Showing papers by "University of Massachusetts Boston published in 2013"

Development of a framework and coding system for modifications and adaptations of evidence-based interventions

Abstract: Background: Evidence-based interventions are frequently modified or adapted during the implementation process. Changes may be made to protocols to meet the needs of the target population or address differences between the context in which the intervention was originally designed and the one into which it is implemented [Addict Behav 2011, 36(6):630–635]. However, whether modification compromises or enhances the desired benefits of the intervention is not well understood. A challenge to understanding the impact of specific types of modifications is a lack of attention to characterizing the different types of changes that may occur. A system for classifying the types of modifications that are made when interventions and programs are implemented can facilitate efforts to understand the nature of modifications that are made in particular contexts as well as the impact of these modifications on outcomes of interest. Methods: We developed a system for classifying modifications made to interventions and programs across a variety of fields and settings. We then coded 258 modifications identified in 32 published articles that described interventions implemented in routine care or community settings. Results: We identified modifications made to the content of interventions, as well as to the context in which interventions are delivered. We identified 12 different types of content modifications, and our coding scheme also included ratings for the level at which these modifications were made (ranging from the individual patient level up to a hospital network or community). We identified five types of contextual modifications (changes to the format, setting, or patient population that do not in and of themselves alter the actual content of the intervention). We also developed codes to indicate who made the modifications and identified a smaller subset of modifications made to the ways that training or evaluations occur when evidence-based interventions are implemented. Rater agreement analyses indicated that the coding scheme can be used to reliably classify modifications described in research articles without overly burdensome training. Conclusions: This coding system can complement research on fidelity and may advance research with the goal of understanding the impact of modifications made when evidence-based interventions are implemented. Such findings can further inform efforts to implement such interventions while preserving desired levels of program or intervention effectiveness.

Attack Robustness and Centrality of Complex Networks

Abstract: Many complex systems can be described by networks, in which the constituent components are represented by vertices and the connections between the components are represented by edges between the corresponding vertices. A fundamental issue concerning complex networked systems is the robustness of the overall system to the failure of its constituent parts. Since the degree to which a networked system continues to function, as its component parts are degraded, typically depends on the integrity of the underlying network, the question of system robustness can be addressed by analyzing how the network structure changes as vertices are removed. Previous work has considered how the structure of complex networks change as vertices are removed uniformly at random, in decreasing order of their degree, or in decreasing order of their betweenness centrality. Here we extend these studies by investigating the effect on network structure of targeting vertices for removal based on a wider range of non-local measures of potential importance than simply degree or betweenness. We consider the effect of such targeted vertex removal on model networks with different degree distributions, clustering coefficients and assortativity coefficients, and for a variety of empirical networks.

Exceptional Convergence on the Macroevolutionary Landscape in Island Lizard Radiations

Abstract: G. G. Simpson, one of the chief architects of evolutionary biology’s modern synthesis, proposed that diversification occurs on a macroevolutionary adaptive landscape, but landscape models are seldom used to study adaptive divergence in large radiations. We show that for Caribbean Anolis lizards, diversification on similar Simpsonian landscapes leads to striking convergence of entire faunas on four islands. Parallel radiations unfolding at large temporal scales shed light on the process of adaptive diversification, indicating that the adaptive landscape may give rise to predictable evolutionary patterns in nature, that adaptive peaks may be stable over macroevolutionary time, and that available geographic area influences the ability of lineages to discover new adaptive peaks.

Uncovering the hidden costs of offshoring: The interplay of complexity, organizational design, and experience

Abstract: This study investigates estimation errors due to hidden costs—the costs of implementation that are neglected in strategic decision-making processes—in the context of services offshoring. Based on data from the Offshoring Research Network, we find that decision makers are more likely to make cost-estimation errors given increasing configuration and task complexity in captive offshoring and offshore outsourcing, respectively. Moreover, we show that experience and a strong orientation toward organizational design in the offshoring strategy reduce the cost-estimation errors that follow from complexity. Our findings contribute to research on the effectiveness of sourcing and global strategies by stressing the importance of organizational design and experience in dealing with increasing complexity.

Implementation science and school psychology

Abstract: The APA Division 16 Working Group on Translating Science to Practice contends that implementation science is essential to the process of translating evidence-based interventions (EBIs) into the unique context of the schools, and that increasing attention to implementation will lead to the improvement of school psychological services and school learning environments. Key elements of implementation and implementation science are described. Four critical issues for implementation science in school psychology are presented: barriers to implementation, improving intervention fidelity and identifying core intervention components, implementation with diverse client populations, and implementation in diverse settings. What is known and what researchers need to investigate for each set of issues is addressed. A discussion of implementation science methods and measures is included. Finally, implications for research, training and practice are presented.

Poised to prosper? A cross-system comparison of climate change effects on native and non-native species performance.

Abstract: Climate change and biological invasions are primary threats to global biodiversity that may interact in the future. To date, the hypothesis that climate change will favour non-native species has been examined exclusively through local comparisons of single or few species. Here, we take a meta-analytical approach to broadly evaluate whether non-native species are poised to respond more positively than native species to future climatic conditions. We compiled a database of studies in aquatic and terrestrial ecosystems that reported performance measures of non-native (157 species) and co-occurring native species (204 species) under different temperature, CO2 and precipitation conditions. Our analyses revealed that in terrestrial (primarily plant) systems, native and non-native species responded similarly to environmental changes. By contrast, in aquatic (primarily animal) systems, increases in temperature and CO2 largely inhibited native species. There was a general trend towards stronger responses among non-native species, including enhanced positive responses to more favourable conditions and stronger negative responses to less favourable conditions. As climate change proceeds, aquatic systems may be particularly vulnerable to invasion. Across systems, there could be a higher risk of invasion at sites becoming more climatically hospitable, whereas sites shifting towards harsher conditions may become more resistant to invasions.

Beyond Autism: A Baby Siblings Research Consortium Study of High-Risk Children at Three Years of Age

Abstract: Objective First-degree relatives of persons with an autism spectrum disorder (ASD) are at increased risk for ASD-related characteristics. As little is known about the early expression of these characteristics, this study characterizes the non-ASD outcomes of 3-year-old high-risk (HR) siblings of children with ASD. Method Two groups of children without ASD participated: 507 HR siblings and 324 low-risk (LR) control subjects (no known relatives with ASD). Children were enrolled at a mean age of 8 months, and outcomes were assessed at 3 years. Outcome measures were Autism Diagnostic Observation Schedule (ADOS) calibrated severity scores, and Mullen Verbal and Non-Verbal Developmental Quotients (DQ). Results At 3 years, HR siblings without an ASD outcome exhibited higher mean ADOS severity scores and lower verbal and non-verbal DQs than LR controls. HR siblings were over-represented (21% HR versus 7% LR) in latent classes characterized by elevated ADOS severity and/or low to low-average DQs. The remaining HR siblings without ASD outcomes (79%) belonged to classes in which they were not differentially represented with respect to LR siblings. Conclusions Having removed a previously identified 18.7% of HR siblings with ASD outcomes from all analyses, HR siblings nevertheless exhibited higher mean levels of ASD severity and lower levels of developmental functioning than LR children. However, the latent class membership of four-fifths of the HR siblings was not significantly different from that of LR control subjects. One-fifth of HR siblings belonged to classes characterized by higher ASD severity and/or lower levels of developmental functioning. This empirically derived characterization of an early-emerging pattern of difficulties in a minority of 3-year-old HR siblings suggests the importance of developmental surveillance and early intervention for these children.

Two new graphical methods for mapping trait evolution on phylogenies

Abstract: Summary Modern phylogenetic comparative biology uses data from the relationships between species (phylogeny) combined with comparative information for phenotypic traits to draw model-based statistical inferences about the evolutionary past. Recent years have seen phylogeny methods for evolutionary inference become central in the study of organic evolution. Here, I present two different graphical methods for visualizing phenotypic evolution on the tree. Method 1 is a new approach for plotting the posterior density of stochastically mapped character histories for a binary (two-state) phenotypic trait on a phylogeny. Method 2 is a closely related technique that uses ancestral character estimation to visualize historical character states for a continuous trait along the branches of a tree. One shortcoming of Method 2 is that by mapping the point estimates of ancestral states along the branches of the tree, we have effectively ignored the uncertainty associated with ancestral character estimation of continuous traits. To alleviate this issue, I propose a new method for visualizing ancestral state uncertainty using a type of projection of the tree into morphospace called a ‘traitgram.’ All of these approaches should prove useful in summarizing complex comparative inferences about ancestral character reconstruction. They are implemented in the freely available and open-source R phylogenetics package ‘phytools.’

Online Feature Selection with Streaming Features

Abstract: We propose a new online feature selection framework for applications with streaming features where the knowledge of the full feature space is unknown in advance. We define streaming features as features that flow in one by one over time whereas the number of training examples remains fixed. This is in contrast with traditional online learning methods that only deal with sequentially added observations, with little attention being paid to streaming features. The critical challenges for Online Streaming Feature Selection (OSFS) include 1) the continuous growth of feature volumes over time, 2) a large feature space, possibly of unknown or infinite size, and 3) the unavailability of the entire feature set before learning starts. In the paper, we present a novel Online Streaming Feature Selection method to select strongly relevant and nonredundant features on the fly. An efficient Fast-OSFS algorithm is proposed to improve feature selection performance. The proposed algorithms are evaluated extensively on high-dimensional datasets and also with a real-world case study on impact crater detection. Experimental results demonstrate that the algorithms achieve better compactness and higher prediction accuracy than existing streaming feature selection algorithms.

Effects of exercise training on chronic inflammation in obesity : current evidence and potential mechanisms.

Abstract: Chronic, systemic inflammation is an independent risk factor for several major clinical diseases. In obesity, circulating levels of inflammatory markers are elevated, possibly due to increased production of pro-inflammatory cytokines from several tissues/cells, including macrophages within adipose tissue, vascular endothelial cells and peripheral blood mononuclear cells. Recent evidence supports that adipose tissue hypoxia may be an important mechanism through which enlarged adipose tissue elicits local tissue inflammation and further contributes to systemic inflammation. Current evidence supports that exercise training, such as aerobic and resistance exercise, reduces chronic inflammation, especially in obese individuals with high levels of inflammatory biomarkers undergoing a longer-term intervention. Several studies have reported that this effect is independent of the exercise-induced weight loss. There are several mechanisms through which exercise training reduces chronic inflammation, including its effect on muscle tissue to generate muscle-derived, anti-inflammatory ‘myokine’, its effect on adipose tissue to improve hypoxia and reduce local adipose tissue inflammation, its effect on endothelial cells to reduce leukocyte adhesion and cytokine production systemically, and its effect on the immune system to lower the number of pro-inflammatory cells and reduce pro-inflammatory cytokine production per cell. Of these potential mechanisms, the effect of exercise training on adipose tissue oxygenation is worth further investigation, as it is very likely that exercise training stimulates adipose tissue angiogenesis and increases blood flow, thereby reducing hypoxia and the associated chronic inflammation in adipose tissue of obese individuals.

A current analysis of chemotherapy strategies for the treatment of human African trypanosomiasis

Abstract: Despite the recent advances in drug research, finding a safe, effective, and easy to use chemotherapy for human African trypanosomiasis (HAT) remains a challenging task. The four current anti-trypanosomiasis drugs have major disadvantages that limit more widespread use of these drugs in the endemic regions of sub-Saharan Africa. Pentamidine and suramin are limited by their effectiveness against the only first stage of Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense, respectively. In addition, melarsoprol and eflornithine (two second stage drugs) each have disadvantages of their own. The former is toxic and has increasing treatment failures while the latter is expensive, laborious to administer, and lacks efficacy against T. b. rhodesiense. Furthermore, melarsoprol’s toxicity and decreasing efficacy are glaring problems and phasing out the drug as a frontline treatment against T. b. gambiense is now possible with the emergence of competent, safe combination chemotherapies such as nifurtimox–eflornithine combination treatment (NECT). The future of eflornithine, on the other hand, is more promising. The drug is useful in the context of combination chemotherapy and potential orally administered analogues. Due to the limits of monotherapies, greater emphasis should be placed on the research and development of combination chemotherapies, based on the successful clinical tests with NECT and its current use as a frontline anti-trypanosomiasis treatment. This review discussed the current and future chemotherapy strategies for the treatment of HAT.

Biotic and Human Vulnerability to Projected Changes in Ocean Biogeochemistry over the 21st Century

Abstract: Ongoing greenhouse gas emissions can modify climate processes and induce shifts in ocean temperature, pH, oxygen concentration, and productivity, which in turn could alter biological and social systems. Here, we provide a synoptic global assessment of the simultaneous changes in future ocean biogeochemical variables over marine biota and their broader implications for people. We analyzed modern Earth System Models forced by greenhouse gas concentration pathways until 2100 and showed that the entire world's ocean surface will be simultaneously impacted by varying intensities of ocean warming, acidification, oxygen depletion, or shortfalls in productivity. In contrast, only a small fraction of the world's ocean surface, mostly in polar regions, will experience increased oxygenation and productivity, while almost nowhere will there be ocean cooling or pH elevation. We compiled the global distribution of 32 marine habitats and biodiversity hotspots and found that they would all experience simultaneous exposure to changes in multiple biogeochemical variables. This superposition highlights the high risk for synergistic ecosystem responses, the suite of physiological adaptations needed to cope with future climate change, and the potential for reorganization of global biodiversity patterns. If co-occurring biogeochemical changes influence the delivery of ocean goods and services, then they could also have a considerable effect on human welfare. Approximately 470 to 870 million of the poorest people in the world rely heavily on the ocean for food, jobs, and revenues and live in countries that will be most affected by simultaneous changes in ocean biogeochemistry. These results highlight the high risk of degradation of marine ecosystems and associated human hardship expected in a future following current trends in anthropogenic greenhouse gas emissions.

Flow induces epithelial-mesenchymal transition, cellular heterogeneity and biomarker modulation in 3D ovarian cancer nodules

Abstract: Seventy-five percent of patients with epithelial ovarian cancer present with advanced-stage disease that is extensively disseminated intraperitoneally and prognosticates the poorest outcomes. Primarily metastatic within the abdominal cavity, ovarian carcinomas initially spread to adjacent organs by direct extension and then disseminate via the transcoelomic route to distant sites. Natural fluidic streams of malignant ascites triggered by physiological factors, including gravity and negative subdiaphragmatic pressure, carry metastatic cells throughout the peritoneum. We investigated the role of fluidic forces as modulators of metastatic cancer biology in a customizable microfluidic platform using 3D ovarian cancer nodules. Changes in the morphological, genetic, and protein profiles of biomarkers associated with aggressive disease were evaluated in the 3D cultures grown under controlled and continuous laminar flow. A modulation of biomarker expression and tumor morphology consistent with increased epithelial–mesenchymal transition, a critical step in metastatic progression and an indicator of aggressive disease, is observed because of hydrodynamic forces. The increase in epithelial–mesenchymal transition is driven in part by a posttranslational up-regulation of epidermal growth factor receptor (EGFR) expression and activation, which is associated with the worst prognosis in ovarian cancer. A flow-induced, transcriptionally regulated decrease in E-cadherin protein expression and a simultaneous increase in vimentin is observed, indicating increased metastatic potential. These findings demonstrate that fluidic streams induce a motile and aggressive tumor phenotype. The microfluidic platform developed here potentially provides a flow-informed framework complementary to conventional mechanism-based therapeutic strategies, with broad applicability to other lethal malignancies.

Autism: the micro-movement perspective.

Abstract: The current assessment of behaviors in the inventories to diagnose autism spectrum disorders (ASD) focus on observation and discrete categorizations. Behaviors require movements, yet measurements of physical movements are seldom included. Their inclusion however, could provide an objective characterization of behavior to help unveil interactions between the peripheral and the central nervous systems. Such interactions are critical for the development and maintenance of spontaneous autonomy, self-regulation and voluntary control. At present, current approaches cannot deal with the heterogeneous, dynamic and stochastic nature of development. Accordingly, they leave no avenues for real-time or longitudinal assessments of change in a coping system continuously adapting and developing compensatory mechanisms. We offer a new unifying statistical framework to reveal re-afferent kinesthetic features of the individual with ASD. The new methodology is based on the non-stationary stochastic patterns of minute fluctuations (micro-movements) inherent to our natural actions. Such patterns of behavioral variability provide re-entrant sensory feedback contributing to the autonomous regulation and coordination of the motor output. From an early age, this feedback supports centrally driven volitional control and fluid, flexible transitions between intentional and spontaneous behaviors. We show that in ASD there is a disruption in the maturation of this form of proprioception. Despite this disturbance, each individual has unique adaptive compensatory capabilities that we can unveil and exploit to evoke faster and more accurate decisions. Measuring the kinesthetic re-afference in tandem with stimuli variations we can detect changes in their micro-movements indicative of a more predictive and reliable kinesthetic percept. Our methods address the heterogeneity of ASD with a personalized approach grounded in the inherent sensory-motor abilities that the individual has already developed.

Engineering Design‐Based Science, Science Content Performance, and Science Attitudes in Elementary School

Abstract: Background New learning standards call for engineering instruction to be incorporated into elementary education, yet engineering experiences must not detract from quality science instruction. Previous research at the secondary level has found engineering design to be a supportive context for science learning. Designing functional artifacts may ground children's exploration of scientific concepts; engineering design may contextualize science learning. Purpose Our research investigated whether an engineering design-based curriculum changed elementary student science attitudes and science content knowledge in four domains. Design/Method In the first year of the efficacy study, 12 elementary teachers taught science with their school or district's status quo curriculum. In the second year, they taught the same science content with a new engineering design-based curriculum that incorporated LEGO™ design challenges. In both years, students completed pre- and post-tests on science content and attitudinal surveys. Results The increase in science content performance from pre- to post-test was significantly greater for the LEGO engineering students than for the status quo students, but there was minimal difference in the science attitudes of the two student groups. Conclusions The findings suggest that engineering design-based science curriculum units may support elementary students' science content knowledge, while helping students learn to design, construct, and test solutions to engineering problems. Because students using either curriculum had similarly positive attitudes toward science, our research suggests that the benefit of engineering design for science learning cannot be attributed simply to the positive science attitudes that may result from the use of novel materials or methods.

Raising money for scientific research through crowdfunding.

Abstract: In this article we discuss the utility of crowdfunding from the perspective of individual scientists or laboratory groups looking to fund research. We address some of the main factors determining the success of crowdfunding campaigns, and compare this approach with the use of traditional funding sources.

Contested imaginaries and the cultural political economy of climate change

Abstract: This article analyses the evolving cultural political economy of climate change by developing the concept of ‘climate imaginaries’. These are shared socio-semiotic systems that structure a field ar...

Land and cryosphere products from Suomi NPP VIIRS: Overview and status

Abstract: [1] The Visible Infrared Imaging Radiometer Suite (VIIRS) instrument was launched in October 2011 as part of the Suomi National Polar-Orbiting Partnership (S-NPP) The VIIRS instrument was designed to improve upon the capabilities of the operational Advanced Very High Resolution Radiometer and provide observation continuity with NASA’s Earth Observing System’s Moderate Resolution Imaging Spectroradiometer (MODIS) Since the VIIRS first-light images were received in November 2011, NASA- and NOAA-funded scientists have been working to evaluate the instrument performance and generate land and cryosphere products to meet the needs of the NOAA operational users and the NASA science community NOAA’s focus has been on refining a suite of operational products known as Environmental Data Records (EDRs), which were developed according to project specifications under the National Polar-Orbiting Environmental Satellite System The NASA S-NPP Science Team has focused on evaluating the EDRs for science use, developing and testing additional products to meet science data needs, and providing MODIS data product continuity This paper presents to-date findings of the NASA Science Team’s evaluation of the VIIRS land and cryosphere EDRs, specifically Surface Reflectance, Land Surface Temperature, Surface Albedo, Vegetation Indices, Surface Type, Active Fires, Snow Cover, Ice Surface Temperature, and Sea Ice Characterization The study concludes that, for MODIS data product continuity and earth system science, an enhanced suite of land and cryosphere products and associated data system capabilities are needed beyond the EDRs currently available from the VIIRS

Jim Crow 2.0? Why States Consider and Adopt Restrictive Voter Access Policies

Abstract: Recent years have seen a dramatic increase in state legislation likely to reduce access for some voters, including photo identification and proof of citizenship requirements, registration restrictions, absentee ballot voting restrictions, and reductions in early voting. Political operatives often ascribe malicious motives when their opponents either endorse or oppose such legislation. In an effort to bring empirical clarity and epistemological standards to what has been a deeply-charged, partisan, and frequently anecdotal debate, we use multiple specialized regression approaches to examine factors associated with both the proposal and adoption of restrictive voter access legislation from 2006–2011. Our results indicate that proposal and passage are highly partisan, strategic, and racialized affairs. These findings are consistent with a scenario in which the targeted demobilization of minority voters and African Americans is a central driver of recent legislative developments. We discuss the implications of these results for current partisan and legal debates regarding voter restrictions and our understanding of the conditions incentivizing modern suppression efforts. Further, we situate these policies within developments in social welfare and criminal justice policy that collectively reduce electoral access among the socially marginalized.

An apple MYB transcription factor, MdMYB3, is involved in regulation of anthocyanin biosynthesis and flower development

Abstract: Red coloration of fruit is an important trait in apple, and it is mainly attributed to the accumulation of anthocyanins, a class of plant flavonoid metabolites. Anthocyanin biosynthesis is genetically determined by structural and regulatory genes. Plant tissue pigmentation patterns are mainly controlled by expression profiles of regulatory genes. Among these regulatory genes are MYB transcription factors (TFs), wherein the class of two-repeats (R2R3) is deemed the largest, and these are associated with the anthocyanin biosynthesis pathway. Although three MdMYB genes, almost identical in nucleotide sequences, have been identified in apple, it is likely that there are other R2R3 MYB TFs that are present in the apple genome that are also involved in the regulation of coloration of red color pigmentation of the skin of apple fruits. In this study, a novel R2R3 MYB gene has been isolated and characterized in apple. This MYB gene is closely related to the Arabidopsis thaliana AtMYB3, and has been designated as MdMYB3. This TF belongs to the subgroup 4 R2R3 family of plant MYB transcription factors. This apple MdMYB3 gene is mapped onto linkage group 15 of the integrated apple genetic map. Transcripts of MdMYB3 are detected in all analyzed tissues including leaves, flowers, and fruits. However, transcripts of MdMYB3 are higher in excocarp of red-skinned apple cultivars than that in yellowish-green skinned apple cultivars. When this gene is ectopically expressed in Nicotiana tabacum cv. Petite Havana SR1, flowers of transgenic tobacco lines carrying MdMYB3 have exhibited increased pigmentation and accumulate higher levels of anthocyanins and flavonols than wild-type flowers. Overexpression of MdMYB3 has resulted in transcriptional activation of several flavonoid pathway genes, including CHS, CHI, UFGT, and FLS. Moreover, peduncles of flowers and styles of pistils of transgenic plants overexpressing MdMYB3 are longer than those of wild-type plants, thus suggesting that this TF is involved in regulation of flower development. This study has identified a novel MYB transcription factor in the apple genome. This TF, designated as MdMYB3, is involved in transcriptional activation of several flavonoid pathway genes. Moreover, this TF not only regulates the accumulation of anthocyanin in the skin of apple fruits, but it is also involved in the regulation of flower development, particularly that of pistil development.

Oxaliplatin-induced peripheral neuropathy's effects on health-related quality of life of colorectal cancer survivors.

Abstract: Oxaliplatin is a highly neurotoxic chemotherapeutic agent routinely used for the treatment of colorectal cancer. Recent data suggest that oxaliplatin-induced peripheral neuropathy may be long-lasting; however, the effects of persistent neuropathy on colorectal cancer survivors’ physical and emotional well-being are not well understood. This cross sectional, descriptive study included persons who had received oxaliplatin-based chemotherapy for treatment of colorectal cancer at Moffitt Cancer Center between 2003 and 2010. Questionnaires including the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool, Center for Epidemiological Studies Depression Scale (CES-D), Insomnia Severity Index, Medical Outcomes Study Short Form 36, and a demographic survey were administered. Pearson’s correlations and linear regression analyses were used to examine relationships between neuropathy and depressive symptoms, sleep quality, and health-related quality of life (HRQOL). Eighty-nine percent of participants reported at least one symptom of peripheral neuropathy with a mean of 3.8 (±2.4) neuropathic symptoms. Depressive symptoms on the CES-D were significantly associated with more severe peripheral neuropathy(r = 0.38, p = 0.0001) and interference with activities (r = 0.59, p < 0.0001). Higher degrees of sleep disturbance on the Insomnia Severity Index (ISI) were significantly associated with more severe peripheral neuropathy (r = 0.35, p = 0.0004) and interference with activities(r = 0.52, p < 0.0001). HRQOL was significantly associated with peripheral neuropathy and interference with activities.

Posttraumatic stress and posttraumatic growth among low-income mothers who survived Hurricane Katrina.

Abstract: Objective: The purpose of the study was to explore the relationship between posttraumatic stress (PTS) and posttraumatic growth (PTG) after Hurricane Katrina, and the role of demographics, predisaster psychological distress, hurricane-related stressors, and psychological resources (optimism and purpose) in predicting each. Method: Participants were 334 low-income mothers (82.0% non-Hispanic Black) living in the New Orleans area prior to Hurricane Katrina, who completed surveys in the year prior to the hurricane (T1 [Time 1]) and 1 and 3 years thereafter (T2 and T3). Results: Higher T2 and T3 PTS full-scale and symptom cluster subscales (Intrusion, Avoidance, and Hyperarousal) were significantly associated with higher T3 PTG, and participants who surpassed the clinical cutoff for probable posttraumatic stress disorder at both T2 and T3 had significantly higher PTG than those who never surpassed the clinical cutoff. Older and non-Hispanic Black participants, as well as those who experienced a greater number of hurricane-related stressors and bereavement, reported significantly greater T3 PTS and PTG. Participants with lower T2 optimism reported significantly greater T3 intrusive symptoms, whereas those with higher T1 and T2 purpose reported significantly greater T3 PTG. Conclusions: Based on the results, we suggest practices and policies with which to identify disaster survivors at greater risk for PTS, as well as longitudinal investigations of reciprocal and mediational relationships between psychological resources, PTS, and PTG.

How Patient Centered Are Medical Decisions?: Results of a National Survey

Abstract: Importance Informing and involving patients in their medical decisions is increasingly becoming a standard for good medical care, particularly for primary care physicians. Objective To learn how patients describe the decision-making process for 10 common medical decisions, including 6 that are most often made in primary care. Design A survey of a national sample of adults 40 years or older who in the preceding 2 years had either experienced or discussed with a health care provider 1 or more of 10 decisions: medication for hypertension, elevated cholesterol, or depression; screening for breast, prostate, or colon cancer; knee or hip replacement for osteoarthritis, or surgery for cataract or low back pain. Setting Adults living in households in the United States in 2011. Participants A national sample of adults drawn from a probability sample–based web panel developed by Knowledge Networks. Main Outcomes and Measures Patients’ perceptions of the extent to which the pros and cons were discussed with their health care providers, whether the patients were told they had a choice, and whether the patients were asked for their input. Results Responses were obtained from 2718 patients, with a response rate of 58.3%. Respondents reported much more discussion of the pros than the cons of all tests or treatments; discussions about the surgical procedures tended to be more balanced than those about medications to reduce cardiac risks and cancer screening. Most patients (60%-78%) said they were asked for input for all but 3 decisions: medications for hypertension and elevated cholesterol and having mammograms (37.3%-42.7%). Overall, the reported decision-making processes were most patient centered for back or knee replacement surgery and least for breast and prostate cancer screening. Conclusions and Relevance Discussions about these common tests, medications, and procedures as reported by patients do not reflect a high level of shared decision making, particularly for 5 decisions most often made in primary care.

Value fusion: The blending of consumer and firm value in the distinct context of mobile technologies and social media

Abstract: Purpose – The purpose of this paper is to introduce the concept of Value Fusion to describe how value can emerge from the use of mobile, networked technology by consumers, firms, and entities such as non‐consumers, a firm's competitors, and others simultaneously. Design/methodology/approach – The paper discusses the combination of characteristics of mobile devices that enable Value Fusion and discusses specific value and benefits to consumers and firms of being mobile and networked. Value Fusion is introduced and defined and set apart from related, other conceptualizations of value. Examples are provided of Value Fusion and the necessary conditions for Value Fusion to occur are discussed. Also discussed are the conditions under which the use of mobile, networked technology by consumers and firms may lead to Value Confusion instead of Value Fusion. Several research questions are proposed to further enhance the understanding and management of Value Fusion. Findings – The combination of portable, personal, networked, textual/visual and converged characteristics of mobile devices enables firms and consumers to interact and communicate, produce and consume benefits, and create value in new ways that have not been captured by popular conceptualizations of value. These traditional conceptualizations include customer value, experiential value, customer lifetime value, and customer engagement value. Value Fusion is defined as value that can be achieved for the entire network of consumers and firms simultaneously, just by being on the mobile network. Value Fusion results from producers and consumers: individually or collectively; actively and passively; concurrently; interactively or in aggregation contributing to a mobile network; in real time; and just‐in‐time. Originality/value – This paper synthesizes insights from the extant value literature that by and large has focused on either the customer's or the firm's perspective, but rarely blended the two.

A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder.

Abstract: Generalized anxiety disorder (GAD) is a chronic anxiety disorder associated with high comorbidity (Bruce, Machan, Dyck, & Keller, 2001), reduced quality of life (Hoffman, Dukes, & Wittchen, 2008) and significant health care utilization (Hoffman et al., 2008). Meta-analyses reveal that cognitive behavioral therapies are efficacious for GAD (Borkovec & Ruscio, 2001; Covin, Ouimet, Seeds, & Dozois, 2008). However, GAD remains one of the least successfully treated of the anxiety disorders (Waters & Craske, 2005), with most studies finding that fewer than 65% of clients meet criteria for high end-state functioning at post-treatment (e.g., Ladouceur et al., 2000; Newman et al., 2011) and few studies examining the impact of treatment on quality of life. Several researchers have aimed to refine and expand existing models of GAD in an effort to more clearly identify causal and maintaining factors to target in therapy (see Behar, DiMarco, Hekler, Mohlman, & Staples, 2009, for a review). Recent randomized controlled trials informed by these models indicate that targeting intolerance of uncertainty (Dugas et al., 2010), and the interpersonal and emotion focused aspects of GAD (Newman et al., 2011) yield effects comparable to existing CBTs for GAD. A small pilot study found that targeting meta-cognition in GAD (Wells et al., 2010) produced better outcomes than applied relaxation, however, the very low rates of response to applied relaxation, coupled with the small sample size, indicate a need for further research to confirm this finding. Roemer and Orsillo (2002) developed a model of GAD informed by research and theory highlighting the potential roles of experiential avoidance (e.g., Hayes, Wilson, Gifford, Follette & Strosahl, 1996) and ruminative, self-critical processing (e.g., Barnard & Teasdale, 1991) in the development and maintenance of psychopathology. Supported by research comparing individuals with and without GAD, this model suggests that those with GAD have a problematic relationship with their internalized experiences characterized by a narrowed attention toward threat (Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & van IJzendoorn, 2007), and a critical, judgmental reactivity toward their emotional responses (e.g., Lee, Orsillo, Roemer, & Allen, 2010; Llera & Newman, 2010; Mennin, Heimberg, Turk, & Fresco, 2005) and thoughts (Wells & Carter, 1999). This reaction to internal experiences motivates individuals with GAD to engage in experiential avoidance (e.g., Lee et al., 2010) using a variety of strategies including worry, the central defining feature of GAD. Although worry decreases somatic arousal and helps to distract an individual from more emotional topics (see Borkovec, Alcaine, & Behar, 2004, for a review), rigid habitual efforts at experiential avoidance can paradoxically increase distress (e.g., Hayes et al., 1996), leading to a cycle of reactivity and avoidance that in turn affects behavior. Individuals with GAD are less likely to consistently engage in behaviors that are important to them (i.e., valued actions) and as a result experience a diminished quality of life (Michelson, Lee, Orsillo, & Roemer, 2011). This model led to the development of an acceptance based behavior therapy for GAD (ABBT; Roemer & Orsillo, 2009; Roemer & Orsillo, In press), a flexible treatment adapted from traditional CBT for GAD (e.g., Borkovec et al., 2004), as well as other acceptance-based behavioral therapies including Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), Mindfulness-based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2002), and Dialectical Behavior Therapy (Linehan, 1993), that explicitly target these mechanisms1. Specifically, this ABBT aims to help clients to cultivate an expanded (as opposed to narrowed, threat-focused) awareness along with a compassionate (as opposed to judgmental) and decentered (as opposed to seeing thoughts and feelings as all-encompassing indicators of truth) stance towards internal experiences. These new skills reduce rigid experiential avoidance, as does the explicit promotion of an accepting and willing stance towards internal experiences. Behavioral avoidance and constriction are targeted by encouraging clients to identify and mindfully engage in personally meaningful actions. ABBT uses empathic validation, self-monitoring, formal and informal mindfulness exercises, encouragement of acceptance through psychoeducation and experiential exercises, and writing and behavioral exercises that apply these skills to personally meaningful activities (see Roemer & Orsillo, 2009; in press, for a more detailed presentation of the treatment). Data from an open trial (Roemer & Orsillo, 2007) and waitlist RCT (Roemer, Orsillo, & Salters-Pedneault, 2008) indicate significant effects on clinician-rated and self-report symptom measures of anxiety and depression, as well as self-reported quality of life and high rates of end-state functioning. Clients receiving ABBT report significant decreases in experiential avoidance (Roemer et al., 2008), distress about emotional responses, and intolerance of uncertainty (Treanor, Erisman, Salters-Pedneault, Orsillo, & Roemer, 2011) and significant increases in values-consistent behavior (Michelson et al., 2011). Moreover, both the time spent accepting internal experiences and engaging in valued activities significantly predict outcome (Hayes, Orsillo, & Roemer, 2010) providing support for the proposed mechanisms of action. However, studies are needed that compare this treatment to a credible, efficacious alternative therapy. Other acceptance- and mindfulness-based treatments have also been tested for GAD. A recent study comparing ACT to CBT (with behavioral exposures in both conditions) showed comparable effects of the two treatments, with the 14 individuals with GAD who received ACT demonstrating medium to large effects on outcome measures (Arch et al., 2012). Similarly, in a study of older adults with GAD, the seven individuals receiving ACT demonstrated large effect sizes on outcome measures, which were comparable to the nine individuals receiving CBT in this study (Wetherell et al., 2011). A recent meta-analysis demonstrated the promise of mindfulness-based interventions in reducing anxiety generally (Hofmann, Sawyer, Witt, & Oh, 2010), and two preliminary trials of MBCT suggest an effect of treatment on self-reported GAD symptoms (Craigie, Rees, Marsh, & Nathan, 2008; Evans et al., 2008), although outcomes fell short relative to other GAD treatment trials. Unlike ACT and ABBT, MBCT did not incorporate behavioral strategies, which may partly explain the more modest effects. While findings for ABBT are promising, previous studies were limited by absence of an active control condition and modest sample sizes. To more rigorously test ABBT, this study compared ABBT to an established and efficacious treatment, Applied Relaxation (AR). AR is an empirically supported treatment for GAD (Chambless & Ollendick, 2001) and is recommended in the NICE clinical guideline 113 (National Collaborating Centre for Mental Health and the National Collaborating Centre for Primary Care, 2011). This status comes from several methodologically rigorous studies that have examined the efficacy of AR. For example, randomized controlled trials demonstrated that AR was more efficacious than a nondirective, reflective listening therapy (Borkovec & Costello, 1993) and roughly as efficacious as cognitive therapy (Arntz, 2003; Ost & Breitholtz, 2000), cognitive behavioral therapy (Borkovec & Costello, 1993; Dugas et al., 2010), and worry exposure (Hoyer et al., 2009) in treating GAD. Further supporting the efficacy of AR, a meta-analysis by Siev and Chambless (2007) found that cognitive therapy and relaxation therapy were equivalent treatments for GAD. AR is also straightforward and relatively easy to learn, which increases the probability that therapists can deliver it with good adherence and competence. In the spirit of a comparative efficacy trial, we hypothesized that both ABBT and AR would lead to statistically and clinically significant change but that ABBT would be more efficacious than AR on measures of anxiety and quality of life. Additionally, because the processes targeted in ABBT are presumed to underlie many forms of psychopathology, we hypothesized that ABBT would be associated with greater decreases in depression and comorbidity than AR. Finally, we hypothesized that the treatments would be comparably credible and acceptable to participants.