Initial validation of a computer-administered Addiction Severity Index: The ASI–MV.

The Addiction Severity Index—Multimedia Version (ASI–MV) is a CD-ROM-based simulation of the interview-administered Addiction Severity Index (ASI). Clients in treatment (N ?=?202) self-administered the ASI–MV to examine the test–retest reliability, criterion validity, and convergent–discriminant validity of the ASI–MV. Excellent test–retest reliability was observed for composite scores and severity ratings. Criterion validity, tested against the interviewer-administered ASI, was good for the composite scores. For severity ratings, variable agreement was observed between the ASI–MV and each interviewer, suggesting poor interrater reliability among interviewers. This conclusion was bolstered by a finding of superior convergent–discriminant validity for both composite scores and severity ratings compared to the standard ASI. The ASI–MV is a viable alternative to the expensive and potentially unreliable interviewer-administered version. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment delay, outcome, and satisfaction in time-limited group and individual psychotherapy.

As part of a randomized clinical trial in which we compared outcome in time-limited individual and time-limited group psychotherapy, patients were interviewed and completed a battery of assessment measures. All participants in the study were then randomly assigned to one or the other treatment modality. There were inevitable delays before patients began their assigned therapies. Group treatment patients waited an appreciably longer period of time, on average, than did individual treatment patients (48 days vs. 31 days). Nonetheless, it was only for individual therapy patients that we found a highly significant relationship between this delay and treatment satisfaction at the completion of therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. The Cancer and Leukemia Group B

BACKGROUND: Both total dose and dose intensity of adjuvant chemotherapy are postulated to be important variables in the outcome for patients with operable breast cancer. The Cancer and Leukemia Group B study 8541 examined the effects of adjuvant treatment using conventional-range dose and dose intensity in female patients with stage II (axillary lymph node-positive) breast cancer. METHODS: Within 6 weeks of surgery (radical mastectomy, modified radical mastectomy, or lumpectomy), 1550 patients with unilateral breast cancer were randomly assigned to one of three treatment arms: high-, moderate-, or low-dose intensity. The patients received cyclophosphamide, doxorubicin, and 5-fluorouracil on day 1 of each chemotherapy cycle, with 5-fluorouracil administration repeated on day 8. The high-dose arm had twice the dose intensity and twice the drug dose as the low-dose arm. The moderate-dose arm had two thirds the dose intensity as the high-dose arm but the same total drug dose. Disease-free survival and overall survival were primary end points of the study. RESULTS: At a median follow-up of 9 years, disease-free survival and overall survival for patients on the moderate- and high-dose arms are superior to the corresponding survival measures for patients on the low-dose arm (two-sided P<.0001 and two-sided P = .004, respectively), with no difference in disease-free or overall survival between the moderate- and the high-dose arms. At 5 years, overall survival (average +/- standard error) is 79% +/- 2% for patients on the high-dose arm, 77% +/- 2% for the patients on the moderate-dose arm, and 72% +/- 2% for patients on the low-dose arm; disease-free survival is 66% +/- 2%, 61% +/- 2%, and 56% +/- 2%, respectively. CONCLUSION: Within the conventional dose range for this chemotherapy regimen, a higher dose is associated with better disease-free survival and overall survival.     

erbB-2, p53, and efficacy of adjuvant therapy in lymph node-positive breast cancer

BACKGROUND: We have previously reported that high expression of the erbB-2 gene (also known as HER-2/neu and ERBB2) in breast cancer is associated with patient response to dose-intensive treatment with cyclophosphamide, doxorubicin (Adriamycin), and 5-flurouracil (CAF) on the basis of short-term follow-up of 397 patients (set A) with axillary lymph node-positive tumors who were enrolled in Cancer and Leukemia Group B (CALGB) protocol 8541. METHODS: To validate those findings, we conducted immunohistochemical analyses of erbB-2 and p53 protein expression in an additional cohort of 595 patients (set B) from CALGB 8541, as well as a molecular analysis of erbB-2 gene amplification in tumors from all patients (sets A and B). Marker data were compared with clinical, histologic, treatment, and outcome data. RESULTS: Updated analyses of data from set A (median follow-up, 10.4 years) showed an even stronger interaction between erbB-2 expression and CAF dose, by use of either immunohistochemical or molecular data. A similar interaction between erbB-2 expression and CAF dose was observed in all 992 patients, analyzed as a single group. However, for set B alone (median follow-up, 8.2 years), results varied with the method of statistical analysis. By use of a proportional hazards model, the erbB-2 expression-CAF dose interaction was not significant for all patients. However, in the subgroups of patients randomly assigned to the high- or the moderate-dose arms, significance was achieved. When patient data were adjusted for differences by use of a prognostic index (to balance an apparent failure of randomization in the low-dose arm), the erbB-2 expression-CAF dose interaction was significant in all patients from the validation set B as well. An interaction was also observed between p53 immunopositivity and CAF dose. CONCLUSIONS: The hypothesis that patients whose breast tumors exhibit high erbB-2 expression benefit from dose-intensive CAF should be further validated before clinical implementation. Interactions between erbB-2 expression, p53 expression, and CAF dose underscore the complexities of predictive markers where multiple interactions may confound the outcome.     

Acquired factor VIII inhibitors--successful treatment with an oral outpatient regimen

A rare cause of a spontaneous, life threatening coagulopathy in adults is the development of autoantibodies to factor VIII. We recently had the opportunity to treat seven patients with this disorder. After stabilization, they were given a regimen consisting of prednisone and oral cyclophosphamide. All patients had a complete response to treatment. The median time to response was three weeks. Durable remissions were achieved, making this oral regimen an acceptable treatment for this disorder.     

Integrating science and practice in outcomes assessment: A bolder model for a managed era.

Changes in the financing of healthcare have created the need for large, multispecialty group practices capable of delivering a comprehensive array of services under capitation. The financial risk of capitation, together with demands for accountability with respect to the cost and quality of delivered services, require such groups to engage in ongoing data collection. The present article describes these integrated delivery systems as emboldened Boulder Model entities, in which the treatment site,rather than the individual clinician, is the locus of science–practice integration. This trend is leading group practices to tackle some of the most pressing issues in psychotherapy process and outcome research, promising new collaborative structures between academic institutions of research and training and multispecialty group practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

MODELLING AND CONTROL OF AN ALFALFA ROTARY DRYER

A dynamic model of an alfalfa rotary dryer was developed and used to test the performance of two different feedback controllers. One controller is a conventional PI (Proportional-Integral) controller with fixed tuning parameters whereas the other is a gain-scheduled PI controller with automatically adjusted tuning parameters. The performance of the two controllers was compared with the performance of the dryer under manual control. The gain-scheduled PI controller was found to be superior in the sense that it used less control action and achieved the same control performance as the fixed tuning parameter PI controller. The use of the gain-scheduled controller was shown to reduce energy consumption, increase dryer throughput and had an estimated pay-back time of nine months.     

A model of time-effective group psychotherapy for patients with personality disorders: the clinical model

This article describes a model of time-limited psychotherapy for patients with personality disorders that emphasizes the group as a social microcosm. The patient population described is relatively high functioning, although the majority of the group members meet DSM-III-R (American Psychiatric Association, 1987) criteria for an Axis II diagnosis. The clinical model's key theoretical concepts, for example, interpersonal focus; active therapist stance; emphasis on group interaction and processes; use of time limits; primary care/intermittent treatment philosophy; and emphasis on patients' strengths, goals, and resources are described. The relationships between the phases of group therapy and the key theoretical concepts are delineated.     

Stability analysis of nonlinear processes using empirical state affine models and LMIs

A novel methodology is proposed for the analysis of robust stability of a nonlinear process under PI (Proportional-Integral) control. The analysis is based on state-affine empirical models regressed from input-output data. The state model is represented by a set of polynomial matrices nonlinear with respect to the manipulated variables. This model in combination with a linear PI controller results in a closed loop model that can be shown to lie in a polytope of matrices. This allows for the formulation of a Lyapunov stability test in terms of a simple set of LMIs (linear matrix inequalities). This set of inequalities can be also expanded to account for input saturation. The stability analysis produces regions of stability, in terms of the PI controller parameters, that are significantly larger than the regions previously calculated by a singular value test. The issues of saturation and modeling error are also incorporated into the analysis. The technique permits also to test the stability of the closed loop system with a gain scheduling PI controller. The conservativeness of the analysis is assessed by comparison to closed loop simulations of a highly nonlinear CSTR (continuous stirred tank reactor) under PI control.     

Identification of humic acid-like and fulvic acid-like natural organic matter in river water using fluorescence spectroscopy

Identifying the extent of humic acid (HA)-like and fulvic acid (FA)-like natural organic matter (NOM) present in natural water is important to assess disinfection by-product formation and fouling potential during drinking water treatment applications. However, the unique fluorescence properties related to HA-like NOM is masked by the fluorescence signals of the more abundant FA-like NOM. For this reason, it is not possible to accurately characterize HA-like and FA-like NOM components in a single water sample using direct fluorescence EEM analysis. A relatively simple approach is described here that demonstrates the feasibility of using a fluorescence excitation-emission matrix (EEM) approach for identifying HA-like and FA-like NOM fractions in water when used in combination with a series of pH adjustments and filtration steps. It is demonstrated that the fluorescence EEMS of HA-like and FA-like NOM fractions from the river water sample possessed different spectral properties. Fractionation of HA-like and FA-like NOM prior to fluorescence analysis is therefore proposed as a more reasonable approach.