us to derive a mathematical equation for predicting an individual patient's probability of five year survival. Three categories of risk were delineated by measuring tumor thickness (Breslow microstaging) in Stage I patients: 1) thin melanomas (<0.76 mm) were associated with localized disease and a 100% cure rate: 2) intermediate thickness melanomas (0.76-4.00 mm) had an increasing risk (up to 80%) of harboring regional and/or distant metastases and 3) thick melanomas (>/=4.00 mm) had a 80% risk of occult distant metastases at the time of initial presentation. The level of invasion (Clark's microstaging) correlated with survival, but was less predictive than measuring tumor thickness. Within each of Clark's Level II, III and IV groups, there were gradations of thickness with statistically different survival rates. Both microstaging methods (Breslow and Clark) were less predictive factors in patients with lymph node or distant metastases. Clinical trials evaluating alternative surgical treatments or adjunctive therapy modalities for melanoma patients should incorporate these parameters into their assessment, especially in Stage I (localized) disease where tumor thickness and the anatomical site of the primary melanoma are dominant prognostic factors.     

A case study comparing a meta-analysis and a pooled analysis of studies of sinonasal cancer among wood workers

Infectious tolerance can be induced in many ways, does not require a thymus or clonal deletion and can spread to third-party antigens linked on the same antigen-presenting cell-the process being variously described as linked-, bystanderor epitope-suppression. We here review the evidence concerning the mechanisms involved and attempt to make a consistent hypothesis, that during tolerance induction in the Th1-mediated autoimmune diseases and transplantation systems there would seem to be a phase of immune deviation towards Th2 cytokines, like IL-4 and IL-10; however, this may lead to an IL-10-induced form of anergy or nonresponsiveness and generation of the recently characterized Th3/T-regulatory-1 CD4+ T cell subset which is thought to downregulate the antigen-presenting cell, possibly via transforming growth factor beta.     

Treatment of phobic disorders using cognitive and exposure methods: A self-efficacy analysis.

Examined predictions derived from self-efficacy theory in comparing the effects of exposure and cognitive interventions with simple phobics. 22 phobics (25–64 yrs) with fears of either heights, elevators, or darkness were assigned to either guided exposure (GE) or cognitive restructuring (CR) treatments. GE was found significantly superior to CR in enhancing approach behavior, increasing level and strength of self-efficacy, reducing subjective fear, and decreasing physiological reactivity to imagined phobic scenes. High correlations were found between approach behavior and self-efficacy ratings for both groups. GE produced marked improvements in Ss' ability to cope with phobic situations in daily life. CR induced reported improvements in social functioning. At a 1-mo follow-up the results remained much the same. Five additional sessions of GE were then offered to Ss in the CR condition, producing results comparable to those of the original GE group. At a 6-mo follow-up all gains were maintained with further reductions in subjective fear for all GE Ss. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Generalization of the effects of exposure treatments for phobias: A single case study.

Investigated generalization effects of exposure treatment of phobias in a multiple-baseline design with a 20-yr-old female who presented with fear of death (FOD), fear of losing control of herself (FLC), and excessive vulnerability to criticism (VTC). As predicted, treatment of FOD led to some improvement in the FLC but not in the VTC. Treatment of the FOD was associated with a worsening of 1 part of the VTC; treatment of the VTC led to a partial relapse of the FOD and FLC. Findings are explained in terms of conditioned cue and associative network models of the mental representation of fears. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bootstrapping for pharmacokinetic models: visualization of predictive and parameter uncertainty

PURPOSE: We explore use of "bootstrapping" methods to obtain a measure of reliability of predictions made in part from fits of individual drug level data with a pharmacokinetic (PK) model, and to help clarify parameter identifiability for such models. METHODS: Simulation studies use four sets (A-D) of drug concentration data obtained following a single oral dose. Each set is fit with a two compartment PK model, and the "bootstrap" is employed to examine the potential predictive variation in estimates of parameter sets. This yields an empirical distribution of plausible steady state (SS) drug concentration predictions that can be used to form a confidence interval for a prediction. RESULTS: A distinct, narrow confidence region in parameter space is identified for subjects A and B. The bootstrapped sets have a relatively large coefficient of variation (CV) (35-90% for A), yet the corresponding SS drug levels are tightly clustered (CVs only 2-9%). The results for C and D are dramatically different. The CVs for both the parameters and predicted drug levels are larger by a factor of 5 and more. The results reveal that the original data for C and D, but not A and B, can be represented by at least two different PK model manifestations, yet only one provides reliable predictions. CONCLUSIONS: The insights gained can facilitate making decisions about parameter identifiability. In particular, the results for C and D have important implications for the degree of implicit overparameterization that may exist in the PK model. In cases where the data support only a single model manifestation, the "bootstrap" method provides information needed to form a confidence interval for a prediction.     

How different survey techniques can impact consultant recommendations: A scientist-practitioner study comparing two popular methods.

Very little research has compared how consultant survey methods may result in different recommendations for change. This study compared the job satisfaction method to the reason method to understand employee turnover motives. To control for content, measures from both methods were applied to the same attribute categories, such as job pay, the work itself, and job security. Results indicated that the reason approach demonstrated considerably more predictive validity than the job satisfaction approach and provided unique insight into specific turnover motives (e.g., salary and supervisor relationships). These results directly impacted subsequent intervention choices of the client. Results suggest that consultants can generate even better recommendations for clients if they include reason scales in their survey-based projects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial comparing three methods of bowel preparation for flexible sigmoidoscopy

OBJECTIVE: The aim of this study was to assess the optimum method of bowel preparation for flexible sigmoidoscopy. METHODS: A total of 164 adults undergoing flexible sigmoidoscopy at an ambulatory clinic were randomized to receive one of three preparations: a single hyperphosphate enema 1 h before the procedure; a hyperphosphate enema given 1 and 2 h before the procedure; or a hyperphosphate enema administered 1 and 2 h before the procedure, preceded by a 296 ml bottle of magnesium citrate taken p.o. the night before. Patients completed surveys on preparation and procedure comfort and satisfaction. The performing endoscopist assessed preparation quality, procedure duration, and depth of sigmoidoscope insertion. RESULTS: All three preparations were equally well tolerated with slightly more diarrhea reported among patients receiving magnesium citrate (p = 0.007). The addition of magnesium citrate resulted in more procedures rated by the endoscopist as excellent or good (RR 1.5, 95% CI: 1.3-1.9), deeper sigmoidoscope insertion (56 vs 51 cm, p = 0.0036), fewer procedures requiring repeat preparation (RR: 0.21, 95% CI: 0.04-0.98) and more procedures rated by patients as discomfort free (RR: 2.2, 95% CI: 1.39-3.60). Excellent and good preparations were associated with shorter procedure duration (19 vs 14 min, p = 0.008) and greater depth of insertion (56 vs 50 cm, p = 0.003). Fewer diverticuli were noted with a single enema than the two enema preparation (p = 0.006) with the remaining outcomes equal between these two groups. CONCLUSION: The addition of bottle of magnesium citrate to a 2-hyperphosphate enema preparation is well tolerated and improves bowel preparation for flexible sigmoidoscopy.     

Stage process design: A predictive confirmation structure for the single case.

Introduces the stage process design as a predictive confirmation (PC) structure for the single case and contends that PC can be assessed when the clinician operationally defines the important goals of therapy before introducing the change strategies in therapy. To the degree that patient change matches the predictions, PC is achieved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Xenobiotic metabolizing enzymes in fish: diversity, regulation and biomarkers for pollutant exposure

The specificity, detection limit, and stability of twelve anti-Salmonella monoclonal antibodies (Mabs) were evaluated by cloth-based enzyme immunoassay (CEIA) and polymyxin-cloth based enzyme immunoassay (p-CEIA). Using the p-CEIA, five Mabs were found to react with cholate extracted lipopolysaccharide (LPS) antigens of all 44 Salmonella strains representing 19 different serogroups examined, with the exception of the one strain of serogroup-O tested. These five Mabs did not react with cholate extracts of any of 16 Gram-positive or Gram-negative non-Salmonella bacteria tested. The detection limit of purified S. typhimurium LPS antigen in the p-CEIA was approximately 40 ng for four of the Mabs and approximately 20 ng for the other Mab. Four of the five Mabs were stable during storage at 22 degrees C-23 degrees C for 24 h. These four Mabs are potentially useful for the immunodetection of Salmonella in foods and other samples.     

Ototoxicity of carboplatin: comparing animal and clinical models at the Hospital for Sick Children

Carboplatin was introduced to the paediatric population as an alternative chemotherapeutic agent in the management of various malignant neoplasms, including sarcomas of the head and neck, in the hope that it would have fewer side effects than pre-existing agents. While many investigators have considered the ototoxicity of this drug only incidentally, others have presumed it to be of negligible importance. A recent animal model of its use has demonstrated damage to the inner hair cells of the cochlea, particularly at the basal turn, with a corresponding high incidence of hearing loss. Similarly, 11 of 22 patients who received this agent at the Hospital for Sick Children over the past 2 years demonstrated a sensorineural hearing loss in the 4 to 12 kHz range. This complication occurred as early as after the first dose and was generally progressively worse with subsequent doses. Consequently, we recommend careful audiologic monitoring of children receiving this agent.     

Influence of prenatal mercury exposure upon scholastic and psychological test performance: benchmark analysis of a New Zealand cohort

A general biological concept of the unity of structure and function in biological systems at all levels of their organization-cell, tissue, organ and organism-is well known. However, the constructive contents of such unity remain unclear. It appears that until we learn to separate and allocate structural and functional problems of biological systems construction, we cannot understand how this unity is reached. Or else, there is a methodological problem: how to separate and to allocate the basic categories of biological self-organization? Here, we consider different biological tissues in order to separate, in the first place, the basic concepts-structure, function, control-as independent systems which have their own referents. Then to solve the problem of association, a concept of "equipment" is introduced: the structure is equipped with function, the function is equipped with control. As a result, any elementary cycle of bioorganization is represented as a sequence of phases: (1) formation of structural basis, (2) functional equipment of structure, (3) libernetical equipment of function-differentiation of variability freedoms, (4) establishment of control to overcome the superfluous freedom of structural and functional organization.     

A comparison of three methods of analysis for age-period-cohort models with application to incidence data on non-Hodgkin''s lymphoma

Solution structures and hydrogen exchange characteristics of ligand-RNA aptamer and ligand-DNA aptamer complexes have been solved within the past year. The ligands range from cofactors to amino acids, nucleotides, aminoglycoside antibiotics and peptides that are targeted by the nucleic acid aptamers with high specificity and affinity. The structural and dynamics studies provide insights into the principles, patterns and diversity associated with nucleic acid architecture, molecular recognition and the adaptive binding that takes place upon complex formation. These new results provide opportunities for structure-based drug design strategies relevant to therapeutic intervention.     

A simulation study comparing tests for the equality of coefficients of variation

The coefficient of variation is commonly used in medical and biological sciences. In this paper, several parametric and non-parametric tests for the equality of coefficients of variation in kappa populations are reviewed. Simulation studies are conducted to compare the sizes and power of these tests. It is found that the parametric tests perform well if the data are normally distributed, but perform poorly if otherwise. The non-parametric test, however, is rather robust against the underlying distribution. An example using data of the Quality Assurance Program from the Hong Kong Medical Technology Association in Haematology and Serology is provided. The insensitivity of the non-parametric test to outliers is demonstrated.     

Sequential analysis applied to counseling process and outcome: A case study revisited.

A case study presented by C. E. Hill et al (see record 1983-10832-001) was analyzed further with sequential analysis methods developed by B. E. Wampold (see PA, Vol 71:30503; in press) and Wampold and G. Margolin (see record 1983-04841-001) to demonstrate the usefulness of these methods for understanding counseling process and outcome. Several interactive patterns were investigated including unidirectional independence, bidirectional independence, and dominance. Process was linked to outcome by examining the relations of various interactive patterns and satisfaction with and evaluation of each session as rated by the client, the counselor, and observers. The present sequential analysis revealed several facets of the interaction between the counselor and the client that were undetected by Hill et al.'s analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A response-time approach to comparing generalized rational and take-the-best models of decision making.

The authors develop and test generalized versions of take-the-best (TTB) and rational (RAT) models of multiattribute paired-comparison inference. The generalized models make allowances for subjective attribute weighting, probabilistic orders of attribute inspection, and noisy decision making. A key new test involves a response-time (RT) approach. TTB predicts that RT is determined solely by the expected time required to locate the 1st discriminating attribute, whereas RAT predicts that RT is determined by the difference in summed evidence between the 2 alternatives. Critical test pairs are used that partially decouple these 2 factors. Under conditions in which ideal observer TTB and RAT strategies yield equivalent decisions, both the RT results and the estimated attribute weights suggest that the vast majority of subjects adopted the generalized TTB strategy. The RT approach is also validated in an experimental condition in which use of a RAT strategy is essentially forced upon subjects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cognitive-behavioral treatment for impulse control: A case study.

Treated a 9-yr-old impulsive boy with a combination of verbal self-instructions and response cost. The program was sequentially applied to inappropriate "switches" in each of 3 target behaviors (topics, games, and rules) according to a multiple baseline design. Positive change in all of the target behaviors and in response latencies and errors on the Matching Familiar Figures Test were evident at posttreatment and the 6-mo follow-up. In addition, a systematic evaluation of the generalization of the results is reported. Hypotheses generated from this case study are discussed. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A case study in a behavioral analysis of psychotherapy.

A content analysis guided by the points of view of psychoanalytic theory and learning theory was made of the verbalizations from the case history of a 24-year-old male. The content categories utilized were concerned with motivation and defense. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

分析测试中的测量不确定度及评定第二部分测量不确定评定的基本方法

本文叙述了测量不确定度评定的基本程序,A类和B类标准不确定度、合成标准不确定度和扩展不确定度评定的基本方法.