E-mail Sessions Research Articles

Assessing the Effectiveness of Tutor Comments in Email Sessions

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsChere L. PeguesseChere L. Peguesse, PhD, is a Professor of English and Director of the Student Success Center at Valdosta State University in Valdosta, Georgia.

Psychotherapy in a Changing World

Psychotherapy in a Changing World

An asynchronous covert channel using spam

Current Internet e-mail facilities are built onto the foundation of standard rules and protocols, which usually allow a considerable amount of “freedom” to their designers. Each of these standards has been defined based on a number of vendor specific implementations, in order to provide common inter-working procedures for cross-vendor communication. Thus, a lot of optional and redundant information is being exchanged during e-mail sessions, which is available to implement versatile covert channel mechanisms. This work exploits this possibility by presenting a simple but effective steganographic scheme that can be used to deploy robust secret communication through spam e-mails. This scheme can offer unidirectional asynchronous one-to-one or one-to-many covert channel facilities that are able to bypass the most sophisticated firewalls and traffic analyzers. Its implementation neither affects the involved transport protocols nor causes any perceivable performance degradation or data loss to the end-users. The proposed scheme allows one to manage possible filtering/loss of the e-mails being the vehicle of the secret information. A novel retransmission method based on the Raptor codes has been adopted. The use of Raptor codes is key to correctly and efficiently manage the difficulty or impossibility to retransmit e-mails in the case of a unidirectional secret communication starting from one sender and directed to many recipients. In order to evaluate the performance characteristics of the proposed scheme, an empirical estimation of the covert channel bandwidth has been performed.

New Direction for Enhancing Quality in Diabetes Care: Utilizing Telecommunications and Paraprofessional Outreach Workers Backed by an Expert Medical Team

Abstract This article assesses the value of using telecommunications with Promatoras (paraprofessional outreach workers) and an expert medical team of registered nurses (RNs) and endocrinologists in an at-risk type 2 diabetic Hispanic population recruited for a telemedicine feasibility project from a free clinic. Nineteen patients agreed to enter the program and 16 completed the program in 3.5 years of study. A Promatoras is the primary educator and the point of communication to patient or medical personnel overseeing each patient's home glucose monitoring, medical records, and medications, regularly communicating by telephone and e-mail with patients and diabetes specialists. Between clinic visits, all routine care, including body weight, blood glucose, and blood pressure monitoring, was shared over the Internet, and each patient was interviewed by audio and camera. The endocrinologist was in his office, while the primary care physician, patient, and Promotora volunteers were at the free clinic. Four variables were considered in this longitudinal study: weight, systolic blood pressure, diastolic blood pressure, and HbA1c. Estimates of means, correlations, t-tests, and slopes of the repeated measures were obtained, and comparisons were made between first and last values. The most important sign of improvement in the patients' situation was the significant decrease in HbA1c to 7.2% from 9.6% (p = 0.001).

Efficacy of Cognitive Behavioral Therapy Training Using Brief E-mail Sessions in the Workplace: A Controlled Clinical Trial

In the present study, we conducted a clinical controlled trial to evaluate the effects of cognitive behavioral therapy (CBT) training in improving depression and self-esteem in workers. A total of 261 workers were assigned to either an intervention group (n=137) or a waiting-list group (n=124). The intervention group was offered participation in a group session with CBT specialists and three e-mail sessions with occupational health care staff. Between-group differences in the change in Center for Epidemiologic Studies Depression Scale (CES-D) and Self-Esteem Scale from baseline to three months after the end of training were assessed by analysis of covariance. All subjects in the intervention group completed the group session and 114 (83%) completed the three e-mail sessions. CES-D score decreased by 2.21 points in the intervention group but increased by 0.12 points in the control group, a significant difference of -2.33 points (95% confidence interval: -3.89 to-0.77; p<0.001). The between-group difference in change of self-esteem scores was not significant. Results of the present study suggest that CBT training cooperatively provided by CBT specialists and occupational health care staff using brief e-mail is effective in improving feelings of depression in workers.

Morphology of Bone Marrow Plasma Cells (BMPC) and Its Relationship with Interphase Cytogenetics and Prognosis in Multiple Myeloma (MM).

Abstract 1822Poster Board I-848 BackgroundBMPC number is important for diagnostic purposes in monoclonal gammopathies whereas BMPC morphology may be used as a prognostic factor in MM. So far, presence of plasmablasts or of BMPC displaying irregular nuclear outline have been related to adverse prognosis in MM. Interphase FISH demonstrates several cytogenetic changes (CG) in MM, and 17p deletion (del17p) and t(4;14) translocation have been recently shown as both major adverse prognostic factors. Up to 70% pts, however, lack both these CG changes, and prognostic parameters, easy-to-perform in routine practice, are needed for these patients. Our aim in this study was to ascertain whether BMPC morphology displayed prognosis in pts who did not demonstrate both adverse CG changes.Methods. We performed a retrospective analysis of BMPC morphology from 245 patients with MM, uniformly treated within the IFM 99 trials based on presence or absence of high serum beta-2 microglobulin level and 13q- deletion, including IFM 99-02, 99-03, and 99-04. Interphase FISH was performed using previously published methods on sorted BMPC to look for del13q, t(11;14), del17p, and t(4;14) (one to four sets of probes tested in each pt, according to the number of PC sorted in each instance). BM smears were analyzed by at least two out of a group of five morphologists (from different University centers): in each case 100 BMPC were observed, analyzed, and computerized. Comparison between results from observers was performed next: in all instances, if discordance occurred, computerized images were observed by all five morphologists (meeting sessions and Email sessions) leading to consensus. ResultsMedian age was 55, and 38% of patients had ISS 2 and 3 in the overall cohort. 72.3%, 6.8% and 20.9% patients came from the 99-02, 99-03, and 99-04 trials, respectively. Pts were classified according to five morphological subgroups: Mature (>66% of PC displaying mature morphology) [n=74 (30.2%)], Small Plasmacytic (>15% of PC displaying mature morphology but high N/C ratio) [n=14 pts (5.7%)], Plasmablastic (>=1% plasmablasts) [n=48 (19.6%)], Irregular Nucleus (>5% PC displaying irregular nuclear outline, PCIN) [n=32 pts (30.2%)], Activated (one nucleolus in >33% PC and/or immature chromatin network in >10% PC) [n=76 (31%)]. Del13 was found in 125 pts (51%), t(11;14) in 43pts (17.6%), del17p in 16 pts (7.0%), and t(4;14) in 52 pts (21.2%). Del17p and t(4;14) were both absent in 181 pts (73.9%). This group had no clinic-biological difference with the overall population of the trials. The median follow up was 49 months (+/-se 0.74). Median Progression Free Survival (PFS) and Overall Survival (OS) were lower in the adverse CG group [displaying either del17p or t(4;14)] as compared to other pts: 21 vs 43 months (p<0.0001) and 42 months vs median not reached (p<0.0001), respectively.33 pts (51.5%) with adverse CG changes displayed also adverse morphology [either plasmablastic or irregular nucleus]. Combination of adverse CG and adverse morphology led to dismal prognosis: median PFS were 20 months for pts with both adverse CG and morphology prognostic factors, and 36 months for pts with adverse morphology solely (p=0.0001), and median OS were 37 months and not reached (p=0.002), respectively.For pts without adverse CG changes, presence of plasmablasts or/and of irregular nucleus was related to adverse prognosis [median PFS and OS for both subgroups were 36 months (p=0.034) and 49 months (p=0.039)]. In contrast, mature and activated MM groups both showed better prognosis (median PFS were 45 and 49 months and median OS were not reached).Small plasmacytic MM group was peculiar, displaying t(11;14) in 85% cases but almost never del17p or t(4;14) (1.6% cases). This subgroup demonstrated here lower PFS and OS [34 months and 45 months, respectively] as compared to the Mature group, but also as compared to the whole t(11;14) population tested [43 months and median not reached, respectively]. ConclusionAdverse morphological changes and adverse CG changes together lead to dismal prognosis. For pts who do not display del17p and t(4;14) we show here that plasmablasts and irregular nucleus are morphological changes which remain of adverse prognosis. T(11;14) is associated with high number of small PC and is related to intermediate prognosis, whereas quite good prognosis is associated with mature or activated BMPC. Modulation of therapy according to CG but also to BMPC morphology is stressed. DisclosuresNo relevant conflicts of interest to declare.

Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children

Supplementing bibliotherapy with therapist-client communication has been shown to be an effective way of providing services to under-resourced and isolated communities. The current study examined the efficacy of supplementing bibliotherapy for child anxiety disorders with therapist-initiated telephone or email sessions, or with client-initiated contact in a randomised trial using a waitlist control. Participants were 100 anxiety-disordered children and their parents from rural and remote communities. All treatment conditions resulted in improvement on self-report measures and clinician rated severity. Telephone sessions produced superior outcomes with 79% of children being anxiety disorder free post-treatment compared with 33% of email and 31% of client-initiated participants. The results suggest that therapist supplemented bibliotherapy could provide an efficacious treatment option for families isolated from traditional treatment services.

Electronic Mail as a Vehicle for Peer Response

This Qualitative study sought to determine whether four high- and four low-apprehensive first-year college writers responded differently as peer evaluators of writing in a face-to-face group versus a group that communicated via an electronic-mail network. An analysis of recorded group “conversations” revealed that high apprehensives exhibited different strategies than low apprehensives for informing group members about writing during both face-to-face and e-mail sessions. Furthermore, high apprehensives during e-mail sessions participated more and offered more directions for revision than during face-to-face meetings. When revising subsequent to group meetings, high apprehensives reported relying more on group comments received during e-mail sessions than group comments received during face-to-face sessions.