Proportion Of Dyads Research Articles

A prospective cohort study of decision-making role preferences of patients with advanced cancer and their family caregivers.

This study aimed to examine (1) the evolution of patients-caregiver dyad decision-making role preferences over 3years and the predictors of these preferences; and (2) discordance in decision-making role preferences among dyads. A total of 311 patients with advanced solid cancer and their caregivers in Singapore reported their preferences for decision-making roles every 3months. The predictors for decision-making role preferences among dyads were identified via the actor-partner interdependence framework using a mixed-effect ordered logistic model. The proportion of patients and caregivers preferring patient-led decision-making was higher at the end of third year compared to baseline (patients: 40% vs. 20%, p value <.01; caregivers: 33% vs. 21%, p value=.03). Patients with female (odds ratio [OR], 1.74; p value <.01) and older (1-year OR, 1.02; p value <.01) caregivers and younger patients (1-year OR, 0.97; p value <.01) preferred higher involvement in decision-making. Caregivers with tertiary education (vs. lower education) (OR, 1.59; p value= .02) and those who accurately understood patients' treatment goals (OR, 1.37; p value= .01) preferred greater patient involvement in decision-making. Conversely, caregivers of female patients (OR, 0.68; p value= .03) and younger patients (1-year OR, 0.98; p value <.01) preferred lesser patient involvement in decision-making. The proportion of patient-caregiver dyads with discordance in preferred decision-making was lower at the end of the third year (51%) compared to baseline (68%) (p value <.01). Despite a reduction in the proportion of dyads with discordance toward the end-of-life, the percentage with discordance remained high throughout the illness trajectory. Interventions facilitating open communication between dyads should be pursued in efforts to decrease dyadic discordance.

Agreement between parent-proxy and child self-report in pediatric hypermobile Ehlers-Danlos syndrome.

Hypermobile Ehlers-Danlos syndrome (hEDS) is a common disorder in children and adolescents that negatively impacts health-related quality of life (HRQOL). It can include chronic pain, fatigue, autonomic dysfunction, and mood problems. The objective of this study was to examine levels of agreement between children and parents in the setting of hEDS and HRQOL. Individuals with hEDS, ages 10-20years, and their parents were recruited to complete a series of surveys. Instruments included pediatric quality of life generic and multidimensional fatigue scales, Functional Disability Index, Pain-Frequency-Severity-Duration scale, Brief Illness Perception Questionnaire, and Herth Hope Index. Agreement on each measure was evaluated using statistical calculations. Thirty-six parent-child dyads completed the surveys. There were no significant differences between the means of parent and child scores. There was moderate to strong agreement on all survey scores. However, the proportion of dyads with disagreement was relatively high for each individual score. Eighteen dyads disagreed on at least half of the surveys. Body mass index centile and child perception of cognitive fatigue most strongly predicted disagreement in total HRQOL score. Proxy-reporters for children and adolescents with hEDS may agree with their child on average. However, due to significant frequency of clinically important disagreement, information from both children and their parents should be sought whenever possible.

Effectiveness of a group educational intervention \u2013 prolact - in primary care to promote exclusive breastfeeding: a cluster randomized clinical trial

BackgroundThe rates of exclusive breastfeeding at 6 months in Spain are far from recommended by the World Health Organization, which is 50% by 2025. Evidence of the effectiveness of group interventions in late postpartum is limited. The objective of this study was to evaluate the effectiveness of the PROLACT group educational intervention for increasing the proportion of mother-child dyads with exclusive breastfeeding at 6 months compared to the usual practice in primary care.MethodMulticentre cluster randomized clinical trial. A total of 434 mother-child dyads who breastfed exclusively in the first 4 weeks of the children’s life and agreed to participate were included. The main outcome was exclusive breastfeeding at 6 months. Secondary variables were type of breastfeeding, reasons for abandonment, degree of adherence and satisfaction with the intervention. To study the effectiveness, the difference in the proportions of dyads with exclusive breastfeeding at 6 months was calculated, and the relative risk (RR) and number needed to treat (NNT) were calculated with their 95% CIs. To study the factors associated with the maintenance of exclusive breastfeeding at 6 months, a multilevel logistic regression model was fitted. All analyses were performed to intention to treat.ResultsThe percentage of dyads with exclusive breastfeeding at 6 months was 22.4% in the intervention group and 8.8% in the control group. PROLACT intervention obtained an RR =2.53 (95% CI: 1.54–4.15) and an NNT = 7 (95%CI: 5–14). The factors associated with exclusive breastfeeding at 6 months were the PROLACT intervention, OR = 3.51 (95%CI: 1.55–7.93); age > 39 years, OR = 2.79 (95%CI: 1.02–7.6); previous breastfeeding experience, OR = 2.61 (95%CI: 1.29–5.29); income between 500 and 833.33 €, OR = 3.52 (95%CI 1.47–8.47).); planning to start work before the infant was 6 months old, OR = 0.35 (0.19–0.63) .ConclusionsThe PROLACT intervention in primary care is more effective than the usual practice for maintaining exclusive breastfeeding at 6 months, and can therefore be considered evidence-based practice for implementation in standard practice.Trial registrationThe trial was registered with ClinicalTrials.gov under code number NCT01869920 (03/06/2013).

Symptom Intensity of Hospice Patients: A Longitudinal Analysis of Concordance Between Patients' and Nurses' Outcomes

ContextNearing death, hospice patients are increasingly unable or unwilling to self-report their symptom intensity and rely on nurses' assessments. ObjectivesWe hypothesized that concordance between patients' and nurses' assessments of symptom intensity improves over time. MethodA prospective longitudinal study was conducted from January 2012 to June 2015 using dyads of patient- and nurse-reported outcome measures, collected in daily hospice practice in the first three weeks after admission. Main outcomes were symptom intensity and well-being, measured using the Utrecht Symptom Diary (USD) and USD-Professional. Absolute concordance was the proportion of dyads with no difference in scores between USD and USD-Professional per week after admission. For agreement beyond chance, the squared weighted Kappa for symptom intensity and the one-way agreement intraclass correlation coefficient for well-being were used. ResultsThe most prevalent symptoms, fatigue, dry mouth, and anorexia also had the highest intensity scores assessed by patients and nurses. Symptom intensity was underestimated more frequently than overestimated by the nurses. The absolute concordance was fair to good (35%–69%). Agreement beyond chance was low to fair (0.146–0.539) and the intraclass correlation for well-being was low (0.25–0.28). Absolute concordance and agreement beyond chance did not improve over time. ConclusionConcordance between patients' and nurses' assessment of symptom prevalence is good, and both patients and nurses reveal identical symptoms as most and least prevalent and intense. However, nurses tend to underestimate symptom intensity. Concordance between patients and nurses symptom intensity scores is poor and does not improve over time.

The network motif architecture of dominance hierarchies.

The widespread existence of dominance hierarchies has been a central puzzle in social evolution, yet we lack a framework for synthesizing the vast empirical data on hierarchy structure in animal groups. We applied network motif analysis to compare the structures of dominance networks from data published over the past 80 years. Overall patterns of dominance relations, including some aspects of non-interactions, were strikingly similar across disparate group types. For example, nearly all groups exhibited high frequencies of transitive triads, whereas cycles were very rare. Moreover, pass-along triads were rare, and double-dominant triads were common in most groups. These patterns did not vary in any systematic way across taxa, study settings (captive or wild) or group size. Two factors significantly affected network motif structure: the proportion of dyads that were observed to interact and the interaction rates of the top-ranked individuals. Thus, study design (i.e. how many interactions were observed) and the behaviour of key individuals in the group could explain much of the variations we see in social hierarchies across animals. Our findings confirm the ubiquity of dominance hierarchies across all animal systems, and demonstrate that network analysis provides new avenues for comparative analyses of social hierarchies.

Adopting a family approach to theory and practice: measuring distress in cancer patient–partner dyads with the distress thermometer

Significant others are central to patients' experience and management of their cancer illness. Building on our validation of the Distress Thermometer (DT) for family members, this investigation examines individual and collective distress in a sample of cancer patients and their matched partners, accounting for the aspects of gender and role. Questionnaires including the DT were completed by a heterogeneous sample of 224 couples taking part in a multisite study. Our investigation showed that male patients (34.2%), female patients (31.9%), and male partners (29.1%) exhibited very similar levels of distress, while female partners (50.5%) exhibited much higher levels of distress according to the DT. At the dyad level just over half the total sample contained at least one individual reporting significant levels of distress. Among dyads with at least one distressed person, the proportion of dyads where both individuals reported distress was greatest (23.6%). Gender and role analyses revealed that males and females were not equally distributed among the four categories of dyads (i.e. dyads with no distress; dyads where solely the patient or dyads where solely the partner is distressed; dyads where both are distressed). A remarkable number of dyads reported distress in one or both partners. Diverse patterns of distress within dyads suggest varying risks of psychosocial strain. Screening patients' partners in addition to patients themselves may enable earlier identification of risk settings. The support offered to either member of such dyads should account for their role- and gender-specific needs.

Ease of use and preference for a new disposable self-injection pen compared with a reusable pen for administering recombinant human growth hormone: A multicenter, 2-Month, single-arm, open-label clinical trial in patient-caregiver dyads

Background: Improved ease of use of drug-delivery devices may enhance compliance. Development of an easier-to-use device for administration of recombinant human growth hormone (rhGH) may thus be beneficial for patients and their caregivers. Objective: This study compared ease of use and preference for a new disposable rhGH injection pen relative to previous experience with the currently available reusable pen in standard practice. Both pens deliver the same formulation of rhGH. Methods: This multicenter, single-arm, open-label study assessed ease of use and preference for the 2 injection pens in patient-caregiver dyads. Eligible children were aged 8 through 18 years, were currently being treated with rhGH, and had been compliant with use of the current reusable pen for ≥3 months before study entry. A validated self-reported Injection Pen Assessment Questionnaire was administered twice during the study—at baseline (to assess perceptions of the reusable pen) and after 2 months of use of the new disposable pen—to assess ease of use of the individual pens (rated on a 5-point Likert-type scale), the comparative ease of use of the 2 pens, and pen preference. The primary end point was the proportion of dyads who rated the new pen as no different or easier to use than the current pen. Regardless of treatment or suspected causal relationship to the investigational product, all observed or volun- teered adverse events (AEs) were recorded and rated as mild, moderate, or severe. Results: Of 137 screened dyads, 136 (91 boys, 45 girls) were included in the safety population and 133 were included in the efficacy population. The children had a mean age of 12.3 years, a mean weight of 42.2 kg, a mean height of 145.9 cm, and a mean body mass index of 19.3 kg/m 2; 84.6% of the children were white. The majority (82.4%) of adult dyad members were subjects' mothers. The adult dyad members were more likely than the child members to be responsible for preparing the injection (82.0%) and administering the injection (72.9%). Overall, 73.7% of dyads rated the new disposable pen no different or easier to use than the reusable pen (95% CI, 66.2%–81.2%), and 65.2% rated the disposable pen no different or preferable to the reusable pen (95% CI, 57.0%–73.3%). Overall, 60 all-causality AEs occurred in 28 subjects (20.6%), most of them (93.3%) either mild or moderate in intensity. Eight device-related AEs occurred in 7 subjects (5.1%) (injection-site hematoma in 3 and injection-site pain in 5). The most common AEs were headache (7 events), injection-site pain (5), upper respiratory tract infection (4), and pyrexia (4). No deaths or serious AEs were reported. Conclusions: Nearly three quarters of patients and caregivers reported that the new disposable pen was no Accepted for publication October 1, 2010. different or easier to use than the reusable pen, and nearly two thirds preferred the disposable pen. No safety concerns were identified. The findings suggest that the improvements in the new pen were recognized by patients and caregivers.

Visualization in e‐Negotiations: An Inspire ENS Graph is Worth 334 Words, on Average

Electronic negotiations are supported by a number of technologies including e‐mail, web‐enabled decision support systems and e‐negotiation systems (ENSs). The features of the ENS used by a negotiator can affect the negotiation outcome because of the type and scope of support provided and its presentation. ENSs usually interface with users via a natural language system and/or graphical display. This paper reports the results of the effect of the provision of graphical representation on reaching agreement in bilateral negotiation using the Inspire ENS system compared to negotiations conducted using the same system without graphical representation. No difference was observed in the proportion of dyads that reached agreement with graphical representation compared to the system without graphical support. For dyads that reached agreement, participants using the system without graphical support submitted a lower number of offers. The average message size per dyad was 334 words greater, on average, for successful...

Effects of group size on social behavior following regrouping of growing–finishing pigs

A total of 480 growing-finishing pigs in three blocks were used in a 12-week study to quantify the effects of group size (10, 20, 40, and 80 pigs per pen) on aggression, aggression-related injuries, behavioral patterns, and the relationships among aggression, injuries, and growth rate. Pigs were regrouped at 8 weeks of age (BW=23.2±4.8 kg). Aggression of pigs during the initial 8 h post-regrouping was observed by live observation in two blocks. Injury scores were assessed on individual pigs 48 h after regrouping in three blocks. Total duration of aggression for the 8 h post-regrouping was similar among group sizes and averaged approximately 14 min per pig. The total number of fights per pig in the groups of 10 pigs was lower (14.9±0.94, P<0.05) than for groups of 20, 40, and 80 pigs (18.9, 18.5, and 19.4±1.33, respectively). When group size increased to 40 pigs, the average number of naı̈ve fighting pairs (neither pig had previously fought) increased significantly ( P<0.05). However, the ratio of total pigs in the pen to the number of naı̈ve fighting pairs was similar among group sizes. The longest duration of fights and most number of fights occurred in the first 2 h post-regrouping. The proportion of dyads that were not observed to fight during the 8 h post-regrouping was higher in groups of 40 and 80 pigs (70.0 and 80.6%, respectively) than in groups of 20 pigs (51.3±4.0%, P<0.05) and groups of 10 pigs (35.0±2.9%, P<0.05). Across all group sizes, dyads that were observed to fight for the longest time had a lower percentage BW difference than dyads that fought for short durations (11.3 versus 15.9±1.02%, P<0.05). Total injury scores, which were positively correlated with aggression, were similar among group sizes. Although initial BW was positively correlated with the number of fights, the duration of fights and total injury scores, the overall average daily gain (ADG) was not correlated with aggression and injury scores post-regrouping. In conclusion, pigs in large groups did not evidence a higher level of aggression, which would have been required to establish a dominance hierarchy based on dyadic interactions. The commonly held fears of increased aggression, its consequent injuries, and decreased productivity in large groups were not found in this study.

Cytological studies on a haploid cultivar of pelargonium, and its colchicine-induced diploids

Kleine Liebling is a haploid of unusual interest; not only is it a monoploid, but at the same time a successful horticultural variety. Analysis made of pollen mother cell meiosis revealed a very low frequency of bivalents, and evidence of neocentric activity among the univalents. Colchicine-induced diploid plants were synthesised, but contrary to expectation, microsporogenesis was very erratic, and pairing never complete. As in the haploid from which they were derived, a high proportion of dyads formed the final product of meiosis. It was concluded that both these irregularities were the result of mutations effecting the genetic control of meiosis.