Study Intent Research Articles

The changing incidence of primary central nervous system lymphoma is driven primarily by the changing incidence in young and middle‐aged men and differs from time trends in systemic diffuse large B‐cell non‐Hodgkin's lymphoma

There has been an overall decline in the United States incidence of Primary CNS Lymphoma (PCNSL) from 1998 to 2008. This study's intent was to characterize the cohorts contributing to it. First, calculated the PCNSL incidence rates from nine Surveillance, Epidemiology, and End Results (SEER) registries for time period 1973 to 2008. Second, examined the time trends overall and by age and gender. Third, used 1992-2008 SEER data from the same registries to obtain overall trends for diffuse large B-cell lymphoma (DLBCL). Last, rates were age-adjusted to the 2000 US standard population and reported per 100,000 person-years. Rates continued to increase in women at all ages and men aged 65 and older. In men aged 20-39 and 40-64 years incidence rates peaked in 1995 and then declined dramatically, stabilizing after 1998. The trends in the incidence of PCNSL over this time frame were significantly different from DLBCL for ages 20-39 (P < 0.001) and 40-64 (P < 0.001) years but were not different for the 65 years and older age group (P = 0.99). The overall PCNSL incidence rate declined since 1995 and was driven primarily by the changing incidence in young and middle-aged men. The rate has continued to increase in men aged 65 years and older and in women. The trends in incidence in the younger age groups over this time period did not parallel those observed for DLBCL.

Verbal autopsy completion rate and factors associated with undetermined cause of death in a rural resource-poor setting of Tanzania

BackgroundVerbal autopsy (VA) is a widely used tool to assign probable cause of death in areas with inadequate vital registration systems. Its uses in priority setting and health planning are well documented in sub-Saharan Africa (SSA) and Asia. However, there is a lack of data related to VA processing and completion rates in assigning causes of death in a community. There is also a lack of data on factors associated with undetermined causes of death documented in SSA. There is a need for such information for understanding the gaps in VA processing and better estimating disease burden.ObjectiveThe study's intent was to determine the completion rate of VA and factors associated with assigning undetermined causes of death in rural Tanzania.MethodsA database of deaths reported from the Ifakara Health and Demographic Surveillance System from 2002 to 2007 was used. Completion rates were determined at the following stages of processing: 1) death identified; 2) VA interviews conducted; 3) VA forms submitted to physicians; 4) coding and assigning of cause of death. Logistic regression was used to determine factors associated with deaths coded as "undetermined."ResultsThe completion rate of VA after identification of death and the VA interview ranged from 83% in 2002 and 89% in 2007. Ninety-four percent of deaths submitted to physicians were assigned a specific cause, with 31% of the causes coded as undetermined. Neonates and child deaths that occurred outside health facilities were associated with a high rate of undetermined classification (33%, odds ratio [OR] = 1.33, 95% confidence interval [CI] (1.05, 1.67), p = 0.016). Respondents reporting high education levels were less likely to be associated with deaths that were classified as undetermined (24%, OR = 0.76, 95% CI (0.60, -0.96), p = 0.023). Being a child of the deceased compared to a partner (husband or wife) was more likely to be associated with undetermined cause of death classification (OR = 1.35, 95% CI (1.04, 1.75), p = 0.023).ConclusionEvery year, there is a high completion rate of VA in the initial stages of processing; however, a number of VAs are lost during the processing. Most of the losses occur at the final step, physicians' determination of cause of death. The type of respondent and place of death had a significant effect on final determination of the plausible cause of death. The finding provides some insight into the factors affecting full coverage of verbal autopsy diagnosis and the limitations of causes of death based on VA in SSA. Although physician review is the most commonly used method in ascertaining probable cause of death, we suggest further work needs to be done to address the challenges faced by physicians in interpreting VA forms. There is need for an alternative to or improvement of the methods of physician review.

Satan's Playground: Mobsters and Movie Stars at America's Greatest Gaming Resort (review)

Reviewed by: Satan's Playground: Mobsters and Movie Stars at America's Greatest Gaming Resort James R. Curtis Satan's Playground: Mobsters and Movie Stars at America's Greatest Gaming Resort. By Paul J. Vanderwood. (Durham, N.C.: Duke University Press, 2010. Pp. 408. Illustrations, notes, sources, index. ISBN 9780822346913, $89.95 cloth; ISBN 9780822347026, $24.95 paper.) Legendary is undoubtedly the single best word that conveys the short but colorful history and enduring popular image of the luxurious Agua Caliente casino and resort, which rose from scrublands just south of the U.S.-Mexico border during the Jazz Age, a conspicuous product of U.S. Prohibition. But like most urban legends, separating fact from fiction and history from histrionics about the gaming resort and the people associated with it has proved to be highly problematic: gross misconceptions and myths abound. Indeed, despite its significance in the western borderlands experience, critical scholarly interpretation of Agua Caliente, the men who built it and the reasons for its spectacular rise and fall, the casino has been inexplicably neglected. Happily, that situation has ended with publication of Satan's Playground. Vanderwood has filled a gaping hole in the professional borderlands literature, not only setting the record straight about Agua Caliente itself, but also capturing in the process much of the fascinating (anti)social history and character of the greater region during this transformative period. In his effort to chronicle the biographical, social, economic, and political dynamics that surrounded Agua Caliente, Vanderwood takes both a traditional and a kind of postmodernist approach. On the one hand, the story is unveiled in standard chronological sequence, from the 1920s to the present. Although clearly a serious academic treatise, the prose is often evocative with close attention to detail and a strong narrative sense of place, time, and character. The fine writing is augmented as well by the inclusion of historical photographs, mostly of the casino and resort (strangely devoid of people in most shots) and of the cast of famous and infamous characters who populate the story. On the other hand, Vanderwood eschews scholarly convention by failing to identify the study's intent; there is no introductory chapter with stated objectives, no prevailing thesis or argument, not a word on methodology (neither is there a conclusion in the formal sense). He just jumps right in there and begins the story, [End Page 460] telling it in an unorthodox fashion, in which the history of Agua Caliente and its bigger-than-life entrepreneurial founders is juxtaposed across twenty-three chapters with a criminal subplot involving gangsters who held up the resort's money car en route to a bank in San Diego, and their subsequent capture, trials, and travails. In so doing, Vanderwood is tacitly acknowledging that an understanding of Agua Caliente cannot be separated from the general culture of vice and criminality that permeated the area and era; it did not emerge in a vacuum, but rather was an expression of, and has come to symbolize, that particular time and place. There is much to recommend about this work beyond the attributes already identified, including the lavish attention devoted to conveying a sense of the ambience of Agua Caliente as a place: its architecture and design; its nightlife and cuisine; its A-list celebrity guests. In my mind, however, the major contribution of the book rests in its detailed and insightful analysis of the "Border Barons," as Vanderwood labels them—James Crofton, Wirt Bowman, Baron Long, and Abelardo Rodríguez—three Americans, one Mexican. And what a quartet they were! All rich, well connected, driven, corrupt, and fascinating. Reading their stories alone is worth the price of the book. To be sure, this is a volume that is less about place and process than it is about people; it is character-driven from start to finish, and that seems altogether appropriate in this particular case. But Satan's Playground is not beyond criticism. While some will surely fault its failure to conform to academic protocol, I remain more concerned about context, not temporal but spatial. Specifically, I am disappointed that Vanderwood did not elevate his study into a broader, more comparative, and conceptual framework. Tijuana's...

How do young people find out about their parent's cancer diagnosis: A phenomenological study

Aim Grief and its many manifestations can irrevocably change family life and the multiple relationships within. Informed by this, one is led to consider the extent an adult nurse provides a family focus to cancer care. It arguably remains wanting, particularly in adult healthcare environments where ‘family’ can still infer ‘spouse’ and the needs of children and young people at home may as a result go unrecognized. Little attention has been paid to what or how young people should be told about their parent's cancer diagnosis, but from the limited research that has been undertaken, parents are seeking help with this aspect of communication. Methods An interpretative phenomenological approach was used to explore the research question: How do young people experience learning about their parent's cancer diagnosis? This was a single centre study recruiting seven participants, aged 14–18 years, which included two sets of siblings. Participants were interviewed on one occasion only. Results The interview data revealed six dimensions of the young person's experience of learning about a parental diagnosis: first hearing about a parent's diagnosis; vulnerability of self and others, communication within the family, feeling supported in experience, experience and support of school, experience and support of hospital. Young people overwhelmingly advocate honesty and openness in family communication about cancer. Conclusions Our participants demonstrated strength and resourcefulness in adapting to their parent's cancer. Meaning making was central to our study's intent and still today it offers a perspective of the diagnosis period that has not been fully explored in the extant literature.

Association between socioeconomic status and HIV-associated oral lesions in Rio de Janeiro from 1997 to 2004

The prevalence of HIV-related oral lesions may vary according to socioeconomic status and antiretroviral therapy, among other factors. This study's intent was to evaluate the association between socioeconomic indicators, CD4+ counts and HIV-related oral lesions in the city of Rio de Janeiro, RJ, Brazil. A retrospective epidemiological analysis was performed of the medical records of HIV-positive patients that attended the Federal University of Rio de Janeiro between 1997 and 2004. Gender, age, mode of HIV transmission, level of education, monthly familial income, CD4+ counts and HIV-related oral lesions were assessed. For statistical analysis, the Chi-square test was used with a level of significance of 5%. 254 medical records were reviewed: 83 women and 171 men. Monthly familial income below 2 minimum wages was associated with a higher prevalence of pseudomembranous candidiasis (p = 0.024), while income above 10 minimum wages was associated with a higher prevalence of salivary gland disease (p = 0.021). Lower socioeconomic status was associated with lower CD4+ counts (p = 0.017). In this study, an association was noted between socioeconomic status, immune suppression and prevalence of oral lesions. However, further studies are warranted using other socioeconomic variables in order to better assess this relationship.

A Small-Changes Approach Reduces Energy Intake in Free-Living Humans

Objective: America On the Move (AOM) is a national weight gain prevention initiative that promotes small lifestyle changes by increasing walking by 2000 steps/day and reducing energy intake by about 100 kcal/day. The study's intent was to determine the impact of these small changes recommendations on steps/day and energy intake.Methods: In this cross-sectional study, food and fluid intake and physical activity in 116 healthy overweight adults (BMI: 25–36 kg/m2; age: 18–60y) was compared between a non-intervention and an intervention week using diet diaries and pedometers. The major outcomes were steps/day, daily caloric intake, macronutrient intake and meal size. Within subject ANOVAs were conducted to compare results between intervention and non-intervention weeks.Results: Total energy intake was lower during intervention week than non-intervention week (P < .01), including macronutrient contents (all P's < .01), meal size (P < .01), consumption of sugar (P < .01), sugared sodas (P < .01) and sodium (P < .01). Steps/day were higher during intervention week than non-intervention week (P < .01).Conclusions: The results support previous research showing that the message to increase steps/day results in an increase in physical activity. The results demonstrate for the first time that the message to reduce intake by 100 kcal/day does actually result in a lower intake in the short term. People seem to be able to make positive changes in diet and physical activity in response to these messages. If these small changes can be sustained, this approach could be effective in preventing further weight gain in the population.

The "cost" of operative training for surgical residents.

There is an increase in the amount of time required to perform an operation when the procedure involves training a surgical resident. This increased time does not translate into a financial burden for the hospital. Retrospective review of prospectively collected data. During the study period, surgeons and residents were blinded to the study's intent. We compared the operative times of academic surgeons performing 4 common surgical procedures before and after the introduction of a postgraduate year 3 resident into a community teaching hospital. Between January 1, 2001, and June 30, 2002, 4 academic surgeons performed operations without a resident in a community hospital that was recently integrated into a tertiary medical center system. During that period, surgeons operated alone (hernia surgery) or assisted one another (laparoscopic cholecystectomy, colectomy, and carotid endarterectomy). From July 1, 2002, through March 31, 2003, these same 4 surgeons were assisted by a postgraduate year 3 resident on similar procedures. Community hospital recently integrated into a tertiary medical center system. Four experienced academic surgeons operating in the community setting and patients undergoing 1 of 4 surgical procedures (inguinal hernia repair, laparoscopic cholecystectomy, partial colectomy, or carotid endarterectomy) from January 1, 2001, through March 31, 2003. The introduction of a postgraduate year 3 surgical resident rotation into a community hospital in which the same academic surgeons had been performing operations without a resident for 18 months. Mean operating time with and without a postgraduate year 3 resident participating in 4 common surgical procedures. Result For the 4 procedures studied, there was a significant increase in the operative time required to complete such procedures. There is an increased time cost associated with the operative training of surgical residents. This "cost" primarily impacts the attending surgeon.

Elementary Teachers' Attitudes, Perceptions and Practices Towards the Implementation of a Violence-Prevention Curriculum

This ethnographic study's intent was to understand and interpret elementary teachers' evolving attitudes, perceptions and practices towards non-violence curriculum, the Second Stepviolence-prevention program, and a project model utilizing consultants to implement instruction. Findings included that the curriculum was not implemented as intended and that there was a wide range of attitudes and practices reflecting difference in knowledge, cultural experience, and acceptance of the program and project. Recommendations for the future use of violence-prevention curricula are presented.

What quality improvement professionals need to know about IRBs.

Healthcare quality improvement (QI) studies are systematic analyses of processes and outcomes. As such, they meet one of the federal regulatory criteria defining research. They also meet the second criterion in many instances, generalizability of findings, even if it was not the study's original intent. Therefore, to err on the side of patients' rights, any studies involving human subjects or human data must be approved by federally mandated institutional review boards (IRBs) or their designees. This article explores federal regulations to protect research subjects, levels of IRB review, and strategies to simplify the IRB approval process and discusses implications for QI studies.

Nonmaternal care and family factors in early development: An overview of the NICHD Study of Early Child Care

In the most comprehensive US study to date about connections among child care experiences, family factors, and children's early development, 1100 children have been followed from birth through age 7. The study's intent is to describe family and child care/school contexts of children's development and examine associations between contextual variations and children's developmental outcomes in social-emotional, cognitive, and physical health domains. By age 3, over 90% of the children had experienced regular nonmaternal care, and over 50% were regularly spending over 30 hours/week in care. Economic factors, family characteristics, and maternal attitudes all influenced the amount and nature of early nonmaternal care. Observed quality of nonmaternal care consistently predicted social-emotional and cognitive-linguistic outcomes during the first 3 years of life. Amount of time spent in nonmaternal care predicted some social-emotional outcomes. Type and stability of nonmaternal care had limited predictive value. Family factors, including maternal sensitivity, quality of home environment, and income, were more consistent predictors of children's outcomes than any aspect of early nonmaternal care experiences.

Biotechnology in the High School Biology Curriculum: The Future Is Here!

G ENE cloning, genetic engineering, gene splicing, recombinant DNA, and human genome are buzzwords of perhaps the most exciting era in human and scientific history-the biotechnology era (Micklos 1990). Biotechnology has very quickly become an important subject for biology teachers to include in their courses. Leading authorities in the teaching of biotechnology have, through their research and experience, reported what a student should know about biotechnology and its importance to general science literacy. While most educators agree that students should be exposed to the marvels of modem biology, teachers are concerned as to where such units will fit in an already overcrowded list of course objectives (Dixon 1988). Johnson (1989) emphasized that in addition to knowing the history of biotechnology, the high school graduate should have at least a conceptual knowledge of the molecules of life. The student should know that the proteins, of which living matter are constructed, are composed of amino acids according to a transferable code preserved in molecules of DNA. Such knowledge is needed to understand the modern technologies used to build products and processes based on molecular biology. Steggles (1987) believes that the incorporation of biotechnology into the school curriculum is a necessity if this most recent and promising technology is to achieve its maximum potential through intelligent decision making. The search of literature currently shows no clear direction for the infusion of biotechnology into the high school biology curriculum. I determined that a study, based on a survey of biology teachers about biotechnology in the high school biology curriculum, was both necessary and timely. The study's intent is to make available information regarding the perceptions these teachers have as to the appropriate content areas in biotechnology for a high school biology curriculum and the instructional methods that would best convey this information. Biology teachers can then appropriately infuse the specific areas into the course objectives to fit their individual class situations. Personal information about each participant was also gathered and correlated with the survey results to determine how the amount of biotechnology training and the moral/ethical belief in biotechnology influence its implementation into the high school biology curriculum. The research design for the study was a descriptive survey collected from Outstanding Biology Teacher Award (OBTA) recipients throughout the U.S. and Canada. The National Association of Biology Teachers (NABT) provided lists of winners for the past five years that included 250 biology teachers. The fiveyear period represents the time biotechnology publications have been written for the high school biology curriculum. Although the OBTA winners may not be typical of all high school biology teachers in the country, teachers who are members of professional organizations and award winners are excellent change agents for innovations. These teachers show an exceptional desire to keep abreast of the new materials in their subject disciplines (Tye 1981). Therefore, it was assumed that OBTA winners had some experience or knowledge of the biotechnology movement in biology, especially noting the NABT involvement in biotechnology education.

A demonstration of validity for certification by the American Board of Anesthesiology.

To investigate the validity of the certification process of the American Board of Anesthesiology. Specifically, does board certification in anesthesiology identify physicians judged to be clinically superior by evaluators who are not part of the certification process? All 154 U.S. anesthesiology program directors (or faculty members they chose to represent them), unaware of the study's intent, were asked whether they would permit each of their residents completing training in 1991 to administer three increasingly complex anesthetic regimens to the directors themselves. This clinical skills rating was compared with the residents' performances in the certification process in 1992. A list of personal characteristics was also provided to the directors so they could identify reasons for less-than-optimal clinical skills ratings. A total of 1,310 residents participated in the certification process in 1992. A total of 146 programs responded. The directors would have accepted anesthetic care for all three increasingly complex operations from 828 (63.2%) of their own residents; for only the two less complex procedures, from 262 (20%); and for only the least complex procedure, from 127 (9.7%). In addition, 93 residents (7.1%) would not have been accepted to administer anesthesia to their directors for any of these operations. Certification success rates for these groups were 74.6%, 53.8%, 44.9%, and 49%, respectively (p < .00001). The personal characteristics believed important to the practice of anesthesiology were strongly linked to the clinical skills ratings; these included motivation, adaptability, clinical judgment, manual dexterity, several work habits, response to criticism, and handling of stressful situations. These data support validity for certification in anesthesiology and identify characteristics considered necessary for high-quality practice of the specialty.

Private and social returns from wetland preservation versus those from wetland conversion to agriculture

Private and social net benefits from wetland preservation as well as from wetland conversion to agricultural use are derived in this study. The case study method is used for marshes on the east shore of Lake St. Clair in southwestern Ontario, Canada. Lake St. Clair is located between Lake Huron and Lake Erie and is part of the Great Lakes, the largest freshwater body in the world. The study's intent is to determine the most beneficial economic use of these wetlands: preservation or conversion to agriculture. Social benefits are additions to the real national output value regardless of recipient. Conversely, social costs are subtractions from the same national output value regardless of payer. Private benefits and costs are incident on the owner who makes the production or preservation decisions. All agricultural benefits are evaluated, while preservation benefits include only hunting, angling and trapping. The most beneficial use of wetlands for society differs from that for owners. Social net benefits from preservation exceed those from conversion, while private net benefits from conversion to agriculture exceed those from preservation. This difference between social and private net benefits is due to drainage subsidies and property taxes, inability of wetland owners to extract payment for all preservation benefits originating from their preserved wetlands but occuring outside their boundaries, and inability of owners to extract consumer surplus created on such land. The dichotomy between social and private most beneficial use is at the root of the controversy about wetland conversion.

Gender bias in clinical judgment: An assessment of the analogue method's transparency and social desirability

The main purpose of this research was to determine whether clinicians discern the intent of an analogue study of gender bias in clinical judgment and, if so, whether they respond in a socially desirable manner. A total of 147 psychologists responded to a national mail survey in which they were instructed to make clinical ratings of a case summary describing either a female or male client. In one condition (the Social Desirability condition), clinicians were informed of the study's intent and instructed to respond in a socially desirable fashion. In another condition (the No Social Desirability condition), the study's intent was not revealed and clinicians were asked to guess the study's hypothesis following their ratings. Results indicate that only 10 of 100 clinicians reported having deduced the purpose of the study. The small number of guessers prohibited examination of whether guessing the intent leads to socially desirable responses. Results provide no evidence that either therapist or client gender influenced clinical judgment. Implications for evaluating experimental findings which fail to support gender bias in clinical judgment are discussed.

Histologic effects of smokeless tobacco and alcohol on the pouch mucosa and organs of the Syrian hamster.

This study's intent was to measure the histologic effects of smokeless tobacco and alcohol on the buccal pouch mucosa and internal organs of male Syrian hamsters. Eighty hamsters were divided into four groups: tobacco only, alcohol only, tobacco and alcohol, and negative control. 200 mg of smokeless tobacco were placed in each pouch of the tobacco groups five times a week. In the alcohol groups, 2 ml of 15% ethyl alcohol were placed in each pouch five times a week. The negative control group had mechanical stimulation of the right pouch to simulate the placement of the tobacco. After 26 wk the animals were sacrificed with pouches and abdominal organs removed. Alterations were observed in the abdominal organs, but not of statistical significance. However, significant acanthosis of the pouch epithelium was noted in the tobacco and tobacco and alcohol groups. This study reaffirms the lack of carcinogenic potential of smokeless tobacco upon the hamster pouch mucosa and internal organs.